Nutritional Considerations In The Treatment Of Hepatitis
by Carl Germano, M.A., R.D., CNS
http://www.solgar.com/nutrition_library/articles/hepetitus.html
The liver is the largest most complex organ in the body. The
functions it is responsible for are quite numerous and has
significant bearings on the nutritional state of the body.
Therefore, diseases of the liver will markedly affect health.
Hepatitis represents a most common liver disorder characterized by
an inflammatory condition resulting in degenerative changes in the
liver. There are several forms of the disease of which viral
infections are the major cause while alcohol, drug abuse, certain
bacterial, parasitic or fungal infections may also be implicated.
Briefly, the most common types are:
Hepatitis A - known as infectious hepatitis and usually spread
via contaminated food or water. Generally not as serious as the
other types with recovery typically within a few months and rarely
progresses to chronic hepatitis.
Hepatitis B - known as serum hepatitis, viral origin and usually
spread via direct blood contact as well as sexual contact. Type B
is more severe and more likely to progress to chronic stages. The
seriousness of Type B warrants aggressive long term therapy in
efforts to prevent chronic hepatitis.
Hepatitis C (Non A, Non B) - similar to type B, transmission has
been determined to be via blood or infected needle contact and is
of viral origin. This type also presents challenging aggressive
long term therapy.
Typical symptoms in the active stages of all types include
anorexia, fatigue, nausea, vomiting, diarrhea, fever, weight loss
and abdominal discomfort. Treatment generally consists of adequate
rest, nutritious diet and supplements to assist in recovery and the
prevention of further damage to the liver. While there is no drug
treatment to cure hepatitis, the focus of this article is directed
at the role of diet and nutritional supplementation in the
restoration of liver function and repair of hepatic tissue.
Therefore, a brief overview of some of the liver's major functions
is necessary to grasp the rationale of natural nutritional
therapy.
The liver is a most complex organ that plays major roles in a
wide variety of biochemical functions of the body. Liver
dysfunction can therefore significantly impact many other organs
and systems throughout the body. The following represent a few of
the most important functions of the normal liver:
Serves as a storehouse for many essential vitamins and minerals
such as vitamins A & D, converts beta carotene to vitamin A,
converts vitamin K to prothrombin, stores iron, copper and other
minerals
Produces and distributes cholesterol and triglycerides
Serves as one of the most important organs in controlling
carbohydrate metabolism
Produces bile which is necessary for proper fat digestion
Produces some amino acids necessary for it's ability to regenerate
and repair itself
Serves as one of the most important detoxifying and cleansing
organs of the body.
Detoxifies bacterial decomposition products, drugs and toxic
metabolic waste materials
Produces many important protein compounds including one that
controls proper blood clotting, fluid balance and immune
function
Produces many important lipid compounds including lipoproteins and
phospholipids
While you may be treated for infectious or non-infectious
hepatitis by your doctor using interferon or antibiotics, drug
treatment cannot cure hepatitis, is ineffective against the virus
and is limited in it's ability to restore health to the organ.
Therefore, a nutritional program utilizing diet modification and
supplements must be offered, by your physician or health care
practitioner, in efforts to provide effective rehabilitation of the
liver.
NUTRITIONAL CONSIDERATIONS - DIET
The goal of treatment is to relieve symptoms and to promote
healing of liver tissue and function. The importance of the diet
and nutritional supplements cannot be overemphasized in efforts to
prevent relapse and aid in the recovery process. Immediately, all
offending dietary agents must be removed including: alcohol,
caffeine, drugs, aspirin/Tylenol, sugar, margarine, fried foods and
high doses of niacin or vitamin A. Dietary manipulation must
include the following:
Initial Stages - Foods of liquid to soft consistency may be
preferable if there is anorexia present. This affords the
practitioner an excellent opportunity to utilize several quality
protein/calorie powder supplements, particularly the high quality
whey proteins, and additional balanced amino acid supplements.
Adequate Protein Intake - Essential for healing and repair,
adequate protein intake is a critical component of the diet.
Ideally, 60 - 120 grams of good quality protein is recommended
daily and should be adjusted to body weight (at least 1 - 1.5 grams
protein per kilogram of body weight). Although the protein intake
may be obtained from both animal and vegetable sources, adequate
quality protein may be easily obtained via animal sources and may
be the choice when appetite is limited in the initial stages of the
disease.
