How to Enjoy a "Liver- Friendly" Holiday

HOW TO ENJOY A “LIVER-FRIENDLY” HOLIDAY

It’s that time of year again - the holiday season. Thanksgiving, Chanukah, Christmas and New Year’s are approaching. For most of us, the holidays bring an increase in the amount of time spent visiting with friends and relatives and shopping at the mall. Yet, along with the merriment that surrounds this season, comes the likelihood of above-normal stress. This is especially true for a person with liver disease. Important concerns include how can a person with liver disease (who may already be suffering from fatigue, irritability, insomnia, and headaches) enjoy the holiday season? And how he or she can maintain a healthy diet and avoid the temptations of alcohol throughout the holiday season? This article, parts of which are excerpted from my book “"Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease" will provide some advice to people with liver disease as to how they may enjoy the holidays without compromising the health of their liver.

Typically, the holiday season gives rise to some pressure to consume alcoholic beverages. And so, two separate questions must be addressed. First, how can one celebrate the season sociably, yet still avoid all alcohol? And second, do individuals with liver disease need to avoid all alcohol?

The answer to the second question is cleat cut. Since alcohol is a potential toxin to the liver, people with any type of liver disease should refrain from drinking alcohol. This is especially true for people with chronic viral hepatitis since there appears to be an additive harmful effect to the liver which alcohol has on some hepatitis viruses. In people with hepatitis C for example, alcohol has been shown to promote the replication of the hepatitis C virus (HCV) , which results in elevated hepatitis C viral loads. It has also been shown that the consumption of even minimal quantities of alcohol may accelerate the progression of liver disease to cirrhosis in people with chronic hepatitis B or C. Furthermore, it is known that alcohol can increase iron absorption, and that an excess of iron can, by itself, lead to liver damage and cirrhosis. Since many individuals with chronic viral hepatitis have high iron levels it is imperative that they avoid all alcohol consumption. Finally, it is important to remember that for any person with liver disease, excessive alcohol consumption doubles their risk of liver cancer - at the very least.

So, what is the best strategy for achieving both sociability and alcoholic abstinence? You might wish to consider one of the many varieties of non-alcoholic beers, wines and champagne which are available. These beverages are typically sold at local supermarkets. Poured into a glass, these beverages are indistinguishable from the alcoholic counterparts. If you’re giving a party no one will know the difference. If you’re attending a party, it’s perfectly acceptable to bring a bottle of non-alcoholic wine or champagne and to inform the host that you cannot drink alcohol. (Do not feel obliged to give a detailed reason for your abstention if doing so would make you feel uncomfortable. The simple statement “doctor’s orders” should be sufficient) Other viable substitutes for alcoholic beverages include sparkling water, seltzer, and ginger ale. Egg nog is typically spiked with alcohol and it is safest to steer clear of this beverage. It is also important to be aware that alcohol is sometimes a hidden ingredient in cakes and other desserts, as well as some coffees. Therefore, it is important to make your dessert choices carefully and to inquire about ingredients when in doubt. Plain coffee and fresh fruit are recommended alternatives to rich cakes and specialty dessert drinks.

Traditional holiday foods are typically high in fat and sodium content. This poses a challenge for some individuals with liver disease, since it is often important to maintain a low-fat, low-sodium diet. However, this does not mean that one cannot enjoy a eating during this season. But it does mean that food choices should be made carefully. Bear in mind that, one cannot expect to walk into the doctor's office and request "a holiday diet for liver disease ". Such an across-the-board diet simply does not exist, as many variables must be taken into account in designing an optimum diet for the individual. Variations among the different types of liver disease, the stage of the liver disease, as well as medical disorders unrelated to liver disease, must all be factored into any diet. In general, it is recommended to consume complex carbohydrates (such as potatoes and pasta) as opposed to simple carbohydrates (such as candy and pastries), lean animal protein (such as turkey, fish or vegetable protein) instead of fatty animal protein (such as ham or pot roast), polyunsaturated fats instead of saturated fats, fresh organic vegetables and fruits instead of canned vegetables and fruits. Foods high in sodium content should always be avoided. Holiday parties often provide an assortment of raw carrots and celery sticks (crudités) as a snack option. Filling up on crudités is highly advised, as they will normally constitute the most healthy snack choice at any party ( one caveat: stay away from the dip).

Dining out presents a challenge during the holiday season. The fat, sodium, and calorie content of restaurant foods is not disclosed on the menu. During the busy holiday season, restaurants often partially prepare their foods a day or more in advance of a given holiday thus necessitating the use of significant quantities of salt for preservative purposes. When dining out, one should order their food cooked "dry", meaning it should be prepared without butter, margarine, or oil. Although not always feasible, eating only food which you have personally prepared is the safest choice.

