Nutrition in liver diseases

Liver is the seat of metabolism in the body. Whatever food we eat, after digestion passes through liver. 85-90% of the blood that leaves the stomach and intestines carries important nutrients to the liver where the proteins are processed and broken down into amino acids, carbohydrates into glucose and fats into amino acids.

Liver diseases such as hepatitis and cirrhosis may change the way our body uses nutrients from food.

Most of the patients of cirrhosis of liver (replacement of damaged liver cells by fibrous scar tissue) are severely malnourished and require a high calorie and high protein diet. A diet containing approximately 2,000 Kcal which can be provided by 20-25 gms fat, 80-90 gms proteins and 400 gms carbohydrate is suitable.

Too much protein will result in an increased amount of ammonia in the blood; too little protein can reduce healing of the liver. Amount of protein to be given to the patient depends on the liver's ability to metabolise.

Diet tips for liver diseases:

- A healthy liver makes glycogen from carbohydrate. The glycogen is then broken down when the body needs energy. A damaged liver cannot do this. Without glycogen, more carbohydrate is needed from the diet to make sure the body has enough energy.

- A moderate amount of fat is needed. Fat provides calories, essential fatty acids, and fat-soluble vitamins.

- Liver damage can cause high blood pressure in the major vein of the liver. This can result in ascites. Limiting sodium can help prevent this.

- Extra amount of certain vitamins and minerals are needed. A damaged liver has problems storing many vitamins and minerals.

- Foods that contain vitamins C and E are important as antioxidants to protect and treat a damaged liver.

- Methionine and cysteine (egg yolks, red peppers, garlic, onions, broccoli, brussels sprouts, sesame seeds, whole grains and beans) are sulfur-containing proteins that are known to protect the liver and aid in converting fat-soluble toxins to water-soluble substances that can be eliminated through the urine.

- Choline (Soybeans, egg yolks, nutritional yeast, fish, peanuts, cauliflower, lettuce, cabbage, lentils, chick peas and brown rice) is needed to metabolise fats in the body.

- Vitamin B-complex is very important for liver as well.

- Coconut water is excellent in liver cirrhosis.

- Bitter tasting vegetables — all gourds, long gourd, bottle gourd, round gourds, bitter gourds and turnips, radish, carrots, and potatoes — are good in liver failure.

- Junk food, drugs, chemicals, preservatives, alcohol, soda, soft drinks should be avoided at all cost.

- Small meals served separately will be better tolerated than three large meals.

- Drinking water is very important if there is no water retention.

- Avoid sour fruits at all cost. Lemons, oranges are not recommended at all.

The writer is the Chief Nutritionist at United Hospital Limited, Dhaka. E-mail: chowdhury.hasin@uhlbd.com