What you eat and drink can and does affect your liver. When you have hepatitis, eating well and avoiding alcohol are important steps in your treatment plan. Both can make a difference to your health and happiness.
When it comes to eating and drinking, you’re in charge. Some food and beverage choices are smarter than others. Remember, eating well may help you feel better since it can help your body better respond to treatment and its side effects.
Unfortunately, when you feel ill, you might not feel hungry or you may have little interest in food. Eating simply may not seem as enjoyable. Being sick is stressful enough. Mealtimes should not become yet another source of stress. Your doctor or nurse may suggest you speak with a registered dietitian who can help you with your diet and select healthy foods that you may like.
Remember, eating well may help you feel better since it can help your body better respond to treatment and its side effects.
Diet and cirrhosis
If you have advanced liver disease, such as cirrhosis, weight loss may be a problem. When you aren’t eating well, your body may call upon its energy stores. For example, if you are not eating enough protein-rich foods, your body may take protein from the protein that makes up your muscle. This will leave you feeling even weaker, so try to maintain your protein and calorie needs.
To quickly determine your daily protein needs in grams, divide your weight in pounds by 2. (For example, a 150-pound man will need 75 grams of protein.) To figure out your daily calorie needs, you’ll need a minimum of 15 calories a day for each pound you weigh. (Again, a 150-pound man would need a minimum of 2,250 calories a day.)
Keep your salt levels below 2,000 milligrams a day. This means not shaking salt onto your food, and reading food labels carefully to determine sodium content. Limiting sodium is helpful because your body may hold onto extra fluid, and make you feel bloated. If fluid is held in the belly, the condition is called ascites; it is called edema if it is held in the legs. To cut down on salt, eat more fresh foods, most of which are naturally low in sodium, and fewer canned, processed, and prepared foods, such as TV dinners, chips, and fast food. Other salty foods include bacon, sausage, cold cuts, cheeses, Chinese food, and pickles.
Making healthful food choices
Eating a variety of foods is a good idea since different food groups make different contributions to your diet. Food contains important nutrients – carbohydrates, protein, fat, vitamins, minerals, and other key substances – which are the building blocks your body needs every day in order to function properly. If you’re not currently having problems eating, then the food guide pyramid (shown above) that you’ll see on some food packages offers these guidelines for a well-balanced diet. P> Choose 6 to 11 servings of bread, cereals, rice, and other grains daily. Include some whole grains, such as whole wheat or enriched bread, or bran cereal. Any one of the following is equivalent to one serving of grain:
– ½ cup cooked pasta, rice, or oatmeal
– 1 cup cornflakes
– 1 tortilla
– ½ hamburger bun – 3 to 4 small crackers
Choose 2 or more servings of fruits (including fruit juices) daily, including one good source of vitamin C, such as orange juice. Any one of the following is equivalent to one serving of fruit:
– a medium banana, apple, or orange
– ½ cup cooked, canned, or cut-up fruit
– ¾ cup of juice
– ¼ cup dried fruit (such as raisins or apricots)
Choose 3 or more servings of vegetables daily, including at least one serving of a dark leafy green or dark orange vegetable, such as:
– ½ cup cooked carrots or chopped vegetables
– 1 cup lettuce or spinach
Choose 2 to 3 servings equaling 5 to 7 ounces daily of meat, poultry, fish, and other protein foods, such as beans, eggs, tofu, and unsalted nuts. Any of the following is equivalent to a 1-ounce portion of meat, fish, or chicken:
– 1 egg
– ½ cup tofu
– ½ cup cooked beans
– 2 tablespoons peanut butter
Choose 2 to 3 servings of milk, cheese, or yogurt daily. Any one of the following is equivalent to one serving of a dairy product:
– 1 cup milk
– 1 cup yogurt
– 1 ½ ounces of cheese
If you aren’t having problems with fluid retention, you can determine your daily fluid needs in ounces by dividing your weight in pounds by 2. (For 1 150-pound man this would be 75 ounces, or more than nine 8-ounce glasses of fluid per day.) Choose mostly water, fruit juice, seltzers, sports drinks (such as Gatorade TM ), or milk. Alcohol and caffeine drinks such as coffee, tea, and cola act as dehydrators, pulling water out of your system, and are not good choices. If you are having problems with fluid retention, be sure to tell your doctor or nurse. Drinking lots of fluid is especially important if you are having interferon therapy because it may help reduce side effects.
