The food we eat is broken down in the stomach and intestine. Nutrients pass through the intestine, are absorbed into the bloodstream and are transported to the liver.

The body processes all foods into three basic components: carbohydrate, fat and protein. Carbohydrate and fat are the main sources of energy and protein is used by the body for growth and repair.

In the liver, these nutrients are either stored or additionally processed, depending on the body's nutritional needs.

Liver disease can interfere with the normal processing of nutrients, and this can present challenges for diet management in liver disease.

As liver disease progresses, the liver may lose the ability to perform these functions. A weight management program for someone with HCV should accommodate variations in the liver's ability to process nutrients and waste products.

Nutrition and Hepatitis

The relationship between food and weight is simple. All foods contain calories, and a certain number of calories are needed for the body to work.

Carbohydrate and protein each supplies four calories per gram each, and a gram of fat supplies nine calories.

If more calories are taken in than are used up, calories are stored and weight increases. If fewer calories are ingested than are used up, stored calories are burned and weight decreases.

Unfortunately, weight management is not simple.

There are physical needs as well as emotional, psychological and social aspects to weight gain and loss. And for people with hepatitis C, the presence of a complex chronic illness adds additional complication.

Protein. Protein comes from foods such as meat, fish, eggs, cheese, nuts and dairy. During digestion, proteins are broken down into smaller substances called amino acids.

Amino acids are processed by the liver and are used for growth, tissue repair and wound healing.

People with hepatitis should consult with their physicians regarding their protein requirements. Although protein is essential in the diet, the metabolism of protein generates waste products, such as uric acid, urea and ammonia.

In people with severely damaged livers, the proteins cannot be properly metabolized and toxic waste products (including ammonia) can build up and affect the brain (hepatic encephalopathy).

In these cases, physicians may need to prescribe medications (lactulose and neomycin) to reduce blood ammonia levels.

Adults with cirrhosis require a balanced diet providing 2,000 to 3,000 calories a day, with sufficient protein to allow the liver cells to regenerate.

Proteins assist with tissue repair, and prevent fatty infiltration and additional damage to the liver cells.

While too much protein can result in an increased amount of ammonia in the blood; too little protein can reduce healing of the liver. Doctors must carefully prescribe the correct amount of protein for a person with cirrhosis.

Generally, people with liver disease require approximately 1 gram of protein per kilogram of body weight.

For a 70 kilogram man (154 pounds), 70 grams of protein translates into 8 ounces of cooked protein and two 8-ounce glasses of milk per day.

This does not include the protein from starches and vegetables.

People with a severely damaged liver may be on strict protein restriction, and may be limited to only minimal quantities of essential amino acids, obtained through special nutritional supplements.

Carbohydrates. Carbohydrates, found in "starchy" foods like bread, potatoes, rice, pasta, cereals, fruit and sugar candies are broken down in the liver to glucose. Glucose is the main "fuel" of the body.

Surplus glucose is stored as glycogen in the liver and in some muscles. Glycogen can be quickly converted to glucose by the liver when the body needs extra energy.

As well as storing glycogen, the liver helps to control the level of glucose in the blood, preventing low and high blood sugar levels (hypo- and hyperglycemia).

Some weight loss plans advocate the near-total elimination of carbohydrates from the diet, suggesting that increasing the intake of dietary protein and fat will trigger the body to burn stored fat to generate energy.

For people with liver disease, carbohydrates should be the major source of calories.

When damaged by disease, the liver may become less efficient at converting carbohydrates and glycogen to glucose, so a greater proportion of carbohydrates in the diet can helps support the body's energy needs.

Fat. Fat comes in the form of animal fat and dairy products, and is also found in plants, such as nuts and vegetable oils. Surplus fat is stored in the body as a source of energy, and dietary fat is an obvious reason for obesity.

Fat enters the liver through diet and from fat stored in the fatty tissue. Under normal conditions, fat from the diet is metabolized by the liver and other tissues.

If the amount of fat available exceeds what is required by the body, it is stored as fatty tissue.

When glucose is unavailable, the body can "burn fat" - a process called lipolysis - in order to create ketones, which are an emergency source of energy for the body.

Fats cannot be digested without bile, which is made in the liver, stored in the gallbladder, and released into the small intestine. Bile breaks apart the fat so that it can be acted upon by intestinal enzymes and absorbed.

Bile is also essential for the absorption of vitamins A, D, E, and K, the fat soluble vitamins. After digestion, bile acids are reabsorbed and recycled.

Some types of liver disease can cause a backup of bile in the liver which is called cholestasis. This means that bile cannot flow into the small intestine to aid in the digestion of fats.

