My Dietary Recommendations for Liver Health

These are the notes I hand out at my inpatient liver presentations.
They do not promote carbohydrate restriction because they are aimed at people with alcohol and drug issues who more often than not need to eat more of (almost) everything. Nor do they include supplements, as supplementation is decided on a case-by-case issue for inpatients.
Apart from that, it includes everything I had learned about a year ago...

EATING for a HEALTHY LIVER: with regard to RECOVERY from ALCOHOL AND OTHER DRUG ABUSE and HEPATITIS C

The type of diet, and the specific foods you eat, can play a large

role in recovery from liver damage. A few substances found in common

foods can promote liver fibrosis; many specific foods have been shown,

or are suspected, to prevent it.

In general terms

1) Protein is very protective of the liver,

2) Complex carbohydrate (starch) is protective but simple (sweet)

sugars can be harmful, and

3) Saturated fat is protective, while polyunsaturated fat can be harmful.

There are 3 specific substances to minimize or avoid:

Minimize:

Fructose (found in sugar, corn syrup, fruit juice concentrate, agave

juice, honey, as well as sweet fruit).

Fructose is directly converted to fat in the liver and reduces the

insulin response to glucose; high consumption of fructose can cause

fatty liver, type 2 diabetes, gout and irritable bowel syndrome.

Whole fruit and dark honey, in limited amounts, are safe sources of

fructose for most people.

(In the Hepatitis C Virus (HCV) life cycle, fructose induces DGAT1 and

promotes VLDL expression, increasing the release of virus to the

bloodstream).

Minimize:

Polyunsaturated fats; PUFAs (from vegetable oils and non-dairy

spreads). These fats are essential only in such amounts as one might

easily obtain from a diet containing meat, dairy, eggs, and fish, with

occasional nuts and seeds. Vegetable oils contain large quantities of

omega-6 lineolic acid, which promotes inflammation and suppresses

omega-3 fats.

The popularity of omega-3 fish oil in modern times is due to the

excessive amount of omega-6 in food oils and processed foods.

When large amounts of polyunsaturated fats are added to alcohol or

drugs, liver damage and fibrosis are increased.

Persons with Hepatitis C show increased fibrosis and worse responses

to treatment with higher PUFA content of the diet.

Vegetable oils decrease LDL and HDL cholesterol, while saturated

animal fats increase both. In persons with Hep C, higher LDL and total

cholesterol is associated with a lower degree of fibrosis and a better

response to treatment.

(In the HCV life cycle, low LDL causes an increase in LDL-receptors,

which are used by the virus to infect new cells).

The fat from pork and poultry is relatively high in omega-6 PUFA, and

is not protective, whereas fat from beef, lamb, goat, venison, dairy,

cocoa, and coconut is protective.

Minimize, and if possible Avoid:

Gluten grains.

Wheat (flour, bread, pastry etc.), Rye, Barley, Spelt, Kamut, Oats.

These grains contain glutenin and gliadin (proteins), together with

agglutinating lectins, phytates, and fructose-containing fibre (FOS),

which can damage the gut when consumed in the excessive amounts found

in the modern diet (it’s not just the gluten that’s harmful in these

foods). Whole grains contain more agglutinin lectins, phytates, and

FOS than white flour, which is however lacking in most vitamins and

contains added iron.

Gluten grains cause “leaky gut” (increased intestinal permeability)

which allows bacteria and toxic undigested proteins to enter the

bloodstream from the gut.

Parts of these bacteria called LPS can trigger inflammation in the

Liver.

Persons with Hepatitis C have an increased rate of Coeliac disease, a

gluten sensitivity disease. Coeliac and non-celiac gluten sensitivity

can cause liver cirrhosis, gall bladder disease, and diabetes (types 1

and 2), as well as most of the autoimmune diseases common in people

with Hepatitis C.

Humans have been eating grains for a relatively short period of our

history and have not had time to adapt properly to a food that poses

so many digestive challenges.

Grains supply no nutrients not found in other foods; meat, eggs,

dairy, nuts and seeds are better sources of protein, vitamins and

essential fats, while root vegetables and tubers are better sources of

starches, and green vegetables are richer in protective

phytochemicals. White rice, quinoa, buckwheat, millet are non-gluten

grains that are tolerated by most people. Some people who do not

tolerate other gluten grains can tolerate oats in small amounts.

Some special foods that protect the liver:

Beef consumption is related to lower rates of cirrhosis, and this is

probably true for all red meats. The same is true for eggs. However

pork and processed meats (which are mainly pork) may increase

cirrhosis. Red meats are best.