By choosing foods carefully, you may not need a vitamin or mineral supplement. However, if you are having problems with eating, you may take a vitamin and mineral supplement that provides no more than 1 to 2 times the Recommended Dietary Allowances. But before you start, discuss this with your doctor. Certain fat-soluble vitamins, such as Vitamin A, and some minerals, such as iron, can be stored in the liver and can actually cause problems when taken in large amounts.
Coping with common eating problems
Sometimes your hepatitis or the treatment you are receiving may trigger unpleasant side effects. Loss of appetite and even nausea and vomiting are common particularly with hepatitis. Eating may be the last thing on your mind. As liver damage progresses to an advanced stage, weight loss may result. The following suggestions may be practical solutions to common eating problems.
When you don’t feel like eating
Keeping your portions small, so the amount of food on your plate does not seem overwhelming. If you feel up to it, taking a short walk before mealtime can be relaxing and may revive your appetite. Some people may have a better appetite in the morning. If you find that you do, take advantage of it by eating a big, healthy breakfast, and enjoying your meals. For example, you may try to include foods which provide 1/3 to ½ of your protein needs at this time, and use nutritional supplements later on when you don’t feel like eating.
By choosing foods carefully, you may not need a vitamin or mineral supplement.
Changes in taste
Certain foods you once enjoyed may no longer taste the same. Perhaps your medicine is causing a bad taste in your mouth, or liver disease has harmed certain chemical pathways. Some foods with protein, red meat in particular, might taste bitter. But protein foods are important; they give you strength and help you fight off infection and respond well to treatment.
If red meat doesn’t taste good, try chicken, fish, or other protein foods such as beans, cheese, yogurt, tuna, eggs, or peanut butter. You may find that while hot, just-cooked meat tastes unpleasant, it tastes fine when it is well-cooked but served cold or at room temperature. Don’t despair; taste changes might not last forever. Foods that you find unpleasant now may taste good again later. Keep trying as you begin to feel better.
Changes in smell
Some hepatitis patients notice that the smell of cooking or cooked food bothers them. If this happens to you, try serving foods cold or at room temperature. You can also turn on a kitchen fan during your meal and while food is cooking, open kitchen windows when possible, grill foods outside in the summer, or use the microwave or cook in boiling bags to cut down on odors. If the problem continues, you can even use a small fan next to your plate when you eat hot foods that have a strong smell.
Make the most of each mouthful. Even if you can’t eat that much food, choose foods that are high in calories and protein.
If the smell of food is bothering you when you are in the hospital, ask the food service staff, a nurse, or a family member to take the cover off of your tray before they bring food into your room, or remove the cover from your tray by opening it away from you.
When you feel nauseous
No one wants to eat when they feel nauseous. But try not to go for long periods of time on an empty stomach. Eat small amounts of food every 2 or 3 hours and eat slowly. Don’t worry about balanced meals at this point eat what you can tolerate and make sure to replace any lost fluids. During periods of nausea, avoid citrus juices (orange, grapefruit, pineapple). The acid may bother your stomach. Instead, try apple or grape juice, ginger ale, chicken broth, weak tea, or sports drinks, and sip these drinks slowly. If morning nausea is a problem, eat some dry crackers when you first wake up. Also, get out of bed slowly. Avoid foods that have strong smells, or are spicy, greasy, or deep-fried. If your nausea continues, your doctor can prescribe medicine.
