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 stores 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.)
Weight Recommended average protein intake for regeneration of liver cells in non-cirrhotic patients Maximum recommended protein intake for patients at risk 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.
(Information from the American Liver Foundation, 1425 Pompton Avenue Cedar Grove, NJ 07009 1-800-GO LIVER (465-4837) )
Author: Melissa Palmer, MD
ALF Nutrition Education Subcommittee: Bruce R. Bacon, MD, Kris V. Kowdley, MD, Francoise Maillet, RD, Melissa Palmer, MD, Anna Sasaki, MD.