Hepatitis and nutrition

Hepatitis and nutritionUseful products about this

Summary

Eating well and enjoying it must become a therapeutic act as important as taking medication.

Hepatitis affects the entire hepatic tissue and is accompanied by an inflammatory reaction, which can progress to cirrhosis or liver cancer. Among hepatitis caused by a virus, there are hepatitis A, B, C, but D or delta virus and E virus have been detected. Other causes also exist and may be of microbial, toxic or autoimmune origin. The liver is a real plant for our system, at the heart of the nutritional processes. A diseased liver disrupts digestion, absorption, storage, metabolism, which can lead to vitamin and mineral deficiencies and malnutrition in protein and calories. The progression of the disease is frequently a cause of malnutrition, thus nourishing the morbidity and mortality, related to this pathology.

Some foods to avoid

  • In case of jaundice, due to the decrease in the secretion of bile salts, fatty foods can be difficult to digest. Poor fat absorption occurs especially if the liver suffers from a steatosis, linked to an overload of lipids and triglycerides, one of diabetes factors, cardiovasculair complication, obesity but also cancer.
  • Avoid all delis and cooked meats, rich in lipids and salt (sodium). Also hunting the products rich in saturated fatty acids, contained in dairy products, but also in pastries, cookies, chips, industrial sauces. White meats, fresh or frozen poultry not breaded and without sauce are good sources of protein, easier to digest by the liver.
  • It is necessary to consume each day a small amount of unsaturated lipids, because our bodies can not produce them alone. Two to three times a week, enjoy eating small fatty fish such as mackerel, herring, sardines, halibut, which in addition to their protein content, bring the famous omega 3, known as polyunsaturated. Add one tablespoon of cold-pressed vegetable oil to your salad or pan-fried vegetables: rapeseed, nuts, soya, flax and camelin oils are also rich in omega-3, if keep it in the fridge.

It's better to say "no" to alcohol

  • The metabolism of ethanol involves oxidative mechanisms that decrease the cellular stocks of glutathione, an endogenous antioxidant, while maintaining a lipid peroxidation which contributes in particular to the weakening of cell membranes. In chronic hepatitis B or C, alcohol increases histological activity, promotes fibrosis, and progress to cirrhosis. Stopping drinking alcohol means protecting the liver and allowing it to regenerate. Think of herbal teas based on milk thistle (sylimarin), rosemary or artichoke, excellent for the liver.
  • Alcohol is a source of sugars but not the only one: many other foods are rich in it. However, sugar as well as fat, promotes steatosis and increases the triglycerides when eating to excess. You can replace your milk chocolate squares, your ice cream by a fruit or a handful of dried fruits, more beneficial to the body.

Sufficient intake to spread over the whole day

Adequate intake of protein, if it is adapted to the size, activity and spread on 2 to 3 meals a day, will help fight the infection, regenerate the liver and avoid losing muscles. Apart from lean meats (veal, skinless poultry) and fish, which provide protein and other nutrients (iron, zinc, magnesium), legumes, eggs or tofu are also good sources of protein.

Calming a pro-inflammatory ground

  • The deregulation of the immune response in general, and of the tumor necrosis factor (TNF-a) system in particular, especially with alcoholic hepatitis patient (in its severe form) has been demonstrated in clinical studies: the inflammatory response is prolonged with the persistence of abnormally high serum cytokine * levels despite the cessation of intoxication. Several elements contained in the diet can help decrease the production of cytokines.
  • Vitamin D, whose best natural sources are fish such as salmon, mackerel and sardines. Cod liver oil is particularly rich in vitamin A and D.
  • Essential fatty acids like Omega-3, contained mainly in walnuts, almonds, flax seeds as well as fish such as salmon, mackerel, sardines and herring and without forgetting the purslane.
  • Tea in general, but especially green tea, is provided with polyphenols, an antioxidant that neutralizes the free radicals responsible for an increase of cytokines in the blood: consume 3 cups of green tea per day, its flavors are multiple: Sencha, Gyokuro, Tamaryokucha

Some vitamins are real anti-oxidants

Vitamins C and E promote the improvement of the general state. It's the same with vitamin A, which should be handled with more care: it is stored in the liver and becomes hepatotoxic, if not eliminated. The recommended nutrient intakes (ANSES) are 600 μg. Foods rich in vitamin A are mainly poultry and lamb liver, dandelion, spinach and carrot.

Trace elements to help

  • Selenium: a Chinese study showed that selenium in the diet would reduce the impacts of hepatitis B and liver cancer by 35% after 4 years of supplementation. Nuts, seafood (oyster, mussels, bulot), shrimp, crab, offal (especially liver), fish like anchovy, swordfish, herring, sunflower seeds, rice bran or oats are excellent sources.
  • Zinc : Zinc nutritional status would influence the effects of alpha-interferon in patients with hepatitis C, by promoting the induction of metallothionein, a low molecular weight protein that plays a major role in the control of the bioavailability of essential metals such as copper and zinc. The richest foods are fish, crustaceans, meats and whole grain cereals.

What to do in case of nausea and diarrhea ?

  • In order to avoid nausea, it is recommended to eat only when you experience the feeling of hunger, without forcing yourself, and this, whatever the time. In general, dry, cold or low flavored foods (chicken breast,) are easier to swallow than spicy and hot foods, which can make nauseous.
  • In case of diarrhea, think of bananas, rice or milk semolina (prepared with vegetable milk), mashed potatoes, carrots or simply rice water, which can be made self.

Tips to overcome the lack of appetite

It is better to eat smaller portions and more often, to vary the tastes (bitter, acidic, salty, sweet), which whets the appetite, drinking fresh pressed fruit juices or enriched vegetal milks rather than low-calorie liquids (tea, broth, coffee).

Weight and steatosis **: a diet to be reduced

Some overweight patients need to reduce their diet to decrease steatosis, which is present in more than 50% of HCV patients. Hepatic steatosis, when accompanied by obesity, is an important precursor to the development of fibrosis and other liver diseases, as well as an barrier to successful HCV therapy. Loss of weight can therefore lead to an improvement in the liver's condition: healthy eating and regular physical activity can help.

A higher risk of depression in chronic hepatitis C patients

Hepatitis and major depressive disorder may be associated, especially for hepatitis C carriers. Although there is no specific diet able to cure major depressive disorder, some foods may improve mood (in addition to appropriate medical care): omega-3 fatty acids, folic acid, vitamin B6, B12 and vitamin D.

* Mathurin P, Ganne-Carrié N, Poynard T, et al. Rôle des cytokines pro-inflammatoires dans la pathogénie de l'hépatite alcoolique. Gastroenterol Clin Biol 1998 ; 22 : 311-9
** Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002 ; 346 : 122-31.

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Marie-Christine LANGGUTH CUEVA
Naturopathe - Iridologue - Nutrithérapie
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