Download Nutrition in Chronic Liver Disease

Nutrition in Chronic Liver Disease
Weight Loss
Chronic liver disease is often associated with
muscle and body fat loss. This may be
difficult to detect because of fluid retention.
For example, you may be losing muscle, but
To help prevent muscle and fat loss, you
need to eat foods high in energy and
protein.
if you are retaining fluid, you may stay the
same weight.
To increase your energy and protein
intake, include at least one food from
If not corrected, muscle and body fat loss can
result in a variety of health complications.
A high protein diet is important for people with
chronic liver disease as the protein is used to
maintain muscles and body tissues (including
the liver) and to the keep the body working
normally.
Some people believe that people with liver
disease need to avoid protein-rich foods to
help prevent a condition called hepatic
encephalopathy. However, this is not the
case. Hepatic encephalopathy is treated by
medications and avoiding protein will only
make you more malnourished.
each of the following columns at each
meal or snack.
Energy foods
• Bread and bread
products
• Breakfast cereals
• Pasta and Rice,
noodles
• Cakes and Biscuits
• Potato, sweet potato,
corn
• Butter/margarine, oil
• Cream/mayonnaise
• Jam, honey, golden
syrup
• Sugar and sugary
products
Protein foods
• Milk and milk
powder
• Yoghurt
• Cheese
• Custard
• Meat, Fish,
Chicken
• Eggs
• Nuts and Seeds(including pastes)
• Legumes – (baked
beans, lentils,
chickpeas)
Note: Some of these foods may be high in
salt. If you have been advised to follow a low
salt diet, refer to the low salt information
below.
This is a draft document from Queensland Health Dietitian/ Nutritionists
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp
Developed: March 2009
Review Date: December 2013
Further ideas to increase protein and
A number of special nutrition
energy include:
supplements may be able to help
•
Eating six to eight smaller meals and
increase your calorie and protein intake.
snacks throughout the day can help you
Talk to your dietitian-nutritionist about
get more nutrition than having three
these, if required.
normal sized meals. Small frequent meals
•
are also useful if you feel full quickly or if
Note: If you are overweight you should
your appetite has decreased.
focus on having a high protein intake and
Use fat in cooking, frying and baking; add
oils to vegies and salads
limit fatty and sweet foods. Sometimes
people with liver disease require a low fat
diet. If your doctor recommends a low fat
•
•
•
Add eggs, legumes, yoghurt, or low salt
diet of if you are diabetic see your
cheese to your meat dishes or salads.
dietitian for information.
Have a small meal of energy rich food
before going to bed. This has been shown
Vitamins and Minerals
to be helpful in weight management for
The changes that occur in chronic liver
people with liver disease.
disease can lead to vitamin and/or
Replace tea, coffee or water with fluids
that provide energy (such as milk, juice,
cordial or soft drink), especially if you are
on a fluid restriction.
Milk is a great base for nourishing drinks as it
is high in protein and energy. Full cream milk
contains more kilojoules than low fat milks, so
is preferable to use. Fortified soy milk (eg So
Good®) is also suitable. To make your milk
higher in protein and calories, other
mineral deficiencies. Problems such as
excessive bleeding, osteoporosis,
anaemia, and night blindness can result if
vitamin and/or mineral levels are too low.
Eating a variety of foods can help to avoid
deficiencies. However your doctor may
still recommend a vitamin and mineral
supplement if required. Avoid taking any
supplements or following diets not
recommended by your doctor or dietitian.
ingredients may be added, such as ice-cream
and a variety of flavourings.
This is a draft document from Queensland Health Dietitian/ Nutritionists
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp
Developed: March 2009
Review Date: December 2013
Fluid and Salt
1. Do not add salt at the table or
As liver disease progresses, fluid can be
in cooking.
stored around your stomach – this is
What to use instead …
called ascites. If this occurs it becomes
very important to limit the amount of salt
• freshly ground pepper, dry mustard
powder
(sodium) you consume.
