Patients suffering from any liver condition may benefit from adequate nutrition and dietary supplements. Unfortunately, many patients with liver disease believe that they are restricted and condemned to eat little of what they like for the rest of their lives. At the same time, some diets promise too much benefit and have not been proven to change the natural course of the liver disease.
A detailed summary of recommendations is beyond the scope of this brief review. Patients should always discuss nutritional issues with their physicians and look for expert advice. Beware of the commercial interests behind the advertisements of the local or the national chain "nutrition store."
Carbohydrates are rarely a problem and liver patients have no particular restrictions, except when other coexisting conditions are present (obesity, diabetes).
Restriction of protein has been traditionally recommended for patients with cirrhosis based on the fear that excess proteins would precipitate a condition called encephalopathy (changes in mental status). In reality, excess protein intake with diet is not a common precipitant of encephalopathy, as more often there are other reasons for this complication. Therefore, for most patients there are no protein restrictions. When patients have repetitive episodes of encephalopathy, a 40 grams per day protein restriction is issued for the first 48 hours. In general, this can be followed by unrestricted vegetable protein. The total daily dose of any type of protein can be increased to about 0.8-1 gram per kilogram (2.2 lbs.) of body weight daily. Medical treatment of encephalopathy is required in addition to the diet.
For patients who are malnourished, proteins should not be restricted. Severe alcoholic hepatitis may require protein requirements of 1.5-2.0 grams per kilogram per day. Patients who are hospitalized may receive a commercial product with special proteins made for patients with liver disease. These products are very expensive and are rarely indicated for outpatients. Fats may be maldigested by some patients with liver disease. For patients with acute hepatitis, fats should be restricted to a minimum until the condition improves. Patients with chronic liver disease that affect the bile ducts (cholestasis of biliary cirrhosis or sclerosing cholangitis) may also have intolerance to fats (see vitamins below). For patients with advanced biliary disorders, malabsorption of fats may lead to nausea, vomiting and diarrhea. MCT oil is recommended in these patients as it is better absorbed. Unfortunately it does not taste great. Otherwise, most patients tolerate fats well and restrictions in fat are related to the total number of calories and "health diet" recommendations. Overweight patients with fatty liver injury (steatohepatitis) should be placed on diets to achieve weight reduction in a gradual program (no extreme very low fat diets either).
Patients who have problems related to excess alcohol use may be deficient in vitamins of the B complex. Supplements of folic acid, thiamin and multivitamins with minerals are recommended. In general, vitamin supplements are encouraged -- but no megadoses. In particular, excess vitamin A(more than 10,000 IU) daily is discouraged in most cases. Patients with bile duct diseases (chronic cholestasis) may not absorb properly the "fat" type vitamins A,D,E and K. Therefore, these patients should receive supplements (aquasoluble vitamin E is readily available and improves the absorption of the other fat-soluble vitamins (A-D). The dose of vitamin D 25-OHD is 50-100 mg daily. Vitamin K supplementation in adults is needed prior to surgery or if bleeding episodes are life threatening.
Sodium/Potassium: Patients with liver disease who have edema (retain water) in the form of lower extremity swelling or ascites (fluid in abdominal cavity) are sodium restricted to about 2 grams daily. In general, when cirrhosis is diagnosed, patients should be careful with salt in their diets. Potassium may need to be supplemented in those patients who are on diuretics (waterpills), but physicians often prescribe diuretics that save potassium and careful monitoring with blood tests is recommended. Patients who abuse alcohol or those who are on diuretics may need to take magnesium supplements.
Milk Thistle (Silymarin) is used by many patients and is advertised as having properties of liver regeneration (Journal of Hepatology 1989;9:105). Some studies have confirmed this, but none reported any long term efficacy. Certainly no antiviral properties are expected.
TJ-9 ("Sho-Saiko-To") has been shown to influence the immune system in patients with chronic hepatitis C and is used by many in Japan and China. In addition it was shown to prevent liver cancer by Oka (Cancer 1995,76:743).
More Important, the following herbs have been found to be deleterious to the liver: Senecio, Crotalaria, Symphytum, comfrey, Heliotropium Pennyroyal oil, Chaparral - Larrea, creosote bush, Germander - teucrium, Senna, Jin Bu Huan, Atractylis gummifera, "chinese herbals." Probable: skullcap, valerian, mistletoe, sassafras (Kaplowitz, Gastroenterology 1997;113:1408).
