Q: I have chronic Hepatitis C, oesophagael varices and cirrhosis. For the past few months, my cirrhotic condition has heightened dramatically. Ascites, constipation, hallucinations, pronounced memory-loss and confusion and lethargy are common daily events. My current diet is made up of fruits, vegetables and fish. I am lactose intolerant. Please advise a suitable diet for me.
A:In chronic hepatitis you can eat a normal, well balanced diet. You don't need to change your diet unless you have poor appetite and unintended weight loss. Poor appetite, nausea and vomiting are unpleasant and cause nutritional problems only if they last longer than a few days or if you continue to lose weight. If you have loss of appetite follow these simple guidelines:
Eat small but frequent meals.
Nutritious snacks are better than one big meal.
Try to eat something every two hours, however small.
Tempt yourself with foods you like. You don't need to have a proper meal.
Don’t force yourself to eat food you don’t like.
Try to relax before and after you eat.
Take your time over eating – chew well and breathe steadily.
Since you also have cirrhosis you may need extra energy and protein. Cirrhosis causes damage to the liver and affects its working. The liver is unable to store glycogen, a carbohydrate that provides short-term energy. When this happens, the body uses its own muscle tissue to provide energy between meals. This can lead to muscle wasting and weakness. If you have been affected in this way, snacking between meals can top up your calories and protein (a bedtime snack is especially effective) as eating between meals helps preserve muscles and keep them strong. Improved nourishment will also make you feel better. Try to eat every two to three hours. Suitable snacks include: teacake, toast, biscuits, cereal and fruit.
If you don’t feel like eating solid food, try a nourishing drink. These include, homemade milkshakes and products such as Build Up and Complan. Check with your doctor to see if they suit you. Nutritious homemade milkshakes include full-fat milk, honey, banana or pureed fruit. Since you have the following symptoms, you should see a doctor immediately for a change your diet:
Fluid retention causing swelling of your abdomen (ascites)
Mental slowness or confusion (encephalopathy)
Fatty stools/faeces (steatorrhoea).
You can control fluid retention by reducing the amount of salt in your food. While it may be a good idea to cut out foods with a high salt content, it could be harmful to have a diet too low in salt. Your taste buds become more sensitive to salt as you eat less of it. It is quite easy to cut down salt in the food you prepare, but most of the salt is already there in the processed foods. It is often difficult to tell which processed foods are high in salt, as they may not necessarily taste salty, like aerated drinks are high in salt. Ideas for reducing salt:
Try not to add salt at the table
Avoid packet and tinned soups
Tinned vegetables, including baked beans, can be high in salt. Look for low-salt or no-salt versions. Frozen vegetables are low in salt
Smoked and tinned fish, including mackerel, tuna and sardines in brine contain a lot of salt. Have these occasionally or stick to fresh fish.
Do not eat cured meats including ham, bacon, sausages and salami daily. Use cold cooked fresh meat, poultry or eggs more often instead.
Full-fat hard cheese is an excellent source of protein, so include it in your diet but do not have it every day.
Ready meals and sauces are high in salt so try to have these less often. Pasta and cook-in sauces can be used if no other salt is added to the meal.
Salt is not the only way to make your food taste better, instead try to flavour your food with black pepper, lemon juice, garlic, ginger and spring onions with mixed vegetables, olive oil and vinegar with vegetables, mustard powder or nutmeg with mashed potato, various home-made sauces such as onion sauce made with milk and garlic used instead of gravy, toasted and ground sesame seeds added to pastries, breads and stir-fries and washed finely chopped coriander root in soups, stews and stock.
Please check with your doctor regarding your fluid intake. Following might help you to cope with mental confusion:
Eat three or four small meals during the day rather than one large meal.
Eat eggs and cheese as well as meat, fish and poultry for protein.
Avoid eating large amounts of protein at one meal – full cooked breakfast, for example.
Fill up with starchy foods such as potatoes, rice, pasta, vegetables and cereals for slow-release energy.
Breakfast cereal, served with milk, can make a useful snack.
If you have been ill you may not feel like eating your usual meals, but eating well and keeping up both strength and weight are essential for people with liver problems. Nutrition is part of the treatment for liver disease and can help the liver work properly longer. In normal circumstances, a well-balanced diet includes plenty of fruit and vegetables and a small amount of fat and sugar. You probably need nutritional supplements as well. It is important to enjoy what you eat. Please follow up with your doctor regularly, as the type of food you consume needs to be varied depending on your condition.