Hepatic insufficiency
Liver failure is a morbid condition that compromises the functioning of the liver.
Hepatic insufficiency affects the body's homeostasis and results in some sometimes deadly complications. The danger varies according to type, stage and comorbidities.
Liver failure can be acute or chronic.
The acute has a rapid and possibly reversible development. The chronic one is more often increasing and can develop into carcinoma (liver cancer).
The causes of liver failure are several and different; for example: infectious, pharmacological or toxic, hereditary and autoimmune.
Symptoms, clinical signs and complications vary depending on the specific case (cause, type, severity, etc.).
The therapy is bound to the specific aetiology and also differs according to the complications (portal hypertension, esophageal varices, encephalopathy, ascites, nephropathy, coagulopathies, reduction of the immune system, etc.).
The liver is responsible for the nutritional metabolism (fatty acids, cholesterol, glucose, etc.), the oncotic blood pressure (circulating proteins) and the production of bile. The "diet" factor is of fundamental importance in the treatment of any disease affecting the liver.
Diet
Dietary therapy for liver failure varies substantially based on the form (acute or chronic), severity and related complications.
The key principles governing nutritional support are:
- DO NOT strain the organ
- Constantly supplying all essential nutrients
- Increase the intake of useful or therapeutic molecules.
The nutrition for liver failure is of type:
- Food for chronic forms
- Enteral or parenteral for acute forms.
Parenteral nutrition (drip) tends to be discouraged due to the increased risk of infections.
Don't fatigue the Organ
WARNING! What is mentioned below encompasses all forms of liver failure. Obviously, dietary advice should be contextualized based on the type of nutrition (food, enteral and parenteral), the cause of liver failure and the related complications / comorbidities.
In order not to tire the liver, the liver failure diet should:
- Eliminate all harmful molecules from food:
- Ethyl alcohol and drugs: their metabolism is borne by the liver. They must be totally removed.
- Drugs: paracetamol, acetylsalicylic acid, other NSAIDs, antibiotics and all drugs that can be toxic (especially when not needed).
- Unnecessary supplements: for example, products used for sports or slimming purposes.
- Carbonization toxins: excess residue from cooking: proteins, carbohydrates and fats. These are: polycyclic aromatic hydrocarbons, acrylamide, formaldehyde, acrolein, etc. It is possible to almost totally eliminate the carbonization residues by adopting sweet cooking methods such as: boiling, steaming, bain-marie, pressure cooking, vacuum packing and vasocotting. Avoid: frying, grilling, spit-roasting and grilling.
- Food additives: it is a very broad category. The most problematic ones are sweeteners and colorings. Better to consume natural foods, unprocessed or packaged.
- Fungal toxins: all fungi produce toxins, even normally harmless ones. Eliminating them from the diet (including cheese molds) could be beneficial to the liver.
- Poisons, breeding drugs and pollutants: it is advisable to remove all foods that come from farms or crops in which large doses of these products are used. For the same reason, better to avoid drinking water or eating products collected near polluted areas (roads, railways, industries, etc.).
- Avoid fasting: this condition forces the liver to perform many more processes than normal (especially neoglucogenesis).
- In the case of celiac disease, absolutely avoid any contamination with gluten; this would worsen the general inflammatory state.
- Avoid nutritional excess:
- Proteins: they are chains based on amino acids. The liver processes amino acids for use in various metabolic destinations. Those in excess are transformed into carbohydrates or fatty acids. Some, called aromatics, leave nitrogenous residues (ammonium ions) that the liver should convert into urea; being compromised, the organ does not perform its function correctly and allows the accumulation in the blood creating neurological problems (encephalopathy).
To avoid this problem, it is possible to favor the intake of branched amino acids at the expense of aromatic ones. Obviously, this can only be done using food supplements, formulating the solution for enteral nutrition or the parenteral sac. It is not advisable to go below 60g of protein a day; the sources can be of various kinds and it is recommended to alternate plants and animals (lean meats and fish, legumes associated with cereals, eggs and lean milk derivatives, tofu, etc.). The excess of ammonium ions is also fought with the application of lactulose-based enemas.
