Fw: HepCnet Newsletter DIET AND HEPATITIS C (Reposted by request)

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DIET AND HEPATITIS C (Reposted by request)

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DIET AND HEPATITIS CWHAT IS THE RELATIONSHIP BETWEEN DIET AND HEPATITIS C ?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.ALCOHOL AND HEPATITIS CAlcohol 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 disease, 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 foundto 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 hepatitis C accelerates the progression of liver disease. The consensus statement concerning management of hepatitis C releasedMarch 1997 from the National Institutes of Health, further warned about the dangers of excessive alcohol use in patients with hepatitis C. These recommendations stressed limitation of alcohol use to no more than one drink per day. Therefore, patients with hepatitis C would be unwise to drink alcohol in excess, and total avoidance of all alcohol intake is recommended .IRON AND HEPATITIS CThe 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 chronichepatitis 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, patientswith 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.FAT AND HEPATITIS COverweight individuals are often found to have abnormalities related to the liver . Examination of liver specimens may display a spectrum of abnormalities ranging from fatty deposits in the liver,[ steatosis], to fatty inflammation [fatty hepatitis], or even fatty cirrhosis. This condition is called Nonalcoholic Steatohepatitis [ NASH ]. It occurs predominantly in middle-aged obese women with diabetes mellitus and hypertriglyceridemia [excess fat in the blood]. However, this disease may also occur in individuals of normal weight, without other associated diseases, and can also affect men. The presence of fat in the liver can cause the liver to become enlarged and may result in elevations inliver related blood work { liver function tests [LFT's] }. The addition of NASH in patients with hepatitis C may worsen liver related blood work and physical exam. This may confuse interpretation of results and diagnosis. Controlled studies need to be done to determine if the addition of this disease worsens theprognosis of patients with underlying chronic hepatitis C. In overweight patients with a fatty liver who subsequently lose weight, liver- related abnormalities improve. Therefore, patients with chronic hepatitis C are advised to maintain a normal weight. For persons who are overweight, it is crucial to start a prudent exercise routine and a low fat, well balanced, weight reducingdiet. In diabetic patients, a sugar- restricted diet should be adhered to. A low cholesterol diet should be followed in those with hypertriglyceridemia. In individuals with NASH who are of normal weight, a low fat diet may be advantageous. It is essential that patients consult with their physician prior to the commencement of any dietary or exercise program.PROTEIN AND HEPATITIS CAdequate 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. Approximately 0.8 grams of protein per kilogram of body weight is recommended in the diet each day. Therefore, protein intake should be between about 60 - 120 grams a day in patients with hepatitis C, unless a complication of cirrhosis known as encephalopathy occurs. Encephalopathy is an altered mental status. The exact cause is not fully understood and is probably multifactorial. It has been shown that restriction of the diet of animal protein and maintaining a total vegetarian diet, helps reverse this condition and improve mental capacity.SODIUM AND HEPATITIS CAdvanced scarring of the liver [ cirrhosis ] may lead to an abnormal accumulation of fluid in the abdomen referred to as ascites. Patients with hepatitis C 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 in the diet, the better this excessive fluid accumulationis controlled. While often difficult, sodium intake should be restricted to 1000mg each day, and preferably to 500 mg per day. One must become an careful shopper, diligently 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 - 528mg of sodium; one cup of chicken noodle soup - 1108 mg of sodium; and one teaspoon of table salt - 2,325 mg of sodium!Most fast food restaurants are a no no. Meats, especially red meats, are high in sodium content, and adherence to a vegetarian diet may often become necessary. Patients with chronic hepatitis C without ascites, are advised not to overindulge in salt intake, although their restrictions need not be as severe.copyright © 2000 Palmer, MDReturn To Home Page of liverdisease.com

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Diets for patients with hep CAugust 12, 2003 Volume 39 Issue 29NUTRITION / FOOD FOR THOUGHTDiets for patients with hep CDr. Biali presents highlights of the 88-page guidelines from theDietitians of CanadaBy BialiAccording to a survey by the Dietitians of Canada, when patientswith hepatitis C call a consumer association for advice, they almost always include a question about nutrition. I'm glad they're asking someone, because they almost never ask me. I see patients with hepatitis C almost every day, and usually it's because their social worker has sent them in with a high-protein diet form. Hepatitis C patients "qualify" for this benefit, and even the most avoidant patient will come by if it means getting a bigger welfare cheque. That's pretty much it for my dietary advice, other than avoiding alcohol.As