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Section 1: Archives
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Diet and Your Liver
What does nutrition have to do with your liver?
Nutrition and the liver are interrelated in many ways. Some functions
are well understood; others are not. Since everything we eat,
breathe and absorb through our skin must be refined and detoxified
by the liver, special attention to nutrition and diet can help
keep the liver healthy. In a number of different kinds of liver
disease, nutrition takes on considerably more importance.
Why is the liver important?
The liver is the largest organ in the body and it plays a vital
role, performing many complex functions which are essential for
life. Your liver serves as your body's internal chemical power
plant. While there are still many things we do not understand
about the liver, we do know that it is impossible to live without
it, and the health of the liver is a major factor in the quality
of one's life.
Some important functions of the liver are:
- to convert the food we eat into stored energy,
and chemicals necessary for life and growth;
- to act as a filter to remove alcohol and toxic
substances from the blood and convert them to substances that
can be excreted from the body;
- to process drugs and medications absorbed from
the digestive system, enabling the body to use them effectively
and ultimately dispose of them;
- to manufacture and export important body chemicals
used by the body. One of these is bile, a greenish-yellow substance
essential for the digestion of fats in the small intestine.
Why is the liver so important in nutrition?
85-90% of the blood that leaves the stomach and intestines carries
important nutrients to the liver where they are converted into substances
the body can use.
The liver performs many unique and important metabolic tasks as
it processes carbohydrates, proteins, fats and minerals to be used
in maintaining normal body functions.
Carbohydrates, or sugars, are stored as glycogen in the liver
and are released as energy between meals or when the body's energy
demands are high. In this way, the liver helps to regulate the blood
sugar level, and to prevent a condition called hypoglycemia, or
low blood sugar. This enables us to keep an even level of energy
throughout the day. Without this balance, we would need to eat constantly
to keep up our energy.
Proteins reach the liver in their simpler form called amino
acids. Once in the liver, they are either released to the muscles
as energy, stored for later use, or converted to urea for excretion
in the urine. Certain proteins are converted into ammonia, a toxic
metabolic product, by bacteria in the intestine or during the breakdown
of body protein. The ammonia must be broken down by the liver and
made into urea which is then excreted by the kidneys. The liver
also has the unique ability to convert certain amino acids into
sugar for quick energy.
Fats cannot be digested without bile, which is made in the
liver, stored in the gallbladder, and released as needed into the
small intestine. Bile (specific bile "acids"), acts somewhat like
a detergent, breaking apart the fat into tiny droplets so that it
can be acted upon by intestinal enzymes and absorbed. Bile is also
essential for the absorption of vitamins A, D, E, and K, the fat
soluble vitamins. After digestion, bile acids are reabsorbed by
the intestine, returned to the liver, and recycled as bile once
again.
Can poor nutrition cause liver disease?
There are many kinds of liver disease, and the causes of most of
them are not known. Poor nutrition is not generally a cause, with
the exception of alcoholic liver disease and liver disease found
among starving populations. It is much more likely that poor nutrition
is the result of chronic liver disease, and not the cause.
On the other hand, good nutrition - a balanced diet with adequate
calories, proteins, fats, and carbohydrates - can actually help
the damaged liver to regenerate new liver cells. In fact, in some
liver diseases, nutrition becomes an essential form of treatment.
How does liver disease affect nutrition?
Many chronic liver diseases are associated with malnutrition. One
of the most common of these is cirrhosis. Cirrhosis refers to the
replacement of damaged liver cells by fibrous scar tissue which
disrupts the liver's important functions. Cirrhosis occurs as a
result of excessive alcohol intake (most common), common viral hepatitis,
obstruction of the bile ducts, and exposure to certain drugs or
toxic substances.
People with cirrhosis often experience loss of appetite, nausea,
vomiting and weight loss, giving them an emaciated appearance. Diet
alone does not contribute to the development of this liver disease.
People who are well nourished, for example, but drink large amounts
of alcohol, are also susceptible to alcoholic disease.
Adults with cirrhosis require a balanced diet rich in protein, providing
2,000 to 3,000 calories a day to allow the liver cells to regenerate.
However, too much protein will result in an increased amount of
ammonia in the blood; too little protein can reduce healing of the
liver. Doctors must carefully prescribe the correct amount of protein
for a person with cirrhosis. In addition, the physician can use
two medications (lactulose and neomycin) to control blood ammonia
levels.
What other nutritional problems are caused by cirrhosis?
When the scarring of cirrhosis interferes with the flow of blood
from the the stomach and intestines to the liver, a condition called
portal hypertension may develop. This simply means that there is
back pressure in the veins entering the liver. Surgical "shunting",
or rerouting of blood away from the liver and into the general circulation
can relieve this pressure, but it often causes a new set of problems.
