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Part 6: Nutrition

6.1.0 What should I do about Nutrition?

Many dieticians and medical experts working with hepatitis C feel that except for alcohol, diet has little direct effect on the activity of the virus and the outcome of long-term infection. There is no specific dietary approach that can be recommended which can guarantee to alter the outcome of any particular liver disease. This isn’t to say that modifying your diet has no effect. Nutrition and the liver are interrelated in many ways. Everything we eat, breathe and absorb through our skin must be refined and detoxified by the liver, special attention to nutrition and diet can help keep the liver healthy.

85-90% of the blood that leaves the stomach and intestines caries important nutrients to the liver where they are converted into substances the body can use.

Bitter foods are useful as they stimulate the digestive process and assist the liver. Eating salads containing bitter leaves such as dandelion or chicory 10-15 minutes before meals is a long-standing European recipe to aid the liver.
In Taiwan, a diet high in vegetables was associated with a lowered risk of liver cancer in people with hepatitis C.
Vegetable juices 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. The juice of carrots, beets, cucumber, spinach, celery , wheat grass and parsley are all used in liver cleansing fasts, and are generally thought to be good for livers.

Drinking 2-3 liters of water each day is universally recommended for good health, but also protects against lymphatic congestion, which would put further strain on the liver.

As for diets in particular, The Alternative Medicine Guide says:
Jonathan Wright, M.D. recommends a diet low in protein to minimize stress on the liver—a whole foods diet that follows a hypoglycemic regime, of small meals throughout the day, avoiding stressor foods such as refined sugars, alcohol, and caffeine. Consume plenty of filtered water. Drinking fresh lemon juice water every morning and evening followed by vegetable juice is one of the most therapeutic regimes for the liver. Do this consistently for two to four weeks and then several mornings a week for several months and whenever liver symptoms reoccur. Have lots of vegetables each day. Ideal is at least one salad and one meal of steamed or lightly sautéed vegetables per day. Grains that are easily digestible, such as millet, buckwheat, and quinoa are very good.

According to the Encyclopedia of Natural Medicine:
A natural diet, low in natural and synthetic saturated fats, simple carbohydrates (sugar, white flour, fruit juice, honey, etc), oxidized fatty acids (fried oils) and animal fat, and high in fiber is recommended.

And this from the Canadian Journal of Health and Nutrition: “Natural substances to help your liver detoxify are as close as your kitchen cupboard. Eating foods rich in lecithin (soybean), essential fatty acids (salmon, flax oil) and green leafy vegetables rich in fiber and antioxidants like vitamins C and E, are all gourmet cuisine for your liver.

Lowering your intake of saturated fats, refined carbohydrates and animal protein and avoiding excessive amounts of alcohol are other recommendations that are good both for your liver and overall body health. Dandelion root and artichoke are both excellent spring time dietary condiments that are very helpful in improving liver bile flow.

In addition to these food choices, supplements like L-methionine are an excellent choice for a congested liver. This sulfur-containing amino acid not only improves bile flow but also helps protect liver glutathione. Glutathione peroxidase is one of the body’s major detoxification enzymes and is in part defended by methionine during a toxic challenge to the liver...” The article goes on to describe the function of Milk Thistle.

It concludes that the most potent substances for protecting the liver are Milk Thistle, Dandelion and L-methionine. L-methionine is classed as a “supplement,” and Milk Thistle and Dandelion as “botanical medicines.” - “Protecting and Enhancing Liver Function,” by Ronald G. Reichert, ND, Alive: Canadian Journal of Health and Nutrition (#161, March 1996): pp. 14-16.

The Mediterranean Diet
The benefits of the Mediterranean Diet are more than just losing weight, according to a study done at St. Vincent’s Hospital in Melbourne. They studied 12 patients without diabetes with non-alcoholic fatty liver disease (NAFLD), and showed that the diet improved their liver health even with no weight loss. The participants had a big improvement in insulin sensitivity, thus lowering their risk for Type 2 diabetes, possibly indicating that the diet improves metabolism. Even 6 weeks on the diet could lower liver fat by 39%, compared with “a current recommended healthy diet”. Until now, there have been few studies for NAFLD, which causes fat to be stored in the liver, and the only suggestion has been for patients to lose weight. NAFLD can be discovered by testing liver enzymes, by ultrasound, or by doing a biopsy.
(www.aasld.org/LM2011/PRESS/Pages/pressfive.aspx Nov 7, 2011. More info:
http://en.wikipedia.org/wiki/Mediterranean diet)

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PEANUTS: Some foods, especially peanuts, contain aflatoxins, a mould which increases the chance of liver

RAW SHELLFISH: Vibro vulnificus, a bacteria, can be contracted by eating raw oysters, etc. Shellfish, if
uncooked, can be very dangerous for people with liver disease. Either avoid or be careful that the shellfish
you eat is well-cooked.

SATURATED FATS: It’s generally best to keep fats at a minimum.
Many people complain of increased pain in the liver area after eating high fat meals. With saturated fats, the
liver must work harder than normal to neutralize their harmful effects.

