Hepatitis and Nutrition

Nutrition and Hepatitis: What you need to know

Hepatitis refers to an inflammatory condition of the liver tissue. The most common cause of hepatitis is viruses, but other possible causes include auto immune diseases, toxins, certain medications, heavy alcohol use, other infections and non-alcoholic steatohepatitis (NASH).

The liver is located in the right upper area of the abdomen. It has many critical functions that includes:

  • Filtering of toxins from the body
  • Bile production (essential for digestion)
  • Excretion of bilirubin, cholesterol, hormones and drugs
  • Breakdown of carbohydrates, fats and proteins
  • Storage of glycogen (a form of sugar), minerals and vitamin (A,D,E and K)
  • Activation of enzymes, which are specialized proteins essential to body functions
  • Synthesis of blood proteins (like albumin)
  • Synthesis of clotting factors

Signs and symptoms of acute hepatitis includes:

  • Abdominal Pain
  • Loss of appetite
  • Weight loss
  • Fatigue
  • Flu-like symptoms
  • Pale stools
  • Dark urine
  • Yellow skin and eyes (might also be signs of jaundice)

Chronic Hepatitis develops over time and the symptoms might be too subtle to notice.

Hepatitis is diagnosed by physical exam, liver function tests, blood tests, an ultrasound or a liver biopsy.

There are five main types of viral hepatitis:

Hepatitis A

Hepatitis A is caused by an infection with the Hepatitis A virus (HAV). This type of hepatitis is most commonly spread by contaminated food and water (by faeces from a person infected with Hepatitis A).

Treatment includes bed-rest and good hydration and nutrition when vomiting and diarrhoea are experienced.

Tips on minimizing nausea and vomiting:

• Eat smaller, more frequent meals
• Eat slowly
• Avoid fatty foods, as it might make you more nauseous because it takes much longer to digest that low fat meals
• Avoid sweet foods/ beverages
• Clear, cool beverages are best tolerated (clear soups, carbonated beverages, popsicles and ice cubes)
• Liquids should be taken 30-60 minutes before or after eating and not with meals
• Avoid lying down for at least 2 hours after your meal
• Avoid cooking as this might make you feel more nauseous, rather let someone else do the cooking

What to do when experiencing diarrhoea:

• Stay hydrated to replace fluid losses
• Eat 5 – 6 small meals a day
• Increase foods high in soluble fiber (banana, oats, mashed potato, cooked/canned fruits without the skin)
• Avoid foods high in insoluble fiber (raw fruit and vegetables with skin, wholegrain breads and cereals, nuts, seeds, popcorn, beans, lentils and peas)
• Avoid very hot or very cold foods
• Avoid caffeinated and sugary drinks
• Avoid fried and spicy foods
• Try the ABC recipe (peeled and grated apple, cooked carrots and banana)

Hepatitis A vaccine is available to prevent this infection.

Hepatitis B

Hepatitis B is transmitted through contact infectious body fluids (blood, vaginal secretions and semen) infected with the hepatitis B virus (HBV). HBV is mainly sexually transmitted, but may also be passed from a mother to her baby during pregnancy or birth, or when sharing needles or razors.

Chronic Hepatitis B is treated with antiviral medication which is usually continued for several months/years. Treatment also requires regular medical monitoring and evaluation to determine whether the virus is responding to the treatment.

Hepatitis B can be prevented with vaccination.

Hepatitis C

Hepatitis C (HCV) is also transmitted through direct contact with infected body fluids (injection of drugs or sexual contact).

Acute and Chronic Hepatitis C are treated with antiviral medication. Chronic hepatitis C needs to be treated with a combination of antiviral medication, further tests might be needed to determine if the best combination of treatment.

There is not a vaccine available currently for hepatitis C.

People who develop liver cirrhosis or disease as a result of chronic hepatitis C may be a candidate for a liver transplant.

Hepatitis D

Hepatitis D (HDV) is a serious liver disease and is contracted through direct contact with infected blood. Hepatitis D only occurs in the conjunction with Hepatitis B infection and can only multiply with the presence of HBV.

Currently there doesn’t exist antiviral medication for the treatment of hepatitis D.

