Liver Awareness Month: What pain medication can Liver Disease patients take? Is milk thistle good for my liver?
October has been busy around here folks, fall is one of our favorite times of the year. Nana and the little people finally completed our little Halloween horror movie, a family tradition since 2013. I am hoping this isn't the last year, but it could be.
People are saying (my daughter) that I went a bit too far this year. Note to self; during lunch never film a bloody zombie attack - especially at Taco Bell.
Who knew our blood curdling screams would offend so many people. I ask you, how scary can a four and eight year old be? After the manager explained the situation, I somewhat understood. Manager Frank made a special appearance in "Zombies Eat Tacos - Not People" I love the title too, brainchild of the baby!
Moving on to something more important, as most of you know October is both Liver and Liver Cancer Awareness Month. Yes, because of my movie career I almost missed it. Not to worry, the wonderful website of the American Liver Foundation (ALF) just published their E-Newsletter "LIVERLOWDOWN" chock–full of great information about the causes, symptoms and risk factors associated with liver disease.
ALF Mayo Nutrition and Wellness Liver Chat
Is milk thistle good for my liver? How about the Paleo diet? Leading experts from the Mayo Clinic and University of Florida Health answered these questions and more at ALF’s September Nutrition Tweet Chat. Three transplant hepatologists and a dietician weighed in on wellness and nutrition.
Q1. Why do people who have never consumed alcohol get Liver Disease?
A1. Many causes besides alcohol. Your doctor will check to see if you have a condition requiring specific treatment.
Q2. What kinds of processed or salty foods should patients with ascites/edema limit?
A2. Patients should read nutrition labels. Common culprits include frozen meals, deli meats, chips, fast food
Q3. Is it healthy to skip meals or try to drastically decrease calorie intake to lose weight?
A3. Patients with cirrhosis can often suffer from malnutrition. The key to losing weight: healthy diet and exercise.
Q4. For patients with issues such as nausea or lack of appetite, are smaller meals better than 3 meals/day?
A4. Smaller, frequent meals can be beneficial. Especially to those with slow gastric emptying and decreased appetite.
Q5. Next, what are some smart snacks to pack or have on hand, instead of reaching for candy or chocolate?
A5. High protein stacks are always favorable: nuts, seeds, yogurt, protein bars, or high protein shakes.
Q6. Patients often ask, you recommend the DASH diet to all patients?
A6. Despite limited data showing the benefits of DASH for Fatty Liver Disease, I recommend discussing with your dr.
Q7. What foods should I be eating if I have liver disease and low platelets? Or what if I'm anemic?
A7. Drink 1.5-2 L water per day, but avoid all fruit juice. Make sure you eat 3-4 servings vegetables, 2 servings fruit. Fruit juice contains significant amounts of fructose sugar- metabolized like fat. Also eat 4 servings whole grains/day, 3 servings low fat dairy. Try eating 1-2 servings ocean fish weekly, 2 egg yolk. Finally, avoid meats/sausages/butter/vegetable oil. And limit sodium (<2g daily), as well as processed and restaurant foods!
Q8. If I have fatty liver disease- are there good fats I should consume or should all be eliminated for your diet?
A8. Avoid fried foods, pizza, and sausage. Choose ocean fish, which are good sources of Omega-3 fatty acids.
Q9. The Paleo diet is popular- but is it a good choice for overall wellness?
A9. No, too much saturated fat and minimal whole grains. It's easy to develop Vitamin B deficiencies
Q10. If I have too much iron in blood- are there foods I should avoid or limit consumption of?
A10. Avoid red & processed meats, fatty foods, supplemental Vitamin C, sugary foods/beverages. DO eat nuts, grains, rice & beans.
Q11. Very popular question: Is coffee OK to consume? How many cups a day is OK?
A11. 2-3 6-8oz cups of coffee daily are fine.
Q12. If you have ascites/edema (water retention), what kinds of processed or salty foods should you limit consumption of?
A12. Avoid processed foods, salty foods, sausage, pizza, and baked goods like muffins. Minimize restaurant foods.
Q13. For patients w/issues such as nausea or lack of appetite- are smaller meals better than 3 square meals per day?
A13. 4-6 meals per day helps meet your calorie and protein needs. Remember to included a good source of protein w/ every meal.
Q14. Is the DASH diet one that you would recommend for all liver patients?
A14. DASH diet benefits most patients except for those on a low potassium diet.
Basic DASH Diet includes 7 day meal plan with 2000 calories, 100 gram protein, 1500 mg sodium-(link) As the responses from the experts keep coming in, we're moving onto our next topic- supplements, liver function, and medication
Q15. What is the best test to assess liver function?
A15. No single test. Blood tests + imaging assess functions and complications of Liver Disease. Liver biopsy can also provide valuable diagnostic info.
Q16. What pain medication can Liver Disease patients take?
A16. No more than 2gm acetaminophen (Tylenol and its related medications) in 24 hrs. Avoid NSAIDs if you have cirrhosis
Q17. Is it ok for patients with Liver Disease to take statin meds?
A17. Yes, statins may be taken to treat high cholesterol. Recent studies suggest statins may help patients with cirrhosis.
Q18. Is milk thistle okay to take?
A18. We usually refer people to speak with their nutritionists/providers/pharmacists to double check out supplements. Clinical evidence for milk thistle isn't established but may benefit some types of liver disease. Studies are inconclusive. However, available evidence suggests that milk thistle is likely harmless with minimal minor side effects.
Q19. Should you be consuming large amounts of protein? Are protein shakes ok? What are ways to consume protein w/o added sugar?
A19. A good guide is 25-30 g of protein per meal, unless you have chronic kidney disease. Focus on fish, chicken, dairy, and vegetable proteins. Protein shakes or bars may help if you can't eat enough.
Q20. Our last question before answering some from the chat: Are probiotics OK for someone to take if they have liver disease?
A20. Yes, but make it a food source like Greek yogurt or kefir. Speak to you doctor before taking any supplements.
Liver Chat participants
Q Is jogging safe for someone with stage 3 liver disease?
A There is no reason not to consider jogging with stage 3 fibrosis. Enjoy!
Q Should I expect my MELD score to drop after hepatitis c treatment?
A Generally yes, we do see improvements in MELD after treatment for HCV
Q At what bilirubin range should a patient get listed? Or is it MELD 15?
A Patients are evaluated for liver transplantation generally at meld15 or with symptoms of liver decompensated (confusion, ascites)
Q What causes liver to produce high HDL even though eat healthy all life?
A You're lucky if you have HDL cholesterol. Patients with low HDL and high LDL are at greater risk of heart disease.
Q Vitamin B12 shots post transplant?
A b12 shots should be provided if patients are deficient
Q Any advice on naturally reducing a FNH liver mass?
A There is no diet or natural therapy to reduce FNH.
Q Any specific suggestions for someone with Autoimmune Hepatitis?
A Would AIH require any specific requirements on diet or just good liver nutrition as highlighted in chat. Autoimmune hepatitis requires assessment with blood tests + liver biopsy. Rx with prednisone + azathioprine usually effective.
Q Are there specific risk factors for African American men and Liver disease?
A Actually fatty liver disease in African Americans, has a better prognosis.
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