- Lipids: to avoid excess cholesterol and fatty acids, especially saturated or hydrogenated. The liver produces bile for the digestion of fats but, by working little, the organ is not able to perform this function (impairing digestion and absorption). Furthermore, the liver produces the lipoproteins that carry cholesterol and other fats in the body; any shortage of these carriers could lead to severe metabolic decompensation.
Sometimes fats tend to accumulate in the liver (steatosis).
It is better to prefer vegetable and natural lipid food sources, such as extra virgin olive oil; avoid margarines and fatty foods of animal origin (butter, lard, lard, fatty sausages, etc.).
- Carbohydrates: the liver is a reserve organ of carbohydrates but, being compromised, it does not store them properly. A part of the absorbed carbohydrates is converted into fatty acids and remains in circulation for a long time; in the end, it accumulates in the adipose tissue or in the liver itself (steatosis).
We recommend low-glycemic, natural, unrefined and high-fiber foods; for example, small portions of whole grains and legumes cooked with little fat.
- Iron and copper: there are inherited diseases that do not allow the disposal of these minerals. In that case, they are themselves the etiological cause of liver failure.
- Sodium and potassium: hepatic failure can cause ascites (accumulation of fluids in the abdominal cavity). This must be treated with diuretics and dietary sodium reduction.
- Water: a condition of hyperhydration can aggravate cerebral edema and ascites. It is customary to use diuretics and laxatives to fight it, making sure that the levels of mineral salts in the circulation do not go down too much.
- Total calories: an excess of calories, whatever the origin, favors hepatic steatosis and forces the liver to increase many processes. It is advisable to eliminate all high-calorie foods, especially junk food.
Provide All Essential Nutrients
Liver failure compromises the digestion, absorption and metabolism of certain substances. Moreover, it also seems to be associated with a state of constant inflammation.
This means that it is desirable to increase:
- Vitamins: all, without exception. Liver failure compromises the vitamin reserves in the organ. Due to coagulopathies (metabolic complication), the nutritional increase of vitamin K is particularly useful.
- Mineral salts: liver failure is often associated with encephalopathy caused by cerebral edema and the accumulation of nitrogen groups. This can worsen with the collapse of sodium and potassium blood levels due to the treatment of ascites. The doctor will determine which complication to give precedence.
It is reasonable to think that the saline values in the blood must be restored and the ascites compensated with a drainage; sodium and potassium are naturally present, especially in fruits and vegetables. Sometimes calcium and phosphorus (present in milk, dairy products and aged cheeses) also fail.
- The contribution of essential fatty acids: they are omega 3 and omega 6. They perform a multitude of functions, including the regulation of the inflammatory state. The deficiency is debilitating. If hepatic failure is associated with poor digestion, long periods of bedding and artificial nutrition, it is necessary to guarantee the additional intake of these essential molecules.
Omega 6 are typical of oilseeds and extraction oils (nuts, pistachios, macadamia, pecans, etc.); omega 3 are typical of fishery products (sardines, tuna, bonito, mackerel, etc.), algae, some oily seeds and extraction oils (flax, kiwi, etc.).
Increase the Introit of Useful Molecules
The molecules useful for liver failure are of various kinds:
- Antioxidants; they fight free radials, counteract inflammation, oppose neoplastic formation and support the immune system:
- Vitamin: vitamin and provitamin A (abundant in animal liver, shellfish, vegetables and red or orange fruits), vitamin C (abundant in citrus fruits, chilli, parsley, lettuce, apples, etc.) and vitamin E (abundant in olives, oil seeds, wheat germ and extraction oils).
- Saline: zinc and selenium (to a different extent, they are abundant in meat, fish and some oily seeds).
- Of a different kind: polyphenols, tannins, chlorophyll, etc. They are present mainly in vegetables, especially in fresh fruit and vegetables.
- Specific molecules: cynarin (contained in artichokes) and silymarin (contained in milk thistle); they exert a beneficial effect on the metabolism of hepatocytes (liver cells).
- Probiotics: it seems that the administration of probiotics ( Lactobacilli, Bifidobacteria and Eubacteria ) improves the general condition of liver failure; the reason is not clear. These are contained in fermented foods such as: yogurt, buttermilk, kefir, tempeh, tofu etc.
