Eat Well for Your Liver by Hepatitis SA

Eat Well For Your Liver

Tips and Recipes from Hepatitis SA

Contents Why is it important to eat well? ...........................................

How do I eat well? ..............................................................

Fill your plate with variety ...................................................

Which food does what? .......................................................

Can I have snacks... and “extras”? .......................................

Baby steps or big steps... you choose ..................................

Healthy snack ideas .............................................................

Liver friendly drinks .............................................................

Tasty recipes to try ..............................................................

Appendix 1 (How much to eat) ............................................

Appendix 2 (What is one serve?) .........................................

Appendix 3 (Food labels) .....................................................

More Information ...............................................................

About Hepatitis SA .............................................................

Useful Contacts ..................................................................

Acknowledgements ...........................................................

Why is it important to Eat Well? Your diet and your liver Your liver is an amazing organ which performs many tasks that are vital to your health. Your liver breaks down the nutrients from the food you eat turning it into energy that it stores until you need it. At the same time, it removes waste products and other harmful substances from your body. Your liver also destroys bacteria, helping you fight off infections. Good nutrition is important for your liver to carry out its functions. If your liver is sick, it will not be able to perform all these jobs properly. A healthy liver can repair itself but if your liver is damaged by viruses or toxins, this ability can be impaired. Eating well is important for everyone but it is especially important if you have a liver problem such as hepatitis. This is because eating well: • • • • • •

strengthens your immune system which helps your body fight the viral infection, helps ease some symptoms of hepatitis infection or treatment, like nausea, provides nutrients that your liver cells need to repair and regenerate, gives you energy! helps you achieve and maintain a healthy weight, reduces the chance of other chronic diseases like heart disease and diabetes.

Is this book for you? Use this book as a first step on your path towards healthier eating. It provides general advice on healthy food, suitable for everyone and also for most people with hepatitis. (See page 36 for sources). This book also includes some basic information specific to people with hepatitis. However, nutritional needs differ between individuals. The advice provided in this book may not be appropriate for everyone. Speak to your doctor or nutritionist if you are unsure whether you need specialised advice on your diet.

How do I eat well? It’s easy! Eat a variety of nutritious foods and avoid snacks loaded with fat, sugar and salt. Follow this simple guide to eat well. Your meals should be made up of... MOSTLY • Vegetables. Go for a variety of types and colours including sprouts. • Fruits. • Tubers e.g. potato, sweet potato, yam. • Legumes: beans, lentils, peas. • Breads, cereals, rice, pasta, noodles. Choose wholegrain varieties where possible. SOME • Eggs. • Fish and lean meat (including poultry). • Milk, yoghurt, cheese. Choose low or reduced-fat varieties where possible. • Nuts. Choose a variety. LIMITED • Saturated fat. Found in red meat, butter, cheese; also in vegetable oils like palm oil, cocoa butter, coconut oil − often found in commercially processed foods. • Alcohol. • Sugar. • Salt. Foods and drinks high in the above ingredients are classed as “discretionary” by the Australian Dietary Guidelines. They include sweet snacks (biscuits, cakes, etc), salty and/or high fat snacks (crisps, pies, etc), processed meat products, high-fat spreads, soft drinks, energy drinks and alcoholic drinks.1 And don’t forget to… Drink plenty of water! Choose water most of the time. Strictly speaking, you don’t need to drink eight glasses a day if you eat food with fluids like soup and fruits2 3 4, but eight is a useful guide. If you exercise and do physical work you may need more. Listen to your body, and when you’re thirsty, drink water instead of other beverages.

Fill your plate with variety Eating many different types of food is important because you cannot get all the nutrients your body needs to stay healthy from a only a few types of food. Eating different foods helps your body get all the nutrients it needs. Increase variety in your meals by buying a range of different foods each week and alternating between similar products. For example, if you only ever buy one type of bread try alternating between white, wholemeal, wholegrain and rye. Or if you only ever eat rice as your staple, try noodles or pasta.

How do I know I am getting enough variety? You may have heard about the five core food groups.5 This is a system of food grouping based largely on the European diet. If you are from a non-European cultural background, these core groups may not make sense to you. If you seldom, or do not, eat food from one of the groups identified, e.g. meat or dairy products, it does not necessarily mean that your diet is inadequate. Basically, we need food for: • energy, • body building, • maintaining bone strength, • fibre for healthy gut, and • vitamins and minerals for our body functions. Most foods meet more than one of these needs, but generally they mainly meet one of these needs e.g. meat provides amino-acids for body building, rice gives carbohydrates for energy. Our diet is healthy and balanced if we make sure we eat a variety of foods so that all of the above needs are met in the amounts that we need. Remember that needs vary; for instance, children need more body building foods because they are growing, and someone doing physical labour will need more energy-giving food.

Which food does what? Food that gives you energy This is usually the staple food we eat. It varies from culture to culture and includes cereals, rice, sorghum, semolina, burghul, polenta, millet, potatoes, plantain, yam and flour-based produce like bread, pasta, noodles, couscous and dumplings. These foods give you energy to go about your daily activities. Many also provide: • fibre for healthy digestion and • vitamins and minerals including folate, thiamin, riboflavin, niacin and iron. Standout foods from this group are oats, brown rice and other wholegrain food.

Food for growing and rebuilding your body Our muscles are made of proteins which are made up of amino acids. So foods which are rich in the amino acids that our body needs will help to us to grow and rebuild our body. Meat (red and white), fish, eggs, nuts and legumes are some good sources of essential amino acids. Some nutritious alternatives to meat are almonds and other nuts, fish such as salmon, mackerel, tuna, swordfish, sardines, herring, trout, oysters and clams, and legumes including kidney beans, chickpeas, cannellini beans, borlotti beans and navy beans. Foods from this group provide your body with: • • • • •

amino acids for manufacture of protein, iron for healthy blood, niacin for healthy digestion and energy, vitamin B12 for healthy blood and other body functions, zinc for making proteins and other essential functions.

If you have chronic hepatitis… Make sure you eat protein rich food as your liver will need it to repair itself. Food that help to build and maintain your bones Dairy products are often named as the source of calcium. While they are good sources of calcium, there are many other foods that can also provide you with calcium6. Besides dairy products such as milk, yoghurt and cheese, other calcium rich foods include: • Almonds (also rich in fibre, folic acid, magnesium, potassium and protein).

• • • • • •

Salmon with bones. Dark green vegetables e.g. Broccoli, Kale, Collard. Tofu. Tempeh. Calcium fortified soy milk. Sesame seeds.

Dairy foods can be good sources of calcium, protein, riboflavin and vitamin B12. Yoghurt contains probiotics which support the health of the digestive tract, but remember... Full cream dairy products are high in saturated fat. Choose low, or no, fat varieties. Avoid ice-cream, cream and soft cheeses such as brie, as they are low in calcium and high in fat.7

Food that gives you vitamins and minerals Vegetables Vegetables, legumes (peas, lentils, beans), herbs and spices are rich in many different kinds of vitamins and minerals which your body needs to function. The vitamins and minerals also help to boost your immune system. Vegetables and legumes also provide fibre for digestion. In addition, starchy root vegetables like potatoes and yam also gives you carbohydrates for energy. Some outstanding vegetables include broccoli, brussel sprouts, cabbage, cauliflower, spinach, baby spinach, silver beet, turnips, dark lettuce, pumpkin, carrots, squash, sweet potatoes and capsicum. Fruits Fruit are another good source of fibre, vitamins – especially vitamin C – and minerals. Starchy fruits like banana are also a good source of carbohydrates for energy. Try fruits other than the usual apples and oranges. Go for fruits in season as they are fresh and usually cheaper. Stone fruits for instance, are rich in vitamins A and C with minerals like calcium, magnesium, iron, phosphorous and potassium. Grapes and berries are full of vitamins A, C, K and other minerals that boost your immune system. Eating whole fruits is better than drinking fruit juices. Too much fruit juice can wear away the enamel of your teeth. Also, whole fruits provide you with more fibre which is good for your gut.

Can I have snacks... and “extras”?

Choose healthy snacks. If you feel like something sweet, have a piece of fruit. Celery sticks in a tasty dip can satisfy the urge for something savoury. Don’t eat snacks with lots of saturated fat, sugar and salt and avoid or restrict your intake of alcohol. These “extras” don’t provide your body with any nutritional benefit and should only be consumed occasionally and in small amounts.

“Extras” to avoid… Alcohol Alcohol stimulates fat build up and the formation of scar tissue in the liver. It can also cause heart disease and brain damage as well as lower your immune system’s ability to fight off infection. The Australian Guidelines to Reduce Health Risks from Drinking Alcohol recommends that healthy adults should drink no more than four standard drinks per day, and no more than ten standard drinks a week. If you have chronic hepatitis… Drinking alcohol increases your risk of developing cirrhosis. To avoid liver damage it is best to avoid alcohol altogether, but if you choose to drink then do so in moderation. Do not drink more than the recommended daily amount on a single occasion.8 If you have cirrhosis… It is recommended you do not drink any alcohol. What is a standard drink? A single drink can often contain more alcohol than one “standard drink”. A standard drink contains 10 grams of alcohol be it in beer, wine or spirits. • Light beer (2.7% alc/vol) 425 mL • Mid strength beer (3.5% alc/vol) 375 mL • Full strength beer (4.9% alc/vol) 285 mL • Regular cider (4.9% alc/vol) 285 mL • Sparkling wine (13% alc/vol) 100 mL

• • •

Wine (13% alc/vol) 100 mL Fortified wine e.g. sherry, port (20% alc/vol) 60 mL Spirits e.g. vodka, gin, rum, whiskey (40% alc/vol) 30 mL

Tips to cut down your alcohol intake: • Switch to drinks with low-alcohol content • Mix drinks with mineral water or lemonade • Space out alcoholic drinks. Have a few non-alcoholic drinks after each alcoholic one • Avoid buying rounds or other situations where there is pressure to drink If you need help in reducing your alcohol intake speak to your doctor or contact the South Australian Alcohol & Drug Information Service on 1300 131 340. Fat The Australian Dietary Guidelines recommends a moderately low fat diet. A high fat diet increases the risk of developing chronic health problems including obesity, heart disease, diabetes and some cancers. However your body needs small amounts of essential fatty acids to function so it is not healthy to cut out fat altogether from your diet. Not all fats are the same. The basic principle to follow is to… Eat small amounts of GOOD fats and avoid BAD fats. If you have chronic hepatitis… Eating fat by itself does not cause fatty liver. However, the liver plays an important role in breaking down and storing fats; a high intake of fat can contribute to obesity which can lead to fatty liver. In addition, people with chronic hepatitis tend to develop fatty liver more than people without hepatitis. The Good Fats: Monounsaturated and Polyunsaturated Amazingly these fats actually help to lower the amount of cholesterol in your blood and protect your blood vessels from damage. They contain essential fatty acids that nourish the cells in your body.

Good Fats to Use in Cooking These are the healthiest oil based products to use when cooking because they are full of mono- or polyunsaturated fats. BUT remember these products still have a high total fat content and so are full of calories or energy. So only eat them in small amounts to avoid weight gain. • Olive, sunflower, safflower, canola and soya bean oils • Polyunsaturated margarine – check the labels to make sure there are no trans fats. Good Fats for Eating These foods contain smaller amounts of good fats as well as other important nutrients for your body. So include lots of these foods in your diet! • Nuts like walnuts, hazelnuts and brazil nuts • Seeds like flaxseeds, linseeds, sunflower, sesame and pumpkin seeds - Add a tablespoon of seeds to your breakfast cereal • Avocadoes • Fish especially salmon, tuna and sardines - Tinned fish is a healthy alternative to fresh • Prawns • Legumes like beans, peas and lentils The Bad Fats: Saturated, Hydrogenated and Trans Saturated fat increases the amount of cholesterol in your blood which causes damage to your blood vessels and also strains your liver. A diet high in saturated fat increases your risk of developing fatty liver, heart disease, diabetes and some cancers. They are found in most animal products, including: • Meat, butter, cheese, full-fat milk products and cream And also some plant-based products, including: • Vegetable fat, hydrogenated vegetable oil and palm oil.    And often used to make: • Cakes, biscuits, pastries, chocolate, potato chips and most fried take-away foods Sugar Sugar is alright when it is found naturally in foods like fruit or added in small amounts to healthy processed foods like baked beans.

Sugar is NOT alright when it is eaten in large amounts. Sugar contains a lot of energy or calories and any excess calories that are not used by the body will be stored as fat. High amounts of sugar can also lead to dental problems and diabetes. Many processed food and drink products contain large amounts of sugar. High sugar foods that provide the body with a lot of calories and little or no nutritional benefit include most soft-drinks, energy drinks, flavoured milks, ice-creams, biscuits, cakes, sweets, lollies and chocolate. Choose “no added sugar” product varieties and check nutritional labels. If you have chronic hepatitis… A diet high in sugar contributes to fatty liver which affects your liver health. Salt Salt is alright in small amounts and is needed by the body to function. Salt is NOT alright in large amounts because in some people it can increase their risk of developing high blood pressure. It is recommended that adults consume less than 2300 mg of sodium each day. That is the same as about 6 g or 1 ½ teaspoons of common salt. Use less salt when preparing meals at home and read labels carefully when buying food in the supermarket. Most of the salt we eat is added to foods by manufacturers. Manufactured foods that are high in salt may not necessarily taste salty.9 Read labels carefully and choose “low salt” or “no added salt” products in the supermarket. If you have chronic hepatitis… A diet high in salt can increase your blood pressure and contribute to fatty liver disease. Work towards a low-salt diet. If you are experiencing fluid retention, speak to your health professional for closer guidance on modifying your diet. Read more about eating low salt in this series of blog posts https://hepatitissa.asn.au/blog/tag/low-sodium/.

Baby steps or big steps– you choose

Eating well isn’t starving yourself on limited foods. It’s eating nutritious foods that your body needs to be healthy. You can change the way you eat by making big changes quickly or by making little changes to the way you buy, cook and eat food. Different ways work for different people. At the shops • • • • • • • • • • •

Add variety to your food choices. Choose different types of foods each week, like alternating breakfast cereals. Have seasonal fruits and vegetables regularly. Choose low fat dairy products like cheese, yoghurt and milk. Include beans and pulses like chickpeas, lentils, split peas, borlotti beans and navy beans. Keep tinned or dry stock in your pantry on standby. Buy wholegrain or wholemeal varieties of bread, cereal and pasta. Buy lean cuts of meat. Consider meat alternatives like tofu, tempeh, dry bean curds and mushrooms. Enjoy fish at least once a week. Keep tinned fish like tuna or salmon in the pantry as quick, healthy options. Choose “no added salt” varieties of products. Compare the nutritional value of similar products by reading food labels.

Cooking • Cut off fats from meat before cooking. • Use low fat cooking methods like grille, bake, stir-fry, steam and micro-wave, instead of deep-fry. • Use small amounts of monounsaturated or polyunsaturated oils for cooking. • Instead of butter, use small amounts of monounsaturated or polyunsaturated spreads. Eating • Eat smaller portions of meat. • Add more vegetables to all meals. • Always eat breakfast.

• Don’t skip meals. • Chew food well and eat slowly. This gives your body time to tell when it’s full. • Don’t overeat. Don’t eat till uncomfortably full. Stop when you feel you could eat a bit more. • Watch portion sizes. • Drink plenty of water each day. Make water your first choice of drink most of the time. • Eat fruit or drink fruit juice in the same meal as red meat, as Vitamin C helps to increase iron absorption. • Cut down on sugary drinks. How much should I eat? How much you need to eat depends on your size, age and how active you are. As a general guide, if you are not very active eat the recommended serves for your group. See page 31 for more information from the Australian Dietary Guidelines. The recommended serves are minimum requirements. To ensure you meet your nutrition needs, eat the recommended serves even if you are trying to lose weight. If you find it difficult to change your way of eating, take it slowly. Don’t feel that you have to completely change your diet at once. Make small but steady changes to the way you shop, cook and think about food and you will find it easier to maintain a healthy balanced diet for life. In the following pages are practical examples of tasty, healthy snacks and drinks; and easy, delicious recipes contributed by Hepatitis SA staff, board members and volunteers. Some are original, others are traditional recipes. They are all a joy to the palate and it is our pleasure to share them with you.

Healthy snack ideas

Fruit! Try fresh, tinned or dried

Tub of low-fat yoghurt

Vegetable sticks and low-fat dip, like hummus or tzatziki

Baked beans on a piece of wholemeal or wholegrain toast

Home-made bruschetta, top a piece of toast with finely diced tomato, red-onion and basil

Cup of homemade soup

Handful of mixed nuts and seeds

Hardboiled egg and a slice of wholegrain toast

Fruit toast with spread of low-fat cream cheese or low-fat ricotta

Crackers or rice cakes spread with avocado

English muffin topped with low-fat cheese Small tin of tuna on crackers and tomato slices

Liver friendly drinks

Water! Try adding slices of lemon or lime to still or sparkling water

Chilled lemon grass and mint – Steep chopped lemon grass leaves in boiling water. Strain. Chill in fridge. Add a few torn up mint leaves and a bit of honey if you like.

Ginger Tea. Boil 1cm of grated fresh ginger in water. Add 1 black tea-bag or 1 Fresh sage tea – steep fresh sage in hot tspn leaves. Brew covered for 2-3 minutes. water, add honey, then cool in fridge (use 2 stalks of sage per tea pot). Strain. Add milk. Sugar - op tional. Drink hot. Wonderful on a cold day!

Put a tablespoon apple cider vinegar and a teaspoon honey in hot water.

Orange Banana Smoothie – squeeze the juice of 1 orange. Pour into in a blender with a small banana and blend until smooth.

Mango lassi – beat together low-fat natural yoghurt and mango nectar in a glass. Add a sprinkling of nutmeg powder.

Iced tea – pour boiling water over herbal or black teabags with torn mint leaves, strain, chill tea in fridge & serve with ice-cubes. Sweeten with honey or sugar if desired.

Soy and ginger drink – Buy fresh soy drink from Asian stores at the Central Market. Heat the soy drink in a saucepan, add grated fresh ginger. Steep 3 minutes. Remove ginger and enjoy!

Lemon and honey tea – juice of half a lemon with a teaspoon honey in a cup of boiling water.

Real raspberry fizzy drink – combine 300g frozen raspberries, 1 ½ cups sugar & 2 cups water in saucepan. Boil 10 mins. Cool, then add ¼ cup lemon juice and Fruit punch – use any combination of cut strain. Add to one litre soda water in a jug. up fresh fruit pieces and fruit juices with sparkling mineral water

Tasty recipes to try These recipes are some of favourites of staff and volunteers at Hepatitis SA.They include a variety of healthy ingredients from different cuisines. Give them a try.

Carrot Soup 8 large carrots 1 large leek or onion 1 litre stock (any flavour) 1 – 2 cloves garlic, crushed 2 tbsp fresh chopped thyme 1 tbsp fresh chopped oregano ¼ cup buttermilk or natural yoghurt 1 tbsp olive oil Salt and pepper

Finely slice the leek. Sauté in olive oil with garlic until soft. Peel and roughly chop carrots. Add carrots to pot and sauté for 5 minutes. Pour over the stock making sure there is enough liquid to cover the carrots. Add water if needed. Bring to the boil and then simmer for 15 – 20 minutes until the carrots are tender. Remove carrots from liquid and either mash or blend. Return carrots to the stock with the fresh herbs and buttermilk (or yoghurt). Stir through and heat gently. Add salt and pepper to taste. 17

Minestrone Soup This recipe is a good way of using up excess vegetables in whatever combination you like.This soup can be frozen in portions without the pasta, for quick delicious meals. 1 400g tin or 2 large tomatoes - diced 1 400g tin kidney/cannellini beans, 1 cup dried pasta 1 onion 1 or 2 cloves of garlic 1 tsp dried oregano 1 tsp dried basil 1 tsp dried marjoram Salt & pepper to taste 1.5 litres vegetable stock 3 potatoes 3 carrots 4 celery stalks Handful green string beans 1 zucchini ½ cup peas 1 cup mushrooms, sliced 2 tbsp olive oil

Chop all vegetables into small pieces. Finely chop onion and garlic. Sauté onions in olive oil in a large pot over low heat until soft. Add garlic and cook for 1 minute. Add tomatoes, herbs, harder vegetables like celery, carrots and potatoes and stock. Bring to the boil, reduce heat and simmer uncovered for about 7 minutes. Add pasta and softer vegetables (like zucchini, mushrooms and green beans) and cook for another 10 minutes or so. Rinse beans and add to the pot with the peas. Soup is ready when the pasta is cooked and the vegetables are tender. Serve with a wholegrain bread. Sprinkle chopped fresh parsley over. Makes: 6 serves

Shabeena’s Mum’s Rasam Rasam is a strong, refreshing soup from South Asia.

4 or 5 cloves of garlic ½ teaspoon black peppercorns 1 teaspoon cumin seeds 1 teaspoon mustard seeds 1 teaspoon coriander seeds Curry leaves Few slices of lemon 6 or 7 tomatoes Water

Crush fresh garlic, peppercorn, mustard, coriander and cumin seeds in a mortar and pestle. Place tomatoes in a pot and cover with water. Bring water to boil. Crush tomatoes. Add a dash of lemon. In a pan, fry curry leaves and crushed spices until aromatic. Add curry mixture to tomato and water. Steep and leave to cool. Add salt, pepper and lemon to taste. Garnish with young curry leaves or other fresh green herbs. Serve warm with rice or flat bread. Makes: 4 serves

Fred’s Must Try Salad The key to this salad is to slice most ingredients very thinly.

2 carrots, very thinly sliced (wafer thin) 1 Lebanese cucumber, quartered, thinly sliced 1 capsicum, thin slices about 2 cm long 1 punnet cherry tomatoes, halved 6 spring onions, sliced 2 or 3 stalks or celery, also very thinly sliced Handful of snowpeas, sliced 1 avocado, thinly sliced 1 packet of marinated tofu, thinly sliced Chopped parsley Chopped cashews Roasted pine nuts 3 or 4 boiled eggs, cut into quarters (optional) 120 g mixed lettuce

Mix all ingredients in a bowl and Voila! a tasty and nutritious salad!

Caitlin’s Roast Pumpkin Salad ½ butternut pumpkin 1 packet (120g) baby spinach 1 tbsp honey 2 tbsp olive oil 2 tbsp sesame seeds Dressing 1 tbsp wholegrain mustard 2 tsp honey 2 tbsp olive oil 1 tsp white wine vinegar Salt and pepper to taste

Preheat oven to 200°c. Remove skin and seeds from pumpkin. Cut into chunks. Mix oil and honey in a bowl. Toss pumpkin in bowl to coat with mixture. Place pumpkin in a single layer on a baking tray lined with baking-paper. Bake in oven for 20 mins. Remove and sprinkle with sesame seeds. Return to oven for 5 mins, until golden brown. Remove from oven and let cool. Make dressing by placing ingredients in a small cup and whisking with a fork. Place baby spinach leaves in a bowl with pumpkin. Add dressing just before serving.

Cecilia’s Lillipilli & Grilled Tofu Lillipillis are often found growing in gardens and by the roadside. Tree owners are usually more than happy for them to be harvested. If you don’t have access to a lillipilli tree, your local Urban Orchard group may be able to help you. See page 39 for contact. 1 block firm tofu (about 300g) from Asian stores, diced 1 bowl lillipilli, seeds removed. 1 bunch spring onions chopped 1 bunch rocket (or cos lettuce) washed. Half avocado diced. Salt Seasoning 1 teaspoon curry powder 1 teaspoon dry garlic granules 1 teaspoon mustard seeds to grind Freshly ground black pepper Soy sauce 1 tbspn olive oil

Mix diced tofu with seasoning. Set aside half the garlic. Mix in ¼ of the chopped spring onions. Marinate for half an hour. Slice open the lillipillis. Remove seeds (not edible). Grill (or shallow fry) mixture until tofu is golden brown. Mix in the rest of the spring onions. Spin-dry rocket. Mop up remainder of the tofu seasoning. Add salt, black pepper, olive oil to taste. Add avocado to rocket. Mix gently to keep avocado intact. Add lillipilli and rest of garlic granules to tofu mixture Pile tofu and lillipilli mixture onto the rocket and avocado. Sprinkle mustard seeds over and garnish with young rocket leaves. Serve while the tofu is still warm to contrast with the cool lillipilli and rocket. 22

Caitlin’s Nana’s Lychee Salad 2 oranges 1 tin lychees 1 capsicum 2 celery stalks 2 spring onion stalks 4 tablespoons flaked almonds 1 iceberg lettuce Dressing 1/3 cup olive oil 2 tablespoons White wine vinegar 1 teaspoon dijon mustard 2 teaspoons honey Salt and pepper to taste

Cut the capsicum, celery and spring onion into thin slices. Segment oranges. Drain lychees. Toast flaked almonds. Dressing: Combine oranges, lychees, capsicum, celery and spring onions in a bowl. Just before serving, pour dressing over ingredients and mix. To serve, place ingredients either in whole lettuce leaves (as a cup or bowl) for individual serves, or on a bed of shredded lettuce for a group serve, and sprinkle with toasted flaked almonds.

Mahdi-inspired Cucumber Salad 1 large cucumber (or zuchinni) 1 medium carrot 2 small chillis 5 kaffir lime leaves finely chopped 3 mint leaves ½ cup peanuts ½ cup dessicated coconut 1 stalk lemon grass Olive oil Salt to taste 3 kumquats or limes

Use a peeler to slice cucumber and carrot into long thin, flat strips Pile loosely together Chop finely the chillis, mint, kaffir lime leaves and lemon grass stalk and mix all in a shallow dish. Add olive oil, salt. Squeeze kumquat over the mixture. Pile cucumber and carrot on top of dressing mixture. In a shallow pan dry fry coconut stirring until evenly browned. Roast peanuts and crush roughly with a rolling pin Sprinkle roasted coconut and peanuts over the cucumber and carrots. Mix all together just before serving.

Rose’s Best Ever Baked Salmon 2 salmon fillets ½ leek, finely sliced 1 orange 4 tbsps yoghurt Fresh dill

Halve the orange – slice one half and juice the other. Place each salmon fillet onto its own sheet of alfoil, skin side down; around 20cm by 20cm should be enough alfoil to make a nice parcel. Fold up the sides so the other ingredients stay on top of the salmon. Pour over orange juice and yoghurt. Pile on the slices of leek, some sprigs of dill and slices of orange. Wrap up each parcel tightly and place on a baking tray. Cook in a moderate oven (180°c) for 12minutes (rare) 20mins (well done). Serve with steamed rice and a big salad. Makes: Dinner for two.

Gauri’s Bhutayko Bhaat Bhutayko Bhaat is usually eaten as a quick breakfast by Nepali farmers and school children in southern Bhutan. Leftover or freshly cooked rice (Bhaat) is fried (Bhutayko) with onions and chlli in mustard oil or butter and supplemented with eggs and seasonal vegetables. 4 cups pre-cooked rice 2 tablespoons oil 2 tablespoons butter 1 medium onion, finely sliced 2 chillies, finely sliced 1 cm piece of fresh ginger, grated 1 teaspoon salt 2 fried eggs (optional) 100 grams peas 100 grams beans, sliced 100 grams carrots, chopped 200 grams cabbage, sliced Mint-tomato sauce 5 sprigs of mint 6 cherry tomatoes 1 chilli Pinch of salt

Beat eggs and fry in a pan. Allow to cool. Fry chopped onion in pre-heated oil or butter. After about 1 minute add the chilli slices and ginger. Fry on low heat until slightly browned. Add beans to the pan and cook for about 3 minutes. Add carrot and peas and heat for another 2 minutes. Add cabbage and salt. Cook for another few minutes. Add the precooked rice and butter to the vegetable mix and cook on medium fire for 5 minutes. Mix rice with the vegetables thoroughly. Add sliced fried egg and cook on low heatfor another 2 to 4 minutes. Mint sauce: microwave tomatoes for 1 minute and then grind all ingredients together. Serve hot with freshly ground hot mint-tomato or garlic-tomato chutney (achaar).

Mark’s Own Falafel This is always popular with staff and participants at our Love Your Liver lunch events.

1 cup dried chickpeas 1 large onion, chopped 2 cloves of garlic, chopped 3 tablespoons of fresh parsley, chopped 3 tablespoons fresh coriander chopped 1 teaspoon cumin 2 tablespoons flour Salt Pepper Olive oil for frying

Soak chickpeas overnight, covered. Omit this step if using canned chickpeas. Drain chickpeas, add fresh water and bring to boil. Boil for 5 minutes, then simmer for about an hour taking care not to overcook and there’s still some bite to them. Drain and cool. Combine chickpeas, garlic, onion, coriander, cumin, salt and pepper (to taste) in medium bowl. Add flour and mash by hand or with food processor keeping the pieces quite coarse. Form the resulting thick paste into small balls. If the mixture is too runny, add more flour. Flatten slightly and fry in shallow pan with oil Serve hot with plain yoghurt or hommus. Makes about 12 falafels.

Easy Stir-Fry Noodles A simple way to “stir-fry” noodles. Cook the noodles and rest of the ingredients separately. Then mix them together. You may use the same method with ingredients to suit your taste. 5 blocks instant noodles (bulk packs) Olive oil Soy sauce 1 tablespoon sesame seeds, toasted 1 small bunch green leafy vegies in season or broccoli florets, chopped 1 large tomato, chopped. Pulp set aside 2 cups fresh bean sprouts, washed and shaken dry 1 fresh chilli (optional) 4 dried Chinese or Shitake mushrooms soaked in warm water, cleaned, sliced 3 cloves garlic, peeled, finely chopped. ¼ onion, finely chopped 1 bunch fresh coriander

Add noodles to a pot of boiling water.Use fork to the blocks as they soften. Do not overcook. Drain and season with olive oil mixing well to prevent clumping. Add some soy sauce to taste. Fry garlic in a wok over low heat till they start to brown around the edges. Add some soy sauce diluted with water (50-50) Add tomato pulp, mushrooms and stems. Add chilli. Stir for a few seconds. Add leafy greens or broccoli florets. Stir till cooked. Do not overcook leafy greens. Add chopped tomatoes. Mix. Turn off heat and very quickly mix in bean sprouts. Pour the mixture over the noodles. Add chopped onions. Turn and mix gently but thoroughly. Sprinkle sesame seeds and top with coriander. 28

Yvonne’s Magical Health Giving Muesli This makes a fine, healthy, light breakfast because of the protein in the yoghurt and the fibre in the fruit. It can also be a dessert. A variety of fruits can be used and chopped almonds or other nuts added. Try this recipe using mango, passionfruit or chopped strawberries.

Single Serve 6 – 7 tbsp low fat natural yoghurt 4 tbsp natural untoasted muesli 1 tsp honey (to taste) ½ grated granny smith apple (or more if liked)

Place muesli into yoghurt and let it soften for at least 30 mins or overnight. This is not an essential step but it is nice to soften the grains. Add grated apple (peel and core apples first – quarter them to grate). Add honey to taste. Mix and eat.

Group Serve About 500 gm low fat natural yoghurt At least 1 large granny smith apple Honey to taste 8 -10 tbsps of untoasted muesli

Anny’s Two + Two Fruit Cake You can use any type and combination of dried fruits For example, apricots, sultanas, raisins, apple, pear, pineapple, figs, prunes and dates. Note that dates are quite heavy and will sink to the bottom. Try other liquids for variety: apple, pineapple juices, rosewater, tea and coffee. 2 cups dried fruit 2 cups orange juice 2 cups self raising flour 1 tsp margarine (or olive oil spray)

Chop the fruit into small pieces. Combine fruit and juice in a bowl. Cover bowl with cling-wrap and leave in the fridge overnight. Pre-heat fan-forced oven to 160⁰ C. Sift the self-raising flour into the fruit mixture and mix. Lightly grease a cake tin with margarine or an olive oil spray. Line the tin with grease proof baking paper. Pour the cake mix into the tin. Bake at 160⁰ C fan-forced for 1 hour. After 1 hour, turn off fan and reduce the oven to 150⁰ C. Continue baking for another hour. (Two hours total cooking time) Cake is ready when a wooden skewer inserted into the middle comes out clean. If skewer comes out sticky, more baking time is needed.

APPENDIX 1 The Australian Dietary Guidelines recommend eating the following minimum serves per day from each food group. Most people who want to lose weight should stick to that minimum. If you are taller or physically active you may need more serves.

Women Women

Veg

19-50

Fruit

Grain

Protein

Dairy

2½

0-2 ½

Extra

51-70

0-2 ½

70+

0-2

Pregnant

8½

3½

2½

0-2 ½

Lactating

7½

2½

0-2 ½

Men Men

Veg

Fruit

Grain

Protein

Dairy

Extra

19-50

2½

0-3

51-70

5½

2½

0-2 ½

70+

4½

2½

3½

0-2 ½

Notes: Veg: Vegetables & legumes/beans; Fruit: Fruit; Grain: Grain (cereal) foods, mostly wholegrain; Protein: Lean meat and poultry, fish, eggs, nuts and seeds, and legumes/ beans; Dairy: Milk, yoghurt, cheese and/or alternatives e.g. soy; Extra: Approx. number of additional serves from the five food groups choices for taller or more active adults. For children’s serves, visit https://bit.ly/ausservingsguide-kids.

APPENDIX 2 What is one serve?* Vegetables and legumes • ½ cup cooked green or orange vegetables • ½ cup cooked dried or canned beans, peas or lentils • 1 cup green leafy or raw salad vegetables • ½ cup sweet corn • ½ medium potato or other starchy vegetables • 1 medium tomato

Protein • 65g cooked lean red meats (about 90-100g raw) • 80g cooked lean poultry (100g raw) • 100g cooked fish fillet (about 115g raw) or one small can of fish • 2 large (120g) eggs • 1 cup (150g) cooked or canned legumes/beans • 170g tofu • 30g nuts, seeds, peanut or almond butter or other nut or seed paste (no added salt)^

Fruit • 1 medium apple, banana, orange or pear • 2 small apricots, kiwi fruits or plums • 1 cup diced or canned fruit (no added sugar) • Or only occasionally: • 125ml (½ cup) fruit juice (no added sugar) • 30g dried fruit

^Use only occasionally as a substitute for other foods in the group This amount for nuts and seeds gives approximately the same amount of energy as the other foods in this group but provides less protein, iron or zinc.

Milk, yoghurt and cheese • 1 cup fresh, long-life or reconstituted milk, or calcium-enriched soy milk • 1/2 cup evaporated milk • 2 slices (40g) cheese • 1 small tub (200g) yoghurt

Grain, Cereals • 1 slice (40g) bread • ½ medium (40g) roll or flat bread • ½ cup (75-120g) cooked rice, pasta, noodles, barley, buckwheat, semolina, polenta, bulgur or quinoa • ½ cup (120g) cooked porridge • ²/³ cup (30g) wheat cereal flakes • ¼ cup (30g) muesli • 3 (35g) crispbreads • 1 (60g) crumpet • 1 small (35g) English muffin or scone

*Sources: Australian Dietary Guidelines and https://bit.ly/eatforhealthau-servesizes

APPENDIX 3 Read food labels Beware of dodgy claims - Some manufacturers use tricky words to make their products appear healthier than they actually are, to entice more people to buy them. Don’t be fooled. For example: • FAT-FREE products are not necessarily healthy. Some confectionaries and deserts claim to be “fat-free” but are still unhealthy because they are full of sugar and calories. “Fat-free” products that are high in calories will still lead to weight gain if you don’t burn off those excess calories through exercise. • If a product claims to be 80% FAT-FREE it still has 20% fat, and that is high. • LOWER, LESS or REDUCED FAT products can still be high in fat. The claim can mean it has less fat than a similar product or another version of the product but it might still be high in fat. • LIGHT or LITE does not automatically mean something is low in fat or calories. It can be describing the food’s colour, taste or texture. • LOW CHOLESTEROL, NO CHOLESTEROL or CHOLESTEROL-FREE claims can be misleading if the product is made from plant-based ingredients, like margarine or oil, because they naturally don’t contain cholesterol anyway. The product may still be high in fat and calories. The best way to work out if a product is good for you is to check the information on the nutrition panel. Below is an example: NUTRITION INFORMATION Servings per package: 4

Serving size: 250mL Average Quantity per serving

Average Quantity per 100g

Energy

600 kJ (141 Cal)

240 kJ (57 Cal)

Protein

2.4 g

Fat, total

3.2 g

- saturated

Carbohydrate

14 g

5.6 g

- sugars

14 g

5.6 g

Sodium

100 mg

40 mg

Calcium

300 mg (38% RDI)*

120 mg

*Percentage of recommended dietary intake

HOW TO READ A FOOD LABEL • Look at the amount of energy per Serving you are consuming. • Compare the nutritional value of similar products by the information per 100 g if they have different serving sizes. • To work out if a product is high or low in fat, sugar and salt read the amounts per 100 g. • Read the amount of nutrients, like calcium, per Serving and work out if these are high or low by the RDI value. • If you are trying to lower your salt intake read the amount of sodium per Serving. Remember you should consume less than 2300 mg of sodium each day. What to look for Energy Shows how many kilojoules (kJ) and sometimes calories (Cal) are in a serving of a product. Eating foods high in energy will lead to weight gain if you do not burn off the excess energy through exercise. Total Fat Includes unsaturated and saturated fats. Look at the amount of fat per 100g: • Low-fat = under 3 g (solid food) • Low-fat = under 1.5 g (liquid) • High fat = over 20 g With 3.2 g of fat per 100 g the product above is neither low nor high in fat Saturated This is the BAD fat. Less is healthier. Sugars Look at the amount of sugars per 100g: • Low sugar = under 2 g • High sugar = over 30 g The above product is not low or high in sugar with 5.6 g of sugar per 100 g Sodium Look at the amount of sodium per 100g: • Low salt = under 120 mg • High salt = over 600 mg With only 40 mg per 100 g the product is low in salt

Nutrients If a product claims to contain certain nutrients, like calcium, fibre, folate or iron, the label must state the amount. The label will usually also include how much of an average adult’s recommended daily intake (RDI) of that nutrient is contained in one serving of the product. The RDI value helps you work out if there is a high or low amount of that nutrient in the product. One serve of the above product contains 38%, just over a third, of an adult’s RDI of calcium which is quite high. Fibre Fibre is good for your digestive health. In products claiming to be high in fibre look at the amount per 100 g: • High fibre = over 3g • Low fibre = under 0.5g Ingredients The ingredients are listed in order of their amount in the product. The first ingredient is the ingredient used in the largest amount, the last ingredient is the ingredient used in the smallest amount. Be aware that fat and sugar can be listed by many different names in the ingredients list. FAT includes butter, shortening, coconut oil, palm oil, copha, cream, dripping, lard, mayonnaise, sour cream, vegetable oils and fats, hydrogenated oils , full-cream milk powder. SUGAR includes corn syrup, dextrose, disaccharides, fructose, glucose, golden syrup, honey, lactose, malt, maltose, mannitol, maple syrup, molasses, monosaccharides, raw sugar, sorbitol, sucrose, xylitol.

More Information Useful Websites Eat for Health - Australian Dietary Guidelines An easy-to navigate Department of Health and Ageing resource. Learn about food groups, daily requirements, discretionary foods, healthy eating and understanding food labels. There are also handy nutrition calculators for estimating your energy needs. Visit eatforhealth.gov.au for more. The Dieticians Association of Australia This website is full of good nutrition tips as well as advice on how to find an Accredited Practising Dietician. Head to daa.asn.au. Hepatitis SA hepsa.asn.au to learn about viral hepatitis

Know your liver: k3myliver.org.au

Assess your hep C risk: hepccheck.info

British Liver Trust A rich source of information about liver health and care including diet. Look under the liver, diet and liver disease. Visit bit.ly/BLT-diet-n-liverdisease

References General Hepatitis SA Library Australian Diet/Nutrition collection. Accessed 18/10/2023. bit.ly/hepsalib-nutrition-oz. The Australian Guide to Healthy Eating. (Website QR code above). Accessed 18/10/2023. www.eatforhealth.gov.au/guidelines/australian-guide-healthy-eating. Australian Guidelines to Reduce Health Risks from Drinking Alcohol, National Health and Medical Research Council, Commonwealth of Australia, 2020. bit.ly/ozboozerisk End notes 1.

Australian Dietary Guidelines - Discretionary food and drink choices. https://www. eatforhealth.gov.au/food-essentials/discretionary-food-and-drink-choices 36

Water: How much should you drink every day? https://mayocl.in/3S0koTc Mayo Clinic

How Much Water Should You Drink? It Depends, Science Daily release 11 Aug 2007 https://www.sciencedaily.com/releases/2007/08/070811225126.htm.

Fact or Fiction? You Must Drink 8 Glasses of Water Daily, Karen Bellenir, Scientific American, 4 June 2009 - https://www.scientificamerican.com/article/fact-or-fictionyou-must-drink-8-glasses-of-water-daily/

Australian Dietary Guidelines, National Health and Medical Research Council, Department of Health and Ageing, February 2013.

Healthy Bones Australia - Calcium and Bone Health. https://bit.ly/healthybonescalciumfoods. Scroll down to ‘Calcium and food’ section.

Calcium Content of Foods, University of California San Francisco Medical Center. https://www.ucsfhealth.org/education/calcium-content-of-foods. Accessed: 17 October 2023.

A single occasion is defined as a consequence of drinks taken without the blood alcohol concentration reaching zero in between. The risk of an alcohol-related injury arising from a single occasion of drinking increases with the amount consumed. For healthy men and women, drinking no more than four standard drinks on a single occasion reduces the risk of alcohol-related injury arising from that occasion (NHMRC 2009 Australian Guidelines to Reduce Health Risks from Drinking Alcohol. https://www.aihw.gov.au/reports-data/behaviours-risk-factors/alcohol/glossary

British Liver Trust - Diet and Cirrhosis - https://britishlivertrust.org.uk/informationand-support/living-with-a-liver-condition/diet-and-liver-disease/cirrhosis-and-diet/ Scroll to section on ‘Reduce salt to help manage fluid retention and bloating’.

About Hepatitis SA Hepatitis SA is a community-based organisation providing information and services to South Australians affected by viral hepatitis. We work to realise a society that cares about the health and well-being of people affected by hepatitis and understands the link between health and social justice. Our services include: Telephone Information Hepatitis SA has a free, confidential telephone information service available Monday to Friday from 9 am to 5pm. Call 1800 437 222. Support Free, confidential support groups meet regularly at Hackney, Elizabeth and Port Adelaide. For more information, call 1800 437 222 or email admin@hepatitissa.asn.au. Find information, send queries or chat with our information workers at hepsa.asn.au. Education We offer free education sessions about hepatitis B and C, treatment options and living with hepatitis. Call 1800 437 222 to make a booking. Print Information Our online library of hepatitis-related free-to-access electronic publications is available to anyone with internet access. Check it out at hepsa.asn.au/ library. Our quarterly magazine and selected publications can be read online at issuu.com/hepccsa. You can request free printed information on hepatitis-related topics via telephone on 1800 437 222, or online at hepsa.asn.au/orders.

Contact Kaurna Country, 3 Hackney Road, HACKNEY SA 5069 Tel: 08 8362 8443 / 1800 437 222 admin@hepsa.asn.au Facebook: @HepatitisSA | X/Twitter: @hep_sa | YouTube: @HepSA

Useful Contacts About Food OzHarvest NEST program - Besides collecting food and redistributing them to people in need, OzHarvest runs a six-week program that teches healthy eating and easy, affordable cooking in a friendly and fun environment. More information: https://www.ozharvest.org/education/nest/ The Food Centre is a supermarket that sells affordable fresh food and groceries. It’s open Monday to Friday 8:30 am to 5 pm, Shop 5, 580 Main North Road, Gepps Cross, SA. More information at thefoodcentre.com.au or call 8262 7345. Sustainable Communities One Planet Market is a monthly market that includes produce exchange, local produce, home made foods many of which are available on a non-cash trading system. More information: https://www. facebook.com/01planet/

Support The MOSAIC program of Relationships Australia SA provides counselling to people affected by hepatitis C and to some extent, hepatitis B. Call 8340 2022 to make an appointment. P.E.A.C.E. is the multicultural HIV hepatitis education program of Relationships Australia SA. It provides information and support to people from non-English speaking cultural backgrounds. Call 8245 8100 for more information. Viral Hepatitis Nurses can provide information and support about any concerns you may have regarding your liver. Call 0423 782 415 (central), 0401 717 971 (north) or 0466 777 876 (south) to make an appointment.

Acknowledgements Thank you to: Ellie Jayne for generously giving her time to photograph our food and for the beautiful pictures so important to an attractive recipe book. Dr Jill Benson of the University of Adelaide and Migrant Health Service SA, and Gauri Giri of the Migrant Resource Centre and Migrant Health Service SA for their invaluable feedback on this booklet. Caitlin Dowell for the wonderful work she put into this project, collecting recipes, organising the cookup and photography, and writing up the drafts. Rose Magdalene for photography styling and finding us Ellie. All the staff members, volunteers and board members of Hepatitis SA who contributed recipes and sampled the food.

Credits Photography Ellie Jayne - Pages 10, 11, 12, 13, 14 (water, sage tea), 15, 16, 17, 18, 19, 20, 21, 22, 23, 25, 26, 27, 29, 30 Cecilia Lim - Pages 14 (lemon grass, ginger tea) , 24, 28 Cover photographs : Ellie Jayne Design Cover design, book design and layout: Cecilia Lim PROP Sage tea bowl (page 13) by Adil Soh-Lim Illustrations Cecilia Lim

Copyright © Hepatitis SA retains all rights to the contents of this book including photographs and illustrations except for photographs by Ellie Jayne where the copyright remains with the photographer. No part of this book may be reproduced without permission from the copyright holders. SA Health has contributed funds towards this program.

Eating well is not as hard as it seems. By following some simple rules and being mindful of what you eat, everyone can move towards healthier diets. This booklet contains basic information about eating well to care for your liver, as well as some affordable, easy to make recipes. Enjoy!

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Third edition - October 2023