Hepatitis D can be prevented by getting the vaccination for hepatitis B.

Hepatitis E

Hepatitis E is a waterborne disease caused by Hepatitis E (HEV). HEV is usually found in areas where there is poor sanitation as a result from the ingestion of fecal material found in the water.

Non-infectious Hepatitis

  1. Alcohol and other substances – consuming alcohol excessively can cause liver damage and inflammation, also known as alcoholic hepatitis. Excessive alcohol consumed, injures the liver cells directly and can lead to permanent liver failure, and thickening and scarring of the liver tissue (cirrhosis) over a long period.
  2. The overuse or overdose of medications and exposure to poison can also cause hepatitis.
  3. Autoimmune System Response – Hepatitis caused by an autoimmune system response occurs when the immune system mistakes the liver as a harmful object and starts to attach it. This causes ongoing inflammation that can range from mild to severe and impair the function of the liver. Treatment for the autoimmune hepatitis includes corticosteroids and immune suppressants.

Prevention of Hepatitis

  1. Hygiene – good Hygiene is critical in the prevention of contracting hepatitis A and E. Ensure to use clean and save water for drinking and cooking. Avoid raw or undercooked shellfish.
  2. Hepatitis B, C and D contracted through contaminated blood and body fluids can be prevented by avoiding spilled blood, using new needles, not sharing razors, not sharing toothbrushes and practising save sex.
  3. Vaccines – the use of vaccines plays a critical role in the prevention of hepatitis. Vaccinations to prevent the development of Hepatitis A and B are currently available, and vaccines against hepatitis C are being developed.

Nonalcoholic Steatohepatitis (NASH)

NASH is the inflamed and damaged liver caused by an accumulation of fat in the liver. Due to the inflammation and damage, the liver can’t function optimally. The progression of NASH can lead to liver cirrhosis (scarring of the liver tissue). NASH is very similar to the kind of liver disease caused by long term alcohol abuse, but it occurs in people who doesn’t use alcohol.

The cause of NASH is still unclear, but research has suggested that it might be caused by environmental factors or it can be hereditary. Risk factors for NASH include obesity, insulin resistance, Diabetes type 2, high cholesterol, high triglycerides and metabolic syndrome.

Symptoms may only become severe enough after a few years and it includes fatigue, unexplained weight loss, pain in the upper right part of the abdomen and general weakness.

Treatment for NASH includes the management of the risk factors for NASH:

  • Reaching a healthy weight, with BMI between 18.5 to 24.9 kg/m²
  • Controlling blood sugar levels by :
  • Eating small frequent meals (5-6 meals a day)
  • Focusing on Low GI carbohydrates
  • Focusing on low fat foods
  • Avoiding sugar and sugary food and beverages
  • Exercising regularly
  • Reducing total blood cholesterol levels by avoiding saturated fats (animal fats, fried foods, coconut oil and palm kernel oil) using small amounts of unsaturated fats (avocado, olive or canola oil, nuts) daily increasing essential fat intake (fatty fish like salmon, sardines, pilchards, tuna and) or supplementing with Omega 3 supplement increasing soluble fiber intake (legumes, oats, fruits, vegetables, rice, pasta, potato and sweet potato)
  • Limit sugary foods and beverages
  • Daily activity –focus on cardio exercises like jogging, swimming, cycling, skipping rope etc. for at least 20 minutes a day 5-7 times a week.
  • Avoiding alcohol

When you are diagnosed with NASH, it is essential to visit your Dietician regularly to monitor the above mentioned risk factors.

Special note: Because Hepatitis E is mostly acute, it resolves on its own. There is no medication available to treat Hepatitis E. People infected with Hepatitis E, is advised to get enough rest, stay hydrated, follow a healthy balanced diet and to avoid alcohol consumption.

If you have any further questions regarding the symptoms or nutritional management of Hepatitis contact one of our Dieticians so that they can advise you on the correct meal plan to meet your specific needs.

AUTHOR: JOANI BRITZ (RD) SA 

About the author:

Tanya has been providing dietary guidance since 2009 as a registered dietician licensed in South Africa. Her goal is to help patients understand the connection between diet and diagnosis for improved nutritional well being.

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