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6.2.0 Nutrition and cirrhosis

Many chronic liver diseases are associated with malnutrition.

One of the most common of these is cirrhosis. Cirrhosis refers to the replacement of damaged liver cells by fibrous scar tissue which disrupts the liver’s important functions. Cirrhosis occurs as a result of excessive alcohol intake (most common), common viral hepatitis, obstruction of the bile ducts, and exposure to certain drugs or toxic substances.

People with cirrhosis often experience loss of appetite, nausea, vomiting and weight loss, giving them an emaciated appearance.

Diet alone does not contribute to the development of this liver disease. People who are well nourished, for example, but drink large amounts of alcohol, are also susceptible to alcoholic disease.

Adults with cirrhosis require a balanced diet rich in protein, providing 2,000 to 3,000 calories a day to allow the liver cells to regenerate. However, too much protein will 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. In addition, the physician can use two medications (lactulose and neomycin) to control blood ammonia levels.

Persons with cirrhosis often experience an uncomfortable buildup of fluid in the abdomen (ascites) or a swelling of the feet, legs, or back (edema). Both conditions are a result of portal hypertension (increased pressure in the veins entering the liver). Since sodium (salt) encourages the body to retain water, patients with fluid retention can cut their sodium intake by avoiding such foods as canned soups and vegetables, cold cuts, dairy products, and condiments like mayonnaise and ketchup. In fact, most prepared foods contain liberal amounts of sodium, while fresh foods contain almost no sodium at all.

The best-tasting salt substitute is lemon juice. In general, reducing meat protein, which is the most toxic protein to the brain, and substituting vegetable protein is advised when cirrhosis is present.

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6.3.0 Coffee, tea, caffeine and other stimulants

In the book Healthy Healing by Linda Rector-Paige, N.D., PhD, she says: “...Some of the health problems of caffeine are...well known—headaches and migraines, irritability, stomach and digestive problems, anxiety, and high blood pressure. As an addictive stimulant, it works as a drug, causing jumpiness and nerves, heart disease, heart palpitations.

Caffeine in excessive amounts can produce oxalic acid in the system, causing a host of problems waiting to become diseases. It can lodge in the liver, restricting proper function, and constrict arterial blood flow.

It leaches out B vitamins from the body...It depletes some essential minerals, including calcium and potassium...however the carcinogenic effects often blamed on caffeine are now thought to be caused by the roasting process used in making coffee, tea and chocolate.

Since decaffeinated coffee has been implicated in some forms of organ cancer, conclusions are being drawn that caffeine is not the culprit—the roasted hydro-carbons are...”

Unfiltered coffee raises serum cholesterol and liver enzymes. One study in the British Medical Journal shows that cafetiere (brewed, unfiltered) coffee raises serum LDL cholesterol levels and serum concentrations of alanine aminotransferase (ALT). Cafetiere coffee is made by pouring boiling water over ground coffee in a container with a sieve plunger. Dr. Rob Urgert and others at Wageningen Agricultural University in the Netherlands observed that unfiltered coffee raised alanine aminotransferase 80% above baseline levels relative to filtered coffee.

Once the subjects stopped drinking cafetiere coffee, the liver enzyme and LDL cholesterol concentrations returned to baseline levels. The Dutch investigators write that “Daily consumption of five to six cups of strong cafetiere coffee affects the integrity of liver cells...” and they attribute the increases in cholesterol and alanine aminotransferase concentrations to the diterpenes cafestol and kahweol that are abundant in cafetiere. - (BMJ 1996;313:00-00)

A study done by the Tohoku University Graduate School of Medicine in Sendai, Japan found that coffee consumption reduced the risk of liver cancer. Another study by the National Cancer Center in Tokyo says that five or more cups of coffee a day cut the chance of liver cancer in half. It was noted that these studies were not preformed on HCV patients. It is not known if they will receive the same benefits from coffee. (J Cancer 2005 Aug 10;116(1):150-4, J Hepatol 2005 apr;42(4):528-34 http://www.sciencedirect.com/science/article/pii/S0016508511002733)

The HALT-C study found that drinking coffee—but not tea—was somehow linked to a greater chance of successful treatment with pegIFN/RBV. It may be because coffee seems to protect the liver and detain the progression of the disease, but why would it affect treatment?

The study used low-dose pegIFN as maintenance therapy for 885 non-responders with fibrosis or to see if it could slow the progression to cirrhosis. The patients filled out questionnaires, which included coffee consumption. Those who drank at least 3 cups a day had twice as much of a drop in their viral load compared to those who didn’t drink coffee, and 60% of them were able to fend off anemia and take full doses of ribavirin. Decaffeinated coffee produced the same results, but neither black nor green tea was beneficial.

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6.4.0 Salt

Those who are prone to episodes of ascites should try to maintain a very low sodium diet (less than 3 gr/day - I shoot for 1-2gr/day).

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Table of Contents


5.6.0 Other Ways to Keep Yourself Healthy

Hepatitis C FAQ

Part 7: Drugs and Alcohol