Many people will immediately raise their hands defensively when hearing or reading the phrase diet and nutrition in liver disease, because they believe that a dietary prescription consists only of prohibitions. This is not infrequently due to the fact that, up to now, the doctor usually put a large number of foods on a forbidden list in the case of disease, instead of first mentioning what is allowed and also showing the possibilities of variety in the dietary menu.
Jaundice as a typical liver disease
Infographic on the anatomy and structure of the liver. Click to enlarge. Liver diseases are extraordinarily common, but by knowing the exact metabolic processes in the liver and how they can be influenced, we can avoid or at least greatly mitigate the previously feared sequelae of this type of disease. Nutritional treatment plays an important role in this. Therefore, our task here is to awaken the reader’s understanding and attention for an easy-to-handle food preparation in liver disease. Among liver diseases, epidemic jaundice (viral hepatitis) is of great importance today. Children show increased susceptibility to this infectious disease. However, this disease is usually mild in very young people, while in adults it often affects the function of liver cells to a greater or lesser extent. This fact, however, does not justify trivializing jaundice in children, but requires the same careful attention to medical and dietary measures as in adults.
Course of liver disease
During the first 14 days of epidemic jaundice, the sufferer feels particularly unwell and often has severe discomfort in the gastrointestinal tract. There is also a noticeable decrease in appetite. In this acute state, the liver requires special care. Of all foods, proteins, such as meat and sausage, milk and cheese, as well as eggs and fats (butter, margarine, oils, lard) place considerable demands on the metabolic activity of the liver, because it is the liver that must convert proteins for the human organism. On the other hand, the carbohydrates in the food do not burden the liver at all. Therefore, during the first 14 days of the disease (often shorter, very rarely longer) we prefer a diet rich in carbohydrates. This means mainly starchy products, the type of which can be changed. Thus, oatmeal, wholemeal flours, brown rice, muesli, but also pasta, semolina and corn starch can be used, although we give preference to wholemeal products because of their higher vitamin and mineral content. All these products can be broken down by appropriate cooking preparation to such an extent that they place little strain on the digestive tract. The action of carbohydrate-splitting agents (ferments) on the food begins as early as in the mouth, thus considerably relieving the stomach and intestines. Starch is broken down and absorbed in the intestine to form glucose or
fructose and absorbed. These sugars, which flow from the intestine to the liver via the bloodstream, have a nourishing and protective effect on the liver. Because of this liver cell-protecting effect, which applies in the same way to vitamins and minerals, glucose is often used to sweeten food and drinks.
Diet and nutrition in liver disease
Kitchen wise, these mentioned foods are cooked in plenty of liquid, water or vegetable broth prepared without fat. Fruit soups and porridges can also be prepared in combination with cereal products. Raw food, a grated apple – also in connection with soaked raw oatmeal or muesli -, freshly obtained raw fruit and vegetable juices, which can also be added to cooked food, should always be given. The fresh food is not only very digestible, but also supports the liver in resuming its full metabolic capacity. Of the breads, the crispbread made from wholemeal products, which is very well tolerated, should be enjoyed above all, but stale buns, toasted stale white bread and rusks can also be considered. Bee honey, also artificial honey, jams and jellies can be taken as a spread. As a drink we recommend the different kinds of tea. Black tea promotes liver circulation and is therefore medically very acceptable. Coffee, on the other hand, must be firmly rejected because of its irritating effect on the stomach and intestinal walls.Alcohol should also be avoided at all costs because of its liver cell-damaging effect. The total amount of fluid should be limited to about one liter (soups, etc. included) during the acute period of illness, since the liver also interferes greatly with the body’s water balance.
Diet tips
However, seasoning food is an art in itself, since in the state of inflammation of the liver we must advise against salt, which aggravates any inflammation in the body. Therefore, only parsley and herbs of all kinds should be used. The following are some dietary tips:
1. breakfast:
Tea sweetened with dextrose or malt coffee. Rusk, toast or crisp bread with jam or jelly. 2nd breakfast:
A plate of oatmeal soup or cereal with fruit juice or whole wheat flour soup. Lunch:
Barley gruel or semolina porridge with stewed apple or vegetable broth with rice. For dessert, muesli with apple. Afternoon:
Rosehip tea with glucose, crisp bread, rusk, toast with jam or jelly. Evening meal:
Broth semolina soup or whole wheat porridge.