Optimum health depends on a healthy well functioning liver. The liver is our largest organ weighing 2.5 pounds and has 500 vital functions to perform. It is quite awesome when you think of how much our liver does for us. That is why it is important to take care of your liver. Some of the more important functions of our liver consists of filtering 2 quarts of blood a minute, storing and processing blood hemoglobin for it's iron content, storing fat soluble vitamins and minerals, storing excess glucose as glycogen, producing bile (1 quart per day) and metabolizing proteins, carbohydrates and fats to provide energy and nutrients.
Foremost is it's detoxifying function. Both internally and externally produced toxins are transformed from fat soluble chemicals into water soluble compounds so they can be released by the kidneys or emulsified by bile in the intestines where they bind with digested food and fiber to form the stool we excrete.
Dietary and environmental toxins place a lot of stress on our livers. That is why it essential to remove all sources of toxins that are not only taxing our liver but also under mining our immune system. This includes additives, colors, waxes, flavorings, preservatives, pesticides and herbicides. Alcohol is also very toxic to the liver and must be avoided when liver disease is present or if we want to avoid taxing our liver. Toxins are stored in the fat of animals so this is important to consider when eating animal products. Keeping animal products at a minimum is a good idea not only to keep fat content, and toxins low but also to keep our exposure to naturally occuring disease related microbes lower.
According to Dr. Robert O. Young, meat and other animal products can contain 336,000,000 per serving of pathogenic micro organisms. In contrast, plant foods contain less than 10 per gram.
A diet that consists of less than 30% fat is a good target to keep the liver from working too hard. It also needs to be noted that fats become rancid easily, overheating and processing can create dangerous free radicals which are damaging to our bodies cells.
Always check the freshness of foods with fat in them, such as seeds, nuts, nut butters, grains, flours, oils, salad dressings and other foods or condiments with oil added. Keep them refrigerated to maintain freshness. Never fry or heat oils to high temperatures and avoid any product with hydrogenated oil in it. Hydrogenation adds hydrogen to oil making it saturated and not easily assimilated. Choose monosaturated and polyunsaturated oils such as olive, safflower, sunflower seed, sesame seed, flax seed, pumpkin seed, soybean, lecitthin, fish or canola.
Foods high in fiber are the cornerstone of a health improving diet. Bile carries toxic substances into the intestines, there fiber can help to speed up the transit time of the stool out of the intestines. In this way carcinogenic chemicals are not hanging around to damage the walls of the intestines or to be possibly re-absorbed into the body. Foods high in fiber include, whole grains and cereals, whole grain flours, brown rice, bran, dried fruits, nuts, seeds, beans, lentils, peas, fruits and vegetables with their skins left on (if they are organic).
Not only it is important to reduce animal products because of their high fat content, but also becaise of the acid ash they leave in our bodies when they are digested and broke down. This acid ash must be buffered so it can be eliminated by the kidneys. This requires minerals which are then carried with the urine out of our body. If we have enough minerals from the foods we are eating this is fine, but when our diets are very high in acid producing ash or low in minerals (which are very deficient in our soils these days and therefore low in our diets), our body will take the minerals it needs from other cells, especially our bones and bile. If this continues for a long time we eventually will suffer illness due to this depletion of necessary minerals.
The liver has the remarkable ability to restore itself and it can function with 80% deterioration. This is the good news. If we stop polluting our body and work to rebuild our liver we can enjoy a relatively healthy life and joyful existence even with severe liver disease. A healthy diet consisting of certain supplements, herbs and nutrients can stimulate this process of detoxification so the liver may regenerate.
Certain enzymes are used by the liver in it's process of detoxifying and there are certain foods that are known to support the functioning of these enzymes. These include:
**Cabbage, broccoli and brussels sprouts, which contain a certain phytochemical called indole-3-carbinol. This is also a anticancer compound and stimulates detoxifying enzymes in the gut.
**Oranges, lemon, tangerines and the seeds of caraway and dill, these contain limonene.This is also an anti cancer phytochemical. Starting the day with one to two glasses of fresh lemon, orange or tangerine juice to cleanse the liver is a good liver supportive practice.
**Nutritional yeast and whole grains, which are sources of B vitamins
**Melons, peppers, tomatoes and fresh fruits. all good sources of Vitamin C
**Tumeric. which is a spice that contains curcumin.It is also regenerating to liver cells and cleanses the liver of toxins. It decreases cholesterol and also inhibits the carcinogen benzopyrene found in meat. This spice is found in curry dishes and can be included in food preparations or taken in powdered form in a gel capsule or as an additive to juices. It does have a bitter flavor.
