Nutrition for people with
At this stage the diet is
generally high in complex carbohydrates (breads, cereals, grains, legumes, dried
beans and peas, pasta, rice). These foods are important because they provide
our bodies fuel source called blood glucose (also referred to as "blood sugar").
During cirrhosis, individuals frequently experience low blood sugar (hypoglycemia)
or high blood sugar (hyperglycemia). Your body is better able to maintain a
healthy, sustained level of energy from complex carbohydrates ("starches") rather
than from simple carbohydrates ("sugars").
Think of your body as an
automobile. Your body's "gasoline" is blood glucose. Sugars found in candy,
fruits, sweet pastries, and milk products supply the body with "gasoline", but
your body uses it quickly. The result is that your energy level usually rises
and then falls too quickly with sugars than it would with complex carbohydrates,
especially those with higher fiber content. This is not to say that simple sugar
foods cannot be eaten, only in smaller proportion to complex carbohydrates and
in more controlled portions.
You will also continue to
need adequate, but not excessive protein in your diet (see When you discover
you're Hepatitis C positive). Protein is needed for repair and maintenance of
blood and body tissues, including liver tissue. Persons with cirrhosis tend
to better tolerate the protein from dairy and plant sources than from meat sources,
and therefore may benefit from a more vegetarian type diet. Daily protein needs
in grams will vary according to your nutritional state. Your R.D. can give you
more specific guidelines on this according to your body weight and the status
of your disease.
Persons with cirrhosis often
begin to experience difficulty digesting and absorbing fat in the diet. The
result is steatorrhea, (the presence of undigested fat in the stool), and thereby
may require dietary fat modification. Fatty liver is also a condition that can
occur which is the accumulation of fat in the liver. In either of these cases,
reducing the fat to 25% of total calories (about 40-70 grams of fat daily) is
recommended. Use of a special prescription type of fat called MCT oil is sometimes
necessary. MCT (medium-chain triglycerides) does not require bile for absorption
into the blood stream, so is advantageous when the liver can no longer produce
adequate bile for digestion and absorption of dietary fat (lipid). MCT can be
used in place of other fats in cooking and some recipes and is also available
in certain types of liquid nutritional drinks.
drinks now contain a mixture of MCT and other fats (called structured lipids).
Using MCT alone can produce undesirable gastrointestinal complaints and is not
indicated for the diabetic or significantly starved person. Structured lipids
also have been found to enhance the immune system over other types of fats.
Also, if MCT is the exclusive fat used in the diet, supplementation with the
essential fatty acid called linoleic acid is required to prevent a dietary deficiency.
Vitamin deficiencies can
occur during this stage of the disease. Fat-soluble vitamins A, D, E, and K
may need to be taken in their water-soluble form by prescription from your doctor.
Deficiencies of the minerals zinc, calcium, and magnesium can also occur during
cirrhosis and may require supplementation. It is important that you do not take
vitamins or minerals not prescribed by your doctor as toxicity can occur with
overdosing. Sodium typically needs to be restricted with cirrhosis. Unfortunately
for many salt lovers, this means learning to enjoy the taste of foods without
salt. Since the taste for salt is acquired, it can also be lost, (usually taking
4-6 weeks of "biting the bullet" until you finally come to enjoy the many tastes
of food, spices, and herbs without the salt shaker!) Beware: many foods are
high in sodium because of what's added in processing. Processed meats, cheeses,
frozen dinners, canned soups and vegetables, snack chips and crackers can pack
over 1000 milligrams of sodium per serving. Considering that the person with
cirrhosis must usually limit sodium to 2,500 milligrams per day, these foods
leave little room for other necessary, more healthy foods in the diet. Remember
that sodium acts like a "sponge" in the body and can cause your body to hold
on to more fluid, predisposing you to abdominal fluid retention seen in cirrhosis
Copyright 1998 Trustees of Dartmouth College
Protein and Hepatitis
Proteins are the major building
blocks that the body uses to make body components such as muscles, hair, nails,
skin, and blood. Proteins also make up important parts of the immune system
called antibodies, which help fight off disease. Since protein is such a vital
component of the body, many people mistakenly believe that the more protein
they consume, the better. Not only is this belief misguided, but for someone
with liver damage such an approach to nutrition can actually be downright dangerous.
The trouble is that a damaged liver cannot process as much healthy liver. And,
when a damaged liver gets unduly overloaded with protein, encephalopathy ( a
state of mental confusion that can lead to coma) may occur. Finally, diets high
in protein have been demonstrated to enhance the activity of the cytochrome
P450 enzyme system, which is responsible for drug metabolism. This enhanced
activity increases the likelihood that a drug may be converted into a toxic
byproduct capable of causing liver injury.
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
to 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 these people. 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 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