Diet & Hepatitis C
WHAT
IS THE RELATIONSHIP BETWEEN DIET AND HEPATITIS C?
Hepatitis C (HCV)
is a virus that infects the liver. Up to 85% of people exposed to this
virus develop chronic liver disease. In general, chronic HCV appears to
be a slowly progressive disease that may gradually advance over 10-40 years.
While not as yet totally defined, many factors influence the rate of disease
progression. Diet may play an important role in this process, as all foods
and beverages that we ingest must pass through the liver to be metabolized.
General guidelines
for individuals infected with HCV include maintaining a healthy lifestyle,
eating a well-balanced, low-fat diet, and avoiding alcohol. A diet high
in complex carbohydrates may be helpful in providing calories and maintaining
weight. Since HCV infection may lead to loss of appetite, those individuals
whose appetite is diminished may find frequent, small meals more easily
tolerated. Adequate rest and moderate exercise can also contribute to a
feeling of well-being.
ALCOHOL
AND HEPATITIS C
Alcohol is a potent
toxin to the liver. Excessive intake can lead to cirrhosis and its complications,
including liver cancer. Heavy drinkers are not the only individuals at
risk for liver diseases, as damage can occur in even some moderate "social
drinkers." The hepatitis C virus has frequently been isolated from patients
with alcoholic liver disease. In fact, these patients have been found to
have a higher incidence of severe liver damage, cirrhosis, and a decreased
lifespan, when compared to individuals without the virus. It is suggested
that the combination of alcohol and HCV accelerates the progression of
liver disease. The consensus statement concerning management of HCV released
in March, 1997 from the National Institutes of Health further warned about
the dangers of excessive alcohol use, and advised limitation of alcohol
to no more than one drink per day. Therefore, patients with HCV would be
unwise to drink alcohol in excess, and total avoidance of all alcohol intake
is recommended.
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 store this metal. The average American diet contains about
10-20 mg of iron per day. About 10% of this iron is absorbed, in keeping
with the body's need for 1 to 2 mg. of iron per day. Patients with chronic
HCV sometimes have an increase in the iron concentration in the liver.
Excess iron can be very damaging to the liver. Studies suggest that high
iron levels reduce the response rate of patients with HCV to interferon.
Thus, patients with chronic HCV whose serum iron level is elevated, or
who have cirrhosis, should avoid taking iron supplements. In addition,
these patients should restrict their intake of iron-rich foods, such as
red meats, liver, and iron-fortified cereals, and should avoid cooking
with iron-coated cookware and utensils.
FAT
AND HEPATITIS C
Overweight individuals
are often found to have abnormalities related to the liver, ranging from
fatty deposits in the liver (steatosis) to fatty deposits accompanied by
inflammation (steatohepatitis). In overweight patients with a fatty liver
who subsequently lose weight, liver related abnormalities improve. Therefore,
patients with chronic HCV are advised to maintain normal weight. For those
who are overweight, it is crucial to start a prudent exercise routine and
a low fat, well balanced, weight reducing diet. Diabetic patients should
follow a sugar restricted diet. A low cholesterol diet should be followed
in those with hypertriglyceridemia. It is essential that patients consult
with their physician before beginning any diet or exercise program.
PROTEIN
AND HEPATITIS C
Adequate protein
intake is important to build and maintain muscle mass and to assist in
healing and repair. Protein intake must be adjusted to one's body weight
and medical condition. Approximately 1.0 to 1.5 gm. of protein per kilogram
of body weight is recommended in the diet each day for regeneration of
liver cells in non-cirrhotic patients.
In a small but
significant number of individuals with cirrhosis, a complication known
as encephalopathy, or impaired mental status, may occur. Affected individuals
may show signs of disorientation and confusion. The exact cause(s) of encephalopathy
is not fully understood. While some experts do not believe there is a link
between dietary protein and encephalopathy, others believe in substantially
reducing or even eliminating animal protein and adhering to a vegetarian
diet, in order to help improve mental status. Patients who are at risk
for encephalopathy may be advised to eat no more than .6 - .8 gm. of animal
source protein per
kilogram of body
weight per day. (Animal source proteins are meat, fish, eggs, poultry,
and dairy products. Each provides 7 gm. of actual protein per ounce of
food.) There is no limit on vegetable protein consumption. Maintaining
adequate protein intake and body weight should be considered a priority
if vegetarian protein substitutes are not utilized .
The table below
gives recommended grams of animal source protein intake per pound of body
weight. (Note: The chart is intended to provide guidelines for patients
with hepatitis C. For specific recommendations, consult your physician.
Recommended average protein Maximum recommended
protein
Weight
intake for regeneration of liver
intake for patients at risk
cells in non-cirrhotic patients
for encephalopathy
100 lbs
45-68 gm. (6 -9 oz. meat or equivalent)
27 gm.
130 lbs
59-87 gm. (8 - 12 oz. meat or equiv.)
35 gm.
150 lbs
68-103 gm. (9.7-14 oz. meat or equiv.)
40 gm.
170 lbs
77-116 gm. (11 -16 oz. meat or equiv.)
46 gm.
200 lbs
91-136 gm. (13 -19 oz. meat or equiv.)
54 gm.
SODIUM
AND HEPATITIS C
Advanced scarring
of the liver (cirrhosis) may lead to an abnormal accumulation of fluid
in the abdomen, referred to as ascites. Patients with HCV who have ascites
must be on sodium (salt) restricted diets. Every gram of sodium consumed
results in the accumulation of 200 ml. of fluid. The lower the salt content
of the diet, the better this excessive fluid accumulation is controlled.
Sodium intake should be restricted to 1,000 mg. a day or less. This requires
careful shopping and reading all food labels. It is often surprising to
discover which foods are high in sodium. For example, one ounce of corn
flakes contains 350 mg. of sodium; one ounce of grated parmesan cheese,
528 mg. of sodium; one cup of chicken noodle soup, 1,108 mg. of sodium;
and one teaspoon of table salt, 2,325 mg. of sodium. Avoid fast food restaurants,
because most fast foods are high in sodium. Meats, especially red meats,
are high in sodium, so meat consumption may need to be reduced and vegetarian
alternatives considered. Patients with chronic HCV without ascites are
advised not to overindulge in salt intake, although their restrictions
need not be as severe.
MEDICATIONS
ARE NOT FOOD, BUT...
Like foods and beverages,
medications also pass through the liver to be metabolized. Individuals
with chronic liver disease should be careful about taking medications,
even those sold over-the-counter. Read package labeling carefully before
taking medications, and discuss any questions you may have with your physician
and/or pharmacist.
SOURCE: American
Liver Foundation *
*
The information contained in this sheet is provided for information only.
This information does not constitute medical advice and it should not be
relied upon as such. The American Liver Foundation (ALF) does not engage
in the practice of medicine. ALF, under no circumstances, recommends particular
treatments for specific individuals, and in all cases recommends that you
consult your physician before pursuing any course of treatment.
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