Jaundice
By jaundice we mean a change in the color of the skin, eyes and mucous membranes, which tend to take on a yellowish appearance; this phenomenon is due to the increase of bilirubin in the blood.
Jaundice can occur in neonatal or adulthood; in the first case it is a physiological and harmless event, while in the second it almost always indicates a disorder of the liver, biliary tract or red blood cells.
Bilirubin is a waste product that the body obtains from the "demolition" of heme, a constituent of hemoglobin (a protein of red blood cells that allows the transport of oxygen in the blood).
Jaundice should not be confused with other changes in skin pigmentation such as, for example, excess carotenoids, phenolic exposure, tanning creams, etc.
Diet can avoid or improve the abnormalities potentially responsible for jaundice. However, each of these causes has a different etiology, which must be treated specifically. That is why in the next chapter we will present a brief breakdown of the pathologies that cause jaundice.
Causes of Jaundice and Nutrition
In the body, bilirubin is present in two different forms:
- Direct or conjugated (circulating in the blood and bound to albumin)
- Indirect or unconjugated (necessary for the structuring of digestive bile juices).
Depending on the type of bilirubin that causes jaundice, it is possible to differentiate the diagnosis, therapy and (if necessary) diet.
Simplifying the classification as much as possible, jaundice could be divided into two types:
- Jaundice caused by an increase in direct or conjugated bilirubin; further differentiable in:
- Hepatocellular, by lesion of liver cells and mainly caused by hepatitis and liver cirrhosis.
- Post hepatic, obstructive and cholestatic, caused by solid bodies that block the passage of bile into the gallbladder or bile ducts. The most frequent cause is stones or lithiasis, but cysts and tumors are also not rare.
- Jaundice caused by the increase in indirect or unconjugated bilirubin, which is triggered by: favism, pernicious anemia, wrong transfusion and everything that determines the destruction of erythrocytes.
Jaundice Hepatocellular and Diet
The nutritional causes of hepatocellular jaundice are those related to hepatitis or cirrhosis of the liver.
NB. Cirrhosis of the liver is a consequence of hepatitis (which can follow carcinoma), often characterized by functional organ failure. These are particular conditions that are treated with drugs, surgery and very specific dietary regimes, which also take into account all possible complications (ascites, encephalopathy, portal hypertension, etc.). There diet for cirrhosis and / or for carcinoma will NOT be treated in a separate article.
Hepatitis is defined as inflammation of the liver; the main causes are: viruses, drugs, alcohol and poisons.
In the case of hepatitis, the jaundice diet can be differentiated into: preventive, curative and support healing.
Preventive Diet Hepatocellular Jaundice
The preventive diet is aimed at reducing the chances of liver inflammation, avoiding contagion / the intake of:
- Pathogens that can be taken with food. Among all, the most relevant is the virus A (HAV), which is mainly contracted via fecal gold. The foods responsible for the hepatitis A infection are: raw seafood, infected water, contaminated fruit and vegetables, etc.
To learn more: Diet and Epatite A - Harmful molecules that can damage liver cells. The most common poisonous element is undoubtedly ethyl alcohol. This is especially harmful in cases of long-term abuse, but there have been quite a few cases of acute inflammation of the organ. On the contrary, certain natural poisons (such as fungal ones) are very powerful and damage the liver (sometimes irreversibly) even with a single intake (eg the toxins of some mushrooms of the genus Amanita).
To prevent hepatocellular jaundice it is therefore necessary to avoid the hypothesis of hepatitis by paying attention to hygiene and food safety.
Preventing virus A infection requires:
- Supply of safe, certified food with a traceable and traceable origin.
- This is especially true for bivalve molluscs (especially mussels and oysters) which, in the wild, retain large viral loads (especially in polluted areas). The case of bivalve molluscs is one of the few in which the animals raised are qualitatively superior to those caught.
- Fruit and vegetables could also be contaminated by virus A, especially if they are irrigated with polluted water (e.g. canal). To prevent the disease it is therefore necessary to wash and peel them carefully.
NB. Cooking effectively eliminates the viral load of the HAV. - Still with regard to food, it is very important to eliminate the risk of eating poisonous mushrooms. Unlike viruses, many of these toxins are NOT thermolabile and can give their first symptoms several days later, when liver misfortune is now inevitable. The safest way to eat mushrooms in the wild is to get supplies from official and regular bodies.
- Elimination of alcohol from the diet or compliance with the limit for a healthy and correct diet. This margin is equal to:
- 0 for growing subjects and pregnant women,
- 1 unit from time to time for nurses,
- 1-3 for healthy adults and half for elderly subjects.
The preventive diet for jaundice from hepatitis prohibits, even if "once in a while", the intake of large amounts of alcohol.
Hepatocellular Jaundice Healing Diet
The healing diet serves to restore the physiological condition of the hepatic organ. This type of remedy affects the following cases:
- Food steatotic hepatitis: it is the accumulation of fat in the liver cells associated with more or less severe inflammation. The triggering cause is dietary excess, in particular of refined carbohydrates (especially granular sucrose and fructose, syrups and white flours) and "bad" fats (hydrogenated or bi-fractionated and saturated vegetables). A sedentary lifestyle plays a predisposing role.
- Alcoholic steatotic hepatitis: manifests itself as the previous one. The triggering cause is alcoholic excess associated with a sedentary lifestyle.
- Mixed steatotic hepatitis: it is the combination of the two previous ones.
The diet against jaundice caused by steatotic hepatitis includes:
- Reduction of total calories if food or mixed (low-calorie diet), AVOIDING fasting
- Elimination of the triggering factor (s): junk foods that contain refined sugars and bad fats, and / or alcoholic beverages
- Elimination of unnecessary drugs, unnecessary supplements, excess food additives (sweeteners, dyes) etc.
- Increased motor activity
- Increase in the consumption of fresh and unprocessed foods, especially by promoting the use of vegetables, fruits, whole grains and legumes. These are rich in useful nutrients such as: fiber, omega 3 fatty acids, vitamins, minerals, other antioxidants and molecules beneficial for the liver (silymarin and cynarin).
To learn more: Diet for fatty liver
Hepatocellular Jaundice Support Diet
It occurs when the preventive diet has had no effect.
The support diet is aimed at supporting the healing organism; the most indicative examples are diets for hepatitis A, B and C.
It is very similar to the healing one, but it doesn't have to be hypo-caloric. If the inflammation is attributable to a pathogen or poison, reducing calories would have no positive impact.
Instead, it is necessary:
- Prevent from making harmful molecules that would certainly worsen the condition (ethyl alcohol, bad fats and sugars if in excess, additives, etc.)
- Promote the intake of beneficial molecules (omega 3, antioxidants, mineral salts, etc.).
Jaundice Cholestatic and Diet
Obstructive cholestatic jaundice can have many causes, but the only one that has a nutritional origin is gallstones of the gallbladder.
These "pebbles" (large or small) are formed due to an imbalance between the various "ingredients" of the bile juice. They can be cholesterol-based or pigmented.
Without going into specifics, we remind you that stones are formed more frequently in predisposed subjects, even more so in women and the elderly, BUT they also have a very important food etiology.
Dietary factors that predispose to gallbladder stones are:
- Diet too abundant in cholesterol and "bad" fats (saturated or hydrogenated).
- Diet too low in "good" (unsaturated) fats and cholesterol.
- Dehydration. NB. All three cause an imbalance in the composition of the bile and the consequent separation-deposit of material.
- Prolonged fasting, which reduces the emptying of bile.
- Obesity and type 2 diabetes mellitus, which cause excessive increases in insulin and triglyceridemia. Both directly and indirectly predispose to gallstones.
- Sedentary lifestyle. Exercise promotes peristalsis (contraction) of the gallbladder and emptying of bile.
- Constipation and fiber deficiency. Both related to biliary lithiasis.
- For further information: Nutrition and Gallstones
The diet for cholestatic jaundice is preventive; the main principles are:
- Energy intake that ensures weight stability or, in case of overweight, a gradual weight loss; it is advisable not to lose more than 3kg per month.
- 25-30% of total calories from lipids. Most must be unsaturated and at least 2,5% essential polyunsaturated type. In practical terms, it is necessary to prefer: cold-pressed vegetable oils (eg extra virgin olive oil), dried fruit, blue fish (sardines, mackerel, bonito, etc.) and edible algae. On the contrary, it is better to minimize: sausages, fatty cheeses, bacon and ribs, butter, cream, lard, lard, sweet and savory snacks, margarines, fried foods, palm oil, etc.
- Reduction of foods with large glycemic loads and high glycemic index, preferring foods rich in fiber and water in moderate portions. It is advisable to eliminate sweet and savory snacks, cakes and brioches, large portions of potatoes, pasta, bread and pizza made with refined flours. On the contrary, prefer the intake of modest quantities of whole grains (rye, spelled, corn, rice, etc.), legumes (beans, chickpeas, lentils, etc.), vegetables (salad, radicchio, zucchini, cabbage, etc.) and not very sweet fruit ( oranges, strawberries, kiwis, apples, grapefruit etc.). In addition to fiber, water, vitamins and mineral salts, these products are rich in phenolic antioxidants and vegetable lecithins.
- Make sure you give the right weight to the stimulus of thirst. The motor activity (which already favors the emptying of the gallbladder) plays a very important function in the regulation of all physiological impulses (hunger, evacuation, etc.)
- Promote the intake of food / medicinal plants that stimulate the peristalsis of the gallbladder; these are called cholagogues (or cholecinetics) and the best known are: chicory, rhubarb, milk thistle, aloe, dandelion, rosemary and boldo.
- See also Diet and Gallbladder Stones
Haemolytic jaundice and diet
Hemolytic jaundice is caused by the destruction of red blood cells. In the dietary field, this very serious reaction can occur due to favism and pernicious anemia.
La diet for favism it is only preventive; in the case of pernicious anemia, on the other hand, it also acquires a therapeutic function.
- Favism is a disease based on the hereditary deficiency of an enzyme (6-glucose-phosphate dehydrogenase). Already deficient, if this enzyme is inhibited by the ingestion of certain legumes, plant drugs, drugs or other substances, it causes the destruction of erythrocytes with consequent jaundice. Favism is a simple exclusion diet and must totally eliminate: broad beans, peas and Verbena x Hybrida. In addition, it is recommended to avoid: mothballs and some drugs or other substances such as: analgesics, antipyretics, antimalarials, salicylates, certain chemotherapy drugs, quinidine, methylene blue etc.
Pernicious anemia is a disease with nutritional aetiology, which increases the breakdown of red blood cells (the reason for jaundice) and is associated with the so-called atrophic glossitis (smooth, reddened tongue at the edges). The main cause is vitamin B12 or cobalamin deficiency, which occurs due to:
- Food defect: diet lacking in foods of animal origin.
- Scarcity of intrinsic factor: a molecule secreted by the stomach necessary for the absorption of cobalamin. It can occur in the case of certain stomach diseases such as, for example, atrophic gastritis.
- Complication of terminal ileum: part of the intestine where vitamin B12 is absorbed. This is the case of surgical resections, sometimes necessary in chronic intestinal diseases such as Crohn's disease.
It is therefore essential that the diet for pernicious anemia responsible for hemolytic jaundice has the following characteristics:
- Wealth of foods that contain vitamin B12: liver, kidney, heart, bivalve molluscs (clams, oysters, etc.), cephalopod molluscs (e.g. octopus), fish, meats, etc.
- Rich in iron and folic acid: while not directly implicated in pernicious anemia, they can aggravate or improve this condition. Bioavailable iron is mainly contained in foods of animal origin (egg yolk, meat, fish, shellfish, etc.), while folic acid is found in raw vegetables and fruit (kiwi, lettuce, avocado, endive, agretti, oranges etc).
NB. in the case of haemolytic jaundice from pernicious anemia, the most timely and decisive intervention is not the diet but the injection of vitamin B12.
