Food provides you with the energy to get through your day, and eating is one of life’s basic pleasures. A well-balanced diet will: • Provide the energy to perform your daily activities • Boost your immune system • Help you maintain a healthy weight, and • Reduce the risk of many diseases such as heart disease, obesity and some cancers. Dietary recommendations for people with hepatitis C, unless they have advanced liver disease, are the same as for the general population – high fibre and reduced fat. There’s information on the internet and within the community suggesting that people with hepatitis C need a special diet. But there’s no research that shows that diet makes any difference to the progression of hepatitis C, and some diets can cause harm – whether or not you have hepatitis C. Making healthy choices about your diet and putting these choices into practice can provide you with a sense of well being and empowerment. This fact sheet provides basic information about diet and nutrition for people who inject drugs who have hepatitis C. It provides information on: • Healthy eating including basic information about different food groups • Junk food • Alcohol use • Relieving gastrointestinal symptoms such as nausea and constipation • A shopping list for a healthy diet. The effects of drug use on diet are under-researched. Drug use affects the body in two distinct ways - the effect of the substance itself and lifestyle changes, such as irregular eating habits and poor dietary intake.
Opiate based drugs affect the gastrointestinal system with a common problem being constipation. The symptoms of withdrawal which can include diarrhoea, nausea, and vomiting, may lead to nutrient deprivation. Eating regular and balanced meals will decrease the severity of these symptoms. Methamphetamine was used to treat obesity in the 1950s and 60s and affects the central nervous system. Its effects include decreased appetite, an aversion to food with subsequent weight loss and nutrition problems can develop in long term users. Anyone with advanced liver disease or nutrition problems should seek expert advice on their dietary needs. There is evidence that people with hepatitis C who are either obese or have type 2 diabetes, are at greater risk of liver damage. Losing weight will not only make you feel better, but it will help your liver function.
The liver performs a range of functions: • Helping digestion by filtering (or breaking down) and removing toxins such as alcohol, drugs (including medicines) and some waste products from the body • Manufacturing and packaging important proteins essential to the body, including blood clotting factors and enzymes • Identifying and labelling proteins and other essential nutrients so that they can be transported to specific parts of the body where they are needed. The liver also stores sugars and vitamins and produces the bile salts that go to the small intestine to help break down fats. This fact sheet provides general dietary information and is not intended to replace the advice of a dietician or nutritionist.
Healthy eating The National Health and Medical Research Council have produced The Australian Guide to Healthy Eating. This guide recommends including a variety of foods in your diet. These foods are:
Bread, cereals, rice, pasta and noodles Eat 4 to 6 serves per day
• Cereals wheat, oat, rye, rice or barley
1 serve equals:
• Vegetables there are a variety of vegetables available including;
2 slices of bread or one bread roll 1 cup of cooked rice or pasta
• Root vegetables; carrots, beetroot, parsnip, ginger
1 cup of cooked porridge
• Leafy green: spinach, cabbage, brussel spouts, bok choy
One and a third cups of prepared cereal ½ a cup of muesli
• Marrow: zucchini, cucumber, eggplant, or pumpkin
Eat wholegrain bread, high fibre cereal, brown rice and wholemeal pasta.
• Flowers: broccoli, cauliflower or lettuce
Rice, pasta and noodles have less salt and sugar than bread or breakfast cereals and are nutritionally better.
• Onion: spring onion, garlic and leek • Peppers and tubas: potatoes, sweet potato and yams Your body absorbs nutrients from different food sources in different ways – this means that the nutritional effect can be very different within and across the food types. Too much of any one food can be unhealthy. The guide suggests that you eat around 30 different foods every day – this may sound challenging, but choosing foods that include a lot of variety such as stir fries, salads, casseroles and multigrain breads make it possible.
Avoid highly processed foods such as white breads or pre-packaged foods Foods in this group provide fibre, energy, protein, fat, magnesium, zinc, riboflavin, niacin, folate, sodium minerals and carbohydrates which are important for energy, growth, and repair of the body.
Vegetables and legumes: Eat 5 serves per day.
The aim of a good diet is to maintain variety in your diet – don’t eat too much of any one type of food, or let one food group dominate your diet.
1 serve equals: ½ a cup of cooked vegetables ½ a cup of cooked dried beans, peas or lentils
Food Groups
1 cup of salad vegetables
There are five food groups you need include in your diet:
1 small potato
• Bread, cereals, rice, pasta and noodles
½ a cup of cooked beans, lentils, chickpeas, split peas and canned beans
• Vegetables and legumes • Fruit • Milk, yoghurt and cheese • Meat, fish, poultry, eggs, nuts, tofu and bean curd.
Legumes are all types of beans including baked beans, black beans, cannelini beans, chickpeas, kidney beans, lima beans etc. Choose a wide variety of vegetables Frozen and canned vegetables are nutritious, often cheaper, quick and easy to prepare, easily stored and available everywhere.
Foods in this group are a good source of vitamins, mineral, fibre, carbohydrates and antioxidants.
Fruit Aim to eat 2 or more serves per day.
1 serve equals: 1 medium piece of fruit (about 150g) such as an apple, banana, orange or pear
Meat, fish, poultry, eggs, nuts, tofu and bean curd Aim to eat 1 serve per day or if you are a vegetarian, 2 or 3 serves of tofu or bean curd per day.
1 serve equals:
2 small pieces of fruit such as apricot, peach or plum
½ a cup of mince, 2 small chops, or 2 slices of roast meat
1 cup of canned fruit
80-120g of cooked fish fillet
1½ tablespoons of sultanas, or 4 pieces of dried fruit such as apricot halves or mango pieces
2 small eggs
½ a cup of fruit juice Whole fresh fruit is higher in fibre than juice. Dried fruits are nutritious and add variety to your diet, although they are high in sugar and can lead to tooth decay. Canned fruit is nutritious especially if it canned in its natural syrup and without added sugar. Fruit is a good source of antioxidants, vitamins, and provides fibre – particularly if you keep the skin on when eating.
Milk, yoghurt, cheese and soy milk Aim to eat or drink 3 serves per day. 1 serve equals: 1 cup of fresh milk 1 cup of soy milk (with calcium) ½ a cup of evaporated milk 2 slices of cheese 1 small carton of yoghurt Dairy products provide calcium, protein, riboflavin and vitamin B12.
One third of a cup of unsalted peanuts or almonds or ¼ of a cup of sunflower or sesame seeds Choose a variety of meats and fish – beef, lamb, pork, chicken, turkey, duck, rabbit, kangaroo, fish and shellfish. This group of foods provides iron – good for carrying oxygen in your blood and zinc – helps in the repairing of wounds and growth. B12 is only found in foods of an animal origin – vegans will need to supplement their diet with vitamin B12.
Fats People with hepatitis C do not need to exclude fats or oils from their diets because of hepatitis C. The liver is able to metabolise fat even when it is very damaged. Small amounts of fat in your diet are essential for body functioning and are a source of energy. A diet high in saturated fats – found in fatty meat, butter, full-cream milk products, cream, and in many takeaway foods – can cause your body to produce cholesterol which can contribute to developing heart disease and some cancers. Unsaturated fats – found in plant oils such as peanut or sunflower oil, margarine, nuts and lean meat – are a healthier choice.
Eat low fat varieties wherever possible (although infants and young children should eat full fat varieties)
Packaged foods that are ‘creamed’ or ‘toasted’ often have added fat.
Calcium enriched soy milk is a good alternative if you can’t tolerate milk or milk products.
Fruit and vegetables (with the exception of avocado) are virtually fat free – unless oil or fat has been added during cooking.
Sugar There’s no research to show that people with hepatitis C have problems metabolising sugar. A lot of foods contain sugar including fruit and milk. Manufactured foods often have added sugar. Many foods with large amounts of sugar also contain high amounts of fat. Sugar, sweets and lollies are very low in nutrients and fill you up, making eating more nutritious foods difficult.
There are some foods that are quick and easy to prepare and eat: • Fruit • Salad sandwich • Baked beans on toast
Salt
• Hamburgers or steak sandwiches made with lean meat, with extra salad on wholemeal or wholegrain bread or a roll with no butter
Salt intensifies flavour, colour and texture of food and a small amount is essential for your body to function.
• Grilled fish instead of fried – use vinegar or lemon instead of salt
Excess salt will increase your risk of high blood pressure.
• Thick chips are better than thin chips
The National Health and Medical Research Council recommend that adults have an upper limit of 1 teaspoon of salt per day.
• Takeaway foods such as sandwiches, rolls and pizzas with a thick base and thin toppings – wholemeal is better if you can get it
Fruit, vegetables and cereals have low salt content, while bread and meat contain salt.
• Asian dishes that are steamed are better than fried
Caffeine
• Barbequed rather than deep friend chicken is better, and not eating the skin is better still
Caffeine is found in tea, coffee, chocolate, cocoa and some cola drinks.
• Kebabs
Caffeine stimulates your brain and nervous system. There is no specific research showing that caffeine causes particular problems for people with hepatitis C. It is recommended that caffeine intake should not exceed about 600ml per day – this is the equivalent of about 6 cups of coffee or tea. Remember though, that the amount of caffeine in a coffee or tea is dependant on how strong, fresh and the type of coffee or tea.
Food additives There’s no evidence that people with hepatitis C should avoid food additives such as artificial sweeteners.
Junk food Not all junk food is bad although foods such as battered fish, chips, hamburgers, deep-fried chicken, potato cakes, hot dogs and meat pies are high in fat and salt and low in fibre.
• Pasta with vegetable rather than cream sauces • Pizzas with low fat toppings – use lean ham rather than salami or pepperoni • Salads • Baked potatoes • Soups • Low fat yoghurt or ice cream.
Alcohol Alcohol is recognised as the most important factor in people with hepatitis C developing cirrhosis and can reduce hepatitis C treatment success rates. Alcohol is a toxin that is broken down by the liver and stimulates the build up of fat in the liver, and the development of fibrosis (or scarring of the liver). Controlling your alcohol intake and drinking in moderation are effective health maintenance strategies for people with hepatitis C.
If you choose to drink, limit the amount of alcohol you drink. It is recommended that men with chronic hepatitis limit alcohol to no more than 4 standard drinks per day and women to 2 standard drinks per day. Both men and women should have 2 to 3 alcohol free days per week. If you have cirrhosis, it is recommended that you don’t drink at all.
There are ways you can limit your alcohol use:
Foods that are high in fat or are spicy or sweet can cause nausea. Avoid drinks at meal times. Try not to skip meals because an empty stomach can make nausea worse.
• finish each drink before having the next drink
If you are vomiting frequently – sip plenty of fluids such as water, herbal teas or plain mineral water to avoid dehydration.
• mix your drink with plain mineral water
Constipation
• switch to low alcohol or alcohol free drinks
• avoid situations where there maybe pressure to drink
One challenge for people using opiate based drugs is constipation and prevention is the best cure.
• alternate a non-alcoholic drink with an alcoholic one.
Using laxatives every-so-often is okay, but long term use can cause problems.
Gastrointestinal symptoms Nausea, loss of appetite and constipation are sometimes experienced by people who inject drugs who have hepatitis C. Sometimes these symptoms relate to the drug use itself or withdrawal, at other times it can relate to your body’s response to having hepatitis C or being treated for hepatitis C. The following are suggestions for relieving common symptoms.
Drink a glass of warm water every morning before eating any food. Drink plenty of water during the day – warm water if you can deal with it. Exercise will help.
Eating the following will help:
Nausea
Yogurt which is full of live bacteria.
Ginger, peppermint, spearmint, fennel seed and aniseed teas can help reduce bloating and abdominal cramps - make ginger tea by grating a one-inch piece of ginger and adding hot water.
Potassium - found in almonds, fruit, especially bananas and paw paw, green leafy vegetables such as spinach Bran, wholemeal bread, brown rice, wheat germ are all helpful - sprinkling bran or wheat germ on your cereal.
Added acid in your stomach can add to discomfort – avoid orange or lemon or other citrus.
Fresh carrots chopped up can be good.
Small sips of fluid are often easier to consume than solids.
If you can, pooh before you use opiates.
Eat smaller meals more often.
Don’t strain too hard when having a pooh, as it can cause piles (haemorrhoids).
Soups and broths can be easier to eat. Toast or crackers can be good if you are nauseous in the morning. If you are sensitive to food smells – avoid being in the kitchen when cooking, or use a fan to move the air around and cook when you a feeling less nauseous. Cold foods such as sandwiches, salads, fruits, cold soups and cheese and biscuits can be useful.
If there are any unusual changes in your bowel habits or faecal appearance - bulky, pale faeces the colour of porridge or clay with a fatty consistency and a gross smell are associated with gall bladder, liver, or pancreatic disease – contact your local general practitioner or drug user organisation.
The good food shopping list Underneath is a shopping list of foods that when eaten in a balanced way will provide the nutrients that will get you through your day and more. If you’re setting up your kitchen or pantry, don’t get too ambitious and think that you have to buy everything all at once. Making a menu of what you’re going or want to eat over the next few days will help in reducing the number of things that you will need to buy and stop you buying food that will just rot because you haven’t used it. When making up menus, there are millions of websites and recipe books to inspire you.
Cupboard: Eggs Peanut butter Honey Jam Vegemite Salt, pepper, herbs and spices Rice Rolled oats for porridge Muesli Spaghetti Noodles Legumes – chick peas, lentils, lima beans, split peas Olive oil Vegetable oil Canned tomatoes Canned tuna, salmon or sardines Baked beans Bread – wholemeal/wholegrain Canned fruit Dried fruit Nuts – peanuts, sesame seeds
Sugar Coffee, tea – including herbal teas Canned soup
Zucchini Cauliflower Bok choy Spinach
Vegetables:
Lettuce
– these will last for a couple of weeks:
Eggplant
Onions
Avocado
Potato
Fresh tomatoes
Sweet potato
Celery
Garlic
Cucumber
Ginger Pumpkin
Other fridge foods: Cheese
Fridge: Fresh fruit – all year round: Apples Bananas Oranges Grapes
Fresh fruit – in season: Peaches Apricots Mango Paw paw Pineapple
Vegetables: – these will last a few days in the fridge: Broccoli Beans Carrots Cabbage Beetroot Parsnip
Milk or soy milk (with added calcium) Yoghurt Bean curd Tofu Butter or margarine Homous
Freezer: Peas and other frozen vegetables Meat or fish – although these are best eaten fresh
Further information: Nutrition Australia www.nutritionaustralia.org Practical food tips and information: www.foodwatch.com.au Vegetarian diet inform ation and recipes: www.vital-health.com.au
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