In the long wait to begin treatment for hepatitis C virus (HCV), it may seem as if there is not much else you can do for your liver’s well-being outside of seeing your doctor for checkups. But actually you can make many beneficial lifestyle choices to keep this all-important organ in the best shape possible in the face of the progressive damage that hep C can cause. Following a healthy diet, cutting out alcohol and getting regular exercise are all vital ways you can support hepatic health.
“One thing that I try to emphasize to patients is that this is not a matter of treating a liver with a patient attached,” says David Ross, MD, PhD, director of the Veterans Affairs National Viral Hepatitis Program and infectious disease physician at the Washington, DC, VA Medical Center
To get a better sense of how the things you consume affect your liver, first consider what your body’s second-largest organ actually does. Weighing in at about 3 pounds and sitting under the right side of your ribcage, the liver filters all the blood in the body before it is sent back to the heart. The liver detoxifies chemicals you ingest, metabolizes medications (or supplements, as the case may be) and makes glucose and various proteins. Meanwhile, hepatitis C attacks the liver and can gradually cause damage that makes the organ less able to perform these vital functions.
The first question on the minds of many people with hepatitis C is, “Can I drink?”
“I tell patients to avoid alcohol with hepatitis C,” says Andrew Aronsohn, MD, an assistant professor of medicine at the University of Chicago Medical Center. “The reason being that we know that drinking alcohol, in the setting of hepatitis C, speeds up the natural history of the hepatitis C virus and allows it to kind of have a synergistic effect that causes more scarring earlier on in the disease course.”
Ross agrees with this policy but notes that when patients tell him they simply cannot bring themselves to abstain from all alcohol, he urges them to cut back as much as possible. However, if someone has advanced liver disease, especially if they need a liver transplant, alcohol is absolutely off the table in Ross’s book. “Virtually all transplant centers will reject somebody unless they’ve been abstinent from alcohol for at least six months,” he says.
While many may be inclined to rationalize their drinking—“But it’s only beer…”—keep in mind that one type of alcohol is no better or worse for your liver than another. A 12-ounce beer, a 5-ounce glass of wine and a 1.5-ounce shot of liquor all have the same alcohol content and are just as taxing to your liver.
When it comes to diet, the basic guidelines are no particular mystery, since most of the recommendations would apply to anyone. Observe a good balance between all your basic food groups, including grains, proteins, dairy, fruits, vegetables and fats—making sure to keep the last devil in those details to more of a minimum. Choose foods that have a high fiber content, including fresh fruits and veggies, and whole-grain breads, rice and cereals.
A major goal is to keep you at a healthy weight, because this reduces your chance of both diabetes and what’s known as non-alcoholic fatty liver disease; the last thing you need is another liver disease on top of hep C to complicate matters even more.
The next all-important guideline may be a tough one for many Americans: You should try to cut out all processed foods, in a particular fast food. In addition to fat and caloric levels that can often go through the roof, processed food is typically drenched in salt, also known as sodium. The reason salt causes trouble in people with liver disease is because when the liver is damaged to the point where it fails to produce enough proteins in the blood, the organ releases more fluid into the tissues to try to even out the imbalance. Salt can then worsen this effect, because too much sodium causes you to retain fluids in order to lessen its concentration. A result may be swollen legs or bellies. So while the typical American consumes 3,000 to 5,000 milligrams of sodium each day, people with hep C should stick to less than 2,000 mg a day—1,500 to 1,800 mg if they have cirrhosis.
Advanced liver disease can also lead to malnourishment, causing significant weight loss of the wrong kind. In this case, it is highly important to get enough calories, and to make sure they are coming from the best possible sources—in other words, not from fatty foods or non-fiber-rich carbohydrates. The liver may be having trouble processing proteins, in which case a physician can prescribe certain nutritional supplements that supply protein in a form that’s easier to absorb.
When it comes to nutritional supplements in the grand scheme of things, proceed with great caution. Unregulated by the U.S. Food & Drug Administration (FDA), these substances are not only relatively unnecessary if you observe a well-balanced diet, but also potentially harmful.
“We’ve seen a lot of patients come to our institution that have had really dangerous side effects to various supplements that you can walk into a store and buy,” Aronsohn says. “We’ve even had to perform liver transplants on some patients who have had liver failure on some of these supplements.”
In addition, many herbs are known to be potentially damaging to the liver. So if you are inclined toward such homeopathic measures, it is vital to first consult your physician about what is safe.
Talking to your doctor is a good baseline for all of these concerns. And an even richer source of wisdom is a registered dietician, since many liver doctors may not necessarily have the more finely honed expertise in this area. Ask your clinician for a recommendation and also do some homework on the dietician’s credentials, education and experience to make sure he or she is qualified to give advice tailored to someone with hep C.
Lastly, exercise can benefit your liver in many ways. Lowering your body mass index (BMI) can reduce both the likelihood of and the effects of non-alcoholic fatty liver disease. Weight loss can also decrease the body’s demands on the liver and improve the organ’s ability to metabolize glucose. Going down in waist size can lessen the risk of diabetes or help manage the condition for those who already have it. Overweight people also respond more poorly to interferon- and ribavirin-based hep C therapies—although this concern will likely stop being as relevant as newer combination therapies increasingly phase out the use of those two drugs in the coming years.
Don’t Take Hepatitis C Lying Down, Make Healthy Choices
How getting up and taking control of your diet, alcohol consumption and exercise can translate into a healthier liver.
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