Diet taboos for drug-induced hepatitis

First, any alcoholic beverages must be completely eliminated. Second, highly processed foods that are high in oil, sugar, and salt, and contain a large amount of preservatives or artificial flavorings must be strictly limited. Third, foods/supplements that are known to increase the metabolic burden on the liver or interact with current treatment medications must be avoided. Most of the remaining dietary requirements need to be flexibly adjusted based on the individual's degree of liver damage and the stage of the disease. There is no one-size-fits-all standard answer.

Last month, I met a 28-year-old programmer at the outpatient clinic. He had been taking isotretinoin for four months to treat acne. His transaminases were only twice as high as the normal value when he was retested. I specifically told him not to drink alcohol and eat less heavy food, but he was celebrating his 10th graduation anniversary. Yes, I thought it would be fine if I drank a few sips less. I drank three bottles of cold beer and ate more than a dozen skewers of roasted butter. That night, I felt nauseated and weak, and my eyes were a little yellow. The blood transaminase test the next day directly increased to 7 times the normal upper limit, and I was admitted to the hospital on the spot. To put it bluntly, alcohol itself is a clear hepatotoxic substance, 90% of which is metabolized by the liver. The acetaldehyde produced will also directly damage the structure of liver cells. Originally, the drug has already damaged the liver cells, so alcohol is equivalent to adding another kick, double damage and stacking buffs. It is no wonder that there is no problem. I have treated too many patients who had the fluke mentality that "one sip will be fine", and in the end they either prolonged the recovery period or directly developed severe liver damage. Don't gamble with your liver.

Many people think it’s okay if I don’t drink, right? Is it okay to eat braised pork elbow, cream cake, and pickled fish every day? That's really not the case. There was a sister who had liver damage caused by taking anti-tuberculosis drugs. When she was discharged from the hospital, her transaminase had dropped to normal levels. Her family felt that she was short-changed after the illness, so they made her stewed with fat chicken soup and marinated pork ribs every day for ten days. When she came back for a review, her transaminase had tripled. In fact, the principle is simple. Excess fat, sugar, and salt must be metabolized by the liver. The liver cells are still in the repair period, and the workload suddenly increases two or three times, which is impossible to handle. The excess fat will directly pile up in the liver cells, turning into drug-induced hepatitis combined with fatty liver, which will slow down the recovery. Of course, it doesn’t mean that you can’t even add oil for cooking. You can usually use olive oil or rapeseed oil to stir-fry some seasonal vegetables, which is absolutely fine, as long as you don’t eat heavy dishes that are heavy in oil and sugar.

Nowadays, there are several controversial taboo issues. Clinically, different doctors have different opinions. There is no need to believe in any one of them. For example, is the often-asked question "eating liver to nourish the liver" reliable? Most nutritionists of the older generation believe that animal liver is rich in iron, B vitamins, and vitamin A, and eating it appropriately can provide nutrients for liver cell repair. ； Younger doctors are more inclined to not allow it to be eaten. After all, animal livers contain high cholesterol and may retain a small amount of metabolic toxins, which puts a burden on the already fragile liver. My own clinical experience is that if the transaminase in the acute phase has not dropped to normal, don’t touch it. When the indicators in the recovery phase stabilize, eat it once a week. Eat about one or two braised pork livers or steamed chicken livers each time. It’s totally fine and you don’t need to beat him to death with a stick.

There is another even more controversial issue: Should I take liver-protecting health products? Nowadays, milk thistle and liver-protecting tablets are everywhere on the Internet. Many patients buy a bunch of them and eat them as soon as they are diagnosed with liver damage, thinking that they can speed up repair. The views of the two schools of thought here are very different: those who support it believe that low-dose liver-protecting ingredients extracted from regular sources can indeed help liver cells resist oxidation and reduce inflammatory reactions. ； The opposing side believes that most of the supplements on the market have complex ingredients, and many also contain preservatives and additives of unknown efficacy. The liver is already in a fragile period, and eating them may increase the metabolic burden. My general advice to patients is not to buy them blindly. If you really want to take them, take the supplements you choose to see your attending doctor to make sure the ingredients are safe and do not conflict with other medications you are taking before taking them. Otherwise, it is really better not to take them at all. Last year, I met a patient who took three Internet celebrity liver-protecting supplements at the same time. It was originally a mild liver injury, but in the end it became moderate after taking it.

Oh, by the way, there is another pitfall that many people easily fall into: as soon as they hear that they need a light diet, they just eat plain porridge with vegetables, and don’t even dare to touch eggs and milk. This is really overkill. Liver cell repair requires a large amount of high-quality protein as raw material. If you don't provide it with any nutrients, what will it do to grow well? There was a retired aunt who didn't even dare to eat egg yolks after being diagnosed with drug-induced hepatitis. She only drank white porridge with pickles. She lost seven pounds in half a month. When she came for a reexamination, her index did not drop at all, and she was also diagnosed with hypoalbuminemia. Later, I asked her to eat a hard-boiled egg every day, drink a cup of sugar-free yogurt, and eat steamed sea bass and lean beef two or three times a week. I rechecked her in less than a month, and all indicators returned to the normal range.

To put it bluntly, the dietary taboos for drug-induced hepatitis are really not as complicated as listed on the Internet. The core principle is just one: don’t cause unnecessary trouble to the already injured liver. There is no need to memorize the list of taboos on the Internet, whether you can eat a certain thing, and whether you feel uncomfortable after eating it. In fact, your body will give you feedback. If you don’t have nausea, fatigue, or bloating, you don’t need to quit completely. If you feel uncomfortable after eating it, just don’t touch it next time. Of course, the most important thing is to have regular check-ups and follow your doctor to adjust your diet plan, which is more reliable than any universal recipe posted online.