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Nutritional Needs for Hepatitis C Patients Who Don't Have Cirrhosis

Caloric Requirements

In general, the noncirrhotic patient with hepatitis C has caloric needs similar to those of noninfected people of the same age and gender. For this reason we recommend the following:
- no salt restriction
- no protein restriction
- 30 to 40 calories per kilogram intake per day
- one multivitamin per day

Patients who drink excessive amounts of alcohol should stop drinking altogether. They may also need supplementation with thiamine and folate.

Vitamin Supplements

In general, noncirrhotic patients with hepatitis C do not require any additional vitamin supplementation other than that noted above. One concern is that if bile production drops, the patient may become deficient in fat-soluble vitamins during the course of hepatitis C infection. This deficiency rarely develops during the early stages of hepatitis C, but it may be fairly prevalent at later, cirrhotic stages of the disease. When detected, deficiencies of fat-soluble vitamins should be corrected by administering proper doses of the compounds.

Nutritional Therapies

Americans spend some $6 billion annually on nutritional supplements. Patients with viral hepatitis have used a number of such "nutritional supplements," such as echinaceae, pycnogenol, dandelion root, silymarin (milk thistle), and a wide array of herbal remedies. None of these have been studied in controlled trials and, thus, are unproved therapies.

Despite the lack of supporting data, the use of these therapies has gained widespread acceptance among patients with hepatitis C. Several factors seem to account for this phenomenon: a history of lack of effective therapies for liver disease in general; incompletely effective treatment for hepatitis C; a general attitude that, "It can't hurt me, and maybe it'll help"; and the relatively mild and slowly progressive nature of hepatitis C. However, because proof of their effectiveness is lacking, we cannot endorse or recommend that patients undergo nutritional therapies. You should, however, inform your doctor if you are considering taking any of these nutritional supplements.

"I went to a health food store and asked them to give me anything that would help my liver. I got coltsfoot, comfrey, petasites, chaparral, and yohimbe.

"My enzymes shot up to 800. When the doctor asked me if I was taking anything new, I brought in the bottles and learned that these herbs were best avoided because they may be toxic for the liver. I stopped taking them, and my enzymes went back down. I never thought anything 'natural' could harm me." Harold

Source: "Living with Hepatitis C: A Survivor's Guide" by Gregory T. Everson, M.D., and Hedy Weinberg. 1997, Hatherleigh Press.

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