What should someone with chronic hepatitis eat? This is a common concern and the answer may surprise you. There's no single recommended diet -- because there's not much difference between a healthful diet for someone with chronic hepatitis and someone without! Even though several books and websites suggests otherwise, there are only guiding principles that you should understand. With these principles, you and your physician can develop a diet that gives your body the nutrition it needs without putting additional stress on your liver.

We all have very similar nutritional needs, whether we have chronic hepatitis, or not. These only change for people with decompensated cirrhosis, which is such extensive scarring (fibrosis) that the liver can't function properly. Distinguishing whether a person with chronic hepatitis has cirrhosis and the stage of their cirrhosis determines how much attention he or she should pay to a special diet.

Enough calories. Anorexia is a symptom associated with advanced cirrhosis that can make it difficult for someone to get enough calories. Usually, this only lasts a short period of time, brief enough for your body to get by on its reserves. However, if it lasts for several days or weeks, you probably aren't getting the nutrition you need. One solution is to discuss with your physician whether you're getting enough food or enough of the right foods.

The right amount of protein. Meats, milk, nuts and cheese are all good sources of protein. Protein is an important nutrient and it's absolutely necessary for good health. People with chronic hepatitis should be able to enjoy moderate amounts of protein without worry. As long as your liver is working properly, protein shouldn't be a problem. However, too much protein is bad for people with advanced cirrhosis and can lead to brain disease as the excess protein accumulates in the blood. Again, the liver is responsible for keeping protein at safe levels, but when the liver is damaged as is the case with decompensated cirrhosis, it can't do as much as it did before. While it's important to eat enough protein, too much is harmful. Talk with your doctor to determine what's the best amount of protein for you.

Enough vitamins and minerals. Some people with chronic hepatitis, especially those with alcoholic hepatitis or advanced cirrhosis, may not be getting enough of the fat-soluble vitamins and necessary minerals they need through their diet. Your doctor or nutritionist may measure your levels of vitamins A, D and E to check your clotting time. One solution to this deficiency is using doctor-prescribed supplements. Otherwise you'll need to make certain you get these vitamins and minerals the old-fashioned way: through a balanced diet.

Prepare Meals with Your Liver In Mind

Low-fat meals. The liver is an incredibly important organ to your body. It's involved with many aspects of nutrition. One important function of the liver is to produce bile, which the body uses to emulsify dietary fats, such as from potato chips or hamburgers. Before the body can absorb the fats and use their nutritional energy, all fats must be prepared by this process. However, depending on the damage to your liver, you might not be able to prepare enough bile to handle a meal high in fats. As a result, you might suffer indigestion because of the undigested fat. One solution is just to eat low-fat foods. An alternative is to eat very small amounts of a high-fat food.

Small meals. Because your liver is damaged, it isn't able to store as much energy as it once could. One of the jobs of the liver is to store the chemical glycogen, which it can quickly give back to the body when it needs immediate energy. Most people can store relatively large amounts of glycogen in their livers, but when the liver is damaged with fibrosis, the scar tissue takes away valuable storage space for glycogen. This explains one reason why people with chronic liver disease often get tired quickly. One solution is to eat small, frequent meals making sure to include carbohydrates. This gives your body the chance to replace its glycogen reserves.

Protect Your Liver

The liver is such a powerful filtering organ. Every five minutes, your entire blood supply is filtered through it. As blood filters through, the liver removes the toxins (anything poisonous to your body). The liver has an amazing capacity to keep doing its job even while damaged, but eventually too much damage will reduce liver function. Therefore, it's in your best interest to reduce toxins to your liver. Here's some common toxins to the liver:

Alcohol. People with chronic hepatitis should avoid alcohol since it speeds progression to cirrhosis. People with cirrhosis should absolutely avoid alcohol.
Unnecessary medicines. Even though medicines are beneficial, they are still toxic chemicals that must be processed by your liver. It's important to follow your doctor's advice and take the medicines that you need and avoid the ones that you don't. Check with your doctor before taking a medicine if you have liver disease.
Pesticides and herbicides. Though these can absorb through your skin, they are still toxins ultimately processed by the liver.
Household chemicals. We use chemicals daily, sometimes without a second thought. People with chronic hepatitis should take extra caution to reduce exposure of these through fumes, ingestion and skin absorption.
Vitamins and supplements. Some vitamins (K, A, D and E) are very important and necessary for people with chronic hepatitis and many doctors will prescribe vitamin supplements. However, aside from physician-recommended vitamins, use caution with additional supplements because they may be toxins.
Tobacco products
Recreational drugs

