Liver Diseases and Dietary Guidelines

INTRODUCTION

The liver is the largest organ or gland of the body in the body and weighs about four pounds. It is the only organ that has the ability to regenerate itself when part of it is damaged. It plays a vital role, performing many complex functions which are essential for life. One of the most important functions of liver is the secretion of bile which plays an important role in the digestion of fats and assists in the absorption of fat soluble vitamins like A,D, and K. Liver plays a vital role in the synthesis of fatty acids from amino acids and sugars, in the production of lipoproteins, cholesterol, phospholipids and in the oxidation of fat to produce energy. Liver also performs as a detoxifier. It eliminates toxins from the blood, produces immune agents which help to control infections and reduces the toxicity of metabolic substances and wastes, drugs, alcohol and chemical residues. Foods, nutrition and the liver work in tandem. What we eat is detoxified by the liver and for this reason it is better to eat healthy foods that gives less strain to the liver. 85-90% of the blood that leaves the stomach and intestines carries important nutrients to the liver where they are converted into substances the body can use.  As mentioned earlier good nutrition and a balanced diet with sufficient intake of calories, proteins, fats, vitamins and minerals along with fiber is what the liver needs to regenerate its damaged cells. Therefore nutrition becomes an important part of treatment for any type of liver disease.

DIFFERENT LIVER DISEASES:

1) Fatty liver
Fatty liver is not always caused by excessive fat consumption and is merely a pathological term for fatty infiltration of the liver. This is mainly due to obesity, protein malnutrition, starvation and bypass surgeries done for obesity. If this condition is due to poor nutrition, treatment is easy and simple and can be done with a well balanced diet.  Obesity is one of the main causes of this condition. Gradual weight management will reduce the enlargement of the liver. Diet should consist of plenty of fruits and vegetables, reduced fat intake and reduced or no alcohol for quick recovery.             

2) Acute viral hepatitis
Hepatitis is wide spread inflammation of the liver. People with acute viral hepatitis who are relatively well should try to eat a normal diet. People with acute hepatitis can be treated with a high calorie and protein diet for improvement.

3) Chronic hepatitis
Generally, people with chronic hepatitis (lasting longer than six months) can eat a normal well balanced diet and do not need to change their food intake. But care must be taken to reduce fat intake.

4) Primary biliary cirrhosis
Many people with primary biliary cirrhosis (PBC) do not need to change their diet. Some have difficulty tolerating fatty good such as chips, full fat milk and cheese and can develop a condition called Steatorrhea. This is characterized by pale bulky stools and  nausea and stomach cramps. For treatment it is required to reduce the fat in the diet by avoiding butter, margarine, full cream milk, cheeses, fatty meats like red meat, organ meat, sausages, fried snacks, biscuits, cakes, pastries and processed foods. It is advisable to adopt cooking methods like steaming, grilling, boiling or baking instead of frying. Use of fresh herbs, lemon juice and spices are recommended to make the food more palatable.  


5) Cirrhosis
Cirrhosis is the medical term to describe excessive development of scar tissue (fibrosis) within a liver, irrespective of the underlying cause. Usually, when the liver is acutely damaged, some of the liver cells die and the organ then regenerates itself without scarring. But in this condition the liver is incapable of functioning normally due to the presence of scar tissues. Cirrhosis of the liver is a degenerative disease where in the liver cells get damaged and cannot repair themselves. People with cirrhosis generally need more protein and energy and should eat a well balanced diet.

Causes of Cirrhosis:

• Excessive alcohol consumption is a major cause of cirrhosis. The amount of alcohol needed to damage the liver differs from person to person. Alcohol interferes with the normal metabolism of carbohydrates, fats and proteins.
• Viral Hepatitis is also a cause though less frequent. Hepatitis B and D are the most common cause of cirrhosis.
• Prolonged use of drugs and its reactions, infections, exposure to environmental toxins, malnutrition can also lead to cirrhosis.
• Bile duct getting blocked or inflamed can lead to the accumulation of bile and consequent damage to the liver.
• Poor nutrition and malnutrition especially among the poorer sections of the society.
• Symptoms are as follows.
• Fatigue
• Loss of appetite.
• Fever and upset stomach
• Exhaustion and weakness.
• Weight loss. As the disease progresses complications like jaundice, edema, ascites, bruising and bleeding, anemia, and build up of toxins in the brain and blood are common features. These can cause personality changes, coma and sometimes death. Many people with cirrhosis do not experience complications and therefore do not feel they need to follow a special diet.
  A dietician should be consulted to tell you what foods to eat and to guide you with recipes and menus that can suit your individual needs.

