Gastrointestinal System Liver Nutrition Nutritional needs of the

Gastrointestinal System Liver Nutrition

Nutritional needs of the patient with liver disease Nutritional Needs of Patients with Liver Disease “Accelerated Starvation”: It would take a healthy adult 72 hours of starvation to reach same level of fat & muscle breakdown as occurs in overnight fasting for cirrhotic patient (due to low liver & glycogen stores)

What Does the Liver Do? Nutrition Related Functions OManufacturing Plant OStorage Facility OWaste Disposal

Manufacturing Functions O Protein- for the bloodstream (albumin) O Glycogen- storage form of glucose for energy O Bile- to help digest fats that are needed for cell structure and energy) O Cholesterol – and special proteins to carry fat through the blood

Storage Facility OGlycogen-released when our bodies need energy (this includes during sleep for basic metabolism) OIron- most is stored in the liver

Common Problems that Interfere Eating O O Decreased abdominal room due to ascites Delayed gastric emptying Decreased appetite Poor nutrient absorption: O Decreased bile production = low fat absoprtion O Diarrhea O Overzealous diet restrictions O Altered mental status/ encephalopathy

Waste Disposal O Ammonia - from the breakdown of dietary protein and muscle tissue O Bilirubin - from the breakdown of red blood cells O Bacteria – removed from the bloodstream O Drugs and Alcohol - are metabolized in the liver

Common Problems that Interfere Eating O Decreased abdominal room due to ascites O Delayed gastric emptying O Decreased appetite O Poor nutrient absorption: O Decreased bile production = low fat absorption O Diarrhea O Overzealous diet restrictions O Altered mental status/ encephalopathy

How Diet Can Help with Symptoms O Fluid Gain: Ascites, Edema O 1. Low Sodium Diet: decreases water/ fluid retention O 2. Adequate protein: keeps fluid O in the arteries and veins rather than leaking into tissues O 3. Avoid Excessive Fluid Intake

Low Sodium Diet O 2000 - 2400 mg Sodium/ day O <200 mg/ serving or 700 mg/ meal O Replace salt shaker with herb shaker O Stock kitchen with fresh unprocessed foods O Avoid eating out- eat in! O Be patient- tastes change

Fluid Intake O Avoid overhydration- usually 6 -8 cups/day is adequate (48 -64 oz) O Suck on ice chips, candy or gum rather than guzzling water O If low serum sodium is an issue, may need a fluid restriction O Avoid dehydration O however-can lead to renal problems

Protein Intake O Meat Group: 4 -5 oz. /day for women or oz. /day for men, plus 1 -2 cups milk/day OAdequate to: O maintain muscles protein levels in blood O Protein Restriction: only used as last resort O Cases of TIPS or no improvement in encephalopathy O First try medicines: lactulose, Neomycin, Metronidazole O More common causes of encephalopathy: O GI bleed, infection, medicines, missed lactulose doses

Small Frequent Meals O Ascites- decreases room in stomach O Muscle wasting- from low glycogen stores O Nausea O Blood sugars

Gastroparesis O Control blood sugars if diabetic O Avoid gut slowing meds if possible such as many painkillers O Use liquids over solids if necessary O Avoid high fiber, high volume foods O May need meds to increase GI motility

Avoiding Toxicity O Bacteria: O -no uncooked shellfish O wash hands prior to eating O keep leftovers refrigerated O Protein waste products: O avoid too little protein intake (increases muscle breakdown) O avoid too much protein intake O Alcohol and over-the counter meds- check all drugs with doctor

Supplements O Zinc- lost in urine O Milk Thistle - likely harmless but not shown to be beneficial O SAMe- (s-adenosylmethionine) - May be beneficial but expensive O 400 mg QID O Betaine- from juice of sugar beet O Helps decrease homocysteine levels O 10 grams 2 x’s day O Ongoing trials

Remember O Check with Doctor to see if any special restrictions are needed O Consult with a dietitian as needed O Don’t wait until signs of malnourishment are advanced to take action