When you feel full quickly
If your liver is inflamed or enlarged it may press on your stomach and make you feel as if there’s less room for food. To lessen this problem, eat smaller portions of foods at meals, and drink liquids later. Beverages taken with your meals will leave less room for food. Instead of 2 or 3 big meals a day, try 6 small meals spread out over the day. You will eat less food at a time, but you will be eating more often. Some small meal and snack ideas include:
– a bowl of oatmeal and half a banana with milk
– canned peaches and graham crackers with peanut butter
– yogurt and pretzels
– half a turkey sandwich and applesauce
– broiled chicken (skinless) and mashed potatoes
– scrambled eggs and toast with jelly
– chocolate pudding and oatmeal cookies
Make the most of each mouthful. Even if you can’t eat that much food, choose foods that are high in calories and protein. To add to the nutrition of the foods you can eat, add ingredients. For example:
– Add powdered milk to regular milk, milkshakes, even casseroles, soups, eggs, mashed potatoes, hot cereal, and puddings. Use ½ cup of powdered milk to 1 quart of regular milk.
– Spread peanut butter on breads, tortillas, waffles, pancakes, and fruit.
– Add cooked beans or hard boiled eggs to soups, casseroles, and pasta that already contain cheese or meat.
– Melt cheese on sandwiches, hamburgers, vegetables, rice, or noodles.
– Try products such as instant breakfast powders, canned formulas, and special puddings.
Alcohol and your liver
Put simply, beware of booze. You’ll need to stop drinking completely to give your liver a break – a chance to heal, a chance to re-build, a chance for new liver cells to grow. This means avoiding beer, wine, cocktails, champagne, and liquor in any other form. If you continue to drink, your liver will pay the price, and if your doctor is checking your liver function tests, it may be hard for him or her to determine if a change in a test means there has been damage to your liver due to the disease itself or because of the alcohol.
Besides, by adding calories, alcohol may decrease your appetite and cause you to eat less of the protein-rich foods important for healing your liver. For your health’s sake, find other ways besides drinking to cope with any feelings of sadness, anger, or fears about having hepatitis. (See Chapter 9 for a discussion about coping with your feelings.)
When the liver develops cirrhosis, some healthy liver cells are destroyed and replaced by scar tissue. Scarring prevents the liver from carrying out its many tasks. More liver cells are being destroyed than are being replaced. Fortunately, eating well and avoiding alcohol can still prevent additional damage to any remaining healthy liver cells.
Finally, avoid combining alcohol and acetaminophen (an ingredient in some over-the-counter pain relievers, and many drug combinations used for colds). Taken together, they can cause a condition called fulminant hepatitis, which can lead to fatal liver failure. Clearly, you should never combine these two substances, and talk to your doctor about any medications you take.
Eating right is an important way to improve your overall health. Your feelings are another key part. In See Chapter 9, you’ll find out about ways to keep your mind working well, too.
Q U I Z
Q. Why should I stop drinking if my liver is already damaged?
A. Alcohol will damage your liver even further, making it more difficult for your liver to replace the damaged cells. You may end up developing cirrhosis, or even liver failure.
Q. What’s the best dietary advice for cirrhosis?
A. Avoid alcohol, limit salt, and eat lots of protein-rich and high-calorie foods to prevent weight loss.
Q. Red meat tastes bad to me now. Where else can I get protein?
A. Other good protein foods include chicken, fish, beans, eggs, tofu, unsalted nuts, yogurt, and peanut butter.
Q. Will I need a vitamin?
A. Not necessarily, if you eat well. But if you are having eating problems, then you may take a vitamin supplement containing no more than 1 to 2 times the Recommended Dietary Allowances (RDAs). You may want to check with your doctor to see whether you really need vitamins.
– Say no to alcohol.
– Eat small but frequent meals and snacks.
– Sip plenty of fluids throughout the day, for example, water, fruit juices, seltzers, milk, and sports drinks. If you feel sick to your stomach, avoid citrus juices (orange, grapefruit, pineapple).
– Choose foods rich in protein and calories when you do feel like eating.
– If you have cirrhosis, limit your salt and maintain adequate amounts of protein and calories.
– Eat a variety of healthful foods.