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Nutrition and liver
Nutrition and liver: what is really bad.
Premises
It is the opinion of many people that certain foods, such as for example eggs or mussels, cannot be eaten by anyone suffering from gallstones (or liver stones as they are often incorrectly termed) or by someone with chronic liver disease. Often, when someone has a pain on the right side of the abdomen, or has difficulty with digestion, he says he has a sore liver!
Nothing could be more wrong: eggs or mussels in general, if cooked and eaten
in moderation do not damage the liver and the liver very rarely causes tummy
pain!
The “fault” of these erroneous but widely held opinions lies not
with the individual citizen but with the schools, especially the compulsory
schools, which do not have any programmes for the teaching of nutrition and
also with the mass media which frequently and only with rare exception, transmit
information which is scientifically incorrect, produced by journalists who
are not experts in the field.
The science of nutrition and diet is often at the bottom of the teaching
list even in the university environment; and often is not taught sufficiently
even in the general medical degree or specialisation schools where it
should be at the top of the list.
One of the most difficult things for a doctor or for anyone in fact, is to
change dietary habits. Like the language each one of us speaks or like many
of the notions we acquire, the way in which we eat depends on how we
were taught as children; and as is well known, learning English or any other
language is easy if we are taught when small, but not when we are grown-up.
The same is true for learning to eat well.
Obviously in just one article, it is not going to be possible to teach everyone
how to eat well in order to keep one’s liver healthy, but some
essential tips are helpful.
How to eat properly and not damage your liver.
Generally speaking, the fundamentals of the classical Mediterranean
diet are valid also with respect to the health of one’s liver.
One of the most frequent pathologies encountered today in most people living
with a “fatty” diet, for example in a region such as Emilia Romagna,
is liver steatosis.
Our recent epidemiological investigation ( the Dionysos Project) in the Municipal
area of Campogalliano, reveals that hepatic steatosis or “fatty
liver” as the English most eloquently call it, is present in 23% of the
people who are of normal weight and who do not drink alcohol or wine ( teetotallers),
in 48% of people who are of normal weight but drink more than 60 grams of
alcohol daily (the equivalent of about a bottle of Lambrusco per day), in
76% of the people who are obese, even if they are teetotallers, and in as much
as 94% of the people who are obese and who drink more than 60 grams of alcohol
per day.
As you have by now understood, the two most important factors causing fatty liver are the abuse of alcoholic beverages (among which are also wine and beer!) and incorrect nutrition which causes overweight and leads to obesity.
However, fatty liver is not really a proper illness or
disease as it is only in fewer than 10% of cases that it leads to more serious
conditions such as cirrhosis; but it is a pathology which denotes an incorrect
diet which may lead to liver enlargement (and a large liver can also be harmful!),
visible with ultrasound and sometimes affecting those blood analyses concerning
the liver integrity (the famous transaminases or the gamma GT’s!), and
hence lead to the death of some hepatic cells.
The fatty liver is a liver which always functions badly, which is always
under conditions of maximum stress ( like when in a car, if one were to travel
always with the accelerator pushed down to the maximum); but it is however
a reversible condition, one which may be remedied by means of a more correct
diet.
Hence what should one do to avoid developing a fatty liver:
- First of all, arm yourself with a ruler and using the diagram in Figure
2 together with its instructions, check your Body Mass Index (BMI), and whether
your weight is normal, or whether you are overweight or perhaps even obese
( otherwise ask your house doctor).
If you are within the range of normality (normal weight),there are no problems.
If you are within the overweight or obese categories, you are at an up to 10 times higher risk of having a fatty liver, and this can be checked with a simple hepatic ultrasound.
Remember that, always from an epidemiological study (Project Dionysos) conducted by our association (Foundation for the Study of Liver Disease), overweight and obesity conditions in the population of Campogallino (Modena province) and of Cormons (Gorizia province) are very frequent and represent 32% and 10% of the general population respectively.
In the age group over 45 years, 45% of the people (i.e. almost one in every two) is overweight and 15% of the people (i.e. about one in 6 people) is obese. - In second place, examine your conscience and try to understand if
your daily intake of alcohol is greater than 30 grams of alcohol, which is
the safety threshold, or if in fact it is greater than 60 grams of alcohol
per day, i.e. the equivalent of a bottle of wine having a low gradation (about
8-9 degrees), or the equivalent of two glasses of distilled alcohol.
To be more precise, with the ruler in hand once more, use Mellor’s normogram, displayed in figure 3, and follow the instructions shown in the diagram.
If this is the case, it is imperative that you reduce the quantity of alcohol that you consume daily, and it is even more important that you do so if you are overweight or obese (see point 1).
Alcohol abuse is still today the second highest cause of cirrhosis in Italy (after the Hepatitis C virus, which is addressed in the next article), even though the per-capita consumption of alcohol by Italians has halved in the last 20 years.
Today, unfortunately, there is greater abuse of alcohol amongst young people, with respect to the past, and hence the promotion of broad campaigns on nutrition and dietary education at a national level are necessary, also because alcohol is considered an actual drug by the World Health Organisation.
What does it mean to reduce weight or to have a better diet?
Obviously you can get more precise and detailed information from your house
doctor or from our association (see addresses and panel below), but as a rule,
as well as trying to stay in shape and therefore keeping an eye on the bathroom
scale and your calorie intake, if necessary (remember that with little or moderate
physical activity, an adult male of average stature and age should have a daily
calorific intake of not more than 2500-2700 calories, and an adult female (not
during pregnancy) some 500 calories fewer), there are some fundamental rules
which should be followed:
- If you can drink alcohol, i.e. if you do not have a diseased liver, you must do so in moderation: the ideal quantity for no risks should not be more than 30 grams, the equivalent of a couple of glasses of medium gradation wine preferably during meals.
- Always try to maintain a balanced diet, comprising for the most part (60-65 % of calorific intake) carbohydrates (i.e. pasta, bread, cereals, potatoes, legumes),but never in excess (never more than 70 – 80 grams of pasta per day and not more than two portions of bread per day), then also lipids (i.e. fats, oils, cheese, milk products etc.) for some 20% of the calorific intake and then finally proteins (i.e. meat, preferably white or even better fish or legumes) for the remaining 15% of the daily calorific intake.
- Every day eat at least two portions of vegetables, preferably fresh, and two or three fruits.
- Avoid the simple sugars (varieties of puddings, sugar drinks, sweets, chocolates etc.)
- As far as possible, avoid saturated fats (all types of cheese, processed meats such as sausages, salamis, puddings, various condiments, dried fruit, etc.)
- Do not eat more than 3 spoons of oil per day (sure, olive oil is good for you, but don’t exaggerate!). Ideally you should eat a mix made up of 2/3 extra-virgin olive oil and 1/3 seed oil.
- Drink lots of water (at least a litre and a half outside of meals) and have at least 4 or 5 small meals per day, avoiding snacks and rolls.
However the best way to change your eating habits is to have a “personalised diet”, and hence go to your house doctor and get his advice about specialists in the sector (Nutritionists and Dieticians).
To sum up, if your liver is already sick, i.e. you have chronic hepatitis or cirrhosis or other rarer hepatic illnesses, you must remember that very often, you may be in a condition of malnutrition (often lack of proteins or vitamins) and hence dietary advice, over and above the absolute avoidance of alcohol, which as you know is the second highest cause of serious hepatic illnesses (cirrhoses) in Italy, must be absolutely personalised and evaluated by specialists (in this case by Gastroenterologists or Hepatologists).
For any advice, we do however renew our invitation for you to consult us and contact us at our premises.