After explaining the role of nutrition as a possible cause of various types of hepatitis, let's try to understand what are the goals of a diet aimed at treating liver problems.
Strange as it may seem, in many cases it is NOT possible to pursue all the aforementioned objectives simultaneously; a choice between the various possibilities is therefore necessary. This decision (ALWAYS and ONLY AT THE DISCRETION of the CURANT SPECIALIZED DOCTOR) should be carried out according to some primary factors, which are: severity of the hepatitis, organ function and insufficiency, other comorbidities, prognosis and subjective characteristics of the patient etc. In definitive, there is NO ONE diet for hepatitis, since this must be established based on the situation; it is therefore not a coincidence that various diets for hepatitis may even be almost diametrically opposed to each other. Furthermore, as far as they are potentially (but not necessarily!) Correlated, it is necessary to specify that "hepatitis" is: HEPATICAL INSUFFICIENCY, HEPATIC FIBROSIS, HEPATIC CIRROSIS or HEPATIC CARCINOMA are NOT synonymous! It is indeed possible that severe acute hepatitis causes transient but treatable liver failure, or that chronic hepatitis does not induce liver failure but tends to evolve slowly into fibrosis and then into cirrhosis; still, it is possible that from a steatohepatite it passes quickly to a mild but stable cirrhotic state. In short, the possibilities are really many!
However, among all this dutiful variability, there are some UNIQUE shareable rules, which are:
- ABOLITION of ALCOL
- ABOLITION OF DRUGS and food SUPPLEMENTS NOT NECESSARY
- ABOLITION / REDUCTION to the minimum terms of OTHER NERVINI (coffee, tea, chocolate ...) and SALT (and, if desired, also SUGAR) ADDED
- ABOLITION OF BRUSHED FOODS or in any case FATS or in any case rich in REFINED SUGARS
- REGULARIZATION of meals and NUTRITIONAL EQUILIBRIUM TREND (FORBIDDEN both the FAST and the EXCESS CALORIC, especially if over 10% of the NORMO-caloric).
WARNING! The article refers to the DIET understood as FOOD nutrition for hepatitis, therefore excludes ENTERAL and PARENTERAL nutrition! Obviously, in the case of severe hepatitis (or at least in the midst of acute symptoms), parenteral use is more common; however, during long periods of artificial feeding, the use of the enteral one is always more indicated, which guarantees the maintenance of the functionality of the various digestive organs.
First, we will analyze the diet for alcoholic and / or dietary steatohepatitis; then, the hepatitis diet will be described WITHOUT serious impairment of liver function. Finally, basic nutritional principles for liver degeneration and the complications associated with it (ascites, encephalopathy, portal hypertension, bleeding etc.) will be mentioned.
Diet for Alcoholic and / or Food SteatoEpatite - Diet for Fatty Liver
Steatohepatitis is the most widespread liver disorder in populations of industrialized countries.
The diet for this hepatitis (which can be acute or chronic depending on the case) is, to tell the truth, very simple. First of all, it is FUNDAMENTAL to remove the etiological origin of steatosis, that is the abuse of alcohol on the one hand and food abuse on the other (possibly, both!). Then, being a condition frequently linked to overweight / obesity, the diet should be associated with a program of physical activity and acquire a certain slimming effect; ultimately, the diet for fatty steatosis is often a low-calorie diet that removes 30% of the total energy needed to maintain normal weight.
The nutritional organization is quite rigid, especially with regard to the absence of alcohol, sweet foods and junk foods. The abolition of added sucrose (and of the foods that contain it), and of table salt (and of the foods that include it) is required. The main lipid source is extra virgin olive oil, the protein source is mixed, therefore composed of animal and vegetable foods, while simple sugars are ONLY contained in raw vegetables and dairy products (fruit, vegetables, semi-skimmed milk and natural yogurt). All cereals are whole and possibly whole (not in the form of flours and derivatives); these must however be alternated with legumes, obtaining a ratio of cereals to legumes of 2: 1 or even 1: 1. The vegetables, to be eaten raw and cooked alternately, are in season and in portions that range between 100 and 200g both at lunch and at dinner. Fruit and yoghurt alternately structure secondary meals.
The breakdown into energy nutrients is balanced, ie: about 1g / kg of DESIRABLE DESPENSIVE protein, 25% of lipids with the largest possible quantity of unsaturated (ratio omega3 / omega6 1: 4 - omega 9 in abundance), and the rest energy in totally complex carbohydrates, with the exception of fructose and lactose in food. Respecting individual susceptibility, the fiber must reach 30g / day and both mineral salts and vitamins must comply with the right recommended rations. Meals must be at least 5 and with the same calorie breakdown as a balanced diet: 15% for breakfast, 5-10% for the two snacks, 35-40% for lunch and 30-35% for dinner.
