Liver Disease/Hepatic Encephalopathy
what is Liver Disease / Hepatic Encephalopathy?
The liver is a multi-functional organ that produces blood proteins, stores and delivers nutrients to the bloodstream, breaks down fats into cholesterol, manufactures bile that helps to digest food, and assists with sugar storage. Liver Disease is most commonly caused by the Hepatitis B or Hepatitis C virus, fatty liver due to alcohol consumption or obesity, cirrhoses, bile duct disease, hemochromatosis, or Wilson’s disease. Hepatitis B and Hepatitis C viruses are contracted via contact with infected blood, semen, or vaginal secretions. Cirrhoses, where healthy liver tissue is replaced with hardened scar tissue, is most commonly caused by Hepatitis C viral infection, alcohol abuse, or fatty liver disease. Bile duct disease occurs when bile is blocked from moving from the liver to the small intestines. Hemochromatosis occurs when excess iron is deposited in the liver and Wilson’s disease is when there is abnormal storage of copper in the liver.
Depending on the stage of your liver disease you may need to increase your protein intake, and limit your sodium and fluid intake to minimize fluid retention. Speak with the care team providing treatment for your liver condition to determine the specific dietary requirements for your condition.
Patients with Fatty Liver Disease should follow a low fat, low calorie diet.
Patients with Bile Duct Disease should use oil substitutes or canola, olive, corn, sunflower, peanut or flax seed oils because these need less bile to be digested.
Patients with advanced liver disease or Cirrhosis as well as patients with alcoholic hepatitis commonly have malnutrition and loss of muscle mass. These patients require a diet where protein intake is managed carefully. Most liver disease patients require a high protein diet with a caloric intake of between 2,000-3,000 calories per day. Carbohydrates should be the primary source of calories. Patients with cirrhosis must also stop drinking alcohol or limit consumption to one drink and must also reduce their sodium intake to minimize fluid retention. The use of supplementary enteral nutrition, preferably via oral supplements, when patients cannot meet their caloric requirements with normal food, are encouraged. In general, guidelines from the Nutrition Societies recommend a caloric intake of 35 to 40 kcal/kg/day and protein intake of 1.2 to 1.5 g/kg/day in these patients. Avoid consuming raw seafood.
Some patients, such as those with Hepatic Encephalopathy (a temporary worsening of brain function in people with advanced liver disease), have a protein intolerance and must follow a low protein diet. In this instance, the liver is damaged and can no longer remove the toxic substances resulting from protein metabolism from the patient’s blood. These toxins build up and can travel through the body until they reach the brain, causing mental and physical symptoms.
Patients with Hemochromatosis, or hereditary iron overload, and patients with Hepatitis C should avoid foods and supplements that are high in iron and should not use iron pots or pans for cooking. Agents that increase absorption of iron such as vitamin C should be avoided as well. High concentration of iron increases the risk of growth of certain bacteria that can be found in uncooked seafood. Therefore, patients with Hemochromatosis are advised to avoid consuming uncooked seafood. Some patients with Hemochromatosis should maintain a low protein diet to avoid the buildup of toxins in the liver.
Patients with Wilson’s Disease must avoid foods that are high in copper, such as chocolate, nuts, and shellfish.