Calories - Sufficient calories are to be provided to maintain
weight or address weight loss (at least 30 calories per kilogram of
body weight). A liberal intake of complex carbohydrates and low fat
yet adequate essential fatty acids is essential. If a low fat
intake is prescribed, the use of essential fatty acid supplements
are advisable and may include borage oil, evening primrose oil,
flaxseed oil and the marine lipid concentrates. Small frequent
meals to provide calories and are recommended over the high calorie
powdered supplements on the market that chiefly consist of high
refined sugars.
Additionally, the use of a powdered high chlorophyll beverage
such as the cereal grasses are an excellent addition of calories as
well as being nutrient dense with cleansing & detoxifying
properties.
NUTRITIONAL CONSIDERATIONS - SUPPLEMENTS
The use of nutritional supplements for the treatment of liver
disorders is paramount to appropriate aggressive rehabilitative
therapy. The liver directly benefits from nutritional support and
requires a continuos supply of vitamins, minerals and herbal
compounds necessary for healing (1). The following supplements
should be utilized in any liver support protocol and should prove
to be an excellent adjunct to any medical treatment.
Specific Amino Acids
Taurine - an antioxidant, supplementation has shown to
significantly decrease serum bilirubin in patients with acute
hepatitis (2,3)
SAM (S-Adenosyl Methionine) - studies have revealed that SAM had
reversed pathological liver changes from toxins, restores normal
liver cell membrane fluidity and ATPase activity - all necessary
for healthy liver function and repair (4,5,6).
NAC (N-Acetyl Cysteine) - as an antioxidant and is essential for
the regeneration of glutathione for the glutathione peroxidase
detoxifying enzyme system in the liver.
Branched Chain Amino Acids - may be beneficial in maintaining
positive nitrogen balance when routine amino acid/protein
supplements are not tolerated (7).
Specific Vitamins/Minerals
B Complex - compared to normal subjects, many of the B vitamins
have been shown to be deficient in hepatitis and other liver
diseases especially B-12 and folic acid (8).
Antioxidant Nutrients - important for their immune support and
healing effect on the liver, several antioxidants have been shown
to be depressed in patients with hepatitis (9).
Vitamin C - studies have demonstrated important aspects of
treatment with vitamin including immunomodulation action,
decreasing the duration of the disease and useful as a prophylaxis
(10,11).
Selenium - important as an indirect antioxidant, supplementation
has been shown to decrease the incidence of hepatitis (12).
Lecithin/Choline - lecithin/choline is essential for the prevention
of fatty liver, liver cell death, liver cell cancer and has been
shown to protect the liver from alcohol (13,14).
Lipoic Acid (Thioctic Acid) - an essential nutrient that must be
part of any liver rehabilitative protocol. Lipoic acid, when
present in adequate amounts, acts as a potent detoxifying agent in
the liver and is typically depressed in liver disorders. Lipoic
acid actually protects liver cells against alcohol,mushroom
poisoning and heavy metal exposure and has been found to improve
immune function (15,16,17,18,19).
Herbs
Silymarin (Milk Thistle) - a well documented herb phytochemical
that has proven beneficial effects on the liver. Silymarin has been
shown to protect intact liver cells as well as stimulation of
protein synthesis which accounts for new cell growth (20,21,22).
One should choose milk thistle that contains a minimum of 70 - 80%
standardized Silymarin content.
Licorice (Glycyrrhizic Acid)- several studies have demonstrated
that components within licorice are effective in treating viral
hepatitis, particularly chronic active hepatitis, and probably due
to it's antiviral activity (23,24).
Phyllanthus amarus - has been shown to be very effective in the
treatment of chronic hepatitis B via it's protective and antiviral
activity (25).
Catechin - this group of flavanoids have received a great deal of
attention in a variety of clinical studies as an important agent in
treating acute and chronic hepatitis by decreasing bilirubin,
relief of symptoms and improvement of clinical tests. The activity
of catechin on liver rehabilitation is due to it's antioxidant and
immune stimulating functions (26,27).
Others: Dandelion, Artichoke
The above nutritional components have been successfully utilized
in the care and rehabilitation of the diseased liver. Care must be
taken and such a protocol must be reviewed by your physician or
health care practitioner. Of utmost importance is rest and
consistent utilization of the supplements and diet recommended.
Remember, hepatitis is a serious disease and warrants serious
aggressive therapy. If your practitioner does not utilize the above
diet and supplements, they are probably doing more harm than good -
get yourself a better educated practitioner!