usual, preparing this column has made me a better doctor. Idiscovered Hepatitis C: Nutrition Care-Canadian Guidelines forHealth-care Providers, published by the Dietitians of Canada(http://dietitians.ca/resources/Hepatitis C_Guidelines.htm). Thismammoth document is 88 pages long and viewed on your computer withAdobe Acrobat Reader.Since I get paid to read it and you don't, I'll review thehighlights.The liver is our primary metabolic organ. When it's sick, nutrientdigestion, absorption, storage and metabolism can all be affected.Though experts have studied the deficiency states and metabolicproblems that may arise, we don't know much yet about how nutritionitself contributes to the progression of liver disease.People with hepatitis C don't need specific dietary restrictionsunless they have advanced liver disease or a co-existing conditionlike diabetes. Still, we need to advise them early on about healthydiet and lifestyle habits to maximize their well-being.Unfortunately, telling them to "eat a healthy diet" isn't enough.Though it may feel good to say the words, this type of advice isapparently too vague and open to interpretation. The guidelines'Appendix A provides a Healthy Eating Checklist we can run through or give to the patient to properly assess their eating patterns.The basic healthy diet recommended for hepatitis C patientsincludes:. a variety of foods from all groups;. adequate (but not excessive) energy intake spread out over theday;. adequate protein to fight infection and regenerate the liver;. vegetables and fruit to maximize free radical-fightingantioxidants;. food rich in vitamin A and vitamin C;. avoidance of alcohol to protect the liver and allow it toregenerate;. limited high-fat and sugar foods; and. balancing food intake with some activity,within physicallimitations.A simple, yet important, thing we can do is monitor the patient'sweight. Promote gradual weight loss (approximately 10%) in obesepatients, as they risk more rapid disease progression. Otherbenefits of reduced weight include improved steatosis, reduced liver enzyme counts and a decrease in fibrosis.If any patient loses or gains 10% of their original body weightunintentionally, you need to refer them for investigation and/or adietitian consultation. The same goes for those with a body massindex of less than 20 or greater than 30.Additional criteria that merit referral to a dietitian include:advanced liver disease; symptoms such as nausea, diarrhea oranorexia; needing a sodium-restricted diet; and patients who avoidan entire food group.Advise patients with cirrhosis to eat frequent small meals four toseven times a day. This improves nitrogen and substrate use,diminishes fat and protein oxidation and can prevent depletion ofglycogen stores.If the liver isn't able to produce the necessary bile salts required for fat absorption, patients might experience steatorrhea, or fatty diarrhea. I was intrigued by the concept of substituting medium-chain triglycerides into the diet.Apparently these fatty acids don't require bile salts for absorption and can be used like any other cooking oil, be it in cooking, baking or dressings.The only catch-and this is important-is medium-chaintriglycerides don't contain essential fatty acids.If the steatorrhea is more than 10 g/day, you may need to supplement with fat-soluble vitamins (A, D, E and K). These are actually available in water-soluble form by prescription-who knew?Though food is the best way to meet nutrient requirements, amultivitamin with minerals may still be appropriate. However,patients with high iron stores or cirrhosis shouldn't take iron, aselevated hepatic iron may contribute to fibrosis and inhibitantiviral treatment.Approach individual nutrient supplementation very cautiously.For example, some antioxidants might act as pro-oxidants; for now,treatment should be limited to controlled experimental conditions.Patients with hepatitis C, cirrhosis or increased iron stores should probably avoid high-dose vitamin C until its safety is established.Thiamine may have antiviral properties, but for now you shouldn'texceed the recommended daily allowance.Niacin has reportedly caused hepatotoxicity, particularly with time-release preparations.Vitamin A can be hepatotoxic above the multivitamin dose. Assessvitamin D levels in cirrhosis; if low, one can supplement with aliver-activated form such as Rocaltrol. Easy bruising might be asign of vitamin K deficiency.Magnesium deficiency, with symptoms of muscle cramps, weakness andnausea, is common in cirrhosis. The same goes for zinc deficiency, which can present as alterations in taste.Again, these are just the highlights. For more complete (and stillrelatively efficient) information, check out the "PracticeEssentials" summary section of the guidelines. Biali is a family physician in Vancouver and has a degree indietetics. Her column appears once a month.Source URL: Online searchhttp://www.medicalpost.com/mpcontent/article.jsp?content= 030812_135641_3236~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Nature's Response - http://naturesresponse.comI have added or changed a few things in the diet. This one will soon beposted at my website but until then here is your copy....MonaA Basic Diet for Hepatitis by Ramona L. , C.N.C.Foods to AVOIDAnimal products - Animal products should be avoided for several reasons. First of all when you consume animal products you consume what that particular animal has consumed. If it was fed with grains that have been chemically sprayed you also are eating those chemicals. Then