Liver Health

The liver - the largest organ in the body and one of the most active- has a remarkable ability to repair itself given the chance. Hepatitis C is a virus that infects the liver. Up to 85% of people exposed to this virus develop chronic liver disease. Progression to cirrhosis (irreversible scarring of the liver) occurs in about 25% of individuals. While not as yet totally defined, many factors influence the rate of disease progression. Diet likely plays an important role in this process, as all foods and beverages that we ingest must pass through the liver to be metabolized If you have hepatitis or any disease of the liver following are some suggestions that come widely recommended.

Things To Avoid:

• Tylenol and iron containing supplements:
  
  If you have liver disease be careful with all over the counter painkillers. Most drugs are metabolized by the liver. If you are taking prescription drugs ask your doctor if you truly need them. Do not take any over the counter drugs without medical advice. Tylenol overdose can cause liver failure.
• IRON AND HEPATITIS C
  
  The liver plays an important role in the metabolism of iron since it is the primary organ in the body that stores this metal. The average American diet contains about 10- 20 mg of iron. Only about 10% of this iron is eliminated from the body. Patients with chronic hepatitis C sometimes have difficulty excreting iron from the body. This can result in an overload of iron in the liver, blood, and other organs. Excess iron can be very damaging to the liver. Studies suggest that high iron levels reduce the response rate of patients with hepatitis C to interferon. Thus, patients with chronic hepatitis C whose serum iron level is elevated, or who have cirrhosis, should avoid taking iron supplementation. In addition, one should restrict the amounts of iron rich foods in their diet, such as red meats, liver, and cereals fortified with iron, and should avoid cooking with iron coated utensils.
• Strictly avoid alcohol and tobacco. Alcohol is toxic to the liver and can accelerate liver disease, while smoking takes a major toll on the immune system. Avoid chemical fumes and vapors (such as solvents and gasoline) as well as pesticides and herbicides. The liver bears most of the burden of metabolizing and detoxifying unwanted substances that enter the body. Toxins of any kind weaken immunity and make the body more susceptible to infection and disease
• Vitamin Supplements and Nutritional Therapies
  
  Excess vitamin A is very toxic to the liver, and excess amounts of some other vitamins may be a source of stress to your liver. Therefore, avoid using mega-vitamin supplements, especially if they contain vitamins A and D.
• So-called nutritional therapies (e.g., "natural" therapies and herbal remedies) may damage your liver. Plants of the Senecio, Crotalaria, and Heliotopium families, plus chaparral, germander, comfrey, mistletoe, skullcap, margosa oil, mate tea, Gordolobo yerba tea, pennyroyal, and Jin Blu are all toxic to the liver.

What you can do!

• Get plenty of rest.
• Eat low fat, moderate to high protein diet. Daily fresh squeezed vegetable juices and steamed vegetables. Drink plenty of water. Flushing your kidneys with lots of good-quality water (six to eight glasses a day) Will allow your body's purification system to do the job and take some of the workload of detoxification off the liver.
• Take frequent steam baths or saunas. Sweating helps the body eliminate toxins and also reduces the liver's workload. Be sure to replace the fluid with lots of water at the same time.
• Talk to your physician about vitamin and mineral supplementation. A standard multivitamin with mineral supplement with 100% the RDA and w/o iron is recommended. NAC (N-Acetylcysteine) and alpha lipoic acid and other glutathione builders such as glutamine may be helpful. Glutathione is a major antioxidant that protects the liver and the immune system. NAC is sold as a prescription drug to treat Tylenol overdose. An alternative that might help: Milk thistle - An herbal flavenoid protects the liver through several means- this one has some science to back it up.

1. Acts as an antioxidant and protects the liver from free radical damage
2. Increases the livers rate of tissue regeneration
3. Increases the synthesis of glutathione
4. Protects against liver damaging substances such as carbon tetrachloride
   Caution: Introduce gently to avoid over stimulation of the liver and gallbladder that can lead to loose bowels.

