General Nutritional Guidelines for
About Miss Noreen Aslam
After being diagnosed with liver disease, among the first question that patients typically
ask concerns nutrition. Unfortunately one can't expect to walk into the doctor's office
and request " a diet for liver disease ". Such an across-the-board diet simply
does not exist. Many factors account for the unfeasibility of a standardized liver diet
including variations among the different stages of liver disease (e.g. stable liver
disease without much damage versus unstable decompensated cirrhosis, complicated by
encephalopathy). Other medical disorders unrelated to liver disease, such as diabetes or
heart disease must also be factored
into any diet. Each person has his or her own individual nutritional requirements, and
these requirements may change over time.
Nutrition and liver disease is a complicated subject. An optimal diet for a person with
stable liver disease (modifications to be made as per individual needs) might contain all
of the factors listed below.
1- 60-70% carbohydrates - Primarily complex carbohydrates, such as whole grain.
2- 20-30% protein - only lean animal protein and/or vegetable protein.
3- 10-20% polyunsaturated fat.
4- 8-12 ounce glasses of water per day.
5- 1,000 to 1,500 milligrams of sodium per day.
6- Avoidance of excessive amounts of vitamins and minerals especially vitamin A, Vitamin
B3 and iron.
7- No alcohol.
8- Avoidance of processed food.
9- Liberal consumption of fresh organic fruits and vegetables.
10- Avoidance of excessive caffeine consumption - no more than 1-3 cups of caffeine -
containing beverages per day.
Adequate protein intake is important to build and maintain muscle mass and to assist in
healing and repair. Protein intake must be adjusted in accordance with a person's body
weight and the degree of liver damage present. Approximately 0.8 grams of protein per
kilogram (2.2 pounds) of body weight is recommended in the diet each day for someone with
stable liver disease.
People with unstable liver disease or decompensated cirrhosis need to lower the percentage
of protein content in their diets so that it falls between approximately 10-15%. And, they
need to eat only vegetable sources of protein. A diet high in animal protein (which
typically contains a lot of ammonia) may precipitate an episode of encephalopathy among
Vegetarian diets, on the other hand, have a low ammonia content and have been shown to be
much less likely than animal protein diets to induce encephalopathy. It is important.
Fats are the body's most efficient means for storing excess energy. Gram for gram, fats
contain more than double the amount of calories of other nutrients. That is why a diet
high in fat is likely to result in more weight gain than a diet high in calories from
protein or carbohydrates. It is important for people with liver disease to minimize their
fat intake by avoiding foods that are high in fat content. Excess fat can result in a
fatty liver or nonalcoholic steatohepatitis (NASH). Not only can a fatty liver cause liver
disease, it may contribute to the worsening of other liver diseases. e.g. it has been
demonstrated that people with Hepatitis C and a fatty liver are likely to develop scarring
in the liver at an accelerated rate. Furthermore, although uncommon, it is possible for
someone with NASH to develop cirrhosis and liver failure. In fact, fatty livers are felt
to be so unhealthy that they are not
even considered viable for use in transplantation.
People who are overweight should aim for something in the neighborhood of 10% while it is
important to eat as little fat as possible. Eating a small amount of the more healthy fats
does have some benefit. e.g., people need some fat in order to properly absorb the four
fat-soluble vitamins - A, D, E and K. Without some fat, these vitamins may become
deficient in the body, even if they are taken in supplemental form. This type of vitamin
deficiency sometimes occurs in people with cholestatic diseases such as Primary biliary
To keep in mind that some popular weight-loss diets involve the consumption of a very high
animal protein content. People with cirrhosis are advised to avoid any such diets.
The major function of carbohydrate is to provide a ready supply of energy to the body. The
liver plays a crucial role in carbohydrate metabolism. Before sugars are able to supply
energy to the body, they are routed to the liver, which is incharge of deciding their
fate. Thus, it may immediately send sugar into the blood stream to provide an instant
energy boost or, the liver may send glucose to the brain or muscles, depending upon what
activities are being performed at the time, e.g. (taking a test versus exercising) or it
may decide to store glucose (in the form of starch glycogen) for later use. Converting
foods other than carbohydrates into energy is stressful, even to a normal liver. By eating
an unbalanced diet that is low in complex
carbohydrates, a person with liver disease will add to the stress that the disease has
already caused the liver. In fact, this is one reason why so many people with liver
disease feel fatigued. Simply putting, their diets are working against them.
People with liver disease should strive for a diet consisting of approximately 60-70%
carbohydrate, with complex carbohydrates (starches & fibers) predominating. A well
balanced diet will include at least 400 grams of carbohydrates. If there are too few
carbohydrates in a person's diet, this will likely result in excessive protein & fat
Vitamins and Minerals
The liver is the body's main warehouse for storing nutrients. It absorbs and stores excess
vitamins and minerals from the blood. If a person's diet does not supply an adequate
amount of these nutrients on a given day, the liver releases just the right amount of them
into the bloodstream. However, the liver has only a limited capacity for processing
vitamins and minerals. Any excess amounts that the liver is unable to process are
generally eliminated from the body. Yet, at same point, the liver can become damaged due
to the strain of processing an overabundance of certain vitamins and minerals
(particularly iron, vitamin A and niacin).
The liver plays an important role in the metabolism of iron since it is the primary organ
in the body that stores this metal. Patients with chronic Hepatitis C sometimes have
difficulty in 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 in iron coated utensils.
Advanced 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 accumulation is controlled. While often difficult, sodium intake should be
restricted to 1000 mg each day, and preferably to 500 mg perday.
One must become a careful shopper, diligently reading all food labels. It is often
surprising to discover which foods are high in sodium. 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.
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 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 found to have a higher incidence of severe liver
damage, cirrhosis and a decreased life span, 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 released March 1997 from the
National institutes of Health, further warned about the dangers of excessive alcohol use
in patients with hepatitis C. These recommendations stressed limitations of alcohol use.
& Nutrition Association