Many people living with Hepatitis C take an interest in what they are consuming in an effort to reduce damage to their liver. This includes eating a healthy diet and avoiding substances that may increase liver damage. The information contained in the following pages aims to assist people with their lifestyle choices as well as detailing substances that may be toxic to the liver. In addition to the information here, you may also like to take a look at the diet and liver disease pages of the British Liver Trust.
Overview
Diet and Liver disease have been discussed at length over many years and the reality remains that there is no specific dietary approach that one can recommend which is guaranteed to alter the outcome of any particular liver disease. Be wary of any unusual diets and their claims to cure or improve your condition. These may be harmful as they are often very restrictive and may not provide you with enough protein, calories, vitamins and minerals. It is important that you remain well nourished so that you feel well.
It is inappropriate to recommend that people with Hepatitis C or any other liver disease change their diet in a radical manner. However, having a consistent diet of healthy nutrients will greatly assist your energy levels. Combine this with regular low to moderate exercise and you will notice your general feeling of well being begins to increase.
One of the limitations in providing dietary advice is that individuals have very different tolerances, requirements, likes and dislikes for certain foods. Therefore, individual assessment and modification of the diet may be necessary. It is useful to note reactions to foods to get an idea of individual tolerance. If fatty or rich foods create nausea or queasiness they are obviously not tolerated well and so best to be avoided. A balanced diet is important for general health.
The most important message that can’t be overemphasised is that each individual will greatly benefit from observing their own reactions to food. Note the different foods that cause you problems and what appears to be good for you. It is also a good idea to seek back up support from a dietician or your preferred practitioner. Talking with others living with Hepatitisatitis C may also be useful, although there will be individual differences.
The approach taken is to minimize any burden on our liver and body so that our protective and rejuvenative energies can be maximized. The liver is constantly challenged by our environment. Include a virus and this vital organ is under considerable pressure.
Tips & Hints
One perhaps ludicrously simple and overlooked technique of improving digestive function is to encourage proper chewing of food and to eat under restful conditions. People too often in our stressed-out culture, will bolt their food. This does affect the next stage of digestion in the stomach and in turn the absorption of nutrients later in the digestive process. Eating under relaxed conditions maximizes parasympathetic nervous system function and allows for maximum nutrient digestion and absorption.
A very important benefit of eating fresh whole foods is that they contain enzymes. These are substances that help the body digest food and are found only in living food. High temperatures kill enzymes so most processed food require a lot more effort by the liver to digest them. The use of certain spices such as ginger, is another simple way of enhancing digestive and liver function. Hot spices such as pepper or chilli are contra-indicated in Hepatitis C but other slightly warm to neutral (energetically) spices such as ginger, fennel, cardamon or cumin are warranted in any diet for Hepatitis C. Bitter foods and ginger are also very good in helping to alleviate nausea and in stimulating the appetite.
Dairy foods are often not tolerated well by people with liver dysfunction. A simple way of determining if dairy foods are having an affect upon your health is to abstain from dairy foods for a period of 4-6 weeks. Carefully observe any differences in health, such as abdominal bloating, gas, fullness, stool consistency, tiredness, depression, skin rashes etc. After the end of the period of abstinence, you should then have a thorough splurge on dairy products and once again compare your sense of well being.
Drinking 2-3 litres of water each day is universally recommended for good health, but also protects against lymphatic congestion - which can put further strain on the liver. As with other suggestions it is advisable to tune into the needs of your own body as there may be individual differences.
The four golden rules for ensuring good immune function are:
- Get some protein at every meal.
- Include some essential fats in your diet each day.
- Eat at least 2 cups of salad or vegetables each day.
- Avoid excessive sugar and hydrogenated fat.
It is recommended that there be an emphasis on as wide a variety of fruits and vegetables as possible in the diet. Research is constantly validating that vegetables are a rich source of anti-oxidants which are most important for minimizing free radical damage within the body. This is particularly so in any condition of chronic inflammation like hepatitis. It’s a good idea to eat fruits and vegetables that are in season.
Vegetable juices (fresh whenever possible, otherwise preservative free) have a particular nature that helps lessen the bloated and stagnant feelings often associated with liver conditions. Vegetable juices act to flush out the body and relieve some of the symptoms that people with liver disease experience such as heaviness and lethargy. There are no strict proportions to be followed so experiment for yourself. Some juices are very strong so you may like to dilute them initially with water. The only caution is with carrot juice (high levels of Vitamin A can irritate the liver), or spinach juice (high levels of oxalic acid). Best vegetable juices are celery, cucumber, broccoli and beetroot (tops and bottoms). Best fruit juices are lemon juice, apple, pineapple, pear, paw-paw, mango and melons as well as red berries. It has been suggested that it is best to drink melon juice on its own and not mixed with any other fruit.
