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Monday, November 3, 2008

Diet in Liver Disease

What is the energy requirement of patient suffering from liver disease?
A high energy intake is required to promote weight gain and to ensure maximum protein utilisation. Initially, a patient is put on 1500 - 2000 cal. because of anorexia. Gradually the energy intake may be increased to 20 - 30% more than the normal intake.

How much carbohydrates should be consumed?
A high carbohydrate diet is recommended to provide bulk of the energy to build.up glycogen stores in the liver as well as for their protein sparing action. A daily.intake of 300 - 400 gms of carbohydrates like glucose, sugar, honey, fruits and .fruit juices and also from starches like cereals and root vegetables is recommended.

How much fat should be consumed?
Patients of liver disease can freely consume 20 – 30 gms of fats per day without.any apprehension unless there is nausea. Preferred sources are Medium Chain Triglycerides (MCT’s) – coconut .oil, butter, cream & emulsified fats such as from milk & eggs.

How much protein should be consumed by a liver disease patient?
Protein intake depends on the stage of liver disease. Generally the patients is put on 1- 1.5 gms per Kg body weight for regeneration of liver cells with emphasis on vegetable proteins (milk and milk products, pulses, legumes, and nuts) as they have branched chain amino acids i.e. isovaline, leucine and isoleucine. Animal proteins (meat, fish and poultry) have aromatic amino acids-tryptophan, tyrosine, phenylalanine, methonine which can lead to hepatic encephalopathy.

When is a liver disease patient put on sodium and fluid restriction?
A patient who has developed “ascitis” with accumulation of fluids comprisingof protein, sodium & water in the abdominal cavity, is put on sodium and fluid restricted diet.

Why are Vitamin B, Vitamin C and Vitamin K important?
The requirement of B group of vitamins are increased due to increased energy. metabolism, higher amount of Vit C (amla, lemon, guava, citrus fruits etc.) are needed for tissue healing. Vitamin K foods (green leafy vegetables) are required to correct increased prothrombin time.

What minerals should be included in liver disease patient?
All minerals, particularly
a) Calcium (milk and milk products) because these patients have a.tendency to develop osteopaenia.
b) Iron (jaggery, beet root, raisins, lotus stem) in case of oesophageal varices (enlarged veins) with danger of rupture & haemorrhage.

When is fibre restricted in liver disease diets?
The fibre is restricted in cirrhotic patients with oesophageal varices.

What role does turmeric play in liver disease?
Turmeric has an antioxidant “curcumin” which stimulates the production of good enzymes in liver. These enzymes help in removing toxins, carcinogens & other metabolites from the body via faeces and urine.

How are cruciferous vegetables beneficial in liver disease?
Cruciferous vegetables (Broccoli, Cabbage, Cauliflower) contain phytochemical i.e. indoles, isothiocinates which help in production of enzymes glutathione S. transferase that help in detoxification of metabolites and carcinogens in the liver.

What are the ways to improve palatability in liver disease diet?
Alternate seasoning like tamarind and lemon, vinegar, mango powder may be used to enhance the flavour of the food.

What are the tips to deal with anorexia and loss of appetite?

Nausea
- If some smell makes you feel sick, take a breath of fresh air before you eat.
- Keep your mouth fresh by brushing your teeth, using a mouth wash or sucking mints.
- Don’t let yourself get too hungry. Hunger makes nausea worse.
- Take small frequent meals.
- Cold snacks are easier to cope with as they don’t smell much.
- A nutritious small snack may replace a proper meal.
- Eat when you are relaxed.
- High calorie and protein supplements can be used if you are loosing weight.

Loss of appetite
- Eat small frequent meals take a nutritious snack instead of big meal.
- Choose foods that you like.
- Try to relax before and after you eat.
- Eat slowly chew well and breath steadily.
- A nourishing drink like milkshake, milo, complan may be had if you don’t like solid foods.

Can alcohol be consumed?
Alcohol should not be consumed as it has a damaging effect on liver.

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