Nutritional compromise is commonly seen in patients with Primary Biliary Cirrhosis (PBC). The following is an excerpt from a lecture given by Nan Cameron, MSN, RN, LAc to a PBC support group.
How often have your heard the following statements. The life in food gives us life. We are what we eat. Patients frequently ask me, "Where do I start?" I hope you find this information helps you begin to make changes in your diet. There are three free therapies - diet and nutrition, rest and exercise, and deep relaxation. Making small changes in these areas often makes a dramatic change in your health and how you feel.
As foods are processed they often don't have the essential enzymes and bacteria that are critical aids to digestion and metabolism. Fresh foods have greater amounts of enzymes. If your body doesn't have to work overtime making enzymes, it has more energy for other processes.
For example, hybridized foods may look or taste better but the nutrient content has changed. Corn has 14% less protein than it did 40 years ago. Whole wheat contains 22 vitamins and minerals that are removed to make wheat flour. After the bran and germ are removed to make white flour, 98% of Vitamin B 6, 91% of manganese, 84% of nagnesium and 87% of fiber are extracted. One of the many lost nutrients is chromium which is critical for maintenance of blood sugar levels, normalizing high serum cholesterol levels and fat burning. (from Digestive Wellness)
Did you know?
When our liver is not functioning well our digestion is affected, which leads to an overtaxed liver, which leads to more digestive problems and so on. The liver has 3 lobes: the main lobe is like a chemical factory, it produces chemicals and enzymes necessary for body functions, the left lobe regulates and maintains body functions (toxic left lobes often result in allergic or environmentally sensitive reactions), We often crave what makes our body worse. The lower lobe provides storage for essential fatty acids, vitamins A, D, E, K and is responsible for the production of cholesterol and many hormones. The liver works at detoxification, but if there is too much or it is unable to perform this function it will store the toxins in the lower lobe of the liver or other parts of the body. Toxins include radioactive substances, pesticides, food preservatives and dyes.
The gallbladder stores and concentrates bile that has been produced by the liver. When we eat, bile is released by the gallbladder and liver to help emulsify or breakdown fat into smaller pieces so that lipase (fat splitting enzyme) can digest them.
There are more bacteria in our intestinal tract than cells in our body. We have 4-500 types of bacteria in our body. The two most important forms are lactobacilli, found mainly in the small intestines and bifidobacteria, found mostly in colon or large intestine. As a fetus our bodies our sterile, but the trip down the birth canal begins our relationship with bacteria. Friendly bacteria manufacture many of our B vitamins, folic acid, and Vitamin K. Lactobacillus acidophilus and bifodobacteria increase absorption of minerals such as calcium, copper, iron, etc., aids in digestion of dairy products, acidifies the digestive tract to provide a hostile environment for pathogens and yeasts.
What causes dysbiosis? Dysbiosis is an imbalance of intestinal flora in the GI tract. There are many causes, but we generally bring it on ourselves. It can be due to high levels of stress, exposure to chemicals, poor food choices, oral contraceptives, antibiotics, pain killers to name just a few. For instance, NSAIDs work by blocking prostoglandins. Some prostoglandins can cause pain and inflammation, but others cause healing and repair. Our intestinal lining replaces itself every 3-5 days. Prolonged use of NSAIDs interfere with the repair of gut mucosa. This can lead to the lining becoming weak, inflamed and leaky (increased intestinal permeability). Leaky gut syndrome puts an increased workload on the liver, it has more to detoxify. Low levels of hydrochloric acid in the stomach can lead to bacterial overgrowth. Poor transit time in the GI system (constipation) can lead to bacterial overgrowth.
Where to begin: Clean our body by removing as many irritants as possible - food, medicine, pathogenic microbes, provide good nutrients, replace missing intestinal flora, enzymes, HCl, and give the body time to heal itself.
One of the many functions of the liver is to act as filter - let the good nutrients pass through, change the toxic ones to safe substances that can be eliminated by the body through urine, stool and sweat. When the liver can't break them down they are stored in the liver or somewhere else in the body, often in fatty tissue. Our bodies form antibodies to toxic substances, but antibodies can often trigger a systemic effect that results in an autoimmune reaction. The body fights or attacks itself.
The nervous system, endocrine system and immune system all work together to control appetite, food intake, and metabolism of food. Long term success in weight control can occur only by normalizing the function of neuroendocrine-immune function by modification in meal timing, food choices, exercise and stress management. The brain talks to the gut (our second brain) via the autonomic nervous system which has two parts the sympathetic and parasympathetic nervous systems. The sympathetic nervous system is responsible for the stress response. It slows down digestion so that are body can defend itself. This promotes fat storage, decreases the metabolism (burning fat), increases secretion of glucose, cortisol and adrenaline; promotes insulein resistance and increases reflux and constipation. Insulin is often considered the master metabolism hormone. It helps the body use the carbohydrates we eat or if we eat too much store it for later use. Eating quickly digested, high glycemic load carbohydrates such as sugar or highly processed and refined carbohydrates such as bagels or muffins get us into trouble. They increase the production of insulin which prompts us to eat more. Sugar comes in many forms - high fructose corn syrup (HFCS), sucrose, glucose, maltose, dextrose, lactose, corn syrup, white grape juice and other fruit juice concentrates, honey, barley malt, sucant, cane sugar. Food suppliers are required to list only the total grams of sugar not whether any was added. Two factors that influence our food intake and appetite are HFCS and fiber. HFCS is different from regular sugar. It is absorbed more quickly and does not require insulin to be absorbed into the cells. Foods containing HFCS trigger none of the normal controls for appetite. It makes us even more hungry for sugar. Artificial sweetners - aspartame, neotame, acesulfame potassium, saccharin, sucralose, dihydorcholcones have become a significant component in our diets. Many questions of their safety remain. Known effects include stimulation of our appetite by increasing insulin production. Aspartane may disrupt brain chemistry and increase seizure risk, depression and headaches. Sorbitol, malitol, and xylitol are common nonabsorbed sugar alcohol sweetners that increase gas production, bloating and abdominal pain.
Meal composition: Not all calories are created equal. Low fat diets slow your metabolism more than low glycemic load diets.
Meal timing: Eating in a regular, rhythmic pattern - approximately the same time each day, 3 meals and 2 snacks reduces calorie consumption, increases fatty acid oxidation, lowers cholesterol and insulin levels. Studies have shown that aside from emotional balance eating breakfast is one of the few things consistently correlated with longevity and healthy weight.
Fiber: Fiber is like a sponge it soaks up fat and sugar in gut and both slows and prevents some of their absorption. Eating an apple requires more metabolic effort and takes longer to breakdown then drinking a glass of apple juice.
Super fibers: Konjac, is an Asian tuber made into a rubbery jelly or noodles that has been used in Japan. Rye fiber. Fiber is an important part of long term weight loss and is found in unrefined, unprocessed whole plant foods such as beans, whole grains, nuts, seeds, fruits and vegetables.
Impairment of bile flow which results in malabsorption in the intestinal tract.. Many digestive enzymatic reactions in the small intestine are impaired. In one study, 40% of PBC patients were malnourished, and the problem did not appear to be related to poor nutritional intake. Poor nutritional acquisition can lead to loss of muscle mass, fatigue, bone density problems, and vitamin and mineral deficiencies.
Severe protein deficiency is not normally observed until an individual has had PBC for 10-20 years and has developed cirrhosis. Neither protein or sodium restriction is necessary in the early stages of PBC.
Studies have shown that there is a high incidence of glucose intolerance and insulin resistance that can cause significant problems with carbohydrate metabolism.
Fatty liver (steatorhea) typically means that there is a component of pancreatic failure. Restriction of fats are then important.
Supplementing with medium-chain triglycerides (MCT) is helpful in improving energy levels. Coconut oil is easily hydrolyzed in the absence of bile salts and is easily absorbed. MCT dosage recommended is 15 ml 3-4 times per day. MCTs help with the absorption of calcium which may be important in some patients with osteoporosis.
Celiac disease is not uncommon in PBC patients. Celiac disease is the inability to digest foods containing the gliadin fraction of gluten. This results in damage to the small intestine and affects the ability to absorb nutrients. Gluten is in wheat, rye, barley, millet and probably spelt. Many people with celiac disease are able to eat oats. Celiac disease if often mistaken for irritable bowel disease.
Hyperlipidemia is common in patients with chronic cholestasis (gallbladder disease). Two studies indicate that heart disease may not be associated with increased mortality so treatment should only be given when a patient has multiple risk factors such as family history, obesity and diabetes.
Vitamin D osteoporosis
Vitamin E ataxia, progressive neuromuscular disorders, peripheral neuropathy, eye problems
Vitamin K bleeding problems, impaired osteoblast function
Vitamin A nightblindness, dermatologic disorders
Other: fuzzy thinking, depression
Progressive complications of fibrosis: swollen feet, muscle loss, ascites, confusion, memory loss, difficulty sleeping at night and increased sleeping during the day, vomiting blood or blood in the stool, jaundice, bruising easily or clotting problems, high bilirubin, low plateletts, high or low cholesterol.
High bilirubin - problems with the breakdown of heme, the main oxygen-transporting molecule in red blood cells. Becomes a toxin and produces jaundice.
Low albumin levels - a blood protein level. Low levels allow fluid to leak out of the blood vessels and result in edema (swelling) of legs and abdomen.
High ammonia levels - is a by-product of protein metabolism. High levels can cause mental confusion and may lead to encephalopathy. Zinc levels may be low. Zinc is required to clear ammonia. Reduce meat consumption to no more than three 3 ounce servings per day. If encephalopathy is present eliminate red meat.
Abnormal INR or bleeding time - leads to increased bruising or bleeding.
Portal hypertension causes ascites. Blood backs up in the portal vein which increases the pressure in the spleen, esophagus and stomach. This results in accumulation of fluid in the abdomen and may cause bleeding in the esophagus and stomach. Reduce sodium intake to 500 milligrams per day.
Pruritis (itching) - the liver cannot remove toxins.
Functions of the liver - Western
Functions of the liver - Traditional Chinese Medicine (TCM)
Functions of the spleen - TCM
Treatment by Oriental Medicine
The Oriental Medicine practitioner completes a comprehensive evaluation and arrives at a Chinese Medicine diagnosis for you and will plan an individualized treatment plan for you that includes acupuncture, herbal formulas, dietary guidelines and other lifestyle changes. Common
Chinese Medicine diagnosis include: liver qi stagnation, spleen qi deficiency, liver yin deficiency, liver/GB damp heat.
Chinese Medicine talks about food in terms of Temperature and Flavor. We need to balance these. But if you tend to be hot then you want more cooling or neutral foods and if you are cold all the time, warming foods make a difference.
Temperature of the food: Hot, Warm, Neutral, Cold or Cool
Cooling - tends to direct energy inward and downward, cooling the upper and outer parts of the body first.
Warming - move energy upwards and outwards from the core; warm us from the inside out. Very hot foods such as chili peppers or alcohol heat us up intensely and then cool us down by sweating.
Warmer foods speed us up and cooler foods slow us down.
General guidelines to determine a food's temperature:
|Raw food||cooling||Baked||more warming|
Eating Well: General Considerations According to Chinese Medicine
|Vegetables and fruits||40-60%|
|Beans, Dairy, Meat, Nuts||10-20%|
In order to get the most from the acupuncture and Chinese herbs, it is important to support your treatment with proper diet and lifestyle.
Each food has a nature and flavors. A food's nature is the affect it has on the temperature of the body. A food can be hot, warm, neutral, cool or cold. Since Chinese Medicine works by restoring balance to the body, if a person has a hot pattern then one should avoid foods with a hot temperature and eat more neutral or cool foods.
Each food has a flavor - sour, bitter, sweet, spicy (pungent), salty or bland tastes. Each flavor is associated with an organ and guides the effects of the food to that organ. For example, sweet is associated with the spleen and guides the effects of sweet foods to it. Excess sweet will create dampness in the spleen. Each flavor has a general affect on the body's metabolism. Sour astringes, spicy causes upward and outward movement that can disperse stagnation and promote circulation, salty leads downward and softens, bitter clears heat, sweet supplements and moistens and bland tends to cause urination.
Whether a food is good or bad is entirely dependent on your Chinese Medicine diagnosis. My Chinese teachers would say, it isn't just that Americans tend to overeat, but we eat the same things all the time. You can make it simple by eating moderate amounts of food with each meal and having lots of variety.
For liver imbalances
Avoid or minimize the following foods:
|Alcohol||Greasy, fatty, oily foods||Overeating in general|
|Coffee (regular and decaf)||Hard to digest foods like nuts||Large amounts of red meat|
|Excessively sour foods and drinks||Spicy, pungent, hot foods|
For spleen weakness
Avoid or minimize the following foods and drink that weaken spleen function:
|Raw salads, fruits, vegetables||Pork||Overeating in general|
|Sugar and sweets||Buckwheat||Beer|
|Frozen or chilled drinks||Fruit juice from concentrate||Frozen or chilled foods|
|Lettuce, radishes, celery||Echinaccea or Goldensea|
Eat warm, cooked foods, plenty of cooked vegetables, rice, noodles, soups and stews. Eat more frequent but smaller, easier to digest meals. Drink a teacup of warm water, broth or herb tea with each meal. You may use black and white pepper, cardamom, fresh ginger, ginger powder, cloves, nutmeg, orange peel or fennel as cooking spices.
For excessive phlegm
Avoid or minimize the following:
|Dairy products||Heavy, hard to digest foods||Sugar and sweets|
|Overeating in general||Pork and beef||Oily, greasy, fried and fatty foods|
|Oats, possibly wheat|
For damp heat
Avoid or minimize the following foods:
|Sugar and sweets||Spicy, pungent and hot foods||Alcohol|
|Nuts and nut butters||Greasy, oily, fried and fatty foods||Pork and beef|
Fruit juice from concentrate, especially orange and tomato
If damp heat is complicated by candidacies (yeast infections), also avoid:
Vinegar Yeasted breads and baked goods Fermented foods (except miso, shoyu, and yogurt
For blood deficiency
Eat plenty of the following foods:
|Cooked leafy greens||Meat and marrow broths and stews|
|Black beans||Regular small portions of animal protein|
|Orange and yellow vegetables||Cherries, beets, grapes and raspberries|
Basic Dietary Guidelines According to Western Medicine
Prescription and over the counter medications that can affect liver function
|Acetaminophen (Tylenol)||alpha-methyldopa (Aldomet)||amiodarone|
|Chlorzoxazone (Parfon Forte)||Fluconazole or ketoconazole (Diflucan, Nizoral)|
|Hydralazine (Apresoline)||ibuprofen (Motrin)||isoniazid (NIH)|
|Nitrofurantion (Macrodantin)||phenytoin||quinidine (Cardoquin)|
|Rifampin||Sulfa medications (Septra or Bactrim)|
|Vitamin A (in doses >5000 units/day)|
Herbal patent medicines, tonics, elixirs and prepackaged solutions can be risky for anyone, whether they have liver disease or not. Ingredients labels may be incomplete. Avoid self- prescribed premixed preparations, rely on a trained and experienced herbalist who can individualize your herbal therapy and monitor your reactions.
Important: You should discontinue taking any drug or herb if you experience a skin rash, substantial nausea, bloating, fatigue and/or aching in the area of the liver, yellowing of the skin or pale feces.
Articles and books:
Hyman, Mark. Systems Biology: The Gut-Brain-Fat Cell Connection and Obesity. Alternative Therapies. Jan/Feb 2006. Vol. 12. No. 1.
Lipski, Elizabeth. Digestive Wellness. McGraw Hill. 2005.
Alnounou, Mustafa and Munoz, Santiago. Nutrition Concerns of the Patient with Primary Biliary Cirrhosis or Primary Sclerosing Cholangitis. Practical Gastroenterology. April 2006.
Leggett, Daverick. Recipes for Self-Healing. Meridian Press. 1999.
Pitchford, Paul. Healing with Whole Foods. North Atlantic Books. 1993.