Eat more wholegrains, rice and legumes (beans, lentils, barley, split peas). These give you better quality energy. Some people describe symptoms such as bloating, gas and indigestion after eating some of these foods. If you experience these or other problems after eating particular foods either reduce your intake of the food or cut it out altogether. Wholegrains and their products are an important source of vitamins from the B group and minerals like zinc that are essential for so many functions within our bodies, inclusive of liver and proper immune function. Processed grains and their subsequent products are definitely not as nutritious as wholegrain.
Try and buy organic foods if you can afford them - they have less added chemicals, therefore cause less stress on the liver. Naturopathically the emphasis is on eating free range chicken to minimize the amount of chemical and hormonal residues that are in chickens raised under modern commercial methods. The liver of a person with Hepatitis C does not need any further toxins to deal with, especially from a regular source like food.
Red meats are very potent foods and require a lot of effort to digest; nutritionally excellent in moderation, but often high in fats and toxins. Meat will take a minimum of 8-10 hours to be digested, often sitting in the bowel the whole night adding a further burden to your body.
Many herbs can be seen as a type of concentrated food. Teas made from various herbs such as yarrow, dandelion, chicory, licorice incorporated into the diet can have a significant effect on enhancing digestive function and nutrient absorption.
Generally you should try to broaden your diet and keep away from food that requires the liver to work harder.
Food Groups
Variety is very important. Eating too much of one type of food (e.g. fruit) will not make up for not eating another type of food (e.g. vegetables). A good diet will be made up of a balanced intake of all of the essential building blocks called ‘macronutrients’. These are Proteins, Essential Fats and Carbohydrates. For proper functioning of the immune system, you need to focus on getting plenty of protein and enough essential fats.
Protein
When protein foods are broken down (digested) by the body, amino acids are produced. Amino acids are the building blocks for our entire body. Amino acids and the new proteins made from them are essential to build, maintain and repair the body and all its symptoms. Protein comes from a number of sources including meat, chicken, fish, textured vegetable protein (TVP), eggs, dairy foods, nuts (many people have adverse reactions to peanuts, best to avoid), seeds, soya beans (tofu and tempeh) and other legumes. Protein foods will also provide other macro and micronutrients (e.g. from meat we get iron, zinc and B-group vitamins; from dairy foods we also get calcium, vitamin A and D; legumes, pulses, nuts and seeds are an excellent source of fibre). A number of people have described feeling heavy or bloated for quite a while after eating red meat such as beef. If you have similar problems reduce your intake or cut it out completely.
Essential fats
Fats, when digested, provide fatty acids which are needed for the proper function of your body. There are four different types of fat found in food but not all of them are needed by the body. Essential fats (which mainly come from polyunsaturated and monounsaturated fats) can only be supplied by food. The main types of fat are:
Monounsaturated fats: come from vegetables, seeds and plants. They are important in keeping your heart healthy and your immune system functioning. These fats should be included in the diet regularly: olive oil, canola oil, sunflower oil, cashews, pecans, hazelnuts, macadamias, almonds, avocado.
Polyunsaturated fats: come from vegetables, seeds, plants, fish and fish oils; they are vital for keeping your heart healthy, your immune system working and your brain functioning optimally. These fats should be included in the diet regularly. Omega-3 fats (from linseed, fish and fish oil) and Omega-6 fats (from vegetable oils) perform important functions in your immune system. Examples include sunflower oil, safflower oil, fish and fish oil, linseed and flaxseed oil, soybean oil, sesame oil, most nuts and seeds (e.g. evening primrose oil, walnuts).
Saturated fats: can be used as an energy source in helping cells work, or stored away as body fat. A small amount is essential (and unavoidable) in the diet. Examples include cream, milk fat, some dairy fats, some animal fats, lard, copha, ghee, dripping, palm oil, coconut oil.
Hydrogenated (trans) fats: are processed fats that cannot be used effectively by the body; they are stored as body fat, raise cholesterol levels and have many other detrimental health effects. They possibly hinder the immune system and they should be avoided wherever possible. Examples include hydrogenated vegetable oils (e.g. margarine), potato crisps and other snack foods (e.g. Twisties, Burger Rings), donuts, muffins, pasties, pies, sausage rolls, hot chips, cakes, biscuits and many fast foods.