• lemon juice, lime juice, vinegar
Because salt acts like a sponge with fluid
• a sprinkle of dried herbs
in your body, by reducing the amount of
• chopped fresh herbs- basil, oregano,
salt you eat you can limit the amount of
mint, rosemary, thyme, parsley, chives,
fluid that stays in your body. If you have
sage, tarragon
ascites, your doctor and dietitian will
• garlic, curry, chilli, onion, fresh ginger,
spring onions
recommend you follow a low salt diet.
• spices- cinnamon, nutmeg, cardamom,
ginger, cumin
You may also be asked to limit the
amount of fluids you drink through the
day. This includes all beverages and
Also, try….
watery foods such as soup, ice-cream,
•
‘wet’ curries, fruits etc.
slowly cutting down your salt intake
over a few months to allow your taste
buds to adjust.
HINTS TO REDUCE SALT
•
tasting food before adding salt or salty
sauces
1. Do not add salt at the table or
in cooking
Other products such as sea salt,
vegetable salt, celery salt, lemon pepper,
2. Choose low salt foods
herb salt can still contain high levels of
3. Count your salt
sodium. Check the nutrition panel and
ingredients.
This is a draft document from Queensland Health Dietitian/ Nutritionists
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp
2013
Developed: March 2009
Review Date: December
FLAVOUR COMBINATIONS TO TRY
•
pork - garlic, lemon rind, coriander,
apple sauce, ginger, mustard.
•
beef - bay leaf, thyme, mustard, sage.
•
lamb - mint, ginger, currant jelly,
•
black pepper.
•
paprika, oregano, rosemary, garlic.
•
chicken - sage, tarragon, garlic, chilli.
•
fish - lemon juice, lemon pepper, lime
potato - chives, paprika, mint, parsley,
carrots - ginger, cinnamon, honey,
parsley.
juice, chives, parsley, vinegar.
•
tomato - basil, garlic, black pepper,
parsley, oregano.
2. Choose low salt foods
Most sodium (75%) comes from processed foods. When shopping, buy fresh, unprocessed,
or frozen foods. Also choose foods labelled “low salt” or “no added salt”.
Some foods labelled “reduced salt” can still contain high levels of sodium. Check the nutrition
panel – a sodium (Na) content less than 150 mg per 100gm serve is desirable.
FOOD
Bread &
Cereals
Often high in
salt
Lower Salt - CHOOSE
♦ salt reduced bread
♦ fresh and dried pasta
♦ salt reduced and low salt crackers
and biscuits eg Ryvita, Vitaweat,
rice and corn cakes
♦ rolled oats, porridge
♦ Weetbix, Sustain, muesli, Just
Right, puffed wheat, oat or wheat
bran
♦ rice
♦ plain flour & cornflour
This is a draft document from Queensland Health Dietitian/ Nutritionists
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp
2013
High Salt - AVOID
♦ savoury crackers
♦ sweet biscuits & shortbread
♦ croissants, pastry, cakes, scones,
muffins
♦ savoury breads, bread, bread
rolls (products based on self
raising flour are high in salt)
♦ packet rice & pasta with
flavouring, instant noodles
♦ breakfast cereals with more than
150 mg sodium per serve eg
Cornflakes, Rice Bubbles, Bran
Flakes
♦ tinned spaghetti
Developed: March 2009
Review Date: December
FOOD
Fruit
Vegetables
Milk, yoghurt
and cheese
Meat , Fish,
Chicken,
Eggs
Lower Salt - CHOOSE
♦ fresh fruit
♦ dried fruit, tinned fruit
♦ fruit juices
♦ all fresh and frozen vegetables
♦ legumes (lentils, chickpeas, soup
mix, soybeans, kidney beans),
canned bean mix
♦ ‘no added salt’ canned vegetables
♦ milk – all types
♦ yoghurt
♦ custard, dairy desserts, icecream
♦ cottage, ricotta or continental
(quark) cheese
♦ fresh, unprocessed meat (lamb,
beef, veal, pork), chicken, turkey,
fish and seafood
♦ eggs
♦ ‘no added salt’ tinned seafood eg
tuna in springwater
High Salt - AVOID
♦ olives
♦ canned plums
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
Fats
Drinks,
Snacks &
Extras
♦ unsalted butter, oil and avocado
♦ no added salt (e.g. Becel, Sundew)
or reduced salt (Gold’n Canola,
Flora) margarines
♦ no added salt peanut butter
Drink water!
