DIET AND HEPATITIS C

Dietary Principles
Diet is one of the most important aspects of staying healthy. The idea that what we eat is not important to our well being is one of the greatest failings of western medicine. Hippocrates, the father of modern medicine said, "Food is medicine, medicine is food." My favorite is: "You are what you don't poop out."

The Liver metabolizes the final products of digestion in the blood from the intestines. From this the Liver removes Glucose, excretes bile, creates heparin, manufactures cholesterol and carries on dozens of biochemical processes. It truly is the most complex organ of the body, except the brain. The liver is well known for the detoxification process. From the most deadly poison to a glass of pure water, the liver is in charge of filtering out impurities.

We must eat to live. Many of us act like we live to eat. If you have not paid attention to your diet then the time has come. We would like to share some basic eating principles. These are basic guidelines and should be followed up with a consultation with a physician or nutritionist knowledgeable with an optimal Hepatitis Diet.

Foods to consider
Dandelion greens, burdock root, mustard greens, black radish, apples and saffron, watercress, beets, parsley, artichokes, cherries, grapefruit, parsnips, endive, garlic, onion, chicory, carob, horseradish, kumquats, limes, quinces, grapes. Include artichokes in the diet, they protect the liver.
Lemon juice mixed with water, upon rising in the morning 30 minutes before eating and a teaspoon of olive oil (virgin cold pressed) has been shown to stimulate the production of bile.

Foods to avoid
Saturated fats, meat, alcohol, hot sauces, spicy foods, fried foods, fatty foods, rich foods, salty foods, cow's milk and other dairy products, white bread, refined foods, processed foods, sugar and sweets, phlegm-forming foods, meat, ice cream, shellfish, coffee, caffeine, unpurified water and other foods that don't agree with you.
Trans-fatty acids, hydrogenated oils (margarine, vegetable shortenings, imitation butter spreads, most commercial peanut butters) oxidized fats (deep fried foods, fast food, ghee, barbecued meats)
Refined, simple carbohydrates: sucrose, white flour, processed foods

Hepatotoxic Medications to avoid:
All nonsteroidal anti-inflammatory drugs Lipid-lowering agents: statins, nicotinic acid (niacin; Nicolar)
Antidiabetic agents: acarbose (Precose), pioglitazone (Actos), sulfonylureas
Antibiotics: amoxicillin­clavulanate potassium (Augmentin), erythromycin, isoniazid (INH), nitrofurantoin (Furadantin), tetracycline
Antifungal agents: fluconazole (Diflucan), itraconazole (Sporanox), ketoconazole (Nizoral)
Retinoids: etretinate (Tegison)
Anticonvulsant agents: phenytoin (Dilantin), valproic acid (Depakene)
Psychotropic agents: bupropion (Wellbutrin), chlorpromazine (Thorazine), tricyclic antidepressants
Hormones: tamoxifen (Nolvadex), testosterone
Others: halothane (Fluothane), methotrexate (Rheumatrex).
When treatment with a potentially hepatotoxic medication is deemed necessary, the drug should be used with caution and under close supervision.
Vitamin A is a known hepatotoxin that is available over the counter. Multiple cases of hepatotoxicity have been documented with the ingestion of vitamin A in high dosages, usually more than 100,000 IU per day, and rare cases have occurred with dosages of approximately 25,000 IU per day. The degree of liver injury associated with vitamin A depends on the dose. Alcohol potentiates the hepatotoxicity of this vitamin. Vitamin A can cause steatosis, perisinusoidal fibrosis, chronic hepatitis and cirrhosis. Patients with chronic liver disease should consume less than 25,000 IU of vitamin A per day. Most multivitamin preparations contain 4,000 IU of the vitamin, which is well within the safe range for daily consumption.

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.

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Medical Disclaimer

The information and procedures contained herein is not presented as medical advice nor should it be used as a substitute for consultation with a qualified health care practitioner. The information contained herein has not been evaluated by the Food and Drug Administration. These products and the information set forth herein are not designed to diagnose, treat, cure or prevent any disease nor should any information contained herein be read as prescribing any specific remedy or guaranteeing any specific result. We are not responsible for any adverse effects or consequences resulting from the use of any of the suggestions preparations, or procedures discussed herein. All matters pertaining to your physical health should be supervised by a health care professional.