MYINCIVOTM

SUPPORT PROGRAMME

DIET AND LIFESTYLE INFORMATION

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DIET INFORMATION – WHILST YOU ARE GOING THROUGH TREATMENTYou have been prescribed INCIVO® for the treatment of your hepatitis C. It is very important that you always take INCIVO® with food to ensure the right levels of INCIVO® are in your body.

To give INCIVO® the best chance of working, the food you take with each dose must contain some fat.

Because you need to take 2 (two) INCIVO® tablets 3 (three) times a day with food, your meal times and eating patterns while on INCIVO® treatment may need to change from what you are used to.

The aim of this diet information is to help you plan what and when you eat for the 12 weeks of your INCIVO® treatment. This information also provides you with meal and snack ideas that will help INCIVO® work best and give you the best chance of clearing the virus.

THE IMPORTANCE OF A HEALTHY BALANCED DIET1

For most people, including those with hepatitis C, the best diet is a healthy balanced diet. Eating a balanced diet has a positive impact on your health. A healthy balanced diet means making sure you regularly eat foods that have a lot of vitamins and minerals in them. These foods must supply adequate amounts of calories and protein.

Eating well provides benefits that include:

• Maintaining a healthy weight

• Improving energy levels

• Improving your immune system and protecting from illness

• Improving the regeneration of liver cells

• Better managing hepatitis related symptoms and treatment side effects

• Increasing self-esteem

• Generally feeling better and improving overall wellbeing

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IS IT OK TO EAT FAT WHEN I HAVE HEPATITIS C?2

Evidence shows that you do not need to stop eating all fats and oils because of your hepatitis C infection. Even if your liver may be damaged it is still able to breakdown the fat you eat and make a substance called bile. Bile is important for fat digestion.

A very low fat diet is not required unless a person is unable to absorb the broken down fat. People who are unable to absorb fat may notice oily fatty stools when going to the toilet. These stools may be difficult to flush, pale in colour, loose or offensive smelling. This is not common. However if you are concerned about this speak to your healthcare professional.

WHAT FOOD SHOULD I EAT WITH INCIVO® IF I HAVE HIGH CHOLESTEROL?2

Even if you have raised cholesterol you will still need to eat food containing fat with each INCIVO® dose.

It is important for you to consider the types of fat you eat with your INCIVO® dose. Eating more unsaturated fats will help reduce ‘bad’ blood cholesterol levels. You can also help control your cholesterol by reducing the amount saturated fats in your diet.

Increase unsaturated fats + Decrease saturated fats = Healthier cholesterol reading

Saturated fats Unsaturated fats

Foods these fats are found in

Hard margarines

Biscuits

Cakes

Pastries

Foods that

Contain

‘hydrogenated fat’

Fat on meat

Poultry skin

Hard cheeses

Whole milk

Butter

Ghee

Coconut cream

Palm oil

Lard

Suet

Cream

Cakes

Biscuits

Olive & rapeseed oil

Avocado

Nuts and seeds

(almonds, cashews, hazelnuts, peanuts, pistachios)

Sunflower, corn & soya oil

Nuts & seeds

(walnuts, pine nuts, sesame seeds and sunflower seeds)

Oily fish (sardines, salmon, mackerel, herring, pilchards, trout, fresh tuna)

Flaxseeds

Flaxseed oil

Rapeseed oil

Types of fat

Trans fats Saturatedfats

Monounsaturated fats

Polyunsaturated fats

Omega-3 fats

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The table opposite provides examples of foods containing UNSATURATED fats and SATURATED fats. The table also gives examples of different types of fats you may see listed on food labels.

IMPORTANCE OF LABEL READING

Reading food labels will help you check you are eating enough fat with your INCIVO® dose and that you are eating the healthiest types of fats. Reading food labels can be useful while shopping for food.

Most foods made in the UK display nutritional information on the packaging. This information is usually displayed in a table or circle on the front, back or side of the package. The shop selling the food may also have access to this information or there may be a website address on the package which you can look at on-line.

You may find foods labelled with a, ‘traffic light’ colour system so you can tell at a glance if the food is high in fat (red) has a medium fat content (orange) or is low in fat (green). The same system is sometimes used for sugars and salt.

While you are taking INCIVO® if foods are labelled using this, “traffic light” system you should be aiming to eat foods with a red or orange label.

HOW CAN I MAKE SURE I AM EATING THE RIGHT FOOD WITH EACH INCIVO® DOSE?

To give INCIVO® the best chance to work effectively it is best to plan your meals and snacks around the time you need to take your INCIVO® dose. Because INCIVO® has to be taken 3 (three) times a day (every 8 hours) your meal times are likely to vary from normal.

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The following meals and snack options contain the correct amount of fat which you need to take with each INCIVO® dose.

BREAKFAST IDEAS

Bacon Sandwich

2 x slices of toast/breadMargarine (1 tablespoon) 2 rashers of bacon

Scrambled eggs on toast with cheese

2 x slices of toast/breadMargarine (1 tablespoon) 2 eggs (medium size)Grated cheese ( matchbox sized portion)

Porridge

Quakers Oats So Simple® (1 sachet) Full cream (whole milk) Pouring cream (2 tablespoons)

Muesli

Natural Muesli (medium bowl)Mixed nuts (40g) Semi skimmed milk (150ml)

Chocolate croissant

Tall Latte (whole milk)

Lemon and Poppy seed muffin

Breakfast Smoothie

Whole/full cream milk (300ml)Banana (1 whole banana) and handful strawberriesPouring cream (2 tablespoons)Honey (1 tablespoon)

Toast & Peanut butter

2 x slice bread/toast Margarine (1 tablespoon) Peanut butter (20g)

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MEAL IDEAS

Tomato based chicken pasta salad (350g) bought from shop

Chicken, bacon and lettuce sandwich bought from shop

Chicken Caeser wrap bought from shop

Falafel wrap (including dressing and cheese)

Cheddar and pickle sandwich bought from shop

Jacket potato

Baked potato (medium size) Mild Cheese (30g)Coleslaw (75g)

Spaghetti Bolognaise (home made)

90g beef minceJar Bolognese or pasta sause onion and 4 mushrooms Fresh cooked spaghetti (125g)

Chicken curry (home made)

1 chicken breast, no skin (188g) onion, 2 garlic cloves Curry sauce (stir in)Rice 140g 2 x poppadom (20g)

Grilled Tuna fresh (1 steak)

Pine nuts (uncooked)

1 Tsp olive oil (5ml)

Mixed salad leaves

Balsamic vinegar and lemon juice to taste

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Vegetable Masala ready meal or fresh (375g)

Lasagne ready meal, fresh or frozen (346g)

Oven chips original or baked (100g)

Average Steak and Kidney Pie (139g)

Mash, potato only, homemade (2 x tablespoon)Canned Mushy peas (100g)

Grilled Salmon (1 fillet)

Roasted winter vegetables (average size portion) + olive oil (10ml) New potatoes, boiled (180g)

Cheese Omelette

2 eggs (medium) Mild cheese (30g)

IDEAS FOR WHEN YOU ARE OUT AND ABOUT

It is important to pre-plan your meals if you will be going out. This does not mean you have to take the food with you. Many chain restaurants, sandwich shops and coffee shops will have options which are suitable to take with your INCIVO® dose. Examples are given in the table below:

Chicken and avocado sandwich

Classic Club sandwich

Mature Cheddar and Pickle Sandwich

Fried chicken

Hamburger & Medium Fries

12” Margarita Pizza

Ham and Cheese Panini

Frappuccino®

Steak and Ale Pie

Creamy chicken soup

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SNACKS FOR WHEN YOU ARE NOT FEELING HUNGRY BUT NEED TO TAKE YOUR INCIVO® DOSE

Sometimes you may not feel hungry when you need to take your INCIVO® dose. It is very important you are strong and make sure you still eat food containing fat with your INCIVO® dose (even when you do not feel hungry). Below are some examples of light snacks that may be easier to eat with your INCIVO® dose:

Sultana scone & margarine (15g)

Digestive biscuits x 3 and margarine (15g)

Crackers x 6 and cheese (40g)

Nuts - almonds, brazils or hazelnuts (50g or large handful)

Cracker biscuits x 3 and Crunchy peanut butter (40g)

Banana and nut loaf (1 slice)

Banoffee Pie (small portion)

Lightly salted Crisps

Mars® Bar (65g)

Snickers® Bar (64g)

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WHEN SHOULD YOU SEE A DIETITIAN?l If you are experiencing symptoms

such as nausea, anorexia (reduced appetite) and/or vomiting

l If you experience unexpected weight loss

l If you are suffering from fatigue, lack of appetite and/or sleep insomnia

l If you are overweight

l If you have other conditions such as coeliac disease or diabetes mellitus that require a dietary modification and specialist advice

l If you have symptoms of liver disease such as ascites (fluid accumulation around your abdomen)

l If you have been diagnosed with advanced liver disease by your doctor. This frequently has associated nutritional deficiencies and you should be referred to a Dietitian for specialist advice.

WHAT HAPPENS WHEN I FINISH TAKING MY INCIVO® TABLETS?

The good news is that once you have finished taking your INCIVO® dose tablets (after 12 weeks) your diet can return to back to normal.

Whether you continue therapy with pegintereron & ribavirin or stop all treatments it is important you continue to eat a healthy balance diet.

Disclaimer: Food nutritional values are subject to change, meal options listed in this booklet are only ideas of foods that can be eaten with each INCIVO® dose. Please read food labels for accurate nutritional values. For further information on nutritional values please visit www.nhs.uk/livewell/goodfood or speak to a registered dietitian.

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FRUIT ANDVEGETABLES

BREAD, RICE, POTATOES,

PASTA

MILK AND DAIRY FOODS

FOODS AND DRINKS HIGH

IN FAT AND/OR SUGAR

MEAT, FISH,EGGS, BEANS

THE EATWELL PLATE

FOR GENERAL INFORMATION ABOUT HEALTHY EATING YOU CAN VISIT - WWW.NHS.UK/LIVEWELL/GOODFOOD/PAGES/EATWELL-PLATE.ASPX AND READ

ABOUT THE EATWELL PLATE.

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FAMILY AND PARTNERSl Getting support from family and

friends can really help to get through treatment

l Try to talk about how you feel to your family and friends. Ask for help when you are feeling tired and be honest about how you feel. You might need a hand with looking after children, transport to clinics, help with shopping and household jobs

l Explain to your family and friends that you might get side effects from the treatment that you are on, sometimes you might feel tired and you may not feel yourself

EXERCISEl Try to relax and do things that you enjoy.

This can make you feel better

l A short walk before eating might stimulate your appetite

l Light exercise can reduce tiredness, swimming or even a short walk when you feel like it can help. Start slowly and gradually increase the amount you do

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PRACTICAL LIFESTYLE TIPS – WHILST YOU ARE GOING THROUGH TREATMENT1,2

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WORK ISSUESl If you feel tired whilst you are on treatment, it

might be difficult to work

l Talk to your employer to tell them how you feel. You may be able to agree flexible hours for when you are feeling better

l See if it is possible to work at home

l Talk about options that will suit you with your work

l Speak to the Citizens Advice Bureau about help with claiming benefits if you need to www.citizensadvice.org.uk

SLEEP ISSUESl Avoid caffeine and alcohol before you want

to go to sleep

l Have a warm bath to help you relax

l Relaxation techniques might help such as thinking of something pleasant or listening to music

l Use an eye mask or earplugs if needed

l Try to stick to a regular routine at bed time

l If you can’t sleep or you wake up, get up and do something rather than lying in bed

BE PREPARED l Write your clinic appointment times down on

a calendar or in a diary

l Make sure you have food ready to eat at home in case you don’t feel like cooking something or shopping

l If you have children you may need to consider arranging childcare if you are feeling tired

l If you need medical certificates or prescriptions tell your doctor or nurse when you have your appointments

PRACTICAL LIFESTYLE TIPS – WHILST YOU ARE GOING THROUGH TREATMENT1,2

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KEEPING WELL l Keep yourself well hydrated by drinking water regularly. This will help keep

your skin in good condition, reduce thirst and prevent constipation to keep you feeling healthy. Keep a drink bottle handy with water in it

l When you feel hungry eat a larger meal and remember to take your tablets with food

l Avoiding alcohol and will help your liver and make you feel better

l Cutting down your alcohol intake will help if you can’t stop drinking altogether

l Avoid smoking and taking recreational drugs

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The MYINCIVO™ support programme has been developed as a collaborative project with the kind help of many different people and groups.

Janssen and Bupa Home Healthcare would like to thank Karen Percy & Kirsty Marshall for providing the diet information in this booklet and acknowledge all the below people and groups for their valued contributions to the MYINCIVO™ support programme:

Karen Percy Specialist Dietitian HIV/GUM, Chelsea & Westminster Hospital, London

Kirsty Marshall Dietitian, Chelsea & Westminster Hospital, London

Charles Gore Hepatitis C Trust

Chrissy Davis Hep C Nomads

John Semple Hep C Nomads

Richard Hall British Liver Trust

Jan Tait Lead Clinical Nurse Specialist, Ninewells Hospital, Dundee, Scotland

Yvette Stones Clinical Nurse Specialist (Viral Hepatitis), Rotherham,

Doncaster and South Humber NHS Foundation Trust

Josephine Schulz Lead Clinical Nurse Specialist (Viral Hepatitis), Barts and The London NHS Trust

Angela Narbey MA RGN Clinical Nurse Specialist, South London Healthcare NHS Trust

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References:

1. NHS Choices website, www.nhs.uk/LiveWell/Goodfood. Accessed 15.2.2012

2. Hepatitis Australia website, www.hepatitisaustralia.com. Accessed 15.2.2012

©Janssen-Cilag Ltd 50-100 Holmers Farm Way, High Wycombe, Buckinghamshire, HP12 4EG

UK/TPV/2012/0274

Date of preparation: February 2012