In restoring liver integrity, all plant molecules with a phyto-therapeutic action (thus antioxidant, cholesterol-lowering, hepatoprotective, etc.) play a very important role; among these: vegetable lecithins, phytosterols, phenolic substances etc. In particular, the phenolic substances must be abundant, perhaps with a good content of cynarin (or a polyphenol contained in artichokes) and silymarin (a phenolic complex abundantly contained in milk thistle). Also the intake of provitamin A, vit. C and vit. And it promotes the improvement of the liver condition (especially C).
In the case of alcoholic steatosis, since alcoholism causes intestinal malabsorption and the reduction of vitamin stocks (if present!), The subject could significantly benefit from generic dietary supplementation and especially thiamine (vit. B1).
Hepatitis Diet Without Serious Impairments of Liver Functionality
After the previous one, the hepatitis diet without serious compromises is certainly the most used. It includes all forms of acute or low-level acute or infectious hepatitis of an infectious / parasitic nature. It has an enormous application in the treatment of chronic HBV virus hepatitis (which affects about 350, 000, 000 people in the world) and has many aspects in common with that already described.
Compared to the diet for dietary or alcoholic fat steatohepatitis, this does not require to "empty" the liver cells from excess fats and glycogen. It goes without saying that, although desirable, motor activity takes a back seat or is totally abolished in acute forms and, except for the presence of other comorbidities, the same is true for slimming capacity.
On the other hand, some precautions already mentioned such as the abolition of alcohol, unnecessary drugs and supplements, and the absolute moderation of other nerves, salt, sugar and junk foods are much more important. Furthermore, in spite of what one might believe, it is essential to AVOID fasting or excessive calorie reduction, as well as over-feeding and excessive energy.
The liver is the organ responsible for many metabolic functions, including gluconeogenesis, lipogenesis and proteosynthesis; but also to the production of digestive bile. By virtue of the fact that, in the case of hepatitis, it is necessary to reduce as much as possible the "workload" of the organ (for blood homeostasis and for digestion), the diet must necessarily be NORMALcalorica. Fasting or an inadequate diet REQUIRE a greater liver commitment than normal, as the organ must produce glucose (essential for the central nervous system) starting from glycerol and circulating amino acids. Furthermore, we recall that prolonged IPO (and above all carbohydrate depletion) determines the accumulation of ketone bodies, potentially TOXIC molecules for all tissues. Not least, an insufficient diet does NOT allow the supply of essential amino acids in sufficient quantities for protein synthesis; the liver, already less efficient because it is sick, if it is not supplied with these substrates, it is difficult to produce all the plasma protein molecules. On the other hand, an excess energy leads to other drawbacks; first of all, hepatocytes must increase bile production by emulsifying fats in digestion. Secondly, excess dietary amino acids and glucides require conversion to fatty acids by the liver; here again, we are witnessing an increase in the total work of the organ (without considering the possible tendency to fatty steatosis).
It is then necessary to make a final clarification on the relevance or otherwise of other molecules in the diet. In my opinion, in the nutritional regime for hepatitis, it is also strongly advisable to significantly limit the concentration of certain additives (especially sweeteners and preservatives). We reiterate for the umpteenth time that the liver is responsible for the metabolization of most of the nutritional and circulating molecules in the blood, which is why it is conceivable that the surplus of these synthetic products requires more effort on the part of the organ.
Finally, I dwell on a generally unknown but far from negligible detail, namely the use of fructose as a sweetener. It must be clear that I do not speak of the fructose NATURALLY present in foods (fruit and vegetables), but of the granular one. This, which is not well oxidizable by human cells, must necessarily be converted by the liver into glucose. While the one naturally introduced with raw food reaches percentages ranging from 10 to 16% of total calories, using sweetened foods, sweetening beverages and granular fructose to season, this value can even double.
The breakdown of macronutrients is the same as in the previous diet, as is the energy breakdown of meals. Once again, good amounts of antioxidants and dietary supplementation with vitamins can be of great help.
Notes on the Nutritional Requirements of Hepatic Insufficiency
Hepatic failure may be mild, moderate or severe, and also present (in combination with hepatitis) in acute or chronic form. It is necessary to take into account, first of all, that liver failure is characterized by a reduction in organ functions.
In mild forms, frequently supported by traditional nutrition and not by artificial nutrition, it is advisable to use easily digestible meals, with moderate portions, but without neglecting the overall nutritional intake.
On the other hand, starting from the moderate form and to conclude with the severe one (often subject to enteral or parenteral nutrition) the following precautions are required:
- Exclusion of salt from the diet, to reduce the tendency to edema and ascites
- Moderation of the MA protein quota with a supplement of branched amino acids, since they do not require hepatic metabolism before cellular oxidation and have a very low level of nitrogenous waste (in turn responsible for the onset of hepatic encephalopathy). It is not possible to reduce the intake of amino acids too much since the liver proteosynthesis would be further altered; the consequent reduction of plasma proteins would determine: the collapse of the oncotic pressure with tendency to edema and ascites, and lower coagulation capacity with risk of bleeding
- Some authors suggest structuring a diet that is richer in energy than normal, ie a HYPER-caloric. Personally I do not context the choice but it is certainly necessary that these extra calories are made mainly from glucose.
