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Diet

A healthy and well-balanced diet is essential for general good health. The food we consume is responsible for providing us with energy, as well as maintaining and repairing our bodies. It also influences our immune system and our body's response to disease or illness.

A bad or unhealthy diet can hinder good health and our body’s immune function. The role diet plays in conditions such as coronary heart disease and stroke is well documented. Less well documented is the role diet plays in liver disease. As all foods and fluids must pass through the liver to be metabolised, diet must play an important role.

The most appropriate diet depends on a number of factors. These include age, weight, extent of liver damage, and your symptoms. It is well worth discussing these factors with a dietician (you can ask your GP or consultant for a referral to a dietician). There are some basic changes you can make yourself to your diet that could also help protect your liver.

The most important change that you could probably make at this stage would be the exclusion of any substances that may be harmful to the liver. In particular this refers to alcohol and foods high in fat content, especially saturated fats. Your doctor will be able to advise you about hepatotoxic drugs.

Food to include in your diet

  • Fresh fruit and vegetables.
  • Complex carbohydrates.
  • Adequate amounts of protein.
  • Foods rich in fibre.
  • Foods low in fat.

Foods to avoid

  • Fried foods.
  • Fatty foods especially saturated and hydrogenated fats.
  • Processed food and junk food.
  • Foods containing additives and pesticides.

Diet and liver damage

Although it may be over a very long period of time, in due course your hepatitis C infection will most likely begin to damage your liver. As a result of this your dietary needs may change.

There is no single diet for everyone to follow, as the course of liver disease and the effect on the liver will be different in different people. However, there are some common developments and conditions that are affected by diet:

Iron

The liver plays an important role in the metabolism of iron. Approximately 10% of the iron we consume is naturally excreted from our body. People with chronic hepatitis C sometimes have difficulty in releasing iron, which can result in an overload of iron in the liver, blood, and other organs. This excess iron can be very damaging to the liver and is seen as a factor which can reduce response rates to interferon therapy. Pre-menopausal women are far less likely to experience iron overload because of the loss of blood each month.

For this reason, people with chronic hepatitis C should reduce the amounts of iron rich foods in their diet. These include red meats, liver, oysters, tuna, sesame seeds, apricots, prunes and iron-fortified cereals.

It is important to avoid taking iron supplements, unless advised by your doctor. Multivitamin tablets often include iron, so check the label. It is also important to be aware that vitamin C increases the absorption of iron from food.

Fat

Abnormalities of the liver are more common in those who are overweight. These abnormalities may include fatty deposits found in the liver and fatty inflammation or fatty cirrhosis. This tends to be more common in diabetics. The presence of fat in the liver can result in the organ becoming enlarged and result in raised liver enzymes.

Overweight patients with a fatty liver who reduce their weight are likely to experience an improvement in fat-related liver abnormalities. Consequently people with chronic hepatitis C should try to maintain a normal weight in order to avoid additional stress on their liver.

Protein

The ideal amount and type of protein in the diet of people with liver disease is a much-debated topic and some conflict in opinion is apparent.

The building and maintenance of muscle, and the repair and healing of the body is highly dependent on protein intake. Adequate protein intake for an adult is approximately 60-120 grams per day. Large amounts of protein in the diet can lead to a build-up of protein breakdown products in the blood. This is because they are normally eliminated through the liver.

If the levels of these products are elevated then a complication known as encephalopathy can occur (see end stage liver disease). This condition affects mental function and is often the cause of brain fog. Several studies have illustrated that a vegetarian diet that restricts or eliminates animal protein improves the symptoms of encephalopathy.

Recent studies into encephalopathy suggest that a very low protein diet is not always necessary, except for severely ill people or when specifically advised by your doctor. Low protein intake can contribute to malnutrition and weakness. Therefore the advice is to continue eating adequate amounts of protein (as opposed to large), but to only eat one type of protein at a time. It is also best to eat 3-4 smaller meals, rather than one large one.

The difficulty still remains of striking a balance between having enough protein to meet the body's needs without causing a build-up of protein breakdown products in the blood.
Most guidelines for daily protein intake for people with liver disease recommend 1 to 1.5 grams of protein per kilogram of body weight. However, advice about protein consumption should be gained from your doctor or a dietician, as they might take other medical factors into consideration.

Salt

Cirrhosis may lead to an abnormal accumulation of fluid in the abdomen referred to as ascites. This is one of the symptoms of end stage liver disease. Those who experience ascites must follow a diet that restricts sodium intake to nothing more than 1000mg per day. This restriction can be very difficult as many foods and food products have a surprisingly high salt content. For example, just one teaspoon of table salt contains 2,325mg of sodium.

Sugar

There appears to be a connection between hepatitis C and problems with the regulation of sugar. In some instances this can lead to the development of diabetes.

The liver is responsible for regulating blood sugar levels. It does this by converting the food we eat into substances that the body can use. Carbohydrates and sugars are stored as glycogen in the liver and are released as energy when the body’s energy demands are high. People with end stage liver disease often have difficulty in regulating blood sugar. One remedy is to consume small, frequent meals that will keep blood sugar levels more constant.

Coffee/Caffeine

Drinks that contain caffeine including coffee, tea and some soft drinks dehydrate the body. Caffeine is processed through the liver and then eliminated from the body via the kidneys. This process is drastically impaired if cirrhosis is present in the liver. This can lead to a higher caffeine concentration in the blood. This increased concentration can increase the likelihood of headaches, nervousness, diarrhoea, fatigue, vertigo, insomnia and anxiety. People with hepatitis C should, where possible, avoid drinks that contain caffeine or try to reduce their intake.