Remember the Basics

Healthful foods. Your body needs good nutrition whether you have chronic hepatitis or not. To achieve good nutrition means that you're getting the nutrients you need (vitamins, minerals, protein, fat, carbohydrates, fiber) from the foods you eat. The quality and types of foods are important: fresh fruits and vegetables, lean meats (chicken, turkey, pork) and whole grains (barley, brown rice, whole wheat breads and oat meal).

Exercise. Along with nutrition, exercise is an essential part of good health. Some of the common symptoms associated with chronic hepatitis in the setting of no cirrhosis or cirrhosis that isn't too advanced, such as fatigue or depressed mood, may be improved with regular, moderate exercise. You should begin any exercise program gradually and, depending on your level of health, under a physician's guidance. Most exercise, however small the amount, is very beneficial to your health and well-being. It is an excellent complement to good nutrition.

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Dienstag, JL. Chronic Hepatitis. In: AS Fauci, E
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Jameson, J Loscaizo (eds), Harrison’s Principles
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http://hepatitis.about.com/od/lifestyle/a/NutritionHep_2.htm

Effect of Diet in People with HCV

Jan 2009

Chronic hepatitis C is associated with various metabolic complications such as insulin resistance, but the effects of diet on liver fibrosis progression and response to treatment are not well-understood. As reported in the December 2008 American Journal of Gastroenterology, C. Loguercio and colleagues studied 1084 chronic hepatitis C patients – 432 of whom were treated with interferon-based therapy – and 2326 uninfected control subjects. At baseline, there were no differences between the two groups with regard to dietary habits, metabolic status, or alcohol consumption; about half were classified as overweight and about 60% reported drinking alcohol. In a logistic regression analysis, intake of carbohydrates, lipids such as cholesterol, polyunsaturated fatty acids, and alcohol were independent risk factors for liver damage. In addition to heavier alcohol consumption, intake of some dietary components (including unsaturated fatty acids, iron, zinc, vitamin A, and niacin) differed significantly between treatment responders and non-responders. "Our results show that dietary composition is related to the extent of liver damage,” the study authors concluded. "This suggests that HCV patients may benefit from instructions regarding their diet."

Diet Affects Hepatitis C Progression

http://www.bastyrcenter.org/content/view/789/

People with hepatitis C (HC) may benefit from eating a diet reduced in calories, fat, iron, and protein, according to a study in Nutrition (2004;20:368–71). This study demonstrated the safety of long-term dietary changes for the treatment of HC.

HC is a viral infection of the liver that is spread by contact with blood from an infected person. Although many affected individuals never develop serious problems, chronic HC infection can cause liver fibrosis (abnormal fibrous material in the liver), cirrhosis (permanent scarring of the liver that may lead to liver failure), and more rarely, liver cancer. The progression and severity of the disease can be assessed by liver biopsy and by examining enzyme levels and markers of iron status in the body. The progression of HC is slower among people whose liver enzymes (particularly alanine transaminase [ALT]) can be maintained at low levels.

Drug treatments for HC include interferon (IFN) and ribavirin (Virazole™). IFN is the only substance known to eradicate the hepatitis C virus; however, only about 35% of people with HC have a sustained response from IFN treatment (meaning that the virus is not detectable for six or more months after treatment is discontinued). When combined with ribavirin, the drugs have a sustained response rate of about 55%. These treatments have side effects that some people are unable to tolerate including flu-like symptoms, fatigue, anemia, and depression.

Many people with HC have excessive accumulation of iron in the liver that causes free-radical damage to liver cells. Maintenance of low iron levels in the body has been shown to decrease ALT levels and to delay HC progression by improving liver function. Weight loss also can lead to a decrease in liver enzyme levels and positively affect other factors associated with the progression of HC.