♦
♦
♦
♦
♦
♦
♦
♦
cordial, softdrink
home made, unsalted soups
Milo, tea, coffee
unsalted nuts & seeds
jam, honey, syrup
unsalted popcorn
plain chocolate
plain lollies
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
♦
This is a draft document from Queensland Health Dietitian/ Nutritionists
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp
2013
pickled and
canned vegetables
tomato or vegetable juice
baked beans or reduced salt
baked beans
cheese : cheddar, cream, brie,
camembert, feta, parmesan
cheese spreads
reduced salt cheeses (still high in
salt)
cured, smoked, canned or salted
meat eg corned beef, ham,
bacon, sausages, salami, brawn,
pate, frankfurts
meat pies, sausage rolls, fish
fingers, crumbed or battered fish,
hamburgers, BBQ chicken, pizza,
chicken nuggets, Chinese food
tinned fish in brine or tomato
sauce, anchovies
butter
margarine
peanut butter
sports drinks
soup, Bonox
tomato juice, vegetable juice
clear aspirin or panadol
effervescent drinks e.g. alkaseltzer, Eno and vitamins e.g.
Berocca
dips, olives, marinated & pickled
foods
most sauces - tomato sauce,
tartare sauce, BBQ sauce,
teriyaki , soy sauce (even
reduced salt), Worcestershire
sauce, cheese sauce
gravox, gravy, stock cubes
vegemite, meat & fish paste
salted nuts and snacks
crisps, pretzels
mustard, pickles, relish
Developed: March 2009
Review Date: December
3. Count your salt
Check the nutrition information panel for an accurate measure of sodium per serve in a
particular food, and aim to have less than 2000mg of sodium each day. In some cases,
a limit of 1400mg daily may be needed. Any food with more than 150mg sodium per
100 gm serve should be limited.
The table below provides a general guide.
FOOD
mg sodium FOOD
mg sodium
bread, 1 slice
150
fresh, dried, canned fruit
0
crumpet, 1
290
fresh or frozen veg,
10
average serve
porridge, muesli, weetbix,
0 - 80
(low salt) small bowl
Cornflakes, Nutrigrain
tinned vegetables (peas,
150
corn, etc ) ½ cup
200 - 320
potato crisps 50g packet
450
rice or pasta 1 cup
0
salted nuts 50g
210
2-3 crackers
100
unsalted nuts 50g
5
2 sweet biscuits
100 - 150
baked beans ½ cup
570
piece of cake/ scone
150 - 200
tinned fish in brine 100g
300 - 400
sports drink 500mL
200
chicken, fresh 100g
60
cup of soup, 1
650
ham, 2 thin slices 60g
950
tomato sauce, 20mL
200
bacon, 1 rasher, 20g
650
mayonnaise/dressing 20ml 250
egg, 1 large
70
sausage roll, average 80g
600
cheese, 1 slice 30g
200
meat pie, 1
900
cottage/ ricotta 30g
60
chicken nuggets 6
630
glass of milk
100
hamburger, average
1000
small tub yoghurt
120
sausage, 1 thick
650
butter/marg 1 teaspoon
60
pizza, ¼ medium
1200
2-3 pinches salt (1gram)
1500
1 scone
200
Berocca, 1 tablet
285
(high salt) small bowl
This is a draft document from Queensland Health Dietitian/ Nutritionists
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp
2013
Developed: March 2009
Review Date: December
SUGGESTED MEALPLAN
BREAKFAST
MORNING TEA
LUNCH
AFTERNOON TEA
DINNER
SUPPER
Things I can do to improve my management of chronic liver disease:
1.
2.
3.
For information contact your Dietitian or Nutritionist:
This is a draft document from Queensland Health Dietitian/ Nutritionists
Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp
2013
Developed: March 2009
Review Date: December