Diet for Hepatic Failure 🆙

Hepatic insufficiency

Liver failure is a morbid condition that impairs the functioning of the liver.
This disease negatively affects the physiological functions of the organ and, only in some cases, also compromises its tissue structure (fibrosis and cirrhosis). For example, in the case of hepatic insufficiency, the following are lacking: protein synthesis (blood proteins), the production of bile and lipid, protein, carbohydrate, pharmacological metabolism, etc.
Liver failure affects the homeostasis of the organism and leads to some complications that are sometimes fatal. The danger varies according to the type, stage and comorbidities.
Liver failure can be acute or chronic.
The acute one has a rapid and possibly reversible development. Chronic cancer is more often worsening and can develop into carcinoma (liver cancer).
The causes of liver failure are many and varied; for example: infectious, pharmacological or toxic, hereditary and autoimmune.
Symptoms, clinical signs and complications vary according to the specific case (cause, type, severity, etc.).
The therapy is linked to the specific etiology and also differs according to the complications (portal hypertension, esophageal varices, encephalopathy, ascites, nephropathies, coagulopathies, reduction of the immune system, etc.).
The liver is responsible for nutritional metabolism (fatty acids, cholesterol, glucose, etc.), for the oncotic pressure of the blood (circulating proteins) and for the production of bile. The "diet" factor is of fundamental importance in the treatment of any pathology affecting the liver.

Diet

Diet therapy for liver failure varies substantially based on the form (acute or chronic), severity and related complications.
The cardinal principles governing nutritional support are:

DO NOT strain the organ
Constantly supply all essential nutrients
Increase the intake of useful or therapeutic molecules.

Nutrition for liver failure is of the following type:

Food for chronic forms
Enterale or parenterale per acute form.

Parenteral nutrition (drip) is generally not recommended due to the increased risk of infections.

Do not tire the organ

WARNING! What is mentioned below encompasses all forms of liver failure. Obviously, dietary advice should be contextualized based on the type of nutrition (food, enteral and parenteral), the cause of liver failure and related complications / comorbidities.
In order not to tire the liver, the diet for liver failure must:

Eliminate all harmful molecules from food:

Ethyl alcohol and drugs: their metabolism is in the liver. They must be totally removed.
Medicines: paracetamol, acetylsalicylic acid, other NSAIDs, antibiotics and all drugs that can be toxic (especially when not necessary).
Unnecessary supplements: for example, products used for sports or slimming purposes.
Carbonization toxins: overcooking residues borne by: proteins, carbohydrates and fats. These are: polycyclic aromatic hydrocarbons, acrylamide, formaldehyde, acrolein etc. It is possible to almost completely eliminate the carbonization residues by adopting sweet cooking such as: boiling, steaming, bain-marie, pressure, vacuum and vasocooking. Avoid: frying, grilling, spit roasting and grilling.
Food additives: it is a very broad category. The most problematic are sweeteners and dyes. Better to consume natural, unprocessed or packaged foods.
Mushroom Toxins: All mushrooms produce toxins, even those that are normally harmless. Eliminating them from the diet (including cheese molds) could benefit the liver.
Poisons, farm drugs and pollutants: it is advisable to remove all foods that come from farms or crops in which large doses of these products are used. For the same reason, it is better to avoid drinking water or eating the products collected near polluted areas (roads, railways, industries, etc.).
Avoid fasting: this condition forces the liver to carry out many more processes than normal (especially neoglucogenesis).
In case of celiac disease, absolutely avoid any contamination with gluten; this would worsen the general inflammatory state.

Avoid nutritional excess:

Proteins: they are chains based on amino acids. The liver processes amino acids for use in various metabolic destinations. Those in excess are transformed into carbohydrates or fatty acids. Some, called aromatics, leave nitrogenous residues (ammonium ions) that the liver should convert into urea; being compromised, the organ does not perform its function properly and allows it to accumulate in the blood, creating neurological problems (encephalopathy).
To avoid this problem, it is possible to favor the intake of branched amino acids at the expense of aromatic ones. Obviously, this can only be done by using food supplements, formulating the solution for enteral nutrition or the bag for parenteral nutrition. It is not recommended to go below 60g of protein per day; the sources can be of various kinds and it is recommended to alternate vegetables and animals (lean meat and fish, legumes associated with cereals, eggs and lean milk derivatives, tofu, etc.). The excess of ammonium ions is also fought with the application of lactulose-based enemas.
Lipids: to avoid excess cholesterol and fatty acids, especially saturated or hydrogenated. The liver produces bile for the digestion of fats but, by functioning poorly, the organ is unable to perform this function (impairing digestion and absorption). In addition, the liver produces lipoproteins that carry cholesterol and other fats around the body; any shortage of these carriers could lead to severe metabolic decompensation.
Sometimes, fats tend to accumulate in the liver (steatosis).
It is better to prefer vegetable and natural lipid food sources, such as extra virgin olive oil; avoid margarines and fatty foods of animal origin (butter, lard, fatty sausages, etc.).
Carbohydrates: The liver is a reserve organ for carbohydrates but, being compromised, it does not store them properly. A part of the absorbed carbohydrates is converted into fatty acids and remains in circulation for a long time; eventually, it accumulates in the fatty tissue or in the liver itself (steatosis).
We recommend foods with a low glycemic index, natural, unrefined and rich in fiber; for example, small portions of whole grains and legumes cooked with low fat.
Iron and copper: there are hereditary diseases that do not allow the disposal of these minerals. If so, they are themselves the etiological cause of liver failure.
Sodium and Potassium: Liver failure can cause ascites (accumulation of fluid in the abdominal cavity). This needs to be treated with diuretics and dietary sodium reduction.
Water: A condition of overhydration can aggravate brain edema and ascites. It is customary to use diuretics and laxatives to combat it, making sure that the levels of mineral salts in the circulation do not drop too much.
Total calories: An excess of calories, whatever the source, promotes fatty liver and forces the liver to increase many processes. It is advisable to eliminate all high-calorie foods, especially junk foods.

Provide All Essential Nutrients

Liver failure impairs the digestion, absorption and metabolism of certain substances. Moreover, it also seems to be associated with a state of constant inflammation.

This means that it is desirable to increase:

Vitamins: all, none excluded. Liver failure impairs the vitamin stores in the organ. Due to coagulopathies (metabolic complication), the nutritional increase of vitamin K is particularly useful.
Mineral salts: liver failure is often associated with encephalopathy caused by cerebral edema and the accumulation of nitrogen groups. This can worsen as blood sodium and potassium levels drop due to the treatment of ascites. The doctor will need to determine which complication to take precedence.
It is reasonable to think that the saline values in the blood should be restored and the ascites compensated with drainage; sodium and potassium are naturally present, especially in fruits and vegetables. Sometimes calcium and phosphorus are also lacking (present in milk, dairy products and aged cheeses).
The supply of essential fatty acids: they are omega 3 and omega 6. They perform a multitude of functions, including regulating the inflammatory state. The deficiency is debilitating. If liver failure is associated with poor digestion, long periods of bed rest and artificial feeding, it is necessary to ensure the supplementary intake of these essential molecules.
Omega 6 are typical of oil seeds and extraction oils (walnuts, pistachios, macadamia, pecans, etc.); omega 3 are typical of fishery products (sardines, tuna, bonito, mackerel, etc.), algae, some oily seeds and extraction oils (flax, kiwi, etc.).

Increase the Introit of Useful Molecules

The molecules useful for liver failure are of various kinds:

Antioxidants; fight free radials, counteract inflammation, counteract neoplastic formation and support the immune system:

Vitamins: vitamin and provitamin A (abundant in animal liver, crustaceans, vegetables and red or orange fruits), vitamin C (abundant in citrus fruits, chilli, parsley, lettuce, apples, etc.) and vitamin E (abundant in olives, oil seeds, wheat germ and extraction oils).
Salines: zinc and selenium (to varying degrees, they are abundant in meat, fish and some oil seeds).
Other types: polyphenols, tannins, chlorophyll, etc. They are mainly present in vegetables, especially in fresh fruit and vegetables.

Specific molecules: they are cynarin (contained in artichokes) and silymarin (contained in milk thistle); exert a beneficial effect on the metabolism of hepatocytes (liver cells).
Probiotics: it seems that the administration of probiotics (Lactobacilli, Bifidobacteria and Eubacteria) improves the general condition of hepatic insufficiency; the reason is unclear. These are contained in fermented foods such as: yogurt, buttermilk, kefir, tempeh, tofu etc.