Examples of healthy food which are in keeping with the holiday spirit include : Fresh white meat turkey or chicken, basted in its own juices (as an alternative to pre-cooked seasoned turkey ordered from a caterer, or ham). A baked potato without sour cream and butter (instead of mashed potatoes or french fries). Plain steamed vegetables with fresh lemon (instead of vegetables cooked with butter or margarine, or canned vegetables). Fresh cranberries or pure cranberry spread (instead of canned, processed cranberry sauce). Nuts should be of the unsalted, raw or dry roasted variety if added in. Use whole grain breads instead of white bread. Dessert should consist of fresh organic fruits.

Since Thanksgiving, Chanukah and Christmas tend to entail feasts, one should bear in mind that it is important to pace one’s eating. That is, it is best that you eat small sized portions at a given meal and that your meals are spread out over the course of the day. Large portions may overtax your liver, leading to decreased energy levels and an impaired ability to digest and absorb food.

An extra boost of energy is often needed during the holiday season to enable one to complete the necessary shopping as well as to entertain family and friends. As noted above, eating multiple small meals high in complex carbohydrates (grains, nuts, whole grain breads, pasta, cereals, rice potatoes) is one way to boost energy levels, and to ensure that a healthy energy source will be constantly supplied to the body. Steer clear of the simple sugars which are plentiful during the holiday season. Eating holiday candies will provide a quick burst of energy, because the body easily converts all those simple sugars into glucose. But the pick-me-up is short-lived and is typically followed by a swift energy drop as the liver tries to readjust energy levels. A plate of pasta, on the other hand, is a good source of complex carbohydrates. It takes more time to digest, and so provides a slower, more sustained release of energy.

Excess salt in the diet can cause dehydration which can contribute to fatigue. The body requires about 50 to 400 milligrams of sodium per day. Yet the average American consumes about 25-35 times that amount! While this overconsumption of salt is not necessarily dangerous for most healthy people, it can create problems for a person with advanced liver disease and ascites ( an abnormal accumulation of fluid in the abdomen). The lower the consumption of salt in the diet, the better controlled this excessive fluid accumulation is. Spices, such as basil, dill, pepper, and vinegar, to name a few, may be used in place of salt as a food seasoning.

As a preemptive strike against the omnipresence of food during the holidays, it may be advisable to shed any excess pounds before the holidays begin (caveat: always use a sound weight-reducing diet and never lose more than one-to-two pounds per week). Also, plenty of water, and limiting caffeine consumption to one- to -three cups per day, is also recommended as part of your diet.

Excessive use of caffeine, stress, lack of exercise and lack of sleep are all causes of fatigue which can contribute to holiday stress and which may be rectified via a lifestyle adjustment. Fatigue and stress may be due to working too many hours, In fact, some individuals suffer from the physical and mental effects of overwork without even realizing. Finally, emotional stress should be minimized. Your family and friends should be made aware of your need to keep stress to a minimum. Hopefully, they can help you by reducing the amount of your holiday-related obligations to the level which you feel comfortable with. It is especially important to get a good night’s sleep during the holiday season. If possible, a thirty-to-forty-five minute daytime nap should be taken daily. This may help rejuvenate you. If holiday excitement causes persistent sleeping difficulty, ask your doctor about taking a serotonin reuptake inhibitor (SSRI) - such as Paxil, Zoloft, or Prozac. Melatonin, taken a half hour before going to bed, may help you get a good night’s sleep( bear in mind that melatonin is not regulated by the FDA and therefore you cannot be certain of the exact amount of active ingredient per pill). Be especially wary of any over-the-counter product that boasts “improved energy and decreased stress levels” on its label. Because the liver is in charge of breaking down all supplements and medications, more harm than good may result from taking such a product. Also be aware that taking excessive amounts of vitamins and minerals especially vitamin A, niacin or iron, can lead to worsening of liver disease. It is essential for you to consult with your hepatologist prior to taking any products that promise to cure fatigue and holiday stress.

In sum, a healthy, low fat, well balanced diet, combined with no smoking and no alcohol intake, and a daily routine of moderate exercise and ample sleep will best enable you to surmount holiday-related stress and will give you a healthy head start to the new year.

Have a happy holiday season!

Melissa Palmer, MD is the author of " Dr. Melissa Palmer's Guide of Hepatitis and Liver Disease". (Published 2004. Penguin Putnam).

The offices of Melissa Palmer, M.D. are located at:

1097 Old Country Road Suite 104

Plainview, N.Y 11803

500 Portion Road

Lake Ronkonkama, N.Y. 11779

To arrange an appointment with Dr. Palmer, call

(516) 939-2626

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