References
1) "Nutritional Supplementation in Chronic Liver Disease: An
Analytical View", Nompleggi, D. , et al, Hepatology,
1994;19(2)518-533
2) "The effect Of Taurine Administration On Patients With Acute
Hepatitis", Matsuyama, Y, et al, Sulfur Amino Acids:Biochemical and
Clinical Aspects, New York, Alan R. Liss, Inc., 1983:461-468
3) "Effects Of Ursodeoxycholic Acid and Taurine On Serum Liver
Enzymes And Bile Acids In Chronic Hepatitis", Gastroenterology,
1990; 98(4):1044-1050
4) "S-Adenosyl Methionine Dependent Nicotinamide Methylation: A
Marker Of Hepatic Damage", Cuomo, R., et al, Fat Storing Cells and
Liver Fibrosis, 71st Falk Symposium, Florence Italy, July 1,
1993;348-353
5) "Effects Of S-Adenosyl Methionine Administration On Plasma
Levels Of Sulphur Containing Plasma Amino Acids In Patients With
Liver Cirrhosis", Marchesini, G., et al, Clinical Nutrition,
1992;11:303-308
6) "Role Of S-Adenosyl Methionine In The Treatment Of Intrahepatic
Cholestasis", Almasio, P., et al, Drugs, 1990;40:111-123
7) "Nutritional Therapy In Alcoholic Liver Disease", Schenker, S.,
et al., Seminars In Liver Disease, 1993; 13(2):196-297
8) "Nutritional Therapy In Alcoholic Liver Disease", Schenker,S.,
et al., Seminars In Liver Disease, 1993; 13(2):196-207
9) "Clinical Study Of Vitamin E Status In Patients With Chronic
Liver Disease", Suzuki, T., et al., Nippon Shokakibyo Gakki Zasshi,
1991, 88(4):1066-1073
10) "Humoral And Cellular Indices Of Nonspecific Resistance In
Viral Hepatitis And Ascorbic Acid", Vasil'ev, K., et al., Ter Arkh
1989;= 61(11):44-46
11) "Vitamin C For Prophylaxis Of Viral Hepatitis B In Transfused
Patients", Morishige, F., et al., J Int Coll Prev Med 1978;
5(1):54-58
12) "Chemoprevention Trial Of Human Hepatitis With Selenium
Supplementation In China", Yu, Sy, et al., Biol Trace Elem Res
1989; 21(1-2):15-22
13) "Biology Of Disease:Choline Deficiency, Lipotrope Deficiency
and The Development Of Liver Disease", Laboratory Investigation
1993; 68(3):255-160
14) "Lecithin Increases Plasma Free Choline and Decreases Hepatic
Steatosis", Gastroenterology 1992; 102:1363-1370
15) "Treatment Of Liver Disease With Thioctic Acid", Marshall, AW,
et al., GUT 1982; 23:1088-1093
16) Biochem Biophys Acta 1052:386 1990
17) Biochem Pharmacol 43:407, 1990
18) Toxicology 58:175, 1989
19) Jap J Pharmacol 42:135 & 275, 1986
20) "Silymarin In The Treatment Of Acute Viral Hepatitis", Bode,
JC, et al., Med Klin 1977 (Munich) 72(12):513-518
21) "Nutritional Herbology: Milk Thistle", Peterson, M., AIBR
Scientific Reviews, Botanical Medical Series, 18, 1988
22) "Prevention Of CCL4 Induced Liver Cirrhosis By Silymarin",
Mourelle, M., et al., Fundam Clin Pharmacol 1989: 3(3):183-191
23) "Effects Of Glycyrrhizin On Biochemical Tests In Patients With
Chronic Hepatitis", Suzuki, H., et al., Asian Med Journal 1984;
26:423-438
24) "Antiviral Activity Of Glycyrrhizic Acid", Pompeii, RP, et al.,
Experimenta 1980; 36:304-305
25) "Effect Of Phyllanthus Amarus On Chronic Carriers Of Hepatitis
B Virus", Thyagarajan, SP, et al., The Lancet 1988;766 October
26) "International Workshop On Cyanidanol-3 In Diseases Of The
Liver", Conn, H., et al., Royal Of Med, 47, Academic Press, London
1981
27) " Cyanidanol-3 in The Treatment Of Acute Viral Hepatitis",
Schomerus, H., et al., Hepatology 1984; 4:331-335
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