Carbohydrates
Carbohydrates are quite different from protein or fat. They are burnt as energy in the body, not used as building blocks. All carbohydrate foods are broken down into a sugar called glucose (the type of sugar found in your blood stream). Glucose is the body’s energy source but to use this energy effectively, first you need to make sure you are getting enough of the other macronutrients and micronutrients. Glucose that is not needed for energy is stored as body fat usually around your middle.
There are two types of carbohydrates. Simple carbohydrates (sugary foods) are broken down into glucose very quickly and rapidly affect blood sugar levels. Excess sugar appears to depress the functioning of the immune system and can be stored away by the body as body fat, so it is best to avoid a lot of these foods. A high intake of simple carbohydrates in the diet may also worsen fatigue and deplete energy. Try to choose foods with less than 10gms of sugars per 100gms (read the nutrition information panel on labels).
Complex carbohydrates (starchy foods) are more slowly broken down into glucose and are the better type of carbohydrate to choose; they also provide a good source of fibre, B-group vitamins, zinc, iron and some other micronutrients. The less processed the carbohydrate food is, the more nutrients it will contain. You can fill up with complex carbohydrates, but first be sure you are getting enough protein and essential fats.
Food Labels
Food labels list all ingredients in the product in descending order. The ingredient present in the largest amount will appear on the label first, then the second largest and so on. Many labels also tell you how much fat there is in a serve of the food, and in 100g of the food. Many people may be confused by different names for similar ingredients on food labels. It is useful to know just how many different ingredients are actually fat. Sometimes there is more than one type of fat in a food which, if they were all listed as fat, would come much higher up on the list.
Fat may appear on food labels as vegetable oil or fat, animal oil or fat, shortening, copha, lard, coconut oil, palm oil, butter fat, milk solids, chocolate, chocolate chips. ‘Creamed’ or ‘toasted’ on a label may also indicate that fat was added during preparation. ‘Light’ or ‘Lite’ do not necessarily mean less fat or lower in kilojoules. Compare nutrition labels of different brands of similar products to help you decide. ‘No cholesterol’ or ‘cholesterol free’ doesn’t mean low fat. Foods made with vegetable oil will have no cholesterol but can still be high in fat. A bottle of vegetable oil has no cholesterol but is still nearly 100% fat.
Vitamins & Minerals
The body also needs a smaller amount of other nutrients called “micronutrients” to keep the body working properly. Micronutrients do not supply calories but are vital for normal growth, repair and body function to occur. They are vitamins, minerals, antioxidants and phytochemicals. All of these nutrients are obtained by eating a variety of different foods and have different uses in the body. Important micronutrients involved in immune functioning include vitamin A, vitamin B6, vitamin C, magnesium, zinc and selenium.
Vitamins
Vitamin A, is a fat soluble vitamin which has anti-infective and anti-viral properties. It stimulates and enhances many immune functions including antibody responses and the activity of various white blood cells. The immune enhancing function promotes healing of infected tissues and increases resistance to infection. Vitamin A occurs in foods of animal origin such as cod liver oil, beef liver, whole milk and egg yolks.
Beta carotene is a substance which is converted into Vitamin A, as needed by the body. It has anti-oxidant properties and is effective in destroying free radicals. Beta carotene stimulates and enhances the immune system and also has an anti-inflammatory effect. It is found in orange, yellow and dark green vegetables and fruits.
Vitamin B is a water soluble vitamin that helps to combat fatigue, support immune function and stimulate the appetite. Vitamin B is found in foods such as chicken, fish, liver, wheat germ, brewer’s yeast, whole grains, lentils, millet, brown rice and green leafy vegetables. Supplements in form of a balanced formula B-complex tablet or capsule, at least equivalent to 50mg thiamine (Vitamin B1) can be taken.
Vitamin C is a water soluble vitamin which stimulates the healing process and is essential for healthy immune function. It is involved in antibody production and white blood cell function and activity as well as the production of natural interferon, an antiviral substance. Vitamin C requirements are raised when the immune system is under stress. Sources are fresh fruits and vegetables such as oranges, grapefruit, rockmelons, kiwifruit, berry fruits, red peppers and broccoli. Supplement in the form of Vitamin C Tablets or Calcium Ascorbate powder which can be stirred into fruit juice can be taken.
Vitamin E helps combat fatigue, support the immune system and improve skin tone. It is particularly important in protecting the immune system from damage from chronic viral illness and acts as an anti-oxidant. Studies indicate that it lowers ALT and AST levels and reduces the risk of cirrhosis developing. Sources are wheat germ, sunflower and almond oils, hazelnuts, whole grain cereals, eggs, avocados, broccoli and green leafy vegetables. Vitamin E should not be taken at the same time as iron supplements.
