DIET AND HEPATITIS C
WHAT IS THE RELATIONSHIP
BETWEEN DIET AND HEPATITIS C ?
Hepatitis C is a virus
that infects the liver. Up to 85% of people exposed to this virus
develop chronic liver disease. Progression to cirrhosis { irreversible
scarring of the liver } occurs in about 25% of individuals. While
not as yet totally defined, many factors influence the rate of
disease progression. Diet likely plays an important role in this
process, as all foods and beverages that we ingest must pass through
the liver to be metabolized.
ALCOHOL AND HEPATITIS C
Alcohol is a potent toxin
to the liver. Excessive intake can lead to cirrhosis and its complications,
including liver cancer. Heavy drinkers are not the only individuals
at risk for liver disease, as damage can occur in even some moderate
"social drinkers". The hepatitis C virus has frequently
been isolated from patients with alcoholic liver disease. In fact,
these patients have been found to have a higher incidence of severe
liver damage, cirrhosis, and a decreased lifespan, when compared
to individuals without the virus. It is suggested that the combination
of alcohol and hepatitis C accelerates the progression of liver
disease. The consensus statement concerning management of hepatitis
C released March 1997 from the National Institutes of Health,
further warned about the dangers of excessive alcohol use in patients
with hepatitis C. These recommendations stressed limitation of
alcohol use to no more than one drink per day. Therefore, patients
with hepatitis C would be unwise to drink alcohol in excess, and
total avoidance of all alcohol intake is recommended .
IRON AND HEPATITIS C
The liver plays an important
role in the metabolism of iron since it is the primary organ in
the body that stores this metal. The average American diet contains
about 10- 20 mg of iron. Only about 10% of this iron is eliminated
from the body. Patients with chronic
hepatitis C sometimes have difficulty excreting iron from the
body. This can result in an
overload of iron in the liver, blood, and other organs. Excess
iron can be very damaging to the liver. Studies suggest that high
iron levels reduce the response rate of patients with hepatitis
C to interferon. Thus, patients with chronic hepatitis C whose
serum iron level is elevated, or who have cirrhosis, should avoid
taking iron supplementation. In addition, one should restrict
the amounts of iron rich foods in their diet, such as red meats,
liver, and cereals fortified with iron, and should avoid cooking
with iron coated utensils.
FAT AND HEPATITIS C
Overweight individuals
are often found to have abnormalities related to the liver . Examination
of liver specimens may display a spectrum of abnormalities ranging
from fatty deposits in the liver,[ steatosis], to fatty inflammation
[ fatty hepatitis], or even fatty cirrhosis. This condition is
called Nonalcoholic Steatohepatitis [ NASH ]. It occurs predominantly
in middle-aged obese women with diabetes mellitus and hypertriglyceridemia
[excess fat in the blood]. However, this disease may also occur
in individuals of normal weight, without other associated diseases,
and can also affect men. The presence of fat in the liver can
cause the liver to become enlarged and may result in elevations
in liver related blood work { liver function tests [LFT's] }.
The addition of NASH in patients with hepatitis C may worsen liver
related blood work and physical exam. This may confuse interpretation
of results and diagnosis. Controlled studies need to be done to
determine if the addition of this disease worsens the prognosis
of patients with underlying chronic hepatitis C. In overweight
patients with a fatty liver who subsequently lose weight, liver-
related abnormalities improve. Therefore, patients with chronic
hepatitis C are advised to maintain a normal weight. For persons
who are overweight, it is crucial to start a prudent exercise
routine and a low fat, well balanced, weight reducing diet. In
diabetic patients, a sugar- restricted diet should be adhered
to. A low cholesterol diet should be followed in those with hypertriglyceridemia.
In individuals with NASH who are of normal weight, a low fat diet
may be advantageous. It is essential that patients consult with
their physician prior to the commencement of any dietary or exercise
program.
PROTEIN AND HEPATITIS C
Adequate protein intake
is important to build and maintain muscle mass and to assist in
healing and repair. Protein intake must be adjusted to one's body
weight. Approximately 0.8 grams of protein per kilogram of body
weight is recommended in the diet each day. Therefore, protein
intake should be between about 60 - 120 grams a day in patients
with hepatitis C, unless a complication of cirrhosis known as
encephalopathy occurs. Encephalopathy is an altered mental status.
The exact cause is not fully understood and is probably multifactorial.
It has been shown that restriction of the diet of animal protein
and maintaining a total vegetarian diet, helps reverse this condition
and improve mental capacity.
SODIUM AND HEPATITIS C
Advanced scarring of the
liver [ cirrhosis ] may lead to an abnormal accumulation of fluid
in the abdomen referred to as ascites. Patients with hepatitis
C who have ascites must be on sodium [salt] restricted diets.
Every gram of sodium consumed results in the accumulation of 200
ml of fluid. The lower the salt content in the diet, the better
this excessive fluid accumulation is controlled. While often difficult,
sodium intake should be restricted to 1000mg each day, and preferably
to 500 mg per day. One must become an careful shopper, diligently
reading all food labels. It is often surprising to discover which
foods are high in sodium.
For example, one ounce of corn flakes contains 350 mg of sodium;
one ounce of grated parmesan cheese - 528mg of sodium; one cup
of chicken noodle soup - 1108 mg of sodium; and one teaspoon of
table salt - 2,325 mg of sodium!
Most fast food restaurants are a no no. Meats, especially red
meats, are high in sodium content, and adherence to a vegetarian
diet may often become necessary. Patients with chronic hepatitis
C without ascites, are advised not to overindulge in salt intake,
although their restrictions need not be as severe.
copyright © 2000 Melissa Palmer, MD