Nutritional Considerations In The Treatment Of Hepatitis
by Carl Germano, M.A., R.D., CNS
The liver is the largest most complex organ in the body. The functions it is responsible for are quite numerous and has significant bearings on the nutritional state of the body. Therefore, diseases of the liver will markedly affect health. Hepatitis represents a most common liver disorder characterized by an inflammatory condition resulting in degenerative changes in the liver. There are several forms of the disease of which viral infections are the major cause while alcohol, drug abuse, certain bacterial, parasitic or fungal infections may also be implicated. Briefly, the most common types are:
Hepatitis A - known as infectious hepatitis and usually spread via contaminated food or water. Generally not as serious as the other types with recovery typically within a few months and rarely progresses to chronic hepatitis.
Hepatitis B - known as serum hepatitis, viral origin and usually spread via direct blood contact as well as sexual contact. Type B is more severe and more likely to progress to chronic stages. The seriousness of Type B warrants aggressive long term therapy in efforts to prevent chronic hepatitis.
Hepatitis C (Non A, Non B) - similar to type B, transmission has been determined to be via blood or infected needle contact and is of viral origin. This type also presents challenging aggressive long term therapy.
Typical symptoms in the active stages of all types include anorexia, fatigue, nausea, vomiting, diarrhea, fever, weight loss and abdominal discomfort. Treatment generally consists of adequate rest, nutritious diet and supplements to assist in recovery and the prevention of further damage to the liver. While there is no drug treatment to cure hepatitis, the focus of this article is directed at the role of diet and nutritional supplementation in the restoration of liver function and repair of hepatic tissue. Therefore, a brief overview of some of the liver's major functions is necessary to grasp the rationale of natural nutritional therapy.
The liver is a most complex organ that plays major roles in a wide variety of biochemical functions of the body. Liver dysfunction can therefore significantly impact many other organs and systems throughout the body. The following represent a few of the most important functions of the normal liver:
While you may be treated for infectious or non-infectious hepatitis by your doctor using interferon or antibiotics, drug treatment cannot cure hepatitis, is ineffective against the virus and is limited in it's ability to restore health to the organ. Therefore, a nutritional program utilizing diet modification and supplements must be offered, by your physician or health care practitioner, in efforts to provide effective rehabilitation of the liver.
NUTRITIONAL CONSIDERATIONS - DIET
The goal of treatment is to relieve symptoms and to promote healing of liver tissue and function. The importance of the diet and nutritional supplements cannot be overemphasized in efforts to prevent relapse and aid in the recovery process. Immediately, all offending dietary agents must be removed including: alcohol, caffeine, drugs, aspirin/Tylenol, sugar, margarine, fried foods and high doses of niacin or vitamin A. Dietary manipulation must include the following:
Foods of liquid to soft consistency may be preferable if there is anorexia present. This affords the practitioner an excellent opportunity to utilize several quality protein/calorie powder supplements, particularly the high quality whey proteins, and additional balanced amino acid supplements.
Adequate Protein Intake
Essential for healing and repair, adequate protein intake is a critical component of the diet. Ideally, 60 - 120 grams of good quality protein is recommended daily and should be adjusted to body weight (at least 1 - 1.5 grams protein per kilogram of body weight). Although the protein intake may be obtained from both animal and vegetable sources, adequate quality protein may be easily obtained via animal sources and may be the choice when appetite is limited in the initial stages of the disease.
Sufficient calories are to be provided to maintain weight or address weight loss (at least 30 calories per kilogram of body weight). A liberal intake of complex carbohydrates and low fat yet adequate essential fatty acids is essential. If a low fat intake is prescribed, the use of essential fatty acid supplements are advisable and may include borage oil, evening primrose oil, flaxseed oil and the marine lipid concentrates. Small frequent meals to provide calories and are recommended over the high calorie powdered supplements on the market that chiefly consist of high refined sugars.
Additionally, the use of a powdered high chlorophyll beverage such as the cereal grasses are an excellent addition of calories as well as being nutrient dense with cleansing & detoxifying properties.
NUTRITIONAL CONSIDERATIONS - SUPPLEMENTS
The use of nutritional supplements for the treatment of liver disorders is paramount to appropriate aggressive rehabilitative therapy. The liver directly benefits from nutritional support and requires a continuos supply of vitamins, minerals and herbal compounds necessary for healing (1). The following supplements should be utilized in any liver support protocol and should prove to be an excellent adjunct to any medical treatment.
Specific Amino Acids
Taurine - an antioxidant, supplementation has shown to significantly decrease serum bilirubin in patients with acute hepatitis (2,3)
SAM (S-Adenosyl Methionine) - studies have revealed that SAM had reversed pathological liver changes from toxins, restores normal liver cell membrane fluidity and ATPase activity - all necessary for healthy liver function and repair (4,5,6).
NAC (N-Acetyl Cysteine) - as an antioxidant and is essential for the regeneration of glutathione for the glutathione peroxidase detoxifying enzyme system in the liver.
Branched Chain Amino Acids - may be beneficial in maintaining positive nitrogen balance when routine amino acid/protein supplements are not tolerated (7).
B Complex - compared to normal subjects, many of the B vitamins have been shown to be deficient in hepatitis and other liver diseases especially B-12 and folic acid (8).
Antioxidant Nutrients - important for their immune support and healing effect on the liver, several antioxidants have been shown to be depressed in patients with hepatitis (9).
Vitamin C - studies have demonstrated important aspects of treatment with vitamin including immunomodulation action, decreasing the duration of the disease and useful as a prophylaxis (10,11).
Selenium - important as an indirect antioxidant, supplementation has been shown to decrease the incidence of hepatitis (12).