Because the shunted blood has bypassed the liver, it contains high
levels of amino acids, ammonia, and possibly toxins. When these
compounds reach the brain, they cause a condition called hepatic
encephalopathy, which means "liver caused mental impairment." Patients
become confused and some temporary loss of memory occurs.
Can nutrition be used to treat hepatic encephalopathy?
Restricting the amount of protein in the diet has been used in the
past but may cause further malnutrition. Most physicians will prescribe
lactulose and/or neomycin for patients with this condition.
Food to avoid: Shellfish, if uncooked, can be very dangerous
for patients with cirrhosis. Either avoid shellfish or be careful
to cook them thoroughly. Vibrio vulnificus, a bacteria, can
be contracted by eating raw oysters, etc.
Can diet help in treating other complications of cirrhosis?
There are a number of complications of cirrhosis which can be helped
through a modified diet.
Persons with cirrhosis often experience an uncomfortable buildup
of fluid in the abdomen (ascites) or a swelling of the feet, legs,
or back (edema). Both conditions are a result of portal hypertension
(increased pressure in the veins entering the liver). Since sodium
(salt) encourages the body to retain water, patients with fluid
retention can cut their sodium intake by avoiding such foods as
canned soups and vegetables, cold cuts, dairy products, and condiments
like mayonnaise and ketchup. In fact, most prepared foods contain
liberal amounts of sodium, while fresh foods contain almost no sodium
at all. A good-tasting salt substitute is lemon juice.
Are there other liver diseases where specific changes in diet
can help?
Nutrition and a modified diet have been found to have a significant
effect on a number of other liver diseases. Some types of liver
disease, for example, cause a backup of bile in the liver which
is called cholestasis. This means that bile cannot flow into the
small intestine to aid in the digestion of fats. When this happens,
fat is not absorbed but instead is excreted in large amounts in
the feces, which become noticeably pale-colored and foul-smelling.
This condition is known as steatorrhea. This loss of fat
calories may also cause weight loss.
Special fat substitutes, such as medium chain triglycerides (MCT
oil) and safflower oil can help alleviate this condition because
they are less dependent on bile for intestinal absorption. They
can be used like other oils in cooking, baking and salad dressings.
Patients with steatorrhea may also have difficulty absorbing fat
soluble vitamins A, D, E, K. However, water soluble vitamins are
absorbed normally. Supplementing the diet with fat soluble vitamins
is possible, though it should only be carried out under the guidance
of a physician. Vitamin A in excess over what is needed is very
toxic to the liver.
Wilson's disease, in which large amounts of copper may build
up in the body, is another liver ailment where diet can help. People
with Wilson's disease should avoid eating chocolate, nuts, shellfish
and mushrooms, all copper-containing foods. Medical treatment to
remove excess copper from the body involves use of prescription
medication.
Hemochromatosis is a disease in which large amounts of iron
are transported from the intestine and accumulate in the liver.
Persons with this condition must avoid iron injections, all iron-containing
foods, and are advised not to use iron cooking utensils. Aside from
these precautions, those with hemochromatosis may follow a normal
diet.
What is fatty liver and is it caused by eating too much fat?
Fatty liver is not a disease but a pathological finding. A more
appropriate term is "fatty infiltration of the liver." It is not
caused by excessive eating of fats.
Nutritional causes of fat in the liver include: starvation, obesity,
protein malnutrition and intestinal bypass operation for obesity.
Fat enters the liver through diet and from fat stored in the fatty
tissue. Under normal conditions, fat from the diet is usually metabolized
by the liver and other tissues. If the amount exceeds what is required
by the body, it is stored in the fatty tissue. If fatty tissue is
caused by diabetes, insulin will treat the problem. Fatty liver
resulting from poor nutrition should be treated with a well-balanced
diet of carbohydrates, proteins, and fats as specified by the physician.
Fatty liver can also be caused by certain chemical or drug compounds,
and endocrine disorders. In these cases, the treatment would be
directly related to the cause.
Two ways to avoid fatty liver:
- limit alcohol intake (alcohol can decrease
the rate of metabolism and secretion of fat, leading to fatty
liver);
- watch the diet (starvation and protein malnutrition
can result in fat buildup in the liver).
Most cases of fatty liver are due to obesity. Gradual weight reduction
over time will reduce enlargement of the liver due to fat and associated
liver test abnormalities.
What lies ahead?
The relationship between nutrition and the liver is under investigation.
To what extent good nutrition and dietary practices can control
or perhaps even prevent liver disease can only be surmised at this
time. Further research in this area could prove very beneficial
and is being supported by the American Liver Foundation.
50
Ways to Love Your Liver
Hepatitis
and Liver Disease in the United States
The
Risk of Eating Raw Oysters
What
are the Diseases that Affect the Liver?
What Are the Myths Vs. Facts About Alcohol and the Liver?
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