Diet Affects Hepatitis C Progression
People with hepatitis C (HC) may benefit from eating a diet reduced in calories, fat, iron, and protein, according to a study in Nutrition (2004;20:368–71). This study demonstrated the safety of long-term dietary changes for the treatment of HC.
HC is a viral infection of the liver that is spread by contact with blood from an infected person. Although many affected individuals never develop serious problems, chronic HC infection can cause liver fibrosis (abnormal fibrous material in the liver), cirrhosis (permanent scarring of the liver that may lead to liver failure), and more rarely, liver cancer. The progression and severity of the disease can be assessed by liver biopsy and by examining enzyme levels and markers of iron status in the body. The progression of HC is slower among people whose liver enzymes (particularly alanine transaminase [ALT]) can be maintained at low levels.
Drug treatments for HC include interferon (IFN) and ribavirin (Virazole™). IFN is the only substance known to eradicate the hepatitis C virus; however, only about 35% of people with HC have a sustained response from IFN treatment (meaning that the virus is not detectable for six or more months after treatment is discontinued). When combined with ribavirin, the drugs have a sustained response rate of about 55%. These treatments have side effects that some people are unable to tolerate including flu-like symptoms, fatigue, anemia, and depression.
Many people with HC have excessive accumulation of iron in the liver that causes free-radical damage to liver cells. Maintenance of low iron levels in the body has been shown to decrease ALT levels and to delay HC progression by improving liver function. Weight loss also can lead to a decrease in liver enzyme levels and positively affect other factors associated with the progression of HC.
The current study evaluated the efficacy and safety of long-term dietary modifications on liver function and nutritional status in people with HC. Twenty-two people aged 27 to 72 years with HC completed the two-year study. IFN therapy had been unsuccessful for most of the participants. Participants were given dietary prescriptions that included reduced amounts of iron, calories, protein, and fat. The prescription was as follows: (1) 7 mg or less of iron per day, (2) 13 calories per pound of body weight per day, (3) 0.5 grams of protein per pound of body weight per day, and (4) fat intake constituting less than 20% of total calories per day. Body mass index (a measure of obesity), percent body fat, liver enzymes (ALT and aspartate transaminase), iron status, and nutritional status were monitored during the course of the study.
Liver enzyme levels decreased significantly over the study period, as did the levels of iron in the blood and body tissues. Body mass index did not change substantially, but the percentage of body fat dropped significantly among the participants. Women had more body fat than men at the start of the study, and had greater losses in body fat over the study period. The levels of hemoglobin (a measure of the oxygen-carrying portion of red blood cells) and albumin (a measure of protein nutritional status) were unchanged during the study, indicating that the dietary treatment did not result in iron-deficiency anemia or protein malnutrition. The significant decrease in liver enzyme levels may be attributed to a reduction in iron intake as well as to a decrease in body fat.
This study supports previous findings that dietary restriction of iron, fat, calories, and protein can decrease ALT levels in people with HC, and demonstrates the safety of long-term dietary modification in this population. Because this diet can safely reduce ALT levels, it may be considered for anyone with HC.
Kimberly Beauchamp, ND, received her bachelor’s degree from the University of Rhode Island and her Doctorate of Naturopathic Medicine from Bastyr University in Kenmore, WA. She is a co-founder and practicing physician at South County Naturopaths, Inc., in Wakefield, RI. Dr. Beauchamp teaches holistic medicine classes and provides consultations focusing on detoxification and whole-foods nutrition.
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