Lecithin/Choline - lecithin/choline is essential for the prevention of fatty liver, liver cell death, liver cell cancer and has been shown to protect the liver from alcohol (13,14).
Lipoic Acid (Thioctic Acid) - an essential nutrient that must be part of any liver rehabilitative protocol. Lipoic acid, when present in adequate amounts, acts as a potent detoxifying agent in the liver and is typically depressed in liver disorders. Lipoic acid actually protects liver cells against alcohol,mushroom poisoning and heavy metal exposure and has been found to improve immune function (15,16,17,18,19).
Silymarin (Milk Thistle) - a well documented herb phytochemical that has proven beneficial effects on the liver. Silymarin has been shown to protect intact liver cells as well as stimulation of protein synthesis which accounts for new cell growth (20,21,22). One should choose milk thistle that contains a minimum of 70 - 80% standardized Silymarin content.
Licorice (Glycyrrhizic Acid)- several studies have demonstrated that components within licorice are effective in treating viral hepatitis, particularly chronic active hepatitis, and probably due to it's antiviral activity (23,24).
Phyllanthus amarus - has been shown to be very effective in the treatment of chronic hepatitis B via it's protective and antiviral activity (25).
Catechin - this group of flavanoids have received a great deal of attention in a variety of clinical studies as an important agent in treating acute and chronic hepatitis by decreasing bilirubin, relief of symptoms and improvement of clinical tests. The activity of catechin on liver rehabilitation is due to it's antioxidant and immune stimulating functions (26,27).
Others: Dandelion, Artichoke
The above nutritional components have been successfully utilized in the care and rehabilitation of the diseased liver. Care must be taken and such a protocol must be reviewed by your physician or health care practitioner. Of utmost importance is rest and consistent utilization of the supplements and diet recommended. Remember, hepatitis is a serious disease and warrants serious aggressive therapy. If your practitioner does not utilize the above diet and supplements, they are probably doing more harm than good - get yourself a better educated practitioner!
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2) "The effect Of Taurine Administration On Patients With Acute Hepatitis", Matsuyama, Y, et al, Sulfur Amino Acids:Biochemical and Clinical Aspects, New York, Alan R. Liss, Inc., 1983:461-468
3) "Effects Of Ursodeoxycholic Acid and Taurine On Serum Liver Enzymes And Bile Acids In Chronic Hepatitis", Gastroenterology, 1990; 98(4):1044-1050
4) "S-Adenosyl Methionine Dependent Nicotinamide Methylation: A Marker Of Hepatic Damage", Cuomo, R., et al, Fat Storing Cells and Liver Fibrosis, 71st Falk Symposium, Florence Italy, July 1, 1993;348-353
5) "Effects Of S-Adenosyl Methionine Administration On Plasma Levels Of Sulphur Containing Plasma Amino Acids In Patients With Liver Cirrhosis", Marchesini, G., et al, Clinical Nutrition, 1992;11:303-308
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9) "Clinical Study Of Vitamin E Status In Patients With Chronic Liver Disease", Suzuki, T., et al., Nippon Shokakibyo Gakki Zasshi, 1991, 88(4):1066-1073
10) "Humoral And Cellular Indices Of Nonspecific Resistance In Viral Hepatitis And Ascorbic Acid", Vasil'ev, K., et al., Ter Arkh 1989; 61(11):44-46
11) "Vitamin C For Prophylaxis Of Viral Hepatitis B In Transfused Patients", Morishige, F., et al., J Int Coll Prev Med 1978; 5(1):54-58
12) "Chemoprevention Trial Of Human Hepatitis With Selenium Supplementation In China", Yu, Sy, et al., Biol Trace Elem Res 1989; 21(1-2):15-22
13) "Biology Of Disease:Choline Deficiency, Lipotrope Deficiency and The Development Of Liver Disease", Laboratory Investigation 1993; 68(3):255-160
14) "Lecithin Increases Plasma Free Choline and Decreases Hepatic Steatosis", Gastroenterology 1992; 102:1363-1370
15) "Treatment Of Liver Disease With Thioctic Acid", Marshall, AW, et al., GUT 1982; 23:1088-1093
16) Biochem Biophys Acta 1052:386 1990
17) Biochem Pharmacol 43:407, 1990
18) Toxicology 58:175, 1989
19) Jap J Pharmacol 42:135 & 275, 1986
20) "Silymarin In The Treatment Of Acute Viral Hepatitis", Bode, JC, et al., Med Klin 1977 (Munich) 72(12):513-518
21) "Nutritional Herbology: Milk Thistle", Peterson, M., AIBR Scientific Reviews, Botanical Medical Series, 18, 1988
22) "Prevention Of CCL4 Induced Liver Cirrhosis By Silymarin", Mourelle, M., et al., Fundam Clin Pharmacol 1989: 3(3):183-191
23) "Effects Of Glycyrrhizin On Biochemical Tests In Patients With Chronic Hepatitis", Suzuki, H., et al., Asian Med Journal 1984; 26:423-438
24) "Antiviral Activity Of Glycyrrhizic Acid", Pompeii, RP, et al., Experimenta 1980; 36:304-305
25) "Effect Of Phyllanthus Amarus On Chronic Carriers Of Hepatitis B Virus", Thyagarajan, SP, et al., The Lancet 1988;766 October
26) "International Workshop On Cyanidanol-3 In Diseases Of The Liver", Conn, H., et al., Royal Of Med, 47, Academic Press, London 1981
27) " Cyanidanol-3 in The Treatment Of Acute Viral Hepatitis", Schomerus, H., et al., Hepatology 1984; 4:331-335