for Veterans and the Public
Diet and Nutrition: Entire Lesson
Everything you eat and drink passes through your liver. Your liver changes food into stored energy and chemicals necessary for life. Your liver makes nutrients available so your body can use them to build cells, give you energy, and maintain normal body functions.
How diet affects the liver
A bad diet sometimes can lead to liver problems. If your diet provides too many calories, you will gain weight. Being overweight is linked to the buildup of fat in the liver, called "fatty liver." Over many years, having a fatty liver when you already have hepatitis C will make it more likely to develop cirrhosis. Being overweight and having a fatty liver also have been shown to make it less likely that hepatitis C will successfully be cleared with interferon and ribavirin.
One's diet also can contain toxins that are harmful to the liver. Some toxins act quickly. Eating certain poisonous mushrooms, for example, can cause liver failure and death within days. Other toxins, such as alcohol, damage the liver over time.
A good diet, by contrast, can actually improve liver health in a person with hepatitis C. A balanced diet can lead to better liver functioning and lowered risk of cirrhosis (scarring) of the liver. It also can help the immune system stay strong and fight off illness.
Finally, people infected with hepatitis C have higher rates of diabetes than those who are not infected, but a good diet can help reduce body fat and control blood sugar. This lowers diabetes risk.
Even though following a generally healthy diet and keeping a normal body weight (measured as Body Mass Index, or BMI) may not seem like a specific treatment for hepatitis C, it is a great way of protecting your liver against hepatitis C. With a normal BMI and good diet and exercise, you are helping reduce inflammation in the liver and slow down the progression to cirrhosis from hepatitis C than if you are overweight, have diabetes, have high cholesterol and have fatty liver.
How hepatitis C affects diet
If you have hepatitis, you usually don't need a special diet. Just trying to eat healthy and not being overweight and avoid alcohol is all that is needed.
There are special cases, however, when hepatitis C can affect the diet:
- Patients with cirrhosis
As liver disease progresses, patients may lose their appetite and become so tired they have a hard time eating. They may become very thin and poorly nourished and be less able to fight off disease. They may need to limit salt in their diet to prevent their body from putting fluid into their legs and abdomen.
- Other medical conditions and diet
People who have other medical conditions may need other specific changes in their diet. Conditions that warrant specific dietary restrictions include high blood pressure, heart disease, diabetes mellitus, high cholesterol, celiac sprue or chronic kidney disease.
People with hepatitis C don't need to follow a special "hepatitis C diet." The advice that an average, healthy person gets will work just as well for people with hepatitis C, unless those people also have cirrhosis or another condition, such as diabetes, HIV, or kidney disease.
General dietary advice:
- Eat regular, balanced meals
- Maintain healthy calorie intake
- Eat whole-grain cereals, breads, and grains
- Eat lots of fruits and vegetables
- Get adequate protein
- Go easy on fatty, salty, and sugary foods
- Drink enough fluids
- Reach and maintain a healthy weight
- Avoid alcohol
- Be careful with dietary supplements
Eat regular, balanced meals
Eating regularly means eating at least 3 meals a day. One way to keep your energy level up is to eat small meals or snacks at least every 3 to 4 hours.
If you are currently on hepatitis C treatment, eating often also can help prevent nausea, which is sometimes a side effect of the medicine.
Balanced meals include a variety of foods from all 4 food groups:
- Whole-grain breads, cereals, and grains
- Vegetables and fruits
- Dairy products
- Meats, fish, dried beans, soy, nuts, and eggs
Each of these food groups gives you important nutrients.
Eat plenty of cereals, breads, and grains
Cereals, breads, pasta, tortillas, and grits are full of B vitamins and minerals.
Try to buy at least half of your grains as "whole grains." Whole grains include the bran and the germ of the grain and provide lots of fiber (to keep you "regular"). "Refined grains," such as white bread and white rice, have the bran and germ removed. Whole wheat bread slices provide at least twice the amount of fiber, zinc, vitamin B6, and magnesium as white bread.
You cannot tell by a food's color if it is whole grain or not. Bread can be brown because of molasses or other added ingredients. Foods labeled with the words "multi-grain," "stone-ground," "100% wheat," "cracked wheat," "seven-grain," or "bran" usually are not whole-grain products. Read the ingredient list to see if it is a whole grain.