When this happens, fat is not absorbed but instead is excreted in large amounts in the feces, a condition known as steatorrhea.

This loss of fat calories may also cause unintended weight loss and deficiency in fat-soluble vitamins (A, D, E and K).

Supplementing the diet with fat soluble vitamins is possible, though it should only be carried out under the guidance of a physician. Too much vitamin A can be very toxic to the liver.

Although fat can contribute to weight gain, it is a valuable source of calories and vitamins.

Reducing dietary fat intake to reduce weight needs to take possible fat-absorption problems into account, to avoid malnutrition and vitamin deficiencies.

Obesity is also associated with the development of steatosis, or Fatty Liver.

Nearly all morbidly obese people have some degree of steatosis, and it is found in approximately 75% of people who exceed their ideal body weight by 10% or more. Obese children are just as susceptible as obese adults.

When steatosis causes liver inflammation in the absence of alcohol use, it results in a condition called Nonalcoholic Steatohepatitis, or NASH. NASH is a serious condition that can lead to liver fibrosis, cirrhosis, and end-stage liver disease.

A Sample Menu for Liver Patients, from the National Institutes of Health

Breakfast

1 orange
cooked oatmeal, with milk and sugar
1 slice of whole-wheat toast
2 teaspoons of margarine
strawberry jam
coffee or tea

Lunch

4 ounces of cooked lean fish, poultry, or meat
a starch item (such as potatoes)
a cooked vegetable
salad
2 slices of whole-grain bread
2 teaspoons of margarine
1 tablespoon of jelly
fresh fruit
milk

Afternoon Snack

milk with graham crackers

Dinner

4 ounces of cooked fish, poultry, or meat
starch item (such as potatoes)
a cooked vegetable
salad
2 whole-grain rolls
2 tablespoons of margarine
fresh fruit or dessert
8 ounces of milk

Evening Snack

high-protein milk (milk with non-fat dry milk added)

Usually, specific foods are not prohibited, but strongly flavored vegetables, high-fat foods, fried foods, chocolate, nuts, and foods that have a lot of seasoning may not be palatable for some people.

Source

National Health and Nutrition Examination Survey (NHANES), 1999.

Defining Overweight and Obesity. Centers for Disease Control and Prevention.

Viral Hepatitis C Fact Sheet. Centers for Disease Control and Prevention.

Diet and Liver Disease. British Liver Trust.

Diet - Liver Disease. MedlinePlus Health Information. National Institutes of Health.

Diet & Your Liver. American Liver Foundation. http://www.liverfoundation.org/db/articles/1022

Patel, T. Fatty Liver. http://www.emedicine.com. August 31, 2001.

Yu, S, Keeffe, E. Nonalcoholic Fatty Liver Disease. Rev Gastroenterol Disord. 2002; 2(1):11-19.

http://www.hepatitisneighborhood.com/content/treatment_options/food_and_nutrition_1571.aspx

Protein in the Diet

Proteins are complex organic compounds composed of chains of amino acids held together by peptide bonds.

They are the main component of muscles, organs and glands. Every living cell and all body fluids, except bile and urine, contain protein.

The cells of muscles, tendons, and ligaments are maintained with protein.

During digestion, proteins are broken down into amino acids, which are transported to the liver.

In the liver, amino acids are recombined to form new proteins, according to the body's needs.

Essential vs. Non-Essential Amino Acids

The human body requires approximately 20 amino acids for the synthesis of its proteins, but it can only make 13 of the amino acids - these are known as the nonessential amino acids.

There are 9 essential amino acids that are obtained only from food, and cannot be made in the body.

Complete vs. Incomplete Proteins

If the protein in a food supplies enough of the essential amino acids, it is called a complete protein.

If the protein of a food does not supply all the essential amino acids, it is called an incomplete protein.

All meat and other animal products are sources of complete proteins. These include beef, lamb, pork, poultry, fish, shellfish, eggs, milk and milk products.

A diet high in meat could lead to high cholesterol or other diseases, such as gout.

Another potential problem is that a high-protein diet may put a strain on the kidneys.

Extra waste matter, which is the end product of protein metabolism, is excreted in the urine.

Protein in grains, fruits, and vegetables are either low, incomplete protein or lack one of the essential amino acids. These food sources are considered incomplete proteins.

Plant proteins can be combined to include all of the essential amino acids, and form a complete protein.

Examples of combined, complete plant proteins are rice and beans, milk and wheat cereal, and corn and beans.

A nutritionally balanced diet provides adequate protein.

Vegetarians are able to get enough protein if they eat the proper combination of plant proteins.

Normal Dietary Protein Requirements

The amount of recommended daily protein depends upon age, medical conditions, and the type of diet one is following.