Treatment and Dietary recommendations for Cirrhosis:

• Quick and prompt treatment can reduce complications and delay worsening of the condition. Consult your doctor to identify the cause and then begin the treatment and to include remedies for complications like edema, ascites and itching caused by bile products that get deposited in the skin. A well planned diet is of utmost importance in the prevention and treatment of most hepatic disorders.
• A high protein diet especially of vegetable sources is beneficial in treatment. Green and fresh vegetable juices made of beet, carrot, spinach and cucumber, etc have been found beneficial in the treatment of cirrhosis and other liver disorders. Fresh fruits and fruit juices should be included daily.
• Have a well balanced diet with whole grains, vegetables, fruits, nuts and seeds.
• Avoid fats and oils for some weeks. Also eliminate canned and processed foods, strong tea, coffee, alcohol, full cream milk, animal fat, white flour, and sodium rich foods.
• Read labels carefully to understand the contents of the packaged food. Avoid  use  of butter, margarine, fried foods or snacks, cheeses, as these foods damage the liver fast.
• Use freshly ground black pepper, lemon juice, onion, spring onions, garlic, ginger, herbs, mustard powder for flavorings in place of oil, butter and strong spices.
• A healthy and clean colon or intestinal tract is important in the treatment of cirrhosis to prevent toxin accumulation. Easily digested foods, fiber, warm water with lemon, aloe-vera juice are useful recommendations as these foods also help in detoxifying the liver.


• Gallstones
  
  Gallstones are lumps of solid material that form in the gallbladder. They look like small stones, sometimes fine as sand or sometimes resembling large pebbles. Sometimes it is the cholesterol that crystallizes and combines with the bile to form gall stones. The gallbladder is a tiny organ located directly under the liver. The gall bladder contains the bile that the body uses to digest the fats. It also helps the body to absorb the fat soluble vitamins A, D, E and K. Approximately 1 in 20 people may develop gallstones. Often a patient with gall stones will show no sign or symptom. When the bile passage is blocked with the stone, symptoms like nausea, severe pain in the upper right abdominal area and vomiting is seen.

Treatment and Dietary recommendations for Gallstones:
Over eating should be avoided. Obesity and gall bladder diseases often go hand in hand. A detoxification diet for the liver is also helpful for proper gall bladder function. Include plenty of raw foods, vegetables and avoid sugar, fatty foods, animal fat, spicy foods, soft drinks, margarine and refined carbohydrates. Use I to 2 tablespoons of olive oil in lemon juice before going to sleep. This helps to flush out the stones in the stools as well. Drink plenty of water and other liquids like coconut water, lemon juice or grape fruit juice. Fresh vegetable juices also will help cleanse the liver.

GUIDELINES FOR A HEALTHY LIVER

Food recommendations

• Eat plenty of fresh fruits and lightly cooked vegetables especially dark green, leafy vegetables and orange, yellow, purple, and red colored fruits and vegetables—they contain living enzymes, fiber, vitamin C, natural antibiotic substances, and anti-cancer phyto-nutrients.
• Asparagus, watermelon, broccoli are good sources of glutathione while papayas and avocados are foods that help the body to produce glutathione.
• Raw juice of lemon, papaya, grapes, grape fruit, carrot, tomato, beet and cucumber is also helpful for liver ailments.
• Bitter foods like dandelion greens, mustard greens, bitter melon, Romaine lettuce and broccoli can help in cleansing the liver.
• Herbs like dill, caraway seeds, garlic, onions, turmeric and cayenne are easy to use in cooking and can help protect the liver.
• Green tea has immune-boosting properties and contains less caffeine than coffee.
  Drink lots of water (6–12 cups per day) because it helps the kidneys to get rid of the toxins that the liver has broken down.
• Omega-3 fats are very helpful. These fats are found in cold water fish such as salmon, tuna, mackerel, sardines and halibut. Other good sources are ground flaxseeds, flaxseed oil and walnuts.
• Nuts, seeds, and avocados are good food sources of polyunsaturated fats and monounsaturated fats that are less harmful to the liver than saturated fats.

Food to avoid

• Saturated fats are harder for the liver to process. Limit high fat meats like sausage, bacon, salami, hot dogs and high fat dairy products like whole milk, ice cream and cheese, which contain saturated fats.
• Other foods to limit that have a lot of saturated fat are French fries and high fat snack foods like potato chips and cookies.
• Limit processed foods like white bread, white rice, cakes, cookies, donuts and candy. Add whole grains like whole grain breads and cereals, brown rice, quinoa and barley to your diet.
• Limit caffeine to 2-3 cups/day. Caffeine is broken down by the liver and may make it more difficult to cleanse the liver. Coffee, tea and most sodas contain a lot of caffeine.
• Eat light meals more frequently. Eating a light evening meal can help to reduce the liver’s work during the healing hours of sleep.
• Avoid alcohol. Alcohol is known to be a powerful toxin that will damage the liver.
• Recreational drugs can also be stressful to the liver.
• Limit, as much as possible, chemicals such as food colorings, flavorings and preservatives as well as toxins such as insecticides and pesticides because these substances make the liver work harder.

Yoga asanas good for liver:

• Fish (Matsya Asana)
• Shoulder Stand (Sarvang Asana)
• Hidden Lotus (Baddhapadmasana)

SUMMARY
With all of the above suggestions, the best strategy is to begin by including a warm breakfast with some of the above grains and steamed foods. If making a 100% change in your diet is intimidating to you, begin by shifting your breakfast patterns and eat your normal diet throughout the rest of the day. This will begin a new rhythm which will set the stage for a more gentle transition. Do not try too hard to make the change right away just to "fall back" to your old diet in a week or two. Set reasonable goals and always think first about adding foods in, instead of taking food out. Then, hopefully over time, the bad habits will slowly fall away.