Choose foods that name one of the following whole-grain ingredients first on the label's ingredient list:
- brown rice
- graham flour
- whole oats
- whole rye
- whole wheat
- wild rice
- whole-grain corn
Eat lots of fruits and vegetables
Fruits and vegetables are important sources of many nutrients, including potassium, fiber, vitamin C, beta-carotene (a form of vitamin A), and folic acid. Some of these substances are antioxidants that can fight cell damage. As a bonus, most fruits and vegetables are naturally low in fat, sodium, and calories.
Eat at least 5 servings of fruits and vegetables a day.
Fresh, frozen, or canned fruits are all good choices. If you buy canned vegetables, buy the ones with "no added salt."
Buy fresh fruits and vegetables in season when they may be less expensive and at their peak flavor.
Buy vegetables that are easy to prepare. Pick up prewashed bags of salad greens and add baby carrots or cherry tomatoes for a salad in minutes. Buy packages of baby carrots or celery sticks for quick snacks.
Get enough protein
Protein is needed to fight infection and to heal damaged liver cells. Protein helps rebuild and maintain muscle mass and it aids in healing and repair of body tissues.
Good protein sources can be divided into 2 groups:
Besides providing protein, dairy products are the richest source of calcium and one of the few sources in the diet of vitamin D. Dairy products include milk, cheese, yogurt, ice cream, and puddings made with milk.
Choose dairy products that are low-fat or fat-free. Go easy on dairy products that have lots of fat and little calcium, such as cream cheese, cream, and butter.
Meats, fish, dried beans, soy, nuts, and eggs
This group of foods provides protein, as well as B vitamins, vitamin E, iron, zinc, and magnesium.
Choose lean meats. Boil, bake, or stir-fry them instead of frying.
Caution about iron
Some people with hepatitis C have above-average iron levels in their body. If you have too much iron, your doctor may ask you to eat fewer iron-rich foods, such as red meats, liver, and iron-fortified cereals. You also should avoid cooking with iron-coated cookware because the iron from the pots gets absorbed into food.
Go easy on fatty, salty, and sugary foods
Fats and oils are used to store energy in the body, protect body tissues, and transport vitamins through the blood. Some fats are better for you than others.
"Good" fats can be found in nuts and seeds, flax seed, olive oil, and fish oils.
"Bad" fats are found mostly in animal sources such as meat and poultry, whole or reduced-fat milk, and butter. They also are present as "trans" fats in fried foods, fast foods, and some processed products, such as cookies and crackers.
All fats, whether good or bad, contain calories and can add unwanted pounds if you eat too much.
If you are like most people in the United States, you already eat too much sodium (salt). Most salt in the diet comes from processed foods, such as crackers, chips, and canned soups.
If you need a lower sodium diet, you will need to read food labels to know which foods are the best choices. Learn how to read a food label.
Sugar goes by many names: sucrose, corn syrup, honey, maple syrup, and fructose. Sugary foods tend to offer little more than calories. Many of them (such as pastries and desserts) tend to be high in fat, too.
There is nothing wrong with having sugary foods now and then. But if you fill up on sweets, you won't have room for foods that are better for your health.
Drink plenty of fluids
Drink at least 6 to 8 glasses of fluid a day.
You don't have to limit yourself to water. Milk, juice, herbal teas, soup, pudding, and frozen fruit bars all count as fluids, too. If you have a fever, or have experienced vomiting or diarrhea, you will need extra fluids.
Reach and stay at a healthy weight
Weighing either too much or too little can allow hepatitis C to progress more quickly in your body.
But what is a healthy weight?
The Body Mass Index (BMI) Table is a tool that can help you decide. You can find your BMI by using a BMI calculator, like this one from the National Heart, Lung, and Blood Institute. Type in your height and weight, and your BMI will appear in the figure's heart.
If your BMI is under 20 or over 30, ask your health care provider to refer you to a dietitian, who can create a diet to help you reach a healthier weight. (Note: If you work out and have lots of muscle, your BMI may indicate that you are overweight, even if you aren't.)