Certain amino acids are used by the liver so that it may bind with toxic chemicals and carry them away or neutralize them, these include: Glutamine, ornithine, arginine, and especially glutathione.
Glutathione is one of the most important liver antioxidants . We destroy it in our body when we take Tylenol. Glutathione is an amino acid complex made up of Cysteine, Glutamic acid and Glycine. Dietary sources of Glutathione include fresh fruits and vegetables, cooked meats and fish, onions and garlic, and sprouted seeds. Fenugreek seeds are particularly supportive of liver function and help with digestion.
All sprouts are power houses of enzymes, vitamins and minerals , having superior nutritive value. A sprouted seed adds protein to our diets and essential energy. It is bursting with life force. Including sprouts in the diet is easy , fun and tasty.
There are sprouting devises that are for sale at most health food stores or through some seed catalogs (Johnny's Seeds is one).
You can easily make them from a large mouth glass jar with a screen piece to cover and a large rubber band to secure.. Rinsing frequently through out the day and keeping your seeds well drained between rinsing will produce in a few days a nutritious whole food. It is important to use filtered or spring water or any source of water that is not bacteria laden to ensure the quality of your sprouts . Also take care to check them for mold and do not eat them if that should happen. The sprouting trays make for a more consistent level of quality sprouts and do not require as much time for rinsing as they provide adequate drainage to prevent molding.
Other food sources to support Glutathione production are the dietary sources of cysteine found in meat, fish, eggs, soy, wheat gluten and Brazil nuts and Glutamic acid which needs zinc and copper for it's absorption. Zinc is also needed for tissue repair and acts as an anti viral. Good sources of zinc can be found in Brewer's yeast, dulse, kelp, egg yolks, fish and lamb. Sources of copper include almonds, green leafy vegetabes, avocado, beets and black strap molasses.
Another mineral needed by the liver to neutralize harmful sulfites to safer sulfates is Molybdenum. Sulfites are found naturally and added as preservatives in wines. Salad and vegetables bars and even some grocery store fruit and vegetable displays use sulfites to keep produce fresher looking. It is important to ask restaurant and store managers if they use sulfites at their establishment.
As we have mentioned before, minerals are very deplete in our soils and therefore in our foods, so getting the molybdenum we need may be difficult. We may choose to take a supplement to get an adequate supply of all minerals.
Dietary sources of molybdenum include legumes, whole grain cereals, milk, dark green and leafy vegetables and organ meats of kidney and liver. These organ meats would be hard to find in a non toxic state due to the meat raising practices prescribed to in many countries. Animals are fed hormones and many other chemicals to enhance their meat production. These chemicals have settled into the animal's organs of detoxification, namely kidneys and liver. This meat would now be counter productive to our original purpose for eating it. Unless you personally know that the animal has only been fed organically, I would not eat organ meats of any animal raised with today's toxic practices.
**Miso lowers cholesterol and helps to neutralize environmental toxins in the intestines. It is also alkalizing for our system. Can be taken as a soup, tea or broth.
**Dulse and other sea vegetables are a good source of protein, complex carbohydrates, enzymes, fiber, vitamins, chlorophyll, iodine and other minerals.
They are alkalizing and also neutralize envionmental toxins from our intestines. Sea vegetables can be added when cooking rice or other grains, put into stews and soups, added to bean dishes or in the case of Dulse and Kelp, eaten raw in salads or mixed into dips, or wherever your imagination takes you.
As we can see many foods can be useful for natural liver therapy. They provide support to the liver while they nourish us.
General Warnings for People with Liver Disease
Like it or not, what you Don't know can sometimes be fatal. When I found out I had Hep C, my doctor told me not to drink alcohol, to use aspirin sparingly and to get my liver enzymes tested. That was about it. The rest of what I know was up to me to find out. I understand these people are very busy and I also understand that it's not feasible for them to sit there and tell us everything that can be threat to our health, we'd be there for hours! Since I wanted to avoid potentially life threatening and hazardous things. I search the internet for warnings for people with liver disease. Here is what i found.
Threat from the Ocean
People with HCV should be aware of a bacteria called V. vulnificus, found in the gulf of mexico and other warm waters. It infects oysters and other shellfish. Pollution is not what causes the contamination in the shellfish, so just avoiding contaminated waters is not enough of a pre - caution. This bacteria can be in raw or undercooked fish. But, get this, its not enough just to avoid oysters, sushi and lightly cooked shellfish(some of my personal favourites!) but this bacteria can infect open wounds when a person goes swimming in infected waters!Humour: Okay, so like my vacation I was planning in the Gulf of Mexico, where I wade in the warm water after savoring a raw oyster in my "Bloody Mary" and downing a few deep fried shrimp and a double chocolate cheesecake is out, Doc? Bummer! I'm like so bummed out, Dude. I have Hep C, I have to find out what the other pleasures are in life, right!