Spices, including turmeric, fenugreek, saffron, garlic, vanilla are

protective against fibrosis.

Coffee consumption protects against fibrosis and cirrhosis from

alcohol and possibly Hepatitis C. Green tea (and possibly black tea)

protects against fibrosis, but this effect may be reduced by milk in

tea.

DHA from oily fish is protective against fibrosis in moderate

supplement doses but may increase it in excessive amounts.

Lecithin, betaine and choline protect against fatty liver; these are

found in eggs, chocolate, liver and kidney, and fish roe (lecithin and

choline), and in beetroot and spinach (betaine).

Beetroot contains betaine and some unusual and potent antioxidants,

betalains, which are destroyed by cooking (boil beetroot for less than

15 minutes, roast for under 1 hour).

Vitamins A and K2 protect against liver cancer and are found in animal

fat, organ meats, fermented dairy foods, and (K2 only) spirulina and

fermented soy.

Brazil nuts are the richest source of selenium, which also protects

against liver cancer and fibrosis. Each nut contains 19mcg selenium; 4

a day is enough. Meat and seafood are also good sources of selenium.

Carotenoids, folic acid, and flavonoids protect against fibrosis and

are found in green leafy vegetables; sulfur compounds found in

cruciferous veges (cabbage, broccoli, mustard, radish etc.) stimulate

immunity and protect against cancers.

OPCS, astringent polyphenols found in grape seed, pine bark, cocoa,

berries, and apples, protect the circulation of the liver, and protect

against the blood cancers (lymphoma) associated with both Hepatitis C

and coeliac disease.

Chinese mushrooms such as shiitake, black and white fungus, etc.

(dried or fresh) have benefits for the liver and immune system.

Eat FOOD: don’t eat food products. If possible cook it yourself or eat it raw.

These canned foods are good: sardines, tuna, mackerel: tomatoes,

beans, beetroot: olives; and bottled (not canned) pasta sauces. Frozen

vegetables and berries are excellent foods. Prunes and raisins are

good dried fruits.

MTR boil-in-a-bag curries are good occasional convenience foods.

Try to avoid processed meats, pure beef or venison sausages are the

best varieties.

It is not necessary to try to eat all the special foods. These are

good if you have them and like them, but you will not die from their

lack.

Eat some red meat, eggs, and occasional fish; some dairy (especially

butter, cream, yoghurt, or aged cheese) if this suits you; some

starchy vegetables (potato, kumara, carrot, swede, yam, beetroot,

peas, etc.); some green vegetables - raw or cooked (spinach, cabbage,

cauliflower, celery, lettuce, etc,); and some fruit or berries. Use

spices, onion, garlic, extra virgin olive oil, or herbs for

flavouring. Eat fresh nuts and seeds in moderation if you like. Enjoy

dark chocolate, coffee, tea, herb tea, fruit tea, as far as possible

unsweetened (cream can be a good substitute for sugar in coffee and

cocoa). Drink clean water regularly. Do not overdose on “fibre”.

Cook food at lower temperatures (below 200C in the oven; 170C is good

for roasting most things), remember water in a dish (as with soups and

casseroles) helps to control temperature, and fry and roast with

traditional fats, especially beef and lamb dripping, or butter and

ghee. If a meal needs oil use extra-virgin olive oil. Pan-roast chips

rather than deep-frying.

Some references:

Dietary Fat and Alcoholic Liver Disease; a concise review. Esteban Mezey

Alcohol and dietary intake in the development of chronic pancreatitis

and liver disease in alcoholism.  E Mezey, et al.

Fructose, PUFA and Gluten papers linked to Hyperlipid blog (use blog

search function)

Gluten Grains, Carbohydrates and Fats sections of Archevore blog (ditto)

Beef fat Prevents Alcoholic Liver Disease in the Rat; Nanji et al.

Relationship between Dietary Beef, Fat, and Pork and Alcoholic

Cirrhosis; Bridges

Dangerous Grains; book by Hogan and Braley.

Life Extension Foundation website: Health Concern: Hepatitis C (for

advice on supplements and drugs)

Applying principles of HCV virology to the Development of new

Antiviral Therapies; Stephen J. Polyak

(c) George D Henderson 2012


Feel free to use this.

A video of my 2009 working holiday in New Zealand's scenic Southern Alps. Music: Walrus Arabia, by The Puddle. I'm the one with the moustache and the guitar, Gavin wears the hat and the bass, and my brother Ian was behind the camera, the drumkit, and the steering wheel.