The current study evaluated the efficacy and safety of long-term dietary modifications on liver function and nutritional status in people with HC. Twenty-two people aged 27 to 72 years with HC completed the two-year study. IFN therapy had been unsuccessful for most of the participants. Participants were given dietary prescriptions that included reduced amounts of iron, calories, protein, and fat. The prescription was as follows: (1) 7 mg or less of iron per day, (2) 13 calories per pound of body weight per day, (3) 0.5 grams of protein per pound of body weight per day, and (4) fat intake constituting less than 20% of total calories per day. Body mass index (a measure of obesity), percent body fat, liver enzymes (ALT and aspartate transaminase), iron status, and nutritional status were monitored during the course of the study.

Liver enzyme levels decreased significantly over the study period, as did the levels of iron in the blood and body tissues. Body mass index did not change substantially, but the percentage of body fat dropped significantly among the participants. Women had more body fat than men at the start of the study, and had greater losses in body fat over the study period. The levels of hemoglobin (a measure of the oxygen-carrying portion of red blood cells) and albumin (a measure of protein nutritional status) were unchanged during the study, indicating that the dietary treatment did not result in iron-deficiency anemia or protein malnutrition. The significant decrease in liver enzyme levels may be attributed to a reduction in iron intake as well as to a decrease in body fat.

This study supports previous findings that dietary restriction of iron, fat, calories, and protein can decrease ALT levels in people with HC, and demonstrates the safety of long-term dietary modification in this population. Because this diet can safely reduce ALT levels, it may be considered for anyone with HC.

Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.

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The Impact of Diet on Liver Fibrosis and on Response to Interferon Therapy in Patients With HCV-Related Chronic Hepatitis

ABSTRACT

BACKGROUND AND AIMS: A deranged metabolic status and alcohol intake may trigger induction and progression of chronic hepatitis C virus (HCV) liver disease. The aim of this study was to evaluate whether dietary composition affects the severity of liver damage and response to therapy in patients with HCV-related chronic hepatitis.

METHODS: We enrolled 1,084 patients with biopsy-proven HCV-related chronic hepatitis (432 treated with interferon plus ribavirin) and 2,326 healthy subjects in this prospective study conducted in a university hospital. Dietary habits were recorded in enrolled individuals, and their alcohol consumption was evaluated with a questionnaire (AUDIT). Body mass index, and plasma levels of blood glucose, nitrogen, creatinine, cholesterol, and triglycerides were also measured. All individuals underwent routine liver tests and HCV genotyping.

RESULTS: At study onset, there were no differences in metabolic status or alcohol consumption between patients and controls. About 50% of each group was overweight, and about 60% consumed alcohol. Patients and controls had similar dietary habits. Intake of carbohydrates, lipids and polyunsaturated fatty acids, and alcohol consumption were independent factors of liver damage at histology (logistic regression analysis). Some dietary components (unsaturated fatty acids, iron, zinc, vitamin A, and niacin) and alcohol intake differed significantly (P < 0.05 and P 0.01, respectively; univariate analysis) between responders and nonresponders to interferon therapy. Genotype, age, body mass index, steatosis, and fibrosis were independent predictors of therapy outcome (P < 0.02; multivariate analysis).

CONCLUSIONS: The severity of HCV-related chronic hepatitis depends on a variety of factors. Our results show that dietary composition is related to the extent of liver damage. Although traditional risk factors independently affected treatment response, some dietary components were associated with nonresponse to therapy in our patients. This suggests that HCV patients may benefit from instructions regarding their diet.

http://www3.interscience.wiley.com/journal/121406792/abstract?CRETRY=1&SRETRY=0

Received March 31, 2008; Accepted July 8, 2008.

ORIGINAL CONTRIBUTIONS
Nutrition/Obesity

The Impact of Diet on Liver Fibrosis and on Response to Interferon Therapy in Patients With HCV-Related Chronic Hepatitis

Carmela Loguercio, M.D. ¹ , Alessandro Federico, M.D. ¹ , Mario Masarone, M.D. ¹ , Roberto Torella, M.D. ¹ , Camillo Del Vecchio Blanco, M.D. ¹ , and Marcello Persico, M.D. ¹

¹ Department of Internal Medicine and Hepatogastroenterology, Second University of Naples, Naples, Italy

Reprint requests and correspondence: Marcello Persico, M.D., Department of Internal Medicine and Hepatogastroenterology, Second University of Naples, Via Francesco Petrarca 101b, 80122 Napoli, Italy.

(Am J Gastroenterol 2008;103:3159–3166)