Cirrhosis and Diet

Cirrhosis is advanced liver disease that is irreversible. Normal functional tissue is gradually destroyed and replaced by inactive fibrous connective tissue (scar tissue). The liver is contracted and has lost most of its function. The growth of abnormal tissue limits function by interfering with blood flow through the liver.

One of the complications of liver cirrhosis is ascites- this is the accumulation of fluids in the abdominal area (peritoneal cavity). Ascites, because it causes pressure on the chest cavity, can cause shortness of breath. It can also cause peritonitis a life threatening condition. Sodium restriction is critical - 2-4 grams/day. That means not adding salt to your food or eating processed foods like cold cuts, pickles, salted chips etc. Unfortunately diet therapy is not enough for most patients and pharmacological measures (e.g. water pills) are usually necessary. If neither sodium restriction or water pills can rid the fluid, a procedure called paracentesis is guaranteed to work. This is extraction of the fluid by needle. It sounds painful, but people feel so much better that they soon forget any pain involved in this procedure.

Edema is fluid accumulation in the extremities, legs and feet. Albumin is a protein that is made in the liver. One of its roles is to help regulate the positioning of body water. In liver cirrhosis there is decreased production of albumin, one of the consequences is that water moves out into what is called the "third space" thus the swelling or edema. Edema and ascites both respond to sodium restriction and water pills.

The liver influences on nutrition include the metabolism of carbohydrates, fats and protein. This is the storage place for fat-soluble vitamins A, D, E and K.

Dietary protein is likely to be an issue for some people with cirrhosis. The reason is that the liver is central to protein metabolism. The liver also functions in detoxification of waste products. Protein wastes can be particularly toxic if they are not converted to a form that can be easily removed from the body. Certain proteins (vegetables and dairy) are less toxic than others (meat) are. Hepatic encephalopathy (a long name for confusion) is one problem people with cirrhosis (especially extensive liver damage) might experience. You may be asked to limit protein because it is one of those toxic byproducts of abnormal protein metabolism that is involved in this confusion. Most people think that the vegetable and dairy protein is better tolerated and you might be able to have a lot more of this type than meat protein. There is a drug called Lactulose that is used routinely to rid the body of ammonia - that protein toxin that causes confusion. It is used routinely to allow patients more leverage with their diet. One of the problems with this is that diarrhea is the mechanism of action.

Accumulation of fat in the liver cells interferes with normal function and ultimately causes them to die. Therefore a diet modified in fat is suggested. We normally recommend about 30% for cirrhosis I suggest around 20-25%. Fried foods, whole fat dairy and excess table fats should be avoided. If you need extra calories medium chain triglycerides (MCTS-designer fats) can be substituted for the usual table fats. If you follow a very low fat diet or decide on the MCTs you may need to supplement with essential fatty acids (EFA e.g. evening primrose oil) to prevent an EFA deficiency.

Carbohydrate metabolism can be deranged too. Hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can happen as a result. The recommendation is for high complex carbohydrates (avoid excess simple carbohydrates like sugar, syrups, jellies, regular sodas and sweet desserts) stick with bread, pasta, rice and cereals. Whole grains are always better than white flour products.

With cirrhosis as with any chronic disease a multivitamin with mineral supplement is always recommended. B vitamin deficiency is common and a good B complex vitamin is usually a good idea. The multivitamin with mineral and B complex is pretty safe- however, your MD should prescribe supplements and you should be monitored closely as the liver is no longer capable of detoxifying, too much of any single nutrient might be toxic. This is a very complex disease with multiple complications as you can see- and this is only from a nutrition standpoint.

Hepatitis and advanced liver disease is a serious medical problem- we suggest you consult your private medical doctor and dietitian for tailored advice.

Donna Tinnerello, MS, RD, CD/N is a registered dietitian, living in Manhattan, with more than 10 years experience in HIV and nutrition. Her subspecialties are cardiovascular, renal, gastrointestinal disease, diabetes and weight management.
Donna is available for private consultation by referral only. Ms.Tinnerello has donated time and articles to our web site at always your choice and we sincerely appreciate her contributions.