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Nutrition and Hepatitis C
Nutrition and Diet Recommendations for people with Chronic Hepatitis C

Nutrition and the Liver:
The liver is the major organ responsible for regulating and responding to your body's metabolic demands. Your liver must be functioning well to maintain normal metabolism of carbohydrates, fats, and protein; it is also responsible for processing and using several vitamins. This section deals with the role and healthy liver (and a healthy, well-balanced diet) plays in these nutritional processes.

Carbohydrate Metabolism:
The most common sources of dietary carbohydrate are sugars, such as sucrose (table sugar), fructose (corn syrup), and lactose (milk sugar), and starches, such as breads, pasta, grains, cereals, fruits, vegetables, and potatoes. When you eat carbohydrates, specialized enzymes in the pancreas and gut process them to yield simple sugars (glucose, galactose, fructose, maltose).

These sugars are absorbed by intestinal lining cells, enter the portal circulation, and travel to the liver via the portal vein. During overnight fasting, blood sugar levels dip to a relatively low level, insulin secretion is suppressed, and blood insulin levels diminish. After a meal, blood sugar increases (stimulating the release of insulin from the pancreas), and insulin levels rise. Insulin, which rises in response to a meal, is the hormone that stimulates the liver to take in more glucose and to move the glucose into storage -- mainly in the form of glycogen. The liver can then release glycogen to your muscles for energy during periods of fasting or exercise. Although the liver can store considerable amounts of glycogen, it is the first energy source used during periods of prolonged fasting or caloric deprivation, and it can be depleted rapidly. After glycogen, the body taps other energy sources -- including protein and fat.

Protein Metabolism:
We take in dietary protein from dairy products, produce, and meats. Enzymes produced by the pancreas and intestine break down the protein into its amino acids and small peptides. The intestine rapidly absorbs the amino acids with specific transport systems within its lining cells and then delivers the amino acids to the liver via the portal vein. When they reach the liver, they are used for energy or for making (synthesizing) new proteins. The newly synthesized proteins perform specific body functions.

Fat Metabolism:
In general, fats are neutral lipids (triglycerides), acidic lipids (fatty acids), and sterols (cholesterol, plant sterols). Triglycerides (dairy products, meats, oils, butter, margarine) are the most common type of dietary fat and represent a major source of energy. The liver is uniquely suited to regulate and process triglycerides.

Dietary triglyceride is digested in the intestine by lipase, an enzyme secreted by the pancreas in response to meals. Bile, secreted by the liver, makes the digested fat soluble and promotes its absorption. Absorbed fat is then repackaged and transported into blood, where the liver ultimately removes it from the circulation. Fat that reaches the liver is processed in three ways: (1) stored as fat droplets in liver cells, (2) metabolized as a source of energy, and (3) repackaged, secreted back into blood, and delivered to other cells in the body.

The liver is also intimately involved with the processing of dietary cholesterol and is the main source of newly synthesized cholesterol in the body. Liver disease may be associated with both high or low blood cholesterol levels. In general, as liver disease progresses in patients with hepatitis C, the blood level of cholesterol drops.

Bile:
The liver produces and secretes a fluid (bile) that enters the intestine to aid in digestion and absorption. Bile is clear yellow to golden-brown and contains water, electrolytes (salts), cholesterol, bile salts (detergents), phospholipids, and proteins. Bile helps to activate enzymes secreted by the pancreas and is essential for the digestion and absorption of fat or fat-soluble vitamins.

Vitamins:
The liver plays a role in several steps of vitamin metabolism... Vitamins are either fat-soluble (Vitamins A, D, E, and K) or water-soluble (Vitamin C and the B-complex vitamins).

Patients with advanced liver disease may become deficient in water-soluble vitamins, but this is usually due to inadequate nutrition and poor food intake. Vitamin B12 storage usually far exceeds the body's requirements; deficiencies rarely occur due to liver disease or liver failure. When dietary intake drops, however, thiamine and folate commonly become deficient. Oral supplementation is usually all that you need to restore thiamine and folate stores to the normal range.

Fat-soluble vitamins require not only adequate dietary intake but also good digestion and absorption by the body. That's why normal production of bile is essential. Bile in the gut is required for the absorption of fat-soluble vitamins into the body because these vitamins are relatively insoluble in water. Bile acts as a detergent, breaking down and dissolving these vitamins so they may be properly absorbed.

If bile production is poor, oral supplementation of vitamins A, D, E, and K may not be sufficient to restore vitamin levels to normal. The use of a detergent-like solution of liquid vitamin E (TPGS) improves the absorption of vitamin E in patients with advanced liver disease. The same solution may also improve the absorption of vitamins A, D, and K if the latter are taken simultaneously with the liquid vitamin E.

Source: "Living with Hepatitis C: A Survivor's Guide" by Gregory T. Everson, M.D., and Hedy Weinberg. 1997, Hatherleigh Press.

 

    Page last updated: March 7, 2003


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