Two to three servings of protein-rich food will meet the daily needs of most adults.

The following are the recommended serving sizes for protein for adults:

2 to 3 ounces of cooked lean meat, poultry, and fish (a portion about the size of a deck of playing cards)
1/2 cup of cooked dry beans, lentils, or legumes
1 egg or 2 tablespoons of peanut butter, which count as 1 ounce of lean meat

Select lean meat, poultry without skin, fish, and dry beans, lentils and legumes often. These are the protein choices that are the lowest in fat.

Protein and Liver disease

Muscle Wasting. The liver plays a central role in the metabolism of protein, which is the building-block of body tissues.
When protein metabolism is impaired by a sick liver, the body begins to break down muscle tissue to obtain the protein necessary for other metabolic processes.

In viral hepatitis infection, muscle wasting has been associated with protein-calorie malnutrition. Changes in muscle mass have been observed in hepatitis patients at all stages of liver disease.

Malnutrition tends to be more pronounced as liver disease progresses into its later stages, and is linked to the onset of cirrhosis.

Additionally, hepatitis patients who are severely and moderately malnourished have lower survival rates than normal and over nourished patients.

Hepatic Encephalopathy. This condition is often associated with advanced liver disease, and is characterized by personality changes, intellectual impairment, and alterations in level of consciousness.

Hepatic encephalopathy is commonly attributed to the damaged liver's failure to remove abnormally high levels of ammonia from the blood.

Ammonia has a direct and serious effect on brain tissue, and is a byproduct of protein metabolism.

Although medications exist that can treat encephalopathy, failure to adequately treat this condition will result in confusion, disorientation, hallucination, stupor and coma.

Some patients with encephalopathy may be instructed to reduce dietary protein; however, protein should not be eliminated completely from the diet because it is remains important to the bodies nutritional needs and the repair of damaged tissue and cells.

Source

Protein in diet. MedlinePlus Medical Encyclopedia, National Library of Medicine.

Lautz HU, et al. Protein-calorie malnutrition in liver cirrhosis. Clin Investig. 1992 Jun;70(6):478-86.

Alberino F, et al. Nutrition and survival in patients with liver cirrhosis. Nutrition. 2001 Jun;17(6):445-50.

Wolf D. Encephalopathy, Hepatic. emedicine.com, 2001. http://www.emedicine.com/med/topic3185.htm

Fat in the Diet

Fats are organic compounds that are made up of carbon, hydrogen, and oxygen.

They are the most concentrated source of energy in foods, yielding 9 calories per gram, as opposed to protein and carbohydrate, which yeild 4 calories each.

Fats belong to a group of substances called lipids.

Technically, fats are substances that are solid at room temperature, whereas oils are liquid at room temperature.

All fats are combinations of saturated and unsaturated fatty acids. Fats can be very saturated or very unsaturated depending on their proportions.

You need some fat in the food you eat, but choose sensibly.

Some kinds of fat, especially saturated fats, increase the risk for coronary heart disease by raising the blood cholesterol.

In contrast, unsaturated fats (found mainly in vegetable oils) do not increase blood cholesterol.

Fat intake in the United States as a proportion of total calories is lower than it was many years ago, but most people still eat too much saturated fat.

Eating lots of fat of any type can provide excess calories.

Functions of Fat

Fat is essential for the proper functioning of the body. Fats provide the "essential" fatty acids, which are not made by the body and must be obtained from food.

Linoleic acid is the most important essential fatty acid, especially for the growth and development of infants.

Fatty acids provide the raw materials that help in the control of blood pressure, blood clotting, inflammation, and other body functions.

Fats supply energy and essential fatty acids, and they help absorb the fat-soluble vitamins A, D, E, and K, and carotenoids.

Fat serves as the storage substance for the body's extra calories. It fills the fat cells (adipose tissue) that help insulate the body.

Fats are also an important energy source. When the body has used up the calories from carbohydrate, which occurs after the first 20 minutes of exercise, it begins to depend on the calories from fat.

Healthy skin and hair are maintained by fat. Fat helps in the absorption, and transport through the bloodstream of the fat-soluble vitamins A, D, E, and K.

Types of Dietary Fat

Saturated fats. These are the biggest dietary cause of high LDL (Low Density Lipoproteins), sometimes called "bad cholesterol."

When looking at a food label, pay very close attention to the percentage of saturated fat and avoid or limit any foods that are high (over 20%) saturated fat.

Saturated fats are found in animal products such as butter, cheese, whole milk, ice cream, cream, and fatty meats, as well as some vegetable oils (coconut, palm, and palm kernel oils).