there are the injections, growth hormones, antibiotics, steroids, etc. If the product is in the form of meat, then you have just added stress to the digestive process, stressing the liver, gall bladder, pancreas. Meat is one of the hardest foods to digest. It can sit in the stomach for 5-7 days and ferment, causing flu like symptoms, gas, bloating, and even more stress.Caffeine, including colas, chocolate, coffee, some teas, OTC meds. A good substitute for coffee is Rajas Cup, an antioxidant herbal tea. Caffeine of course is a stimulant. Stimulating the liver can cause stress to the liver. If you are in the habit of drinking caffeinated beverages you need to eliminate them slowly as they are addicting. If you stop too suddenly you can have withdrawal symptoms such as headaches, nausea, irritability, and weak shakes.Tap water - drink distilled water only. No filtered water. Your tap water may contain more than you bargained for, including chlorine, fluoride, inorganic chemicals and compounds that the liver is not able to process. Filtered water is of course better than tap water but filters breed bacteria. In order to reduce the stress from the liver you need to give it the purest form of water possible which is distilled water. Even the shower you take every day has toxins in it which are absorbed through the skin and inhaled through the lungs. If you can possibly purchase a water filter you would be doing yourself a great favor.Junk foods - Junk foods are our favorite foods but the name fits, Junk is junk, meaning worthless. Our body does not get a good source of nutrition from junk foods and most often they are full of all the things we need to stay away from, fats, sugars, empty calories, chemicals, additives, etc. Our poor livers don't need this added stress.White flour unless it is organic and unbleached - Bleached white flour has been chemically processed. Lots of vitamins and minerals are lost during the process, about 78%. When we consume this chemically altered product our bodies need extra vitamins and minerals in order to process it and utilize it. Isn't this the opposite of what we want? We want toeat foods that will nourish the body, not make it work harder.Hydrogenated oils - Hydrogenated (they are refined) oils are another product that is hard for the liver to handle. Any type of oil or fat that hardens whencold. A better choice would be flaxseed oil or virgin olive oil.Dairy products (animal) - Dairy foods are extremely hard to digest and again you are eating whatever the animal ate. Yogurt is not considered a dairyproduct but be sure to read the labels as the commercial brands are usually high in sugar content. A yogurt maker is a great investment.Fruit juices - Fruit juices are high in concentrated sugar. Sugar is a shock to the liver, stresses the digestive process, stresses the pancreas, and itfeeds the virus.Artificial sweeteners (use liquid stevia instead) - The first word gives you the first clue, artificial. These sweeteners are extremely hard for the liverto process. Your poor liver doesn't even recognize what this substance is.Processed foods - we all know processed foods contain unnatural substances, preservatives, fillers, and chemically treated substances. Common sense tellsus this is not healthy for us.Remember our goal, to take as much stress and strain off the liver as possible.Changing your diet is probably one of the hardest things to achieve. Not only are we cursed with this virus but we have probably unknowingly addictedourselves to the wrong foods. I say addicted because most of us tend to eat when we feel depressed, down, bad, tired angry, or when we have insomnia. Before I was diagnosed with Hep C I had been experiencing symptoms for 6 years. I know that many times when I felt just plain rotten I would eat something thinking that it would make me feel better. The majority of the time we tend to eat for all of the wrong reasons but mainly we are reaching out for something to make us feel better. Little did we know that we were only making ourselves feel worse. But the habit was started and now we are going to break it. Any one who is serious about taking care of themselves has got to know it starts right here, with the diet. So let's do it...Start with one step at a time. NEVER try to change your eating habits overnight. You will throw your body into shock! This means that your body has becomeaccustom to receiving any type of food at any time and to bring this to a sudden halt will cause havoc, not only physically but mentally. Caffeine and sugar are the main culprits, giving us that highfeeling and quick energy. If you were to completely stop feeding your body sugar and caffeine your body would most likely have withdrawal symptoms, as Imentioned before, causing you to have the shakes, nausea, a wonderful PMS feeling, being grouchy, irritable, etc. I don't know about you guys but where I live that's grounds for divorce. So youstart with changing a few foods at a time, a little at a time. Take one day and write down everything you eat. You would probably be surprised to see you justconsumed half of the Hershey factory.Foods you CAN eat!Whole wheat breadWhole grain cerealsCheerios!Malt O MealOatmealCream of WheatBrown riceVegetables (potatoes in moderation)Beans, all kindsRefried beans (cook a small pot of pinto beans and put in blender when done andcool) Lots of vegetable juices, freshly juiced by you Fresh fruit in moderation(2-3 pieces per day)Better Than Milk - a soy milk (White Wave is also good)Rice Milk if you like it, I think