Jun 30, 2014 — For patients struggling with liver disease, diet can become a matter of life and death. Dr. Juan Gallegos talks about how daily food choices can impact the diseased liver. He also gives some tips for improving diet and prolonging the lives of patients with liver disease.

Interview

Interviewer: You've been diagnosed with liver disease. How is that going to affect your diet? We'll talk about that next on The Scope.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Interviewer: After you've been diagnosed with liver disease, dietary changes can make a difference. We're going to find out what you should be eating and what you should be avoiding right now, with Doctor Juan Gallegos. He's a liver expert at the University of Utah hospital. Tell us about diet and the importance of diet with liver disease.

Dr. Juan Gallegos: Thank you, Scot. It is very important because the liver receives most of the nutrition that you get through your mouth. It actually makes it into the blood from the small bowel and, then, that blood has to go and get through the liver. The liver cells, basically, detoxify your blood, and are very important in making proteins, making cholesterol, and it's basically like a chemical factory.

Interviewer: So, very important diet.

Dr. Juan Gallegos: Yes. Most of the time when I see patients in my clinic who have chronic liver disease, my main recommendation for them is, first, abstain from alcohol because we know alcohol has a direct toxic effect on the liver. So, if somebody already has liver disease, we strongly recommend that they abstain from alcohol so as not to damage the liver even further. In regards to any particular change in their diet, I do recommend that they try to eat healthy. Meaning, have adequate portions of fruits and vegetables, trying to limit their simple sugars, like a lot of flour, and bread, things of that nature. The other main thing, especially in patients that have very advanced liver disease, something we call cirrhosis, is to limit their salt intake because increased salt intake can lead to complications of liver disease or worsening of those complications, such as fluid build up in the abdomen, which we call ascites, or swelling of the legs and arms.

Interviewer: And why does that happen?

Dr. Juan Gallegos: Well, it happens because the liver is important in maintaining the amount of protein in our blood and, also, in maintaining the adequate amount of salt in our blood. So, when the liver isn't working well, there is an imbalance in those things that lead to people having low levels of protein in their blood, and that makes it easier for the water part of our blood to filter out, or go out of, the blood vessels and stay in the tissues and that causes ascites and swelling.

Interviewer: Is it the same thing with sugar, as well?

Dr. Juan Gallegos: It's a little bit different, but yes, the liver is very involved in sugar and metabolism. So people that have advanced liver disease can have sugar problems similar to diabetics.

Interviewer: So it sounds to me, essentially, the liver is just not doing its job the way it should be and you just have to be really careful because a normal functioning liver might be able to take the overload.

Dr. Juan Gallegos: Correct, that is true. It's just that the liver is so noble that it takes a lot of injury before it actually manifests itself as having problems. So, normally, people, when they get diagnosed, it tends to be later on in their disease course and that's where nutrition is so important.

Interviewer: All right. So we hear these things a lot. We hear nutrition is important. We hear that you should stop drinking because it can affect your liver. How important is it? It's like we hear it so often that I think a lot of people ignore it, so give us some context.

Dr. Juan Gallegos: Well, it is very important because we are what we eat, basically, and when you have a liver that's already damaged, or faulty, then, you don't want to increase the damage to that liver or make things worse and some of the symptoms that have to do with liver disease. The other important part is the alcohol issue. Even patients that have liver disease not related to alcohol, we know that the liver will be damaged by the alcohol intake, so that's why we recommend, in those cases, not to drink alcohol.
But, in those patients that have had injury to their liver because of significant alcohol intake, or now have what we call liver cirrhosis from alcohol, it is extremely important for them to stop their behavior and stop drinking alcohol because what is going to happen, if they continue to drink alcohol, is that their liver is going to get worse and their going to reach a point where their liver fails them and there's no way we can treat them anymore.

Interviewer: But one drink a day, that's not that big of a deal is it?

Dr. Juan Gallegos: Well, that's not big of a deal for a healthy person, that is true. In general, the recommendations are, for men, not to drink more than three or four drinks per day, and in women, as they are more sensitive to the effects of alcohol, the recommendation is not more than two drinks per day, but that's only for healthy people. In patients that have already liver disease, our recommendation is that there's really no minimal safe amount of alcohol and, hence, we tend to be more strict and say "No alcohol for you."

Interviewer: So when it comes to diet and alcohol, when you have liver disease, it makes a huge difference?

Dr. Juan Gallegos: It does. It makes a big difference. Of course, the other important part of it is making sure that you are being taken care of by the adequate medical provider and that you follow the recommendations, not only from a diet standpoint, but also if you're already on medications, to make sure that you follow those as well.

Interviewer: Like the difference of living and dying, living a great life and living a mediocre life; I mean how important are these things that we're talking about.

Dr. Juan Gallegos: It can be, especially in those patients with alcoholic liver disease. Continued use of alcohol will definitely result in, not only a very bad life quality, but, also, a shortened life and those people look forward to, basically, being in the hospital and dying in a very short period of time. And patients that have their types of liver disease, it might not be as dramatic, but, certainly, anything we can do to prolong their life and improve their quality of life, I think, is very important.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope. University of Utah Health Sciences Radio.


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