However, most other vegetable oils contain unsaturated fat and are healthy.

Unsaturated fats. These fats help to lower blood cholesterol if used in place of saturated fats. There are two types: mono-unsaturated and polyunsaturated. Most, but not all, liquid vegetable oils are unsaturated. The exceptions include coconut, palm, and palm kernel oils.

Mono-unsaturated fats. These fats help to lower blood cholesterol if used in place of saturated fats. Examples include olive and canola oils.

Polyunsaturated fats. These fats help to lower blood cholesterol if used in place of saturated fats. Examples include safflower, sunflower, corn, and soybean oils.

Trans fatty acids. These fats form when vegetable oil hardens (a process called hydrogenation) and can raise LDL levels. They can also lower HDL levels ("good cholesterol"). Trans-fatty acids are found in fried foods, commercial baked goods (donuts, cookies, crackers), processed foods, and margarines.

Hydrogenated. This term refers to oils that have become hardened (such as hard butter and margarine). Foods made with hydrogenated oils should be avoided because they contain high levels of trans fatty acids, which are linked to heart disease. The terms "hydrogenated" and "saturated" are related; an oil becomes saturated when hydrogen is added (i.e., becomes hydrogenated).

Partially hydrogenated. This term refers to oils that have become partially hardened. Foods made with partially hydrogenated oils should be avoided because they contain high levels of trans fatty acids, which are linked to heart disease. (Look at the ingredients in the food label.)

Eating too much saturated fat is one of the major risk factors for heart disease. A diet high in saturated fat causes a soft, waxy substance called cholesterol to build up in the arteries. Too much fat also increases the risk of heart disease because of its high calorie content, which increases the chance of becoming obese (another risk factor for heart disease and some types of cancer).

A large intake of polyunsaturated fat may increase the risk for some types of cancer. Reducing daily fat intake is not a guarantee against developing cancer or heart disease, but it does help reduce the risk factors.

Recommendations

You need some fat in the food you eat, but some kinds of fat, especially saturated fats, increase the risk for coronary heart disease by raising the blood cholesterol.

In contrast, unsaturated fats (found mainly in vegetable oils) do not increase blood cholesterol.

Get most of your calories from plant foods (grains, fruits, vegetables). If you eat foods high in saturated fat for a special occasion, return to foods that are low in saturated fat the next day.

Aim for a total fat intake of no more than 30 percent of calories. If you need to reduce your fat intake to achieve this level, do so primarily by cutting back on saturated and trans fats.

Check the Nutrition Facts Label. See how much saturated fat and cholesterol are in a serving of prepared food. Choose foods lower in saturated fat and cholesterol.

Also, look on food labels for words like "hydrogenated" or "partially hydrogenated" - these foods are loaded with saturated fats and trans-fatty acids and should be avoided.

Fats and Oils. Liquid vegetable oil, soft margarine, and trans fatty acid-free margarine are preferable to butter, stick margarine, or shortening.

Choose vegetable oils rather than solid fats (meat and dairy fats, shortening). If you need fewer calories, decrease the amount of fat you use in cooking and at the table.

Meat, Poultry, Fish, Shellfish, Eggs, Beans, and Nuts. Limit animal products like egg yolks, cheeses, whole milk, cream, ice cream, and fatty meats (and large portions of meats).

Choose 2 to 3 servings of fish, shellfish, lean poultry, other lean meats, beans, or nuts daily.

Trim fat from meat and take skin off poultry. Choose dry beans, peas, or lentils often.

Limit your intake of high-fat processed meats such as bacon, sausages, salami, bologna, and other cold cuts. Try the lower fat varieties, and limit your intake of liver and other organ meats.

Use egg yolks and whole eggs in moderation. Use egg whites and egg substitutes freely when cooking since they contain no cholesterol and little or no fat.

Dairy Products. Choose fat-free or low-fat milk, fat-free or low-fat yogurt, and low-fat cheese most often.

Try switching from whole to fat-free or low-fat milk. This decreases the saturated fat and calories but keeps all other nutrients the same.

Foods at Restaurants. Choose fish or lean meats as suggested above.

Limit ground meat and fatty processed meats, marbled steaks, and cheese.

Limit your intake of foods with creamy sauces, and add little or no butter to your food.

Limit your consumption of fried foods, processed foods, and commercially prepared baked goods (donuts, cookies, crackers).

Source

Fat. MedlinePlus Medical Encyclopedia. National Library of Medicine.

Choose a diet that is low in saturated fat and cholesterol and moderate in total fat. Dietary Guidelines for Americans.

Reviewed October 4, 2005 by V. J. Smith, RN, BSN, MA.