it tastes like dirty water but a lot of people do like it.Soy-Sation Cheddar Cheese by natti. It's certified organic soybeans, andyes, it does taste like cheese and it even melts. Miracles never cease! (Tofind a store in your area or to order direct call 503-652-1988)Corn tortillas - love those tacos, make your own chips too, just bake in the oven till crisp Organic flour tortillas made with unbleached white or wholewheat flour Salsa - if it doesn't bother you and you do not have liver damage go for it Canned tuna in small amounts Organic whole wheat pasta or semolina pasta (available at most grocery stores)Spices and herbsHerbal teas, iced or hotLemonade made with fresh lemons and stevia for sweetening Organic unbleachedflour (white) in moderationOrganic Virgin Olive Oil FlaxseedOil Homemade Vegetable Soup Baked chips Nayonaise instead of mayonnaiseYogurt - Do not eat yogurt if you are taking HepaticoOkay, those are some of the foods you can eat. Now let's get a little creative here and slap a few of those together. Here are just a few dishes you can make using healthy foods.SpaghettiMacaroni and CHEESE - use the Soy-Sation or a tofu cheeseTacos - using a meat substitute and lots of seasoningToastadosEnchiladasHamburgers - there are lots of meat substitutes at the health food store. I useone called Gimme Lean Hot dogs - tofu hot dogs Chili Beans Tuna Salad ChickenSalad - made from canned chicken Puddings - sweetened with liquid Stevia, usingBetter Than Milk Cake - in moderation using unbleached flours. Eat desserts inmoderation Distilled water with alittle lemon or lime juice and liquid stevia makes a great drink and NO CALORIESWhole wheat waffles or pancakes - top with a fruit puree sweetened with liquidstevia Ultimate Meal - this is a great healthy drink. I add a banana and 1/2 cup unsweetened apple juice Pizza! - whole wheat crust and vegetarian and CHEESE(SOY cheese) Homemade yogurt with or without fruit-sweeten it with liquid stevia Baked potatoes topped with cheese, or a vegetable or both.These are only a few ideas. I have plenty more in my cookbook. If you are interested in the cookbook you can order it by calling 800-216-5195.So you see, there are more foods to eat than you thought. You can take almost any recipe and convert it into a healthy dish simply by using healthy foods.Now here are a few tips for you regarding your eating habits.Eat 4 small meals per day. Never eat a large meal at one time.Do not eat for 5 hours before bedtime.Try new foods, you may just like them by accident.Drink lots of distilled water throughout the day and pop a vitamin C ever so often.Take a digestive aid (1 or 2) with each meal. ( I suggest Di-Acid Stim by Atrium Nutrition)Eat slowly and eat alone if and whenever possible and not in front of the TV.Prepare your foods ahead of time so they are ready when you are.Sea Salt - if you do not have a problem with retaining fluids and you do nothave high blood pressure then a little added salt is fine. You can tell if you are retaining fluids by pressing on your shin bone. Press and hold for 5seconds, if its indented after releasing pressure you are retaining fluids and should reduce your salt intake or if directed by your doctor to do so.Chew, chew, chew, chew, chew. The digestive process starts in the mouth. The chewing actions begins the release of digestive juices. Chew, chew, chew, chew.Are you finished chewing? Great...Do not eat and then go lay down. If you feel tired you probably ate too much or the wrong foods. (Or you could have hep c)...Do not eat when you are angry, frustrated, or bored. Instead go take a walk and talk to yourself. This is a great way to relieve your stress and stress out theneighbors.If you need help in any way with changing your diet you can always call me at 405-878-6644 or e-mail me. Just remember to make your changes sloooowly butsurely. It took you years to learn those bad habits and it will take time to break them. And just for the record it took me almost two years but I am a slowlearner. Of course the BBQ restaurant that I used to own didn't help matters.Tips for Those with CirrhosisHere are some tips concerning the diet for those who have cirrhosis. The majority of the diet is the same but there are a few difference that I feel areimportant.1. Do not eat raw vegetables but steam them instead. These include carrots, potatoes, cauliflower, or any "hard to chew" vegetables. Juicing is preferred.2. Avoid meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, salty foods, coffee, and caffeine.3. Suggested fresh juices:Carrot, beet, and cucumber

Carrot and spinachCarrot, celery, parsley4. Take 2-3 plums with pits and crush them. Add one cup of boiling water, mixand obtain the juice. Drink in the morning and the evening.5. Cook soybean sprouts and adzuki beans (1/2 and 1/2 in amounts), cook into a light soup and eat.6. Add lecithin to foods and take as a supplement, up to 1500 mg. per day.7. Take 800 mg. of vitamin E per day in dry form. If you have not taken Vitamin E before start with a lower dosage (200 mg per day) and slowly increase.8. Good foods to eat are broccoli, brussel sprouts, cauliflower, onions, garlic, legumes (beans, lentils) , cabbage, peppers (mild such as bell peppers, red bell peppers and yellow bell peppers), whole grains, artichokes, beets, dandelion and herbs such as cinnamon, licorice and turmeric.9. Do not take Vitamin C with meals as it enhances the absorption of iron. Take at least 1-2 hours after eating.Eat healthy and live longer!!!Proper diet is a must for all of us.