Protein is important
The more protein bodies the blood contains, the better our body can protect itself from such diseases. After this rather strict day, you can slowly move to a diet containing mainly protein. First and foremost, protein of animal origin, i.e. milk, eggs, meat, is of particular importance, as they are carriers of the vital amino acids. These, in turn, are the building blocks of our human protein substances and are thus particularly important for the body’s defense functions against all infectious diseases. The more protein bodies the blood contains, the better our body can protect itself against such diseases. But the liver cell itself also always needs a certain amount of protein. As soon as it is deprived of this nutrient over a longer period of time, it reacts very sensitively. The aim of the change in diet now being introduced for jaundice sufferers is to supply them with a protein quantity of 1.5 grams per kilogram of body weight. Converted, this means for a person of about 60 kilograms body weight a pure protein quantity of 100 to 120 grams. When compiling a protein-rich menu, it is not possible to do without calculating, because each food only supplies a certain amount of the necessary daily protein requirement:
An egg, for example, 10 to 14 grams and 100 grams of meat about 20 grams. But since today the consultation possibilities are given in the hospital or with the physician for the ill one, the physician or the Diätberaterin will be gladly helpful to you with the quantity calculations. However, the mentioned amount of 100 to 120 grams of protein does not have to be of animal origin only. It can also be used to some extent proteins of vegetable origin, cereals and soy products.
Diet and nutrition
In terms of cuisine, there are again some things to consider with this diet: Fried foods are not yet tolerated by the liver at all during this time, since liver disease also severely impedes the activity of the gallbladder, and all foods that carry roasted and fatty components place the highest demands on bile production and secretion. The transition from a very low-protein diet to a high-protein diet must be gradual. For this reason, it is advisable to prepare all the soups and porridges used so far with a little milk at first, the proportion of which can be increased from day to day. For can also be enjoyed protein-containing drinks, such as sour and buttermilk, yogurt and mixed milk drinks. The raw, uncooked or even boiled pure milk is usually poorly tolerated because of still insufficient gastric juice formation.
Curd cheese as a source of protein
A particularly great importance comes to the curd, which one can prepare versatile and thus bring variety into the menu. Quark is known carrier of the most important amino acids and therefore particularly beneficial for the liver. The daily menu should always include about 100 grams of white cheese. Eggs, if possible raw to food stirred, should also be used. For this, however, they would have to be as fresh as possible. Meat is best tolerated as scraped meat and may also be processed with raw egg yolk. Other wholesome sources of protein are lean fish and meat, but these must not yet be fried. Apart from boiling or cooking in its own juice, there is now another cooking method that makes the food particularly tasty: steaming, i.e. cooking through hot and moist air.
You can not do without fat
A few more words about fat as a component of food itself and as an ingredient in its preparation: the main types of fat that come into question are oils (content of unsaturated fatty acids and vitamins) raw and heated, and butter. The latter is well tolerated in the intestinal tract because of its favorable melting point and is also important for the liver because of its vitamin content and as a carrier of the so-called short-chain fatty acids. The total amount of fat per day should not exceed 50 to 60 grams. Again, the transition from the low-fat diet to the specified amounts should be made very slowly during the first 14 days. It should also be borne in mind that a considerable amount of fat is hidden in sausages, such as teewurst and fine liver sausage, which must be taken into account. If this is not taken into account, the sick person is often surprised that he has complaints in the upper abdomen and that his recovery makes only very slow steps. It is therefore best if the sick person does not eat any sausage at all during the first weeks and months after the illness. The seasoning of the food is to be handled almost in the same way as with the food at the beginning of the illness. One gets used to low-salt foods very quickly, too, if kitchen herbs, tomato juice or tomato paste, and yeast flakes are used for seasoning.
