Dietary
Considerations
Vitamins |
While a good diet
provides adequate supplies of nutrients for most healthy people,
patients with hepatitis and other liver disorders often have vitamin and
mineral deficiencies
The B vitamins are all required for the normal functioning of specific
enzymes. They are responsible for many important processes such as
converting sugar into usable energy and keeping cells healthy. Because
these vitamins are vital to a vigorous long life, not getting them can
lead to serious problems. Especially for patients with liver disorders,
fatigue is the most common symptom and with the help of B vitamins the
energy generating mechanism in the liver will be functioning well and
can help to release this symptom
Thiamin (Vitamin B1) is
often deficient in patients with liver disease. Thiamin aids in the
proper function of the mucous membranes, nervous system, muscles, heart,
and metabolism. It aids energy levels, decreases pain, and may fight
viruses (e.g., Herpes Zoster).
Symptoms of thiamin deficiency include poor memory, fatigue, muscle
weakness and blindness. These symptoms are also common in liver
disorders. Over time, thiamin deficiency can lead to heart disease and
brain damage.
Riboflavin (Vitamin B2) enables
carbohydrates, proteins, and fats to release energy. Riboflavin is
needed for normal reproduction, growth, and repair of skin, hair, nails,
and joints. It is also important to the immune system.
Niacinamide (Vitamin B3) is
necessary for utilization of fats, tissue respiration and production of
polysaccharides. This vitamin aids in release of energy from foods,
helps synthesize DNA. It is also involved in the manufacture of sex and
adrenal hormones.
Pantothenic acid (Vitamin B5)
is needed for certain detoxification processes in the liver as well as
conjugation of bile acids produced by the liver. Bile acids must be
conjugated in order to help in the assimilation of dietary fats.
Pyridoxine (Vitamin B6) has a
wide variety of metabolic functions in the body, especially in amino
acid metabolism and in the central nervous system, where it supports
production of gamma-aminobutyric acid (GABA). Pyridoxine deficiency
causes blood, skin, and nerve changes. This vitamin is unique in that
both deficiency and excess can cause peripheral neuropathy. Pyridoxine
is needed for proper immune function. Deficiency of this nutrient
impairs immunity. Hepatitis and liver disorders increase the risk of
pyridoxine deficiency
Vitamin B12 promotes healthy
blood cells, appetite and mental function. Because the liver is involved
absorption of Vitamin B12, a diseased or inflamed liver may not be able
to keep up with body demands for this vitamin under stress. B12 is
needed to help cells grow and maintain normal function. It is an
especially important vitamin for healthy bone marrow (where blood cells
are formed) and the nervous system. Not getting enough Vitamin B12 leads
to a condition called pernicious anemia, which results in red blood
cells not getting enough oxygen and causing disorders of the nervous
system.
Supplementation with folic acid
along with vitamin B12 has shown promise in helping to reduce the number
of days of hospitalization from viral hepatitis and to speed healing of
the injured liver. Folic acid and vitamin B12 may protect against
ribavirin-induced anemia, which occurs in 10 percent of hepatitis C
patients being treated with ribavirin.
Biotin is required for fat and
protein metabolism, effective immunity and gene function. Biotin
deficiency is most common in the elderly, people with diabetes and in
those who take too many antibiotics. Anemia, muscle pain, dermatitis and
pins-and-needles in the toes mark biotin deficiency
Vitamin C provides
general support for the immune system. It also is required for the
production of the protein known as collagen. Collagen found in all
tissues of the body. Also found in the filtration apparatus of the
kidneys, which can be diseased in hepatitis patients. High doses of
vitamin C (greater than 2,000 mgs per day) can cause increased
absorption of iron from the bowel and is thus contraindicated in people
with high levels of iron in their liver cells, which are common in
chronic hepatitis patients. High iron level is being considered to have
negative effects on the healing of the liver.
People with hepatitis are
often deficient in Vitamin E, and this deficiency will weaken the immune
system, weaken the red blood cells, and worsen the nerve and muscle
damage that can occur with hepatitis. Vitamin E is a powerful
antioxidant. It helps overcome fatigue and enhances cell mediated
immunity. Vitamin E deficiency is linked to cirrhosis. Vitamin E may
prevent some of the molecular changes associated with the development of
cirrhosis.
Vitamin K deficiency is
associated with liver disease. Poor blood clotting is a symptom of
deficiency. Vitamin K is a key cofactor for the formation of a number of
proteins that include -carboxyglutamic acid. The best recognized of
these is prothrombin. However, it is now recognized that carboxylation
is an important enzymatic step for the activation of a wide range of
proteins with many different functions. These proteins are in the blood,
kidney, lung, and bone. It has been recently recognized that vitamin K
plays a role in bone formation. Recent evidence suggests that even
patients with cirrhosis may have abnormal bone turnover and increased
risk of osteoporosis. Vitamin K therapy may improve bone mass among
people with cirrhosis. The role of vitamin K supplementation is of
greatest interest in patients with cholestatic (blockage of bile
secretion) liver disease, both because these patients are at greatest
risk for malabsorption of fat-soluble vitamins and vitamin K is
fat-soluble.
Chronic liver disease is
frequently associated with osteopenia and osteoporosis and,
occasionally, osteomalacia, particularly in the setting of alcoholic and
cholestatic liver disease. Recent studies suggest that even patients
with chronic viral hepatitis have decreased bone mineral density (BMD)
and osteoporosis. Bone disease associated with cirrhosis is
multifactorial in nature and may be due to malabsorption of fat-soluble
vitamins, including vitamin D, and calcium; malnutrition; and increased
bone turnover from hormonal and metabolic factors. In addition to the
nonspecific effects related to chronic liver disease, patients with
cholestatic liver disease are at risk for malabsorption of calcium and
fat-soluble vitamins such as A, D, E, and K, which may lead to
osteomalacia
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