Hepatitis C Re-Infections
As if one dose of this virus isn't enough! Usually we think about viruses,"Well I've had it, so I can't get it again." Not in the case with HCV (hepatitis C), folks. You can be re-infected with the virus. There are different genotypes, and you can even be re-infected with the same genotype you already have. Isn't that special? No, but in all seriousness, if you became infected with HCV because of risky behavior or lifestyle(using illegal drugs etc), by all means STOP! Don't think "Well, I already have it so what's the use?" or "I already have Hep C, so what's getting a tattoo gonna do?"
Of course, you want to take all precautions not to spread the disease, but you also want to take these pre-cautions for yourself. The Center for Disease Control states, "Prior infection does not protect against re-infection with the same or different genotypes of the virus." The point is, no matter how you got the virus you must protect yourself as well as others from infection.
Raw Shellfish, No Way!
"Eating raw or undercooked shellfish, yes, even from the ocean, can be a serious danger, and even cause death, especially in people with liver disease." The FDA issued an advisory warning to high-risk individuals (that would be us) with chronic liver disease or weakened immune systems urging them to avoid eating raw or partially cooked oysters.
However, the good news is, you can eat shellfish cooked. However, it is important to note that it is advised for people with hemochromatosis (a condition involving iron overload) are advised to avoid shellfish, oysters completely due to iron in them.
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.
Most sources I looked up about vitamin A, said that excess vitamin A can be very toxic to the liver. Prescription for Nutritional Healing by James F. Balch M.D. says "Excessive amounts of vitamin A over long periods may cause liver enzymes to be elevated." When asking my doctor what too much Vitamin A would be, he told me "megadoses, beyond what any multivitamin would contain." James F. Balch suggests, "Anyone taking over 50,000 international units a vitamin A daily for over a year should reduce his or her intake or switch to natural beta-carotene, which should not have any side effects." The typical dose in a multivitamin is 25,000 IU's.
Molds, Aflatoxins and Peanuts
To make a long and boring story short an aflatoxin is a mold. These are substances that grow on certain foods, especially nuts stored in hot and humid conditions are especially prone to this. This is one reason to why some nutrionist advise hepatitis patients to avoid all nuts, mostly I've heard that peanuts are to be avoided.
Mathew Dolan in his book The Hepatitis C Handbook writes "Although many nutritionists appear to be unaware of the severe risks posed by aflatoxins in the diet, particularly people who already have liver disease ... aflatoxins are a definite dietary cofactor in the development of liver cancer." He continues, by explaning that they are carcinogenic and they are a particular problem in peanuts.
Summing it up: Avoid all foods that might potentially contain any traces of aflatoxins (peanuts). Foods that have low levels of it may not be a danger to the general population but they may present a "small risk as cofactors to HCV in triggering the development of liver cancer." And, if you do eat nuts, don't eat discolored or damages nuts of any kind, or one that have been left uncovered for long periods of time. Store them in a cool dry place to avoid contamination.
Mixing Alcohol & Pain Relievers
Alcohol is a "no-no" for your liver. Acetominophen, Aspirin, paracetamol and ibuprofen can all be liver toxic and a have an impact on liver function. The FDA warns and requires warnings on over the counter pain relievers about the danger of mixing alcohol and these various medications. The combination can cause damage to the livers of the people who dont have Hep C, so image what it can do to people who DO have a chronic liver disease. Here is a simplistic, but accurate conclusion: alcohol is bad, drugs are bad, mixing them is really bad. I could give you a bunch of scientific evidence and articles and sources, but you don't need them for the general purpose here, which is just to avoid what hurts you.
Aspirin, Acetaminophen, Ibuprofen, Paracetamol
All these over the counter drugs can have impact on liver function and potentially cause liver damage. It is advised to not take any of these unless absolutely necessary. Persistent long term use in contraindicated for people with Hepatitis C If you have a condition that involves chronic pain and need a pain reliever on a regular basis it is best to consult to your doctor about what would be safest. In The Hepatitis C Help Book by Misha Ruth Cohen and Robert Gish, it is advised, "Although high doses of acetaminophen can be toxic to the liver, it is still the safest pain remedy available if taken in doses of less than 2 grams a day. Acetaminophen is Tylenol.