When you have hepatitis C, you know to be scrupulous about what you eat to maintain good liver health. But do you also scrutinize the beverages you drink and the supplements you take?
Maybe you already avoid alcohol, but did you know a strong cup of coffee can be beneficial? And how safe are the "natural" treatments you've embraced. Could they actually be harmful?
Experts offer tips here on staying hydrated and healthy with hepatitis C.
Stay hydrated, but keep it simple
Rockford Yapp, M.D., is on the board of directors for the American Liver Foundation and a gastroenterologist in the Chicago area. In an e-mail interview, he stressed the importance of staying hydrated when you have hepatitis C.
"Dehydrated patients are under more physiologic stress and (are) more susceptible to damage from inflammatory conditions. Any stress on the liver of a hepatitis-C-infected patient has the potential to accelerate liver disease."
When you reach for a drink, think simple. Steer clear of energy drinks and anything with added vitamins or minerals. Water is best for hydration, but many other choices will do, including low-fat milk, tea, coffee, juice, and even broth-based soup, which is mostly liquid (opt for low-sodium varieties.)
"I usually recommend that my liver disease patients just drink water, coffee, and unsweetened tea as their beverages of choice," said Jonathan Fenkel, M.D., director of the Jefferson Hepatitis C Center and associate professor of medicine at Thomas Jefferson University's Sidney Kimmel Medical College in Philadelphia. HealthCentral reached him via email.
Steer clear of sweetened beverages
Soda, sweet tea, lemonade, and sweetened juice drinks are devoid of nutrition. These aren't ideal beverages for anyone, including people with hepatitis C.
"Empty calories from soda or juices can put patients at risk of non-alcoholic fatty liver disease and are an important part of dietary changes to help weight-loss efforts," Dr. Fenkel said. "A can of regular soda usually has about 200 to 250 calories per can. Just eliminating one can per day can help patients lose nearly 20 pounds per year."
People who frequently drink sugar-sweetened beverages may be overweight or obese, which can cause complications among those with hepatitis C.
"Obesity is an independent risk factor for liver disease, called non-alcoholic steatohepatitis (NASH)," Dr. Yapp said. "Patients with a combination of NASH and hepatitis C have accelerated rates of liver damage and cirrhosis."
Coffee has perks
A cup of joe will do more than just get you moving in the morning; research has shown that liver disease progresses more slowly among hepatitis C patients who are coffee drinkers.
"(Drinking) two or more cups of coffee has been associated with a reduced risk of hospitalization and mortality from a number of chronic liver diseases, including chronic viral hepatitis," Dr. Yapp said. "There have been some studies that suggest lower incidence of liver cancer in patients who drink coffee."
Don't add too much cream and sugar. And a strong brew may have health benefits.
"There is some data suggesting that two to three cups per day of espresso-equivalent coffee can help to decrease liver inflammation in patients with chronic liver diseases, such as fatty liver disease," Dr. Fenkel said.
When you have hepatitis C, there's never justification for toasting the bride or having a beer while watching the game. Alcohol can damage your liver.
"There is little controversy in advising patients with liver disease to avoid alcohol," Dr. Yapp said. "It is widely accepted that alcohol consumption accelerates the damage that hepatitis C causes (with) progression to cirrhosis at an accelerated rate."
You may increase your risks of other complications, too, including "a two-fold higher risk of hepatocellular cancer," said Timothy McCashland, M.D., professor in the division of hepatology at the University of Nebraska Medical Center in Omaha, in an e-mail interview.
Some people reach for dietary supplements to treat any ailment. They may believe that supplements can't be harmful, and won't cause side effects, because they aren't drugs. They may also believe that herbs and other ingredients are "natural" and therefore healthy. This isn't true. Dietary supplements can interact with medication that you take, and some (such as colloidal silver or high doses of vitamin A) can have dangerous side effects.
"I would recommend against routine use of any vitamins or supplements in people with hepatitis C, without discussion with their treating provider," Dr. Fenkel said. "Some over-the-counter supplements may contain compounds that could hurt the liver or make hepatitis C treatments less effective."
Be wary of iron
Certain people with hepatitis C have high levels of iron in their systems. Too much iron can be harmful, so it's unlikely that you'll need an iron supplement. Ask your doctor to check your iron levels if you're concerned.
"Avoid iron supplements if your serum iron level is normal," Dr. McCashland said. "Prior studies showed that patients with excess iron in the liver had more fibrosis and responded less to interferon-based treatments."
If you have too much iron in your system, you can develop hemochromatosis, or iron overload. The condition is more common among people with liver disease.
"An untreated hepatitis C patient (who) has this disease will have a faster progression of liver damage," Dr. Yapp said. "It is important to remember once hemochromatosis is diagnosed, it is treatable, and liver damage can be prevented."
Move on from milk thistle
Milk thistle (silymarin) is the dietary supplement that people with liver disease reach for most often in the United States. But few studies have studied the effects of milk thistle on hepatitis C, and not all of the research has shown a positive effect. Medication that targets the hepatitis C virus is considerably more effective than this plant-based supplement. Using them simultaneously could cause problems.
"Milk thistle inhibits the absorption of many of the newer hepatitis C medications and can make the medications less effective," Dr. Fenkel said. "Milk thistle was popular when hepatitis C medications were difficult to take and unlikely to work. The newer medications are highly effective and highly tolerable, so milk thistle is unnecessary now."
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