Treating hepatitis with diet

This article concerns the dietary treatment of the acute hepatitis phase which occurs in hepatitis A, B, C, D and E, as well as what can be done for chronic hepatitis conditions.

Patient symptoms
A patient suffering from acute infectious hepatitis will experience severe loss of appetite or anorexia, nausea, vomiting, abdominal pain, taste changes, fever and jaundice. All these symptoms complicate food intake and make it difficult to ensure that the patient is well nourished at a time when it is essential to provide the patient with a highly nutritious diet to prevent liver damage.

Diet for Acute Hepatitis
The diet used during acute hepatitis infection must provide the following:

1) Appetite stimulation
Appetite stimulation to overcome anorexia - this is probably one of the most difficult challenges facing anyone who is trying to assist a hepatitis patient who may feel so ill and debilitated that they flatly refuse to eat.

Offer the patient his or her favourite fat-free or low-fat foods (see below for tips on selecting a low-fat diet), for example, fruit juices, energy drinks (Lucozade, Powerade, Energade or Game diluted with cold water), fat-free milk shakes or smoothies (make from fresh or canned fruit, fat-free milk or yoghurt to which you can add flavouring, honey and fat-free milk powder to boost the protein and energy content), 'Slush-puppies' and sorbets made from pureed fruit and sugar which is then frozen, custard made with fat-free milk, jelly and jelly-Ideal Milk desserts, low-fat ice cream, clear soups (chill overnight and remove the fat that coagulates on top of the soup), dry crackers and rusks, bland porridges with fat-free milk and sugar to boost energy intake, hard or boiled sweets, and any other food that the patient is prepared to eat.

Tips to improve food intake:
Serve the above mentioned foods and beverages chilled as this helps to overcome nausea. Let the patient eat a dry biscuit or rusk before eating other foods as this can assist with food aversion. Add slightly more flavouring to milk shakes, smoothies and custard to overcome loss of taste sensation. Serve patient with small quantities more often so that they don't get discouraged if they are only able to drink or eat small portions at a time.

2) Use of liquid meal replacements
Nowadays there are many high-energy, high-protein meal replacement products available from your pharmacy, for example, Ensure, or Nutren Optimum and Nutren Fibre which are made by Nestle, or Fresubin ProvideXtra and Fresubin Original Sip Feeds produced by Fresenius-Kabi. Discuss the use of such liquid meal replacement products with your pharmacist or phone the Nestle Consumer Service at: 0860-009-6789, or Fresenius-Kabi at: (011) 203-2000 for additional advice.

3) Foods to exclude
Avoid giving the patient the following foods:

• Full-cream milk, yoghurt, cream, cream cheese and fatty cheeses
• Biscuits, cakes, pies, tarts, etc with a high-fat content
• Chocolate
• Not more than three eggs a week
• Fatty salad dressings, mayonnaise, sour cream
• Avocado
• Fatty, fried meats, fatty fish, poultry skin, all processed meats and sausages, bacon, fatty gravies, fish canned in oil (buy tuna or pilchards canned in water or tomato sauce)
• Nuts, peanut butter, nut spreads
• Potato chips, vegetables smothered in butter or white/cheese sauces
• Fatty snacks or very spicy snacks
• All food preparation that increases the amount of fat contained in meals, such as frying in butter, margarine or oil. Rather boil, poach, grill, cook in a nonstick pan with Spray and Cook, and cook stews and soups the day before, chill and skim off all the coagulated fat before serving.

4) Vitamin, mineral and electrolyte supplements
Discuss what types of vitamin and mineral supplements you can give to the patient with the treating doctor. The doctor may prescribe supplements that protect live function such as Essentiale or Pro-Hep which contain B vitamins and other factors such as choline that assist liver function.

Patients suffering from dehydration because of repeated vomiting need to drink an electrolyte mixture. In serious cases the patient may have to be put on a drip to replenish body water and electrolytes. Monitor the patients liquid intake and if you suspect dehydration, contact your doctor immediately.

Dietary treatment of chronic hepatitis and cirrhosis
Serious long-term effects of hepatitis infection which can become chronic, should always be treated by a clinical dietician. Find a dietician by visiting the website of the Association for Dietetics in South Africa (Adsa) or ask the treating physician to refer you to a dietician in your area. Patients with chronic hepatitis and liver damage require special diets that need to be worked out for the individual patient so that further liver damage and long-term malnutrition can be prevented.

So if you have to look after a patient with acute hepatitis infection you should be able to manage with the diet tips given above, but any serious complication or drawn-out illness involving the liver, needs the special attention of a clinical dietician.

(Dr IV van Heerden, DietDoc)

(Reference: Krause's Food, Nutrition & Diet Therapy (2000). Edited by Mahan & Escott-Stump, Chapter 32, pp 695-717. WB Saunders Co, Philadelphia, USA)

- (Health24, updated August 2011)

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