Diet & Nutrition in Liver Disease :: Nutrition guidelines

Diet & Your Liver

	What does nutrition have to do with your liver?
	Nutrition and the liver are interrelated in many ways. Some functions are well understood; others are not. Since everything we eat, breathe and absorb through our skin must be refined and detoxified by the liver, special attention to nutrition and diet can help keep the liver healthy. In a number of different kinds of liver disease, nutrition takes on considerably more importance.
	Why is the liver so important in nutrition?
	85-90% of the blood that leaves the stomach and intestines carries important nutrients to the liver where they are converted into substances the body can use. The liver performs many unique and important metabolic tasks as it processes carbohydrates, proteins, fats and minerals to be used in maintaining normal body functions. Carbohydrates, or sugars, are stored as glycogen in the liver and are released as energy between meals or when the body's energy demands are high. In this way, the liver helps to regulate the blood sugar level, and to prevent a condition called hypoglycemia, or low blood sugar. This enables us to keep an even level of energy throughout the day. Without this balance, we would need to eat constantly to keep up our energy. Proteins reach the liver in their simpler form called amino acids. Once in the liver, they are either released to the muscles as energy, stored for later use, or converted to urea for excretion in the urine. Certain proteins are converted into ammonia, a toxic metabolic product, by bacteria in the intestine or during the breakdown of body protein. The ammonia must be broken down by the liver and made into urea which is then excreted by the kidneys. The liver also has the unique ability to convert certain amino acids into sugar for quick energy. Fats cannot be digested without bile, which is made in the liver, stored in the gallbladder, and released as needed into the small intestine. Bile (specific bile "acids"), acts somewhat like a detergent, breaking apart the fat into tiny droplets so that it can be acted upon by intestinal enzymes and absorbed. Bile is also essential for the absorption of vitamins A, D, E, and K, the fat soluble vitamins. After digestion, bile acids are reabsorbed by the intestine, returned to the liver, and recycled as bile once again.
	Can poor nutrition cause liver disease?
	There are many kinds of liver disease, and the causes of most of them are not known. Poor nutrition is not generally a cause, with the exception of alcoholic liver disease and liver disease found among starving populations. It is much more likely that poor nutrition is the result of chronic liver disease, and not the cause. On the other hand, good nutrition - a balanced diet with adequate calories, proteins, fats, and carbohydrates - can actually help the damaged liver to regenerate new liver cells. In fact, in some liver diseases, nutrition becomes an essential form of treatment. Patients are strongly advised not to take megavitamin therapy or to use nutritional products bought in special stores or by catalogue without consulting a doctor.
	How does liver disease affect nutrition?
	Many chronic liver diseases are associated with malnutrition. One of the most common of these is cirrhosis. Cirrhosis refers to the replacement of damaged liver cells by fibrous scar tissue which disrupts the liver's important functions. Cirrhosis occurs as a result of excessive alcohol intake (most common), common viral hepatitis, obstruction of the bile ducts, and exposure to certain drugs or toxic substances. People with cirrhosis often experience loss of appetite, nausea, vomiting and weight loss, giving them an emaciated appearance. Diet alone does not contribute to the development of this liver disease. People who are well nourished, for example, but drink large amounts of alcohol, are also susceptible to alcoholic disease. Adults with cirrhosis require a balanced diet rich in protein, providing 2,000 to 3,000 calories a day to allow the liver cells to regenerate. However, too much protein will result in an increased amount of ammonia in the blood; too little protein can reduce healing of the liver. Doctors must carefully prescribe the correct amount of protein for a person with cirrhosis. In addition, the physician can use two medications (lactulose and neomycin) to control blood ammonia levels.
	What other nutritional problems are caused by cirrhosis?
	When the scarring of cirrhosis interferes with the flow of blood from the the stomach and intestines to the liver, a condition called portal hypertension may develop. This simply means that there is back pressure in the veins entering the liver. Surgical "shunting", or rerouting of blood away from the liver and into the general circulation can relieve this pressure, but it often causes a new set of problems. Because the shunted blood has bypassed the liver, it contains high levels of amino acids, ammonia, and possibly toxins. When these compounds reach the brain, they cause a condition called hepatic encephalopathy, which means "liver caused mental impairment." Patients become confused and some temporary loss of memory occurs.
	Can diet help in treating other complications of cirrhosis?
	There are a number of complications of cirrhosis which can be helped through a modified diet. Persons with cirrhosis often experience an uncomfortable buildup of fluid in the abdomen (ascites) or a swelling of the feet, legs, or back (edema). Both conditions are a result of portal hypertension (increased pressure in the veins entering the liver). Since sodium (salt) encourages the body to retain water, patients with fluid retention can cut their sodium intake by avoiding such foods as canned soups and vegetables, cold cuts, dairy products, and condiments like mayonnaise and ketchup. In fact, most prepared foods contain liberal amounts of sodium, while fresh foods contain almost no sodium at all. A good-tasting salt substitute is lemon juice.
	Are there other liver diseases where specific changes in diet can help?
	Nutrition and a modified diet have been found to have a significant effect on a number of other liver diseases. Some types of liver disease, for example, cause a backup of bile in the liver which is called cholestasis. This means that bile cannot flow into the small intestine to aid in the digestion of fats. When this happens, fat is not absorbed but instead is excreted in large amounts in the feces, which become noticeably pale-colored and foul-smelling. This condition is known as steatorrhea. This loss of fat calories may also cause weight loss. Special fat substitutes, such as medium chain triglycerides (MCT oil) and safflower oil can help alleviate this condition because they are less dependent on bile for intestinal absorption. They can be used like other oils in cooking, baking and salad dressings. Patients with steatorrhea may also have difficulty absorbing fat soluble vitamins A, D, E, K. However, water soluble vitamins are absorbed normally. Supplementing the diet with fat soluble vitamins is possible, though it should only be carried out under the guidance of a physician. Vitamin A in excess over what is needed is very toxic to the liver.
	Diet for liver disease
	A healthy liver is like a processing plant. Carbohydrates, proteins, fats, vitamins, and minerals all go to the liver where they are broken down and stored. Later, they are remade into whatever the body needs and carried through the bloodstream to wherever they will be used. Even when the liver is damaged, these nutrients still come to the liver after they have been digested. But, once they arrive, the liver cannot process them and they build up. This build-up causes more liver damage. As a result, what a person with liver disease eats is very important. This diet needs to provide nutrients without causing further harm to the liver. This type of diet would include: A limited amount of protein. A damaged liver cannot process protein very well. This causes a build-up of ammonia in the bloodstream. Sore carbohydrate. Carbohydrate is the body's energy supply. A healthy liver makes glycogen from carbohydrate. The glycogen is then broken down when the body needs energy. A damaged liver can't do this. Without glycogen, more carbohydrate is needed from the diet to make sure the body has enough energy. A moderate amount of fat. Fat provides calories, essential fatty acids, and fat-soluble vitamins. A limited amount of fluids and sodium. Liver damage can cause high blood pressure in the major vein of the liver. This can result in ascites, a fluid build-up in the abdominal cavity. Limiting fluids and sodium can help prevent this. Extra amounts of certain vitamins and minerals. A damaged liver has problems storing many vitamins and minerals. Liver "sluggishness" is often blamed for poor appetite, listlessness, poor digestion and bad health. In fact, only in a minority of instances, is the liver to blame in these situations. Specifically, only in liver disease which may take the form of hepatitis or cirrhosis will ill-health be due to the liver. Diet For A Healthy Liver A balanced diet with plenty of fruits, vegetables, animal protein with a fat - carbohydrate - protein ratio of 30% - 50% - 20% unless specific problems such as diabetes, kidney disease etc dictate otherwise. · Plenty of fluids Avoidance of excess alcohol Pack your diet with antioxidants Anti-oxidants protect against free radical (produced in all of us due to body's metabolic processes) injury. Apart from protecting the liver and helping in its recovery if damaged, they have been shown to inhibit cancer cells, fight the ageing process and protect the sight. Antioxidants are abundant in fruits and vegetables, as well as other foods including nuts, grains and some meats, poultry and fish. Below are some of the anti-oxidants and their best food sources. Beta-carotene Found in many foods that are orange in color, including sweet potatoes, carrots, apricots, pumpkin, and mangos. Some green leafy vegetables such as spinach and kale are also rich in beta-carotene. Lycopene A potent antioxidant found in tomatoes, watermelon, guava, papaya, apricots, oranges Selenium Selenium is a mineral, not an antioxidant nutrient. However, it is a component of antioxidant enzymes. The amount of selenium in soil, which varies by region, determines the amount of selenium in the foods grown in that soil. Plant foods like rice and wheat are the major dietary sources of selenium in most countries Vitamin A Foods rich in vitamin A include liver, sweet potatoes, carrots, milk, egg yolks and mozzarella cheese. Vitamin C This can be found in abundance in citrus fruits (lemons, oranges etc.), cereals, poultry and fish. Vitamin E This is found in almonds, in many oils including safflower, corn and soybean oils, and also found in mangos, nuts, broccoli and other foods. A host of over-the-counter anti-oxidant preparations such as Salymarin (milk thistle) can be taken although unnecessary if above foods are taken in good quantities.
	What is a liver disease diet?
	The liver is an organ in the body that does several important tasks. One task of the liver is to help the body use the nutrients in food for energy. Liver diseases such as hepatitis and cirrhosis may change the way your body uses nutrients from food. Nutrients include carbohydrate (kahr-boh-HEYE-drayt), protein, fat, vitamins and minerals. Some people with liver disease may not get enough nutrients and lose weight because of these changes. A liver disease diet provides the right amount of calories, nutrients, and liquids for you. A liver disease diet may help your liver work better and prevent other health problems. The dietary changes you will need to make depend on the type of liver disease and health problems you have. Your dietitian (di-uh-TISH-in) or nutritionist (noo-TRI-shun-ist) will tell you about the type of diet that is best for you.
	What can I do to make a liver disease diet part of my lifestyle?
	Changing what you eat and drink may be hard at first. You may need to make these changes part of your daily routine. Following a liver disease diet may help you feel better. Choose a variety of items on this diet to avoid getting tired of having the same items every day. Keep a list of items allowed on this diet in your kitchen to remind you about the diet. Carry a list of items allowed on this diet to remind you about the diet when you are away from home. Tell your family or friends about this diet so that they can remind you about the diet. Ask your caregiver, a dietitian, or a nutritionist any questions you may have about your diet plan. A dietitian or nutritionist works with you to find the right diet plan for you. These caregivers can also help to make your new diet a regular part of your life.
	What should I avoid eating and drinking while on a liver disease diet?
	The foods that you need to avoid or limit depend on the type of liver disease and health problems you have. Following are some of the dietary changes that you may need to make: Sodium: You may need to decrease the amount of sodium in your diet. Sodium causes your body to retain (hold on to) fluids. When your body holds on to fluids, you will have swelling. Your caregiver may suggest that you limit or avoid high-sodium foods. Your caregiver will give you more information about a low-sodium diet. Some foods that contain high amounts of sodium are the following: Bacon, sausage and deli meats. Canned vegetables and vegetable juice. Frozen dinners. Packaged snack foods like potato chips and pretzels. Soy, barbecue, and teriyaki sauces. Soups. Table salt. Liquids: You may also have to drink fewer liquids if you have swelling. Liquids include water, milk, juice, soda, and other beverages. It also includes any food that contains liquid, such as soup. This also includes food that melts when it is not cold, such as gelatin. Talk to your caregiver about the amount of liquid you may drink each day. Alcohol: Alcohol may make your liver disease worse. Avoid alcoholic drinks such as beer, wine, hard liquor (whiskey, gin, vodka) or mixed drinks (drinks made with hard liquor). Talk to your caregiver if you have questions about alcohol in your diet.
	What can I eat while on a liver disease diet?
	Eat ____ grams of protein each day. Eat ____ grams of sodium each day. Drink ____ ounces of liquid each day. Calories: Eat a variety of foods each day to help your liver work as well as possible, and to keep a healthy weight. You may not feel hungry or you may feel full right away after eating. This may make it hard for you to eat enough calories. Eat several small meals throughout the day instead of large meals to make sure you eat enough calories. Ask your dietitian or nutritionist how many calories you need each day. Protein: It is important to eat the right amount of protein when you have liver disease. Your dietitian or nutritionist will tell you how much protein you should have each day. The following foods are good sources of protein. The amount of protein (in grams) follows each listed food. Three ounces of meat, poultry (chicken), or fish (21 grams). One cup of milk or yogurt (eight grams). One large egg (seven grams). Two tablespoons of peanut butter (seven grams). One-half of a cup of tofu (seven grams). One-fourth of a cup of cottage cheese (seven grams). One ounce of cheese (seven grams). One-half of a cup of cooked, dried, pinto, kidney or navy beans (three grams). Fat: Your caregiver will tell you how much fat you should have in your diet each day. Some people with liver disease have problems with digesting (breaking down) and absorbing (using) fat. The fat that is not broken down and used by the body is lost in bowel movements. If you have this health problem, you may need to eat less fat. Your doctor may also suggest that you eat a special type of fat that is absorbed more easily by your body. Carbohydrates: Your caregiver will tell you how much carbohydrate you should eat each day. Carbohydrates are found in breads, cereals, grains (rice, oats), starchy vegetables (potatoes, corn, peas), and crackers. Liver disease may cause blood sugar levels to be too high or too low in some people. You may need to make changes in your diet if you have this problem. Eating certain amounts of carbohydrates at each meal helps to control blood sugar levels.
	What other diet guidelines should I follow?
	Talk to your caregiver before taking any vitamins or herbal supplements (pills). Talk to your dietitian or nutritionist about any other diet changes you should make. Liver disease may cause several different health problems. Your caregiver may suggest that you make other diet changes that can help to improve your health. Risks: You may not get enough nutrients and lose weight if you do not eat a balanced diet. Not following a liver disease diet may cause certain health problems to become worse. Liver disease may cause you to lose your appetite and feel full too quickly after eating. This may make it hard for you to eat enough calories. Talk to your caregiver if you are having trouble eating and drinking. Care Agreement: You have the right to help plan your care. To help with this plan, you must learn about your diet. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

Eat for health

Since everything we eat must pass through the liver, special attention to nutrition and diet can help keep me healthy. Here are some tips on eating for health healthy liver, healthy you!

Eat a well balanced, nutritionally adequate diet. if you enjoy foods from each of the four food groups, you will probably obtain the nutrients you need.

Cut down on the amount of deep-fried and fatty foods you and your family consume. Doctors believe that the risk of gallbladder disorders (including gallstones, a liver-related disease) can be reduced by avoiding high-fat and cholesterol foods.

Minimize your consumption of smoked, cured and salted foods. Taste your food before adding salt! Or try alternative seasonings in your cooking such as lemon juice, onion, vinegar, garlic, pepper, mustard, cloves, sage or thyme.

MEAT, FISH, POULTRY & ALTERNATIVES PROVIDE:
protein, vitamin A, iron, vitamin B12, niacin, fiber, thiamin

BREADS AND CEREALS PROVIDE:
carbohydrates, niacin, thiamin, iron, riboflavin, fiber

FRUITS AND VEGETABLES PROVIDE:
vitamin A, vitamin C, iron, fiber, folacin

MILK AND MILK PRODUCTS PROVIDE:
calcium, riboflavin, niacin,folacin, vitamin A, vitamin B12, vitamin D

Increase your intake of high-fiber foods such as fresh fruits and vegetables, whole grain breads, rice and cereals. A high-fiber diet is especially helpful in keeping me healthy.

Rich desserts, snacks and drinks are high in calories because of the amount of sweetening (and often fat) they contain. Why not munch on some fruit instead?

Keep your weight close to ideal. Medical researchers have established a direct correlation between obesity and the development of gallbladder disorders.

Vegetarianism and The Liver

The liver has been described as a chemical workshop of the human body. All the nutrients and other substances absorbed from the intestines pass through the liver before entering into the systemic circulation. Thus the liver is vulnerable to the damage caused by a host of infections and toxic agents. Several types of viruses and alcohol are by far the commonest of these agents. The impairment of the liver function usually manifests as jaundice. Persistent infection and continuing impairment of function may be followed by death unless these changes can be controlled.
The morphological changes in liver damage can manifest as fatty liver, hepatitis, cirrhosis of the liver and cancer of the liver.
A well planned dietary regimen is of utmost importance in the prevention and treatment of most hepatic disorders. It has been proved beyond doubt that some of the proteins derived from animals are responsible for producing persistent symptoms related to liver disease. Thus vegetarian diet, as mentioned below, has gained momentum in the treatment of hepatic disorders.

Viral Hepatitis
Since there are no antiviral agents against hepatitis,rest, abstinence from alcohol and dietary modifications form the mainstay of the treatment. Most patients have nausea and lack of appetite. They should be served with attractive and well cooked foods. Small meals served separately will be better tolerated than three large meals. A diet containing approximately 2000 kcal which can be provided by 20-25 gms fat, 80-90 gms pro teins and 400 gms carbohydrate is suitable. This requirement can be fulfilled by glucose, sugar, fruits, fruit juices, bread, cereals, vegetables, salads, jelly, jam, rice, boiled potatoes and puddings made with cereals and sugar. Though diets high in their fat content do not ultimately influence the course of the disease they are poorly tolerated by jaundiced patients. Fried food, milk and butter cause dyspepsia and should be avoided. Thus a vegetarian diet is better tolerated by the patients suffering from viral hepatitis.

Cirrhosis of Liver
Most of the patients of cirrhosis of liver are severely malnourished and require a high calorie and high protein diet. A high protein diet, particularly if derived from animal proteins, carries a high risk of precipitating hepatic encephalopathy. The best source of vegetarian proteins is milk, its products and Casilan. Choline present in foods like wheat germ, soyabean, peanuts and skimmed milk may prevent the formation of a fatty liver. It is also believed that cerebral disturbances due to liver damage are caused by the type of protein in the diet. Cirrhotic diet prescribed in a standard Indian books on diet and nutrition does not contain proteins derived from animal sources. A diet high in carbohydrate and proteins low in fat and fortified with vitamins would be most suitable. Thus a vegetarian diet is more suited to patients having cirrhosis of liver.

Ascites
In terminal stages of cirrhosis fluid accumulates in the abdominal cavity due to failure of the liver to synthetize plasma albumin. For such patients, a high protein diet which is low in sodium would be most suitable. But since these patients have no appetite, milk is the only practical diet which can supply the above requirements.
Finally when the liver fails - the condition is known as hepatic encephalopathy. There is a strong incidence of animal protein intake increasing the incidence of hepatic encephalopathy. The clinical features of this syndrome are sleep disturbances, restlessness, drowsiness, impaired intellectual function, confusion and stupor progressing to coma. Significant number of these patients develop chronic encephalopathy and can be managed successfully at home. They should be given 20 gms of protein in the diet. This should mainly be derived from skimmed milk.

Thus, it is very obvious that a vegetarian diet is more useful in the treatment of all liver disorders including the last stage of liver failure.

Support Liver Detoxification With Your Diet

Your liver plays a complex role in many critical functions in your body. A one-word summation of its task could be "detoxification." If there are nutritional deficiencies in your diet, your liver will have difficultly eliminating toxins, which will in turn increase the amount of toxins produced by your body.

Toxins and your liver

Toxins come from variety of sources. They come from the environment, the content of our bowels, the food we eat, the water we drink, and the air we breathe. If you are exposed to chemicals or cigarette smoke, it is your liver's job to clean up the toxins before they do damage.

The liver removes toxins in three ways:

• It filters the blood.
• It neutralizes toxins by excreting fat-soluble toxins with cholesterol through making bile.
• It breaks down toxins with enzymes in a two-step process usually referred to as phase I and phase II detoxification.

A good diet helps your liver detoxify

To support proper liver function, it is important to eat a healthy diet that includes a variety of vegetables, which provide a wide range of essential nutrients. Your liver needs these nutrients to perform its duties. Some of the best things you can do for your liver include:

Eat a high-fiber diet. Fiber binds to the bile in the large intestines, which helps to transport it out of the body. This is one of the ways the body eliminates fat-soluble toxins from the body.

Include variety in your diet. Eat a wide variety of nutrient-rich foods, including foods high in antioxidants (vitamin C, beta carotene and vitamin E) and high in B vitamins, calcium, and trace minerals to protect the liver from damage and help it do its job.

Watch your B vitamins. Make sure to get enough choline, betaine, methionine, vitamin B6, folic acid and vitamin B12. These special nutritional factors are needed to promote liver decongestion, improve liver function and metabolize fat.

Use a medically supervised fast to aid in detoxification. A fast can quickly increase elimination of waste and enhance your body's healing processes. Fasting is not right for everyone, however; talk to your doctor to learn what fast is appropriate for you.

Important nutrients for your liver

A diet high in fiber includes a wide variety of plant-based foods. The best way to increase fiber is to eat more vegetables, beans and fruit. Foods that contain vitamins C and E are important as antioxidants to protect and treat a damaged liver. B vitamins are often depleted when the liver is overworked from alcohol consumption or toxic exposure. Methionine and cysteine are sulfur-containing proteins that are known to protect the liver and aid in converting fat-soluble toxins to water-soluble substances that can be eliminated through the urine. Choline is needed to metabolize fats in the body. Foods that contain these vitamins include:

Vitamin C. Rose hips, kale, parsley, collard greens, mustard greens, cauliflower, red cabbage, strawberries, papaya, spinach, kiwi fruit, citrus fruits, asparagus, mangos, peppers, broccoli, and Brussels sprouts.

Vitamin E. Almonds, filberts, sunflower seeds, avocados, asparagus, walnuts, tomatoes, whole grains, and green leafy vegetables.

B-complex. Nutritional yeast, sunflower seeds, almonds, peanuts, pine nuts, sesame seeds, buckwheat, wild rice, and brown rice.

Methionine and cysteine. Egg yolks, red peppers, garlic, onions, broccoli, Brussels sprouts, sesame seeds, whole grains and beans.

Choline. Soybeans, egg yolks, nutritional yeast, fish, peanuts, cauliflower, lettuce, cabbage, lentils, chick peas and brown rice.

Making specific dietary changes to aid your liver in detoxification can be simple. Eating a wide variety of organic vegetables, fruits, seeds, nuts, beans and whole grains gives your body the fiber and the nutrients it needs to protect and support healthy liver function.