Minerals
Calcium and Magnesium are the most needed minerals for maintaining a healthy body. In every muscle of our body calcium and magnesium enjoy a reciprocal relationship. Calcium stimulates the muscles to contract while magnesium allows them to relax. Calcium is the most abundant mineral in the body, calcium’s main function is the development and maintenance of healthy bones and teeth. It is essential for healthy immune function, for the production and activity of many enzymes and hormones that are involved in digestion, energy and fat metabolism. Calcium is involved in the transport of nutrients and other substances across cell membranes. Good sources of calcium include milk and other dairy products, tofu, canned fish with bones, sunflower seeds, broccoli, cauliflower, soybeans, sesame seeds and paste (tahine).
Magnesium is an essential mineral for effective muscle functioning and for converting blood sugar into energy. It prevents heart disease and lowers blood pressure. It keeps bones strong by working with Vitamin D and calcium. Long term deficiency of magnesium can trigger osteoporosis. Some foods such as meat, ice-cream and other high fat foods can cause a phenomenon known to scientists as the ‘Magnesium Trap’. These foods are low in magnesium themselves, but the primary problem is that they actually impair absorption of magnesium through the intestinal wall.
Zinc is an essential trace mineral which is involved in multiple enzyme reactions in the body, including the detoxification of alcohol. Zinc is one of the most important nutrients for the immune system, being necessary for healthy antibody, white blood cell, thymus gland and hormone function, and is vital in maintaining resistance to infection and for wound healing. Sources of zinc include liver, oysters, meat, canned fish, hard cheese, whole grains, nuts, eggs and legumes (peas, beans, lentils).
Iron is an essential nutrient for helping to carry oxygen in the blood (haemoglobin) and for immune system and nervous system function. Food sources of iron are meat, particularly liver and kidney, oysters and steak. Breakfast cereals and some brands of bread have added iron. Absorption of iron is doubled if a good Vitamin C source is taken at the same time (orange juice, capsicum, kiwifruit). Absorption of iron is reduced if tea is taken with the food and is also reduced somewhat by zinc and folate supplements.
In people with Hepatitis C, iron has a tendency to accumulate in the liver, which is a bad thing. It worsens the ongoing liver damage. Where levels of iron get very high it interferes with interferon treatment and is directly toxic to the liver. Iron levels can be simply measured by a blood test called iron studies, which can be done at the same time as the Liver Function Test (LFTs).
Iron requirements per day are men 5-7 mg, women 12-16 mg, pregnant woman 22-36 mg, breast feeding mothers 12-16 mg, women over 55 7 mg and adolescents 10-13 mg. Young women are often low in iron because of dieting and menstruation. This is not a good thing and iron intake does need to be well balanced.
Common Problems
Loss of appetite can be increased by worry, stress, missing meals and some medications. Personal circumstances may also contribute such as loneliness or having no interest in food. If you are experiencing loss of appetite try to keep a regular eating pattern (you may not feel hungry but your body still needs nourishment). Small meals taken frequently may be better than 3 meals per day. High energy fluids may be required if missing meals or only partly eating them. Eat in a comfortable, pleasant setting and serve meals in an attractive way. Ask yourself if eating with others would help.
It is surprising the number of people who don’t directly relate feelings of nausea to those foods recently eaten. Small, frequent meals or snacks can help. If the smell of cooking causes nausea try:
- making more use of cold foods e.g. salads, sandwiches and milk puddings
- ready prepared foods.
- let someone else cook the food you have prepared.
- cook in advance and reheat when you feel like eating.
- avoid the kitchen when meals are being prepared.
If you are experiencing diarrhoea it is best to contact your doctor to determine the cause and have correct treatment. Treatment may involve a modified fibre or low lactose diet. Drink plenty of fluids and choose plain bland foods. Avoid coarse bread and cereals (unless your diet is low in them) and unripe and raw fruit and vegetables that contain seeds and skins. Raw apples (skin off) contain pectin, which is good for diarrhoea.
Constipation may be due to a number of causes, if it persists doctors advice should be sought. It may help to increase the amount of fibre and fluid in your diet. Include, wholemeal breads, cereal and pasta, lots of fresh fruits and vegetables (eat skin and seeds) and legumes, nuts, pulses, baked beans, lentils, soya beans and chick peas. It is important that you drink plenty of fluids, at least 6 glasses (1 ½ - 2 L) per day and have plenty of exercise.
Gastric reflux can be a problem for people living with hepatitis C. Try taking small meals more frequently but avoid fatty or highly spiced foods. Avoid drinks which contain caffeine. Stay upright for at least half an hour after you eat.