If you are overweight
If the recommended BMI seems too difficult to reach, aim for a slow loss of 10 percent of your current weight. (For example, if your current weight is 200 pounds, try to lose 20 pounds.) Just losing that much weight can help with some of the problems linked to having too much fat.
Risks from being overweight
Overweight people sometimes develop fatty deposits in the liver (called "fatty liver") and have abnormal liver test results. Fatty liver can cause long-term problems in people who have chronic hepatitis C. Being overweight also can make your hepatitis C treatment less effective.
Being too fat also can put you at higher risk for diabetes, heart disease, high blood pressure, and some cancers.
But people who lose weight slowly can reverse these changes. Keeping off extra weight can improve your liver enzymes and fibrosis, even though the hepatitis C virus is still in your body.
Avoid fad diets, because losing weight too fast can put strain on the liver.
Importance of exercise
Exercise is important, and not just because it helps to keep your weight down. Exercise can improve your appetite, relieve some of the side effects of hepatitis C medications if you are taking them, boost your immune system, and improve your sense of well-being.
Try to have 10-minute blocks of exercise throughout the day. Low-impact exercises such as walking or swimming are the best. For example, start with a 10-minute walk. Participate at a comfortable level, take rest breaks, and increase your activity level slowly (15 to 30 minutes, 3 to 5 days a week).
Remember that patients with cirrhosis can put on "fluid weight." This is different from "fat weight," which is what most of us put on. Fluid weight is managed in a different way. Talk to your health care provider if you have cirrhosis or are retaining fluid in your legs or abdomen.
Remember, if you are overweight, it is important that you begin an exercise routine and start eating a healthy, well-balanced diet. Always talk to your doctor before starting a diet and exercise program.
If you are underweight
Before trying to gain weight, talk to your health care provider. You may need to be referred to a dietitian for special diet counseling.
Alcohol is a strong toxin to the liver, even in people without hepatitis C. Drinking too much can lead to cirrhosis of the liver, advanced liver disease, or even liver cancer.
The risk of these problems is much higher for people with hepatitis C. Hepatitis C damages the liver, weakening the liver's natural function of breaking down alcohol and removing its toxins.
At present, there is no evidence for a safe level of alcohol for people with hepatitis C. The best advice is to avoid alcohol completely. This may be the hardest thing for you to do.
Be careful with dietary supplements
Vitamin and mineral supplements
The best way to get vitamins and minerals is through food. Food provides the greatest range of nutrients. However, a multivitamin/mineral supplement can be helpful, especially if you lose your appetite or can't eat a healthy diet. Folate is particularly important vitamin and is not obtained easily from food but is found in multivitamins.
Before taking any supplement, talk to a doctor or dietitian. If you take supplements, don't exceed the recommended doses. Some supplements in high amounts can be dangerous, particularly fat-soluble vitamins, such as A, D, E, and K. Here are some special concerns:
Iron and Vitamin C
Some people with hepatitis C, particularly those with cirrhosis, have above-average levels of iron in their body. Too much iron can damage organs. If these people take multivitamin/mineral pills, they should take the ones without iron. These pills usually are marketed as formulas for men or adults over 50. These people also should avoid taking large doses of vitamin C because vitamin C helps the body absorb iron.
You do not want to take iron supplements if you have hepatitis C, unless you are specifically told to take iron by your provider.
Vitamin A, if taken in doses larger than the recommended 10,000 IU, can harm the liver. Vitamin A is even more toxic in someone who drinks alcohol.
You won't get too much vitamin A from food, but be careful taking routine dietary supplements with high doses. There's a non-toxic form of vitamin A, present in many fruits and vegetables, called beta-carotene. If you take vitamin A supplements, look for those with beta-carotene.
Vitamin D is important for health in normal amounts (such as diets with plenty of milk). The body also can make vitamin D when exposed to sunlight. Taking supplements of 800 IU of vitamin D daily may help people with poor diets or long winter seasons, or those who are housebound.
Vitamin E supplements do not have benefits, though it used to be believed that Vitamin E prevented heart disease. High doses (greater than 400 IU/day) can have be dangerous.
Vitamin K is involved in blood clotting. It is present in the diet mostly in green vegetables. It also is produced by bacteria in the intestines. Vitamin K supplements generally are not taken, nor are they recommended.
Just because something is "natural" doesn't mean it is harmless. Certain herbs, including Kava-Kava and pennyroyal, can cause liver damage. For a more extensive list of herbal cautions, see Alternative or Complementary Approaches.
Always talk to your doctor before taking megavitamin therapy, herbal products, or any other dietary supplement. Remember, your first concern should be safety.
Eating tips for people with cirrhosis
If you have cirrhosis, ask your health care provider for a referral to a registered dietitian, who can create a diet specific to your needs. Cirrhosis can lead to other problems:
- Ascites (fluid buildup in the abdomen)
- Hepatic encephalopathy (mental confusion)
Cirrhosis refers to the replacement of damaged liver cells by scar tissue. Too much scarring prevents blood flow through the liver. This causes even more damage and loss of liver function. Cirrhosis can hinder the body's use of nutrients and can lead to malnutrition.
Many patients with cirrhosis tend to hold onto (or retain) water. This often is shown first by swelling in the ankles, particularly after walking. The swelling may move up the legs to the abdomen. Water buildup in the abdomen is called "ascites" (pronounced "ah-si-teez").
Too much sodium (or salt) in the diet can make the situation worse, because sodium encourages the body to retain water. Your doctor will tell you if you need to limit sodium in your diet. Usually this means restricting sodium intake to about 2,000 mg a day or less.
If you need to restrict sodium, here are some tips that can help:
- Avoid salty foods, salt in cooking, and salt at the table. Anything that tastes salty (such as tomato sauce, salsa, soy sauce, canned soups) probably has too much salt. Spice things up with lemon juice or herbs, instead of salt. Fresh foods usually are a better bet than processed foods.
- Read food labels when shopping. Check the amount of sodium in the foods you are buying. (See sample food label.)
- Avoid fast-food restaurants. Most fast foods are very high in sodium.
- Go easy on meats, especially red meats, which are high in sodium. When possible, consider vegetarian (meat-free) alternatives.
A dietitian can inform you about other products, such as antacids, that also contain lots of sodium.
The more fluid you retain, the greater your need to avoid salt. Your doctor may prescribe diuretics ("water pills") to help you urinate more. But all the water pills in the world won't help if you eat salty foods, such as anchovy pizzas.
Calories and protein
People with cirrhosis may need more extra calories and protein. They may lose their appetite and experience nausea, vomiting, and severe weight loss. This can lead to shortage of the minerals calcium and magnesium (signs include muscle cramps, fatigue, weakness, nausea, and vomiting), or a shortage of zinc (signs include reduced ability to taste, changes in taste).
It can help to eat small, frequent meals (4 to 7 times a day), including an evening snack. Your doctor even may recommend high-nutritional supplement drinks, such as Ensure or Boost.
When the scarring from cirrhosis prevents blood from passing through the liver, pressure increases in the veins entering the liver. This is called portal hypertension. The body is forced to reroute the blood away from the liver and into the general blood circulation. This causes large blood vessels, called "varices," to form.
Because the rerouted blood bypasses the liver, it contains high levels of amino acids, ammonia, and toxins that normally would have been handled by the liver. When these substances reach the brain, they can cause confusion and temporary loss of memory (a condition called "hepatic encephalopathy").
Amino acids and ammonia come from protein in the diet. Some evidence shows that patients with cirrhosis do better when they get their protein from vegetables (such as beans, lentils, and tofu) and from dairy products (eggs, milk, yogurt) instead of from meats.
Doctors can prescribe a syrup called Lactulose to push food through the bowels more quickly. This way, less food is absorbed, the liver has less work to do, and fewer toxins make their way to the brain.
- My HealtheVet
Take advantage of the VA's Healthy Living Centers, where you'll find information and tools for healthy eating, physicial activity, and other lifestyle issues.
- Choose My Plate
Choose My Plate is a program that can help you choose the foods and amounts that are right for you. It replaces the Food Pyramid, from the U.S. Department of Agriculture.
- How to read a food label
This guide can help you read food labels, from the Food and Drug Administration.
- Body Mass Index calculator
This tool can help you decide if you are at a healthy weight, from the National Heart, Lung, and Blood Institute.