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.

Prevention of liver diseases

Prevention of liver cancer

Prevention of liver cancer is possible at two levels. The first level of prevention is to avoid alcohol abuse and to prevent the occurrence of Hepatitis B or Hepatitis C. These are acquired from infected individuals via blood or rarely other secretions, by sharing of infected needles among drug addicts, or by the sexual route. Their transmission can be avoided by use of disposable needles in hospitals, by strict and universal screening of all blood donors in blood banks and refusing donations from infected persons. The spread of Hepatitis B can be curbed by universal vaccination of all newborns and the rest of the non-infected population.

The second level of prevention is in patients who have liver cirrhosis. A significant proportion of them will develop cancer. This can be avoided if they undergo a timely liver transplant and the diseased liver can be removed. All those with cirrhosis should see a liver specialist to find out if a liver transplant is suitable for them.

Prevention of cirrhosis

The three common causes of cirrhosis i.e., alcoholism, Viral Hepatitis B and C are all preventable as is described for the first level of prevention in liver cancer. However, at times, cirrhosis may result from genetically determined diseases such as autoimmune hepatitis, metabolic disorders (for eg. Wilson's disease and others, especially in children), primary biliary cirrhosis and primary sclerosing cholangitis which cannot really be prevented.

Preventing the spread of viral hepatitis

Proper hygiene is the key to preventing the spread of many diseases, including Hepatitis. Other preventive measures include:

Vaccinations - A Hepatitis B vaccine is routinely given to toddlers as part of their immunization schedule. A hepatitis A vaccine is available for people at risk for contracting the disease while traveling. (There are no vaccines for hepatitis C, D, or E at this time.)

Blood transfusion - Blood products are routinely screened for Hepatitis B and C, and HIV, to reduce the risk of infection from transfusion.

Antibody preparation - If a person has been exposed to Hepatitis B, an antibody preparation can be administered to help protect them from contracting the disease.

The prevention of Hepatitis B and C should be aimed at the high risk groups and situations which are

a) Unsafe Blood transfusion,
b) Hepatitis B or Hepatitis C in the family,
c) Surgical procedures or dental manipulation,
d) intravenous drug abuse,
e) Unprotected sexual exposure,
f) Dialysis,
g) Medical or paramedical personnel.

Prevention of Liver Diseases

The rule 'prevention is better than cure' applies very aptly to the liver. Cure of many liver diseases is expensive, time consuming and at times very radical. Hence measures aimed at reducing the incidence of liver disease make more economic sense for both individuals and for a community.

Prevention of chronic liver disease and liver cancer

Liver cancer is the fourth commonest killer among all cancers in the body. The most significant risk factors are- exposure to alcohol, Hepatitis-C and Hepatitis-B.

In India though most blood banks would screen for HBSAg, the carrier rate of this virus is very high and even the HBSAg positivity is quite high at 1-1.5%, hence the chance of viral transmission can be high since many blood banks do not screen for HbcAb status.

Since there is a vaccine to prevent hepatitis-B., all children should receive a vaccination for hepatitis-B.. This is certainly the most cost effective way to prevent liver cancer in the future.

Hepatitis-C is also an important risk factor for liver cancer. However there is no vaccination for this virus. The mode of spread of this virus in the community could be multipronged. Blood transfusion with blood unscreened for hepatitis-C, use of unsterilized needles for injections and unprotected sexual intercourse being the few accepted modes of spread. Precautions that address these issues will reduce incidence of hepatitis-C related liver disease and subsequent liver cancer.

Changing the way certain food grains are stored in the tropical countries could reduce exposure to substances and toxic fungi which are believed to induce liver cancer.

Reducing alcohol consumption and disincentives to reduce alcohol consumption in a community will go a long way in reducing the incidence of chronic liver disease and liver cancer.

HCV Vaccine - Get it! Hepatitis A and Hepatitis C don't mix!

Hepatitis A (HAV) is not ordinarily a lethal disease although it can in some rare cases cause liver failure. But if you already have Hepatitis C(HCV) then HAV can be deadly. According to an article by Dan O' Neill "Hepatitis A and Hepatitis C Don't mix." Source It is highly recommended by many doctors to get the HAV vaccine.