If you have cirrhosis (scarring of the liver) as a result of hepatitis C, you may begin to experience loss of appetite. People with cirrhosis must pay special attention to meeting their daily nutritional needs so that they can keep up their energy levels and avoid losing weight.

If you have hepatitis, eating a variety of foods in the right proportions may help liver cells damaged by disease to regenerate (form new cells). Therefore, what you eat may affect the rate at which your disease progresses. As a result of hepatitis, you may experience loss of appetite, so it's important to pay special attention to meeting your daily nutritional needs to avoid weight loss and keep up your energy levels.

• The Right Amount of Protein
• Serving Size Guide
• Vitamins
• What You Should Drink
• Overcoming Obstacles to Eating

The Right Amount of Protein
If you don't eat enough protein-rich foods, your body, which still requires protein, may take it from your muscles, causing a feeling of weakness. However, a complication of cirrhosis known as hepatic encