Hepatitis CGuide to

Healthy Living

© Hepatitis Australia 2010

Funded by the Commonwealth Department of Health and Ageing.

2001, 2003, 2005, 2008: The Guide to Healthy Eating for People with Hepatitis C.2008: Complementary and Alternative Therapies.May 2010: The Guide to Healthy Eating for People with Hepatitis C and Complementary and Alternative Therapies were combined and renamed Hepatitis C: a guide to healthy living.

If you would like more copies of the booklet or you need more information about hepatitis C, contact your state or territory hepatitis organisation.

Acknowledgements

Hepatitis Australia acknowledges the participation of dietitians, gastroenterologists, the Health Reference Group and people with hepatitis C and thanks them for their contribution to the development of this booklet.

ContentsIntroduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Diet,.nutrition.and.hepatitis.C . . . . . . . . . . . . . . . . . . . . . . . .4

Functions.of.the.liver. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6

Healthy.eating.guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17

Healthy.food.shopping.and.preparation. . . . . . . . 28

Convenience.food.versus.junk.food. . . . . . . . . . . . . . . .31

Fats,.sugars,.salt,.caffeine.and.food.additives. . . 33

Alcohol.and.hepatitis.C. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .41

Dietary.supplements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45

Relieving.gastrointestinal.symptoms . . . . . . . . . . . . 48

Foods.and.medications.to.avoid. . . . . . . . . . . . . . . . . . . . . 51

Complementary.and.alternative.therapies. . . . . .52

Relieving.stress. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

Exercise. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .74

Benefits.of.counselling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .75

Glossary. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .77

Further.reading.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .86

Contacts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .91

Introduction

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he purpose of this booklet is to help people who are living with hepatitis C manage their diet and their use of

alternative and complementary therapies to stay well.

The general dietary advice provided is not intended to replace the advice of a dietitian or nutritionist who can develop a program to meet individual needs. Many benefits can be gained from a healthy, balanced diet, although little research has been done on the effect diet and nutrition have on liver function or the level of virus present in your blood.

The booklet does not provide detailed information about the dietary requirements of vegetarians, people with an intolerance of, or allergy to certain foods, or people with cirrhosis. Dietary choices and conditions such as these might necessitate guidance from a specialist dietitian.

Dietary tips for people with impaired liver function are included in this booklet, along with useful tips to ease gastrointestinal symptoms that can be related to hepatitis C infection and treatments. We

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recommend that you discuss your dietary needs with your doctor, who can refer you to a dietitian if you need specialist advice. A dietitian is qualified to perform a nutritional assessment based on factors such as your medical history, your food intake and clinical test results. From this information they can help you develop an eating plan that meets your particular needs.

People living with chronic illness often explore various options when making choices about their health. Some people with hepatitis C choose existing medical treatments; others manage their symptoms using complementary and alternative therapies. Anyone who has hepatitis C and is considering alternative and complementary therapies needs to be aware that, even though the products are ‘natural’, some preparations can damage the liver. A complementary medicine practitioner can advise you about this.

Hepatitis Australia does not endorse one therapeutic approach over another. All treatments — conventional, complementary and alternative — have potential risks and benefits. We recommend that if you are consulting a doctor or liver specialist you tell them of your treatment choices.

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nutrition and hepatitis C

Diet,

eople with hepatitis C are more susceptible to liver disease and other diseases such as coronary heart

disease and hypertension (high blood pressure).

What you eat affects your quality of life. Enjoying a healthy diet can help to:

• relieve some of the symptoms related to hepatitis C infection and treatment, such as nausea

• boost your immune system

• give your body the nutrients necessary to maintain liver health.

For most people, hepatitis C does not cause nutrient imbalances. Liver dysfunction and liver disease such as cirrhosis can, however, result in malnutrition.

By eating healthy foods, you will be giving your body the opportunity to function at its best. A well-balanced diet offers many benefits, including:

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• energy to engage in your daily activities

• the ability to maintain a healthy weight thus avoiding the health risks associated with obesity

• reducing the risk of many diseases, such as heart disease, and some cancers.

But food alone cannot make you healthy. As the World Health Organization noted in 1986, ‘Health is a complete state of physical, mental and social well-being and not merely the absence of disease or infirmity’. This means that good health is dependent on a variety of factors, including physical factors such as your genes, social factors such as whether you are employed and have access to secure housing, and mental factors such as whether you have family and friends who support you.

The lifestyle choices you make are also important, for example, not smoking, drinking little or no alcohol and using no drugs (or only in moderation), as well as taking regular exercise can improve your ability to cope with any health problems associated with hepatitis C. Making healthy choices and then putting these decisions into practice can also give you a feeling of wellbeing and empowerment.

Functions

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of the liver

fter the skin, the liver is the largest organ in the body. It is found behind the lower ribs on the right side of

the abdomen. The liver’s size depends on the overall size of your body, but in an average-sized person it is about as big as a football.

A healthy liver is brownish in colour; its surface is smooth, and it weighs about 1200 to 1600 grams. People can often function normally with only one-third of their liver, because the organ is able to compensate for areas that have been damaged.

Among the liver’s functions are the following:

• helping the digestive process by filtering (breaking down) and removing toxins such as alcohol, drugs (including medicines) and some waste products from the body

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• manufacturing and packaging proteins that are essential to body functioning, including blood-clotting factors and enzymes

• identifying and labelling proteins and other essential nutrients so that they can be transported to the parts of the body where they are needed

• storing sugars and vitamins

• producing bile salts, which go to the small intestine to help break down fats.

Liver function can be seriously impaired by hepatitis C, so it is important to enjoy a healthy diet to give your body the support it needs.

If the liver is inflamed for a lengthy period, scar tissue can develop. The development of this scar tissue is called ‘fibrosis’. Scarring can restrict blood flow through the liver and in some cases leave the liver unable to function properly, which can lead to cirrhosis. You can reduce the risk of developing serious liver conditions by reducing the amount of alcohol you drink. Excessive alcohol consumption is the most important factor involved in the development of cirrhosis in people with hepatitis C.

Most people with cirrhosis have altered nutritional requirements. Nausea or changes in a person’s sense of taste, although relatively uncommon, can exacerbate the situation. If you have cirrhosis, seek advice from a dietitian.

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12 top foods that are good for the liverMaintaining a healthy liver is about maintaining a healthy body. There is definitely an association between some conditions and liver disease, such as high cholesterol, high blood pressure, insulin resistance, abdominal obesity, and diabetes. It therefore makes sense to lead a lifestyle that prevents, and/or manages, these conditions.

Maintaining or improving a healthy body can be assisted by consuming the right amount of kilojoules to maintain a healthy weight, having lots of fibre to keep your digestive tract healthy, reducing cholesterol levels and eating only a small amount of fat. Try to have some unsaturated fats rather than saturated.

Below is a list of 12 top foods for people with hepatitis C. These have been taken from the ‘Love your liver’ website. www.loveyourliver.com.au

Note: Some people with hepatitis C may have specific dietary requirements for protein, salt and fluid intake. Speak to your doctor or dietician for further guidance.

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1. Almonds

Other sources: other nuts (all except coconut, which contains saturated fat).

Benefits: Almonds are packed with nutrients – fibre, riboflavin, magnesium, iron and calcium. In fact, almonds have more calcium than any other nut – 75mg in one serving (about 23 almonds). Like all nuts, almonds provide one of the best plant sources of protein, and nuts are also good for your heart, as they contain unsaturated fats – a healthier type of fat that helps to lower blood cholesterol levels.

Recommended intake: Aim for 1 – 2 tablespoons of raw, unsalted almonds (or other nuts) five times per week.

2. Oats

Other sources: brown rice, couscous.

Benefits: Eating oats on a regular basis may lower cholesterol levels, reduce heart disease risk, and prevent type 2 diabetes. It is thought that this is because oats have a high soluble fibre content, a low Glycaemic Index, and they are a whole grain, meaning they contain many essential vitamins and minerals.

Recommended intake: Oats, brown rice and couscous fall into the ‘breads and cereals’ food group. Also in this group are foods like wholegrain bread, breakfast cereals and crackers, pasta, rice and noodles. You should have 4 – 8 serves of ‘breads and cereals’ per day, depending on how physically active you are. 1 serve is equal to 2 slices of bread, 1 cup of cooked pasta, rice, noodles or couscous, 1 cup of cooked porridge or 1 1/3 cups of breakfast cereal flakes. Aim for 1/2 – 1 serve of your 4 – 8 serves/day to be oats, brown rice or couscous.

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3. Blueberries

Other sources: cranberries, boysenberries, straw-berries, currants, blackberries and cherries.

Benefits: Blueberries are high in plant compounds (phytonutrients). As with cranberries, phytonutrients in blueberries may help prevent urinary tract infections. Blueberries may also improve short-term memory, promote healthy aging, and lower your risk of heart disease and cancer. They are a low-kilojoule source of fibre, potassium and vitamin C, and have been shown to have anti-inflammatory properties. One cup of fresh blueberries has 350 kilojoules, 3.6 grams of fibre and 14 mg of vitamin C. Vitamin C helps form the connective tissue collagen, keeps your capillaries and blood vessels healthy, and aids in the absorption of iron.

Recommended intake: All fruit is healthy for you, and you should aim to have two servings of fruit per day. One serve is equal to one medium piece of fresh fruit, 1 cup of diced fresh, or 2 tablespoons of dried. Of these serves, aim to have 4 – 5 serves per week of blueberries or other sources listed above.

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4. Salmon

Other sources: all fish, predominantly oily (salmon, mackerel, tuna, marlin, swordfish, sardines, herring, trout), oysters, clams.

Benefits: Omega 3 fatty acids, a type of unsaturated fat, lowers heart disease and stroke risk by decreasing cholesterol and triglyceride levels, slowing down the growth of artery-clogging plaques, and lowering blood pressure. Omega 3’s have also been shown to help reduce inflammation associated with arthritis, and may possibly help with memory loss and Alzheimer’s disease. There is some evidence to show that it reduces depression as well. In addition to being an excellent source of omega-3s, fish is low in saturated fat, and is a good source of protein. Omega-3s are most prevalent in fatty, cold-water fish. Other forms of omega 3’s are available in fortified eggs, flax seed (linseed), and walnuts.

Recommended intake: Aim to eat fish (fresh and/or canned) 2 – 4 times per week.

5. Soybeans

Other sources: soymilk, soy yoghurt, soy custard, soy icecream, tofu, soy-based meat substitutes (soy bacon, soy sausages etc.).

Benefits: Soy is an extremely high quality protein that has no cholesterol or animal fat, is low in saturated fat and high in fibre. Soy is one of nature’s super-foods that can reduce your risk of heart disease and stroke, helps prevent osteoporosis, and may help protect against certain cancers like breast, prostate and bowel cancer. It also helps alleviate hot flushes during menopause. There has been some controversy in recent times over the relationship between soy and cancer. There are now over 3000 scientific research papers on soy, and there is no sound evidence which

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demonstrates any negative health effects in humans from consuming soy foods as part of a balanced diet.

Recommended intake: 1 – 4 servings per day, such as soymilk on your cereal, tofu in your evening meal and/or soy ice-cream for dessert.

6. Tea

Other sources: green or black tea.

Benefits: Tea is rich in antioxidants which help protect our body’s cells against damage and mutation. The overall antioxidant power of black tea is the same as green tea, but green tea does have ECGC, a powerful antioxidant that may inhibit the growth of cancer cells. Black tea, in particular, may boost the immune system, lower the risk of stroke and may prevent osteoporosis.

Recommended portion: 1 cup per day.

7. Yoghurt

Other sources: milk, cheese, custard.

Benefits: Dairy foods are the best sources of calcium. Calcium promotes strong bones and a healthy heart. Yoghurt in particular has additional benefits

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of pre- and probiotics, which promote a healthy digestive tract. Dairy is naturally high in saturated fat, and because the link between saturated fat and heart disease is clear, most people in the general population should be having reduced fat, low fat or no fat varieties. Also, be aware that ice-cream, cream and soft cheeses such as brie and camembert are relatively low in calcium and high in saturated fat.

Recommended intake: Aim to have 3 serves of reduced fat dairy per day. 1 serve is equal to 1 cup (250mL) milk, 1 tub (200g) yoghurt or 40g of hard cheese.

8. Broccoli

Other sources: Brussels sprouts, cabbage, cauliflower.

Benefits: Aside from having important nutrients such as calcium, potassium, folate and fibre, broccoli contains phytonutrients — a group of compounds that may help prevent chronic diseases, such as heart disease, diabetes and some cancers. Broccoli is also a good source of vitamins A and C and antioxidants that protect your body’s cells from damage. These foods have also been linked with reducing the incidence of birth defects, boosting the immune system, and building/maintaining strong healthy bones.

Recommended intake: All vegetables are healthy, and you should make an effort to eat a wide variety. Aim for 5 serves of vegetables per day, with only one serve being starchy vegetables (potato, sweet potato, corn). One serve of vegetables is equal to 1/2 cup of cooked, 1 cup of raw/salad or 1 medium potato. Of the 4 serves of non-starchy vegetables, aim for one serve each day to be broccoli, brussels sprouts, cabbage or cauliflower.

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9. Kidney beans

Other sources: other legumes, e.g. chickpeas, cannelini beans, borlotti beans, baked beans, three bean mix.

Benefits: Kidney beans and other red beans are good sources of iron, magnesium, phosphorus, potassium, copper and thiamine. Other legumes, such as chickpeas, cannelini beans and borlotti beans, are also great choices. All legumes are low in fat, low in kilojoules, and are high in dietary fibre. Red beans also contain phytonutrients that may help prevent chronic diseases, such as heart disease, high blood cholesterol, high blood pressure, and cancer. Legumes, although plant foods, are very high in protein, and thus serve as a meat-alternative for vegetarians. Legumes are categorised into the vegetable group and also the meat group.

Recommended intake: 1 serve is 1/2 cup of canned/cooked legumes. Aim to have 4 servings per week.

10. Spinach

Other sources: baby spinach, silver beet, turnips, dark lettuce.

Benefits: Spinach is high in vitamins A and C and folate. It’s also a good source of riboflavin, vitamin B-6, calcium, iron and magnesium. The plant compounds in spinach may boost your immune system, and may help keep your hair and skin healthy.

Recommended intake: One serving is 1/2 cup of lightly steamed or 1 cup of raw. Aim to have 1 serving 2 – 3 times per week.

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11. Pumpkin

Other sources: carrots, squash, sweet potatoes, capsicum.

Benefits: These vegetables are high in the antioxidant beta carotene. Food sources of beta carotene, which is converted to vitamin A in your body, may help slow the ageing process and reduce the risk of some cancers, such as cancers of the lung, colon, bladder and breast. Unlike true Vitamin A, beta-carotene is not toxic to the liver if consumed in large amounts — excesses are broken down and excreted through the kidneys. Pumpkin is also a good source of fibre, vitamins B6, C and E, folate and potassium, and like all vegetables, they’re fat-free and low in kilojoules.

Recommended Portion: Like other vegetables, one serve equals 1/2 cup of cooked or 1 cup of raw/salad. Aim for 5 serves of vegetables per day, with only one serve being starchy vegetables (potato, sweet potato, corn). Aim for one of your 5 serves of vegetables to be pumpkin or one of the ‘other sources’ listed above.

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12. Vegetable juice

Benefits: Vegetable juice contains the vitamins, minerals and other nutrients found in the original vegetables and it is an easy way to include vegetables in your diet. Tomato juice and vegetable juices that include tomatoes are good sources of lycopene, an antioxidant that may reduce the risk of heart attack, prostate cancer and possibly other types of cancer. Vegetables, unlike fruit, contain no (or very little) sugar, and hence vegetable juices are a low kilojoule, nutrient dense drink. Carrot, celery, beetroot, cucumber, capsicum, tomato, and ginger can all be juiced. You can also buy commercial vegetable juices; however be sure to select the low-sodium varieties.

Recommended intake: If you regularly meet your recommended 5 serves of vegetables per day, aim to have one vegetable juice drink once per week. However, if you struggle to eat enough vegetables, use vegetable juices more often to help you meet your vitamin and mineral requirements. Keep in mind, however, that vegetable juices do not contain the fibre from whole vegetables, and hence you should make an effort to include vegetables in your daily diet.

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eating guidelinesHealthy

The Australian Guide to Healthy Eating developed the following food groups based on the nutrients they provide:

• bread, cereals, rice, pasta and noodles

• vegetables and legumes

• fruit

• milk, yoghurt and cheese

• meat, fish, poultry, eggs and nuts.

Extras, or other foods, such as sugars and salt are not included in the core food groups, because these types of food are not the best sources of essential nutrients for your body. These foods should be eaten infrequently and in small amounts.

Fibre is found in plant products such as wholegrain breads, cereals, fruits and vegetables. Although it is not considered to be an additional food type because it doesn’t provide essential vitamins and minerals; you

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need to include it in your diet help to prevent bowel disease. Fibre improves bowel function by increasing the bulk of faeces and reducing transit time in the body, which results in softer, larger stools and more frequent bowel action.

The Australian Guide to Healthy Eating recommends eating a variety of foods from within each core food group. The serving quantities and sizes listed in this section are an indication only. For more detailed recommendations based on gender, age, level of physical activity, body size and pregnancy and breastfeeding status; see the guide.

The Australian Guide to Healthy Eating can be found at the following link: http://www.health.gov.au/internet/main/publishing.nsf/Content/health-pubhlth-strateg-food-resources.htm

Bread, cereals, rice, pasta and noodlesFor bread, cereals, rice, pasta and noodles, the recommended daily intake for women is three to nine serves and for men four to 12 serves, depending on level of physical activity, age, size and genetics.

• Eat wholegrain bread, high-fibre cereal, brown rice and wholemeal pasta.

• Choose rice and wholemeal pasta and noodles because these products contain less salt than bread and breakfast cereal.

• When choosing breads, opt for variety: brown, wholegrain, mixed grain, rye and rolls, pita breads and other flat breads.

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• Foods from this group provide fibre and energy, protein, fat, magnesium, zinc, riboflavin, niacin, folate, sodium and carbohydrates, all of which are important for energy, growth and repair of the body.

• Avoid highly refined (processed) foods such as white breads and pastas and some pre-packaged meals. Fresh foods are always preferable to processed foods.

Vegetables and legumesFor vegetables and legumes (peas and beans), the recommended daily intake for women is four to seven serves and for men is four to eight serves.

• Legumes are an important source of protein, particularly for vegetarians. There are many types of legumes, such as: adzuki beans, baked beans, black beans, borlotti beans, cannellini beans, chickpeas, kidney beans, lentils, lima beans, mung beans (sprouts), pinto beans, snow peas, green beans, soy beans, dried peas.

• Choose a wide variety of vegetables: root vegetables such as carrot, ginger, beetroot and parsnip; leafy greens such as spinach, silverbeet and kale; marrow-like vegetables such as zucchini, squash and pumpkin; cruciferous vegetables such as broccoli and cauliflower; peppers such as capsicum and chillies; and onions such as shallots, garlic and leeks. Vegetables in season are usually the best value for money.

• Frozen and canned vegetables are a good alternative to fresh vegetables. They are nutritious, often cheaper, quick and easy to prepare, easily stored and available in remote areas.

• Foods in this group are a good source of vitamins, minerals, dietary fibre, carbohydrates and anti-oxidants.

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FruitFor fruit, the recommended daily intake for women is two to three serves and, for men, two to four serves.

• Whole fruit is higher in dietary fibre than juice. Dried fruits are nutritious and can add variety to your diet, although they are high in sugar and excess consumption can lead to tooth decay.

• Canned fruit, especially varieties that are canned in natural juice without added sugar can be used as a nutritious replacement for fresh fruit.

• Fruits are a rich source of anti-oxidants, carbohydrates and vitamins, especially vitamin C and some folate. Keeping the skin on fruit whenever possible will allow you to obtain more dietary fibre.

• Eating a diet rich in fruit and vegetables may reduce the incidence of constipation and some types of cancer.

Milk, yoghurt and cheeseFor the milk, yoghurt and cheese group, the recommended daily intake for women is two to three serves and for men two to four serves. The group also includes calcium-enriched soy milk.

• Dairy products are an excellent source of calcium and also provide protein, riboflavin and vitamin B12.

• A high calcium intake when you are young can help protect against osteoporosis.

• Milk, cheese and yoghurt are available in low-fat varieties. Choose these for yourself whenever possible; remember, though, that low-fat varieties are not suitable for infants and young children.

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• If you don’t like drinking milk or eating yoghurt, add milk or milk powder to soups, casseroles and sauces. You can also add cheese to pancakes, omelettes and vegetable dishes and use yoghurt with curries and in dips.

• If you can’t tolerate milk or milk products, use calcium-enriched soy milk products as an alternative.

• If you don’t like any foods from this food group, try foods such as sardines, tuna, salmon, lentils, almonds, brazil nuts and dried apricots which also provide calcium, although in smaller amounts.

Meat, fish, poultry, eggs and nutsFor the meat, fish, poultry, eggs and nuts group, the recommended daily intake for women is one to one-and-a-half serves, and for men, one to two serves.

• Choose a variety of lean meats: beef, lamb, pork, chicken, turkey, duck, rabbit, kangaroo, and so on and fish and shellfish.

• This food group offers a good source of iron, zinc and vitamin B12. Iron helps your body carry oxygen in the blood, and zinc helps the healing of wounds as well as being important for growth and reproduction.

• If you are a vegetarian, choose foods such as nuts and seeds, tofu and bean curd instead. These foods are good sources of iron and zinc. Drinking fruit juice with your meal can also increase your body’s ability to absorb iron.

Vitamin B12 is found only in foods of animal origin. Vegans, who eat no animal products, will need supplements of vitamin B12.

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Protein intake

Your body needs protein to repair and replace damaged tissue and cells in nearly every structure and system, including the liver and the immune system. People with liver problems (including cirrhosis) are often malnourished, and a reduction in protein intake could be even more harmful than usual.

Dietary experts recommend that protein intake be restricted only if you have cirrhosis and develop a condition called ‘hepatic encephalopathy’. This condition can arise when the liver is so damaged it cannot process protein properly, causing substances such as ammonia to build up in the blood.

Ask a medical professional, dietitian or nutritionist for more advice about how much protein to include in your diet.

What’s in a serve?

Bread, cereals, rice, pasta and noodles

Two slices (60 grams) of bread or one medium bread roll

One cup (180 grams) of cooked rice, pasta or noodles

One cup (230 grams) of cooked porridge, one-and-a-third cups (40 grams) of ready-to-eat cereal

Half a cup (65 grams) of muesli

Vegetables, legumes (peas and beans)

Half a cup (75g) of cooked vegetables

Half a cup (75g) of cooked dried beans, peas or lentils

One cup of salad vegetables

One potato

Food group One serve

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Food group One serve

Fruit One piece of fruit weighing about 150 grams, such as an apple, a banana, an orange or a pearTwo small pieces of fruit (each weighing about 75 grams), such as apricots, kiwi fruit or plumsOne cup (150 grams) of diced pieces or canned fruitOne-and-a-half tablespoons of sultanas, or four pieces of dried fruit, such as apricot halvesHalf a cup (125 millilitres) of fruit juice

Milk, yoghurt, cheese and calcium-enriched soy milk

One cup (250 millilitres) of fresh, long-life or reconstituted dried milkOne cup (250 millilitres) of soy milk fortified with at least 100 milligrams of calcium per 100mlHalf a cup (125 millilitres) of evaporated milk Two slices (40 grams) of cheeseOne small carton (200 grams) of yoghurt

Meat, fish, poultry, eggs, nuts and legumes

65 to 100 grams of cooked meat or chicken, such as half a cup of lean mince, two small chops or two slices of roast meat80 to 120 grams of cooked fish filletTwo small eggsOne-third of a cup of unsalted peanuts or almonds, or one-quarter of a cup of sunflower seeds or sesame seedsHalf a cup (80g) of cooked dried beans, lentils, chickpeas, split peas and canned beans

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If you omit any of the food groups (or a significant component of the range of foods in one of the food groups) for personal, medical or cultural reasons, it is important to replace them with another type of food. For example, if you are a vegetarian, you need to replace meat products with other foods high in protein and iron, such as tofu.

Maintain good food hygiene

Healthy eating also involves maintaining good food hygiene. This involves storing food at the correct temperature, (the bacteria listeria can be particularly dangerous for people with liver disease), and reheating foods that are already cooked, thoroughly.

Never let raw meats come into contact with other foods during storage and preparation. Make sure to wash your hands with soap and water before preparing food and during preparation if you handle raw meat.

Keep workstations clean, and use an anti-bacterial laundry soaker to sanitise dishcloths, sponges and washing up brushes.

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Variety in your dietNutritional educators recommend that you have variety in your diet. ‘Variety’ means choosing a mix of foods across the range of food groups and from within each food type. For example:

• Cereals can be wheat, oat, rye, rice, barley, and so on.

• Vegetables can be root vegetables, leafy greens, marrow-like vegetables, cruciferous vegetables such as broccoli and cauliflower, onions, peppers and tubers such as potatoes and sweet potatoes.

Your body absorbs nutrients from different food sources in different ways, that is, the nutritional effect can vary within each food type and across the range of food types. Including a variety of foods in your diet will allow you to obtain the nutrients your body needs.

Nutrition Australia encourages people to aim to eat about 30 different foods each day. This might sound difficult to do, but if you choose foods or meals that already provide variety, for example: stir-fries, casseroles and multigrain breads, you are more likely to achieve this goal.

Remember to aim for a good degree of variety in your diet by not allowing any particular type of food or food group to dominate. Too much of one thing can be unhealthy.

Within each of the five food groups, some foods provide more of some nutrients than others. If you eat a variety of foods from within each group, you will probably obtain all the nutrients provided by the foods in that group, for example, in the vegetable group, carrots and pumpkin contain much more

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vitamin A than do potatoes. The following are examples of promoting variety in your diet.

Breakfast – wheat-based cereal, milk and orange juice.

Untoasted muesli with added seeds and quinoa flakes, served with yoghurt, fresh fruit and unsweetened juice.

Lunch – toasted cheese and tomato sandwich on wholemeal bread, using low-fat mayonnaise or tahini (sesame seed paste).

Multigrain bread sandwich with chicken (or ricotta if you are a vegetarian), tomato, low-fat cheese, onion, capsicum, mushrooms, mung bean sprouts and lettuce; using avocado for the spread instead of margarine, and served with a low-fat fruit smoothie.

Dinner – lamb chops with mashed potato, peas, broccoli and carrots.

Stir-fry using lean meat, fish or tofu with a variety of vegetables – say, broccoli, capsicum, zucchini, cabbage, garlic, onion, mushrooms, carrot, shallots, snowpeas, bok choy and fresh herbs – served on noodles.

Typical day Suggestion for increased variety

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Eat plenty of plant foods with moderate amounts of animal foods in proportions shown in the guide, small amounts of extra foods and margarines and oils.

Bread, cereal, rice, pasta, noodles, vegetables, legumes and fruit.

Milk, yoghurt, cheese, meat, fish, poultry, eggs.

Biscuits, cakes, desserts, pastries, soft drinks, lollies, chocolates and high fat snack items such as crisps, pies, pasties, sausage rolls.

Drink plenty of water

For good health, the guide recommends that adults drink six to eight glasses of water a day and more if engaging in physical activity and in hot weather.

Plants foods Animal Foods Extra Foods

Healthy

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food shopping and preparation

Tips for healthy food shopping

Healthy ways to prepare and cook your food

Choose lean cuts of meat such as topside, blade, rump, fillet, gravy beef, veal steaks, pork fillet and ‘trim’ lamb varieties such as lean lamb chump.

Trim visible fat from meat before you cook it.

Keep meat portions small (about 100 grams) and ‘bulk-up’ meals with vegetables and legumes, brown rice or wholemeal pasta. Cook vegetables lightly and steam them whenever possible to retain their nutrients.

When roasting meats, trim the visible fat from the meat and place the meat on a rack in a baking dish with one to two centimetres of water. For extra flavour, add herbs and wine to the water. (Alcohol is harmless when used with heat in cooking because it evaporates).

Tips for shopping Healthy ways to prepare and cook your food

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Choose the leanest mince available or ask the butcher to mince beef that has been trimmed of fat.

Drain the fat from mince during or after cooking.

Choose low-fat cheeses (25 per cent less fat varieties, cottage cheese or ricotta) and reduced-fat or low-fat milk. Don’t just try these once; it might take a while for your taste buds to adjust. Try low-fat yoghurt; you can scarcely taste the difference.

Use avocado, chutney, cottage cheese or low-fat mayonnaise instead of margarine or butter on sandwiches. Instead of cream, use evaporated skim milk with gelatine and chill before whipping. Alternatives to sour cream are low-fat yoghurt, evaporated skim milk and lemon juice.

Olive oil, sunflower oil, safflower oil, canola oil and grape-seed oil are good vegetable oils to choose.

Use a non-stick fry pan and cooking spray or brush the base of the pan with oil instead of pouring oil into the pan. Some non-stick fry pans don’t require oil at all.

Choose wholemeal bread, pasta, flour and rice instead of white or bleached grains for extra fibre.

Leave the skin on vegetables and fruits to boost the fibre content and flavour of meals.

Breakfast cereals should be high in fibre and low in salt.

Use breakfast cereals sparingly as a tasty, nutritious snack.

Tips for shopping Healthy ways to prepare and cook your food

food shopping

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M

Choose low-salt or ‘no added salt’ products by comparing food labels.

Don’t add salt to your sandwiches or cooking.

Avoid adding salt at the dinner table.

Breads and cereal products are often sources of hidden salt. Most processed food has a high salt content.

Make your own dressings and mayonnaise using low-fat yoghurt, tomato paste, vinegar, lemon juice, ricotta, mustard and fruit pulp. Buy dressings labelled ‘no oil’ or ‘low fat’.

Use low-fat or no-oil dressings in salads and sandwiches.

Tips for shopping Healthy ways to prepare and cook your food

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Conveniencefood versus

junk food

Many foods that are sold ready to eat, such as battered fish, chips, hamburgers, deep-fried chicken, potato

scallops (or potato cakes), hot dogs and meat pies, are high in fat and salt and low in fibre. The term ‘junk food’ does not mean the same thing as ‘convenience food’ or ‘fast food’. It usually applies to foods that are relatively low in nutrients compared with their energy (kilojoule) content. Generally, junk foods rely on substances such as salt or sugar and artificial colours for their appeal.

Not all ‘convenience foods’ lack nutritional value. Some of the most convenient foods such as a piece of fruit, a wholemeal salad sandwich or baked beans on toast, for example, are healthy foods. The following are other kinds of healthier convenience foods you can choose:

• hamburgers or steak sandwiches made with lean meat and extra salad on wholemeal bread or a roll, with little or no butter or margarine

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• grilled fish, instead of fried, served with lemon or vinegar, rather than salt

• thick chips rather than thin. Thick ones absorb less fat when frying. Wedges are an even better choice

• bread-based take-away foods such as sandwiches, rolls and wraps. Choose wholemeal bread and varieties of pita bread, flat bread and rolls

• Asian dishes that are steamed and braised and include plenty of vegetables, rather than battered or fried dishes

• low-fat milk drinks, fruit juice, mineral water and low-fat smoothies

• barbecued chicken. It is healthier than deep-fried chicken, especially if you don’t eat the skin.

• kebabs

• pasta with vegetable-based sauces rather than cream-based sauces

• pizzas with low-fat toppings, such as pineapple, mushrooms, capsicum, onions, olives and other vegetables with a small amount of lean ham, rather than salami or other types of sausage

• salads with lean, skinless chicken or turkey, salmon or tuna. Avoid high-fat dressings, fried croutons and bacon.

• baked potatoes in their jackets with low-fat sour cream, yoghurt or cheese and chives

• soups; make a large pot of soup with low-fat ingredients, refrigerate or freeze and then serve as required

• low-fat frozen yoghurt or ice-cream for dessert.

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sugars, salt, caffeine and food additives

Fats,

FatsAlthough excessive amounts of fat in the diet can cause health problems, it is important to have small amounts of fat because your body needs essential fatty acids to function properly.

Fats are classified according to their chemical structure: they can be saturated, polyunsaturated or mono-unsaturated. Most of the fat you eat should be mono-unsaturated.

A diet high in saturated fats can cause your body to produce excess cholesterol, which can contribute to your risk of developing heart disease and some cancers. Saturated fats are mainly found in fatty meat, butter, full-fat milk products, cream, lard, and many take-away and processed foods. They are also found in some plant foods, such as palm and coconut oils. Choose meat that has been trimmed of fat, and reduced-fat dairy products wherever possible, especially if heart disease is common in your family.

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Polyunsaturated and mono-unsaturated fats are healthier choices. These types of fats are found in plant oils (such as sunflower, safflower, olive and canola oils), polyunsaturated margarine, nuts and very lean meats. Olive, peanut and canola oils are mostly mono-unsaturated fats.

All types of fat are rich sources of energy; there are about 37 kilojoules of energy in each gram of fat you eat. Your body will, however, store excess kilojoules as body fat, and this can lead to obesity. Obesity is linked to an increased risk of developing type 2 diabetes, high blood pressure, heart disease and fatty liver.

The Australian Guide to Healthy Eating suggests that you aim to have about 30 per cent of your total energy intake in the form of fat. A person’s energy requirements vary, of course, according to their age, size, genetics, state of health and level of physical activity. If you would like assistance to work out how much fat is suitable for you, contact a dietitian. It is also important to be aware that infants and pre-school children, underweight people, breastfeeding women and people engaged in unusually heavy work have a greater need for fat in their diet. Again, talk to a dietitian.

The ‘fat scale’

‘Hidden’ fat in foods can have a big impact on the amount of fat you eat. Fats found in food products can also be labelled as animal fat or oil, shortening, copha, lard, coconut oil, palm oil, butterfat, milk solids, chocolate and vegetable oil. ‘Creamed’ or ‘toasted’ on a label can mean that fat has been added to food during preparation. The following scale is a guide to how much fat is in certain foods.

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0grams Fruit and vegetables (with the exception of avocado) are virtually fat-free, unless fat or oil has been added during cooking or preparation

0grams One cup cooked pasta

1gram One slice of bread

1gram One cup of baked beans

4grams One grilled trim steak (100grams)

4grams One grilled fish fillet (100grams)

5grams One hard-boiled egg

5grams Two plain biscuits (20grams)

6grams One lamington (60grams)

7grams Three small slices of trim lamb roast

10grams Two cubes of full-fat cheese

10grams One glass full-cream milk

13grams One tablespoon of peanut butter

15grams Two scoops of full-fat ice cream

15grams One Croissant (63grams)

15grams One small doughnut (60g)

16grams One barbeque steak, untrimmed (120grams)

17grams One spring roll

18grams Six chicken nuggets

19grams One tablespoon of olive oil

21grams One cup of fried rice

Fat content Food type

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21grams One plain chocolate bar (55grams)

37grams One Big Mac (205grams)

42grams One serve of spinach pie

57grams Two lamb chops, untrimmed (145grams)

Note that the fat contents shown here are approximate. The listing is adapted from a publication issued by Queensland Health and prepared by the Australian Dairy Corporation — Facts on Fat: finding it, reducing it and using low-fat dairy foods.

SugarsHighly refined carbohydrates such as sucrose (sugar) do not contain the nutrients (vitamins, minerals, and so on) they had in their ‘raw’ state. This means the body is effectively leached of the nutrients needed to break down the carbohydrate and metabolise it.

Nevertheless, sugar is added in small amounts to many useful processed foods, and these products should not be excluded from your diet. For example, high-fibre breakfast cereals and foods such as canned baked beans are nutritious, low in fat and high in fibre and are useful foods to include in a healthy diet. Some foods, such as fruit and milk, naturally contain sugar.

Manufactured foods often have large amounts of sugar added to them when they are being processed. During digestion, sugars such as sucrose and lactose, and other carbohydrates such as starch, break down into simple sugar. These provide energy for body cells and are sometimes stored for future use. Excess body fat results when a person eats more kilojoules than the body needs, regardless of whether those kilojoules come from sugars, protein or alcohol.

Fat content Food type

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There are, however, a number of things people with hepatitis C should be aware of:

• Thirty to 70 per cent of people with hepatitis C develop some form of insulin resistance. (Harrison, SA. Clinical Gastroenterol Hepatol 2008; 6(8):864–76)

• Obesity and insulin resistance are associated with a reduced sustained virological response to antiviral therapy. (Poustchi, H et al. J Hepatol 2008; 48(1):28–34)

• Those eating large amounts of kilojoules, carbohydrates and lipids (fats) were found to have more severe fibrosis of the liver. (Loguerico, C et al. Am J Gastroenterol 2008;103:1–8)

• High serum glucose in people with chronic hepatitis C can trigger liver fibrosis. (Ratziu, V. & J Hepatol 2003; 39(6):1049–55)

• The accumulation of fat in the liver blocks its ability for insulin signalling. This can mean there is uncontrolled glucose production in the liver. “Some research has shown that if you lose weight gradually you may be able to reverse early liver fibrosis” (Farrell, GC et al. Fatty liver disease, NASH and related disorders. Melbourne: Blackwell Publishing, 2005).

SaltApart from intensifying the natural flavours, colours and textures of foods, salt has many purposes. Your body needs small amounts of salt to function because it is an essential nutrient the body cannot make by itself. When salt is eaten in excess though, it can increase your risk of developing high blood pressure. Try to reduce your intake of salt and processed foods that contain a lot of salt, such as processed meat, bacon and sausages.

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The link between eating too much salt and the development of high blood pressure is difficult to quantify: some people are sensitive to high intakes of salt and experience a rise in their blood pressure; others experience no change. For this reason the National Health and Medical Research Council recommends that adults do not exceed the upper limit of 2300 milligrams of sodium, or about one teaspoon, of salt a day.

Monitor your salt intake by reading the nutrition panel on packaged foods. (Salt is often called ‘sodium chloride’, its chemical name, on food labels.) Fruit and vegetables have low sodium content unless salt is added during processing — as can happen with canned vegetables and during cooking. Cereals such as pasta, rice, rolled oats and other grains are also low in salt. Breads contain higher amounts of salt, about 120–400 milligrams per slice. Fresh meat contains around 60–90milligrams of salt per 100 grams, and processed meats such as sausages contain 900–1000 milligrams per 100 grams. Bacon contains about twice this amount. Try to reduce your intake of salt and processed foods that contain a lot of salt, such as processed meat, bacon and sausages.

To limit or reduce your salt intake, choose low-salt varieties of food and foods labelled ‘no added salt’.

CaffeineMany people are mildly (and relatively harmlessly) addicted to caffeine. Tea, coffee, chocolate, cocoa, energy drinks and some cola drinks contain caffeine.

Caffeine stimulates your brain and nervous system, and the physical effects vary from person to person. Among these effects, which are temporary and reversible, are increased alertness and heartbeat and a need to urinate more often.

Some studies have shown that caffeine can slightly raise blood pressure; others have found lower blood

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pressure in people who consume caffeine. There is no firm evidence that tea, coffee and other caffeine-containing products consumed in moderate amounts cause particular problems for people with hepatitis C.

The way your body reacts to caffeine depends on many factors including your body mass, general state of health and metabolism. Limiting your caffeine intake to 500mg per day (or less than 200mg a day during pregnancy) is generally recommended.

Approximate caffeine levels per serve include:

• Chocolate drinks – 30 to 60mg • Instant coffee – 60 to 100mg • Drip or percolated coffee – 100 to 150mg • Espresso coffees – such as espresso or latte – 90

to 200mg • Cola drinks – 35mg • Decaffeinated coffee – around 3mg • Tea – 30 to 100mg, depending on the type and

strength of the brew • Energy or sports drinks – such as Red Bull or ‘V’ –

80 to 90mg • Dark chocolate bar – 40 to 50mg per 55g serve • Guarana – can contain up to 100mg per one gram

of guarana • Caffeine tablets – such as No-Doz – 100mg per

tablet.

Drinks that help to keep you alert (such as Red Bull™ and V™) contain about two-and-a-half times the amount of caffeine found in regular cola drinks. Avoid these so-called ‘smart’ drinks if you are limiting your caffeine intake. All caffeine-containing beverages should be consumed in moderation, especially if you have trouble going to sleep. Useful caffeine-free alternatives are decaffeinated coffee, fruit teas, herbal teas, non-cola soft drinks, milkshakes, fruit juice and water.

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Food additives Additives are used in foods for a specific purpose and are not considered to be food themselves. For example, the artificial sweetener aspartame is added to many beverages, yoghurt, chewing gum and other foods to keep the calorie content of the product low. Some additives help maintain or improve the quality, colour, taste and texture of food and prevent it from spoiling.

Stevia (Stevia rebaudiana Bertoni) is a herbal sweetener that is suitable for diabetics and for overweight people who are aiming to lose weight by avoiding sugar in their diet. (Geuns, JM. Phytochemistry 2003;64(5):913–21) It does not pose a risk of genetic damage (Brusick, DJ. Food Chem Toxicol 2008;46(Suppl. 7):S83–91).

The Australia New Zealand Food Authority regulates the use of food additives through the Food Standards Code. The standards, which are compulsory, specify the quantity and type of food colours and preservatives that can be used. Food additives must be listed on packaged and processed foods. See the ‘Further Reading’ section for the website location.

Many convenient and nutritious processed foods contain small amounts of artificial colours and preservatives, but having hepatitis C is not a reason to avoid these foods. If you are sensitive to particular food additives or natural chemicals that occur in food, you need to avoid these whether you have hepatitis C or not. It is unlikely that hepatitis C will cause you to be more sensitive to food additives such as colours or flavours.

If you have an allergic reaction to a particular food or food additive, you should go to a medical clinic that specialises in allergies and have the diagnosis confirmed, usually by skin tests. An accredited practising dietitian can provide dietary advice.

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Alcoholand hepatitis C

Alcohol is a toxin. It is broken down by the liver, but it can stimulate the build-up of fat in the liver (steatosis)

and the development of fibrosis (scarring of the liver). The Australian Alcohol Guidelines: for low-risk drinking, published in 2008 by the National Health and Medical Research Council, report a higher risk of developing cirrhosis if you have hepatitis C and drink alcohol. It is the single biggest risk factor for cirrhosis among people with the virus. Drinking alcohol has an effect on any person’s risk of developing liver disease, although it is unclear how much alcohol puts you at a higher risk.

It is wise to avoid alcohol, but, if you do choose to drink, limit yourself to moderate amounts. These amounts will vary according to your health and whether you have active liver disease or cirrhosis. The recommendation for both women and men to drink is no more than two standard drinks a day over their lifetime if they want to reduce their risk of being harmed by an alcohol-related injury or disease. Some studies have indicated that abstinence from alcohol is strongly recommended before, and during, antiviral therapy; you might decide that this is your preferred course of action.

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If you have any of the following conditions, you should consider lowering your consumption of alcohol.

Acute hepatitis CMost people don’t notice any symptoms during the initial, or acute, phase of hepatitis C — the first six months of infection. However, drinking alcohol during this time can aggravate inflammation of the liver and any symptoms you might have, such as nausea and fever.

Chronic hepatitis CChronic hepatitis C infection develops after an acute phase of infection and your body has not been able to clear the virus. Chronic hepatitis C infection occurs in 75 per cent of people with the virus.

If you have chronic hepatitis C but do not have cirrhosis, it is recommended that you limit your alcohol intake to no more than seven standard drinks a week. Both men and women are advised to have two or three alcohol-free days a week.

CirrhosisIt is estimated that between 5 and 10 per cent of people with chronic hepatitis C will develop cirrhosis of the liver after 20 years. If you have developed cirrhosis, it is recommended that alcohol should be avoided completely, as it will lead to increased liver damage.

Fatty liverPeople with hepatitis C are prone to fatty liver, which, as the name suggests, occurs when excess fat cells build up in the liver. Drinking alcohol to excess over a long period is one of the main causes

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of fatty liver. Other causes are insufficient exercise, a diet containing too many foods and drinks that are high in fats and sugars, having diabetes, and having hepatitis C – genotype 3.

Medication interactionsAlcohol can interact with a range of prescribed, over-the-counter medications, as well as some herbal preparations. Check with your doctor or phamacist.

Standard drinksThe National Health and Medical Research Council’s Australian Alcohol Guidelines: health risks and benefits defines a standard drink as one containing 10 grams of alcohol. The following are examples:

• beer — low-alcohol (2–3 per cent alcohol), one small can (375 millilitres); standard (4–5 per cent alcohol), two-thirds of a small can (250 millilitres)

• table wine (about 10 per cent alcohol) — one glass (100 millilitres)

• fortified wines such as sherry and port (about 20 per cent alcohol) — one sherry glass (60 millilitres)

• spirits and liqueurs (about 40 per cent alcohol) — one nip (30 millilitres).

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Limiting your alcohol intakeHere are a few tips to help you limit your alcohol intake:

• Switch to low-alcohol or alcohol-free drinks.

• Mix your wine with plain mineral water.

• Mix beer or stout with lemonade.

• Avoid situations where there is pressure to drink, for example, drinking in rounds.

• Alternate a non-alcoholic drink with an alcoholic one.

• Aim to have two or three alcohol-free days each week.

If you have trouble reducing your alcohol intake, contact your doctor or your local community health centre for a referral to someone who might be able to help you. You can also contact an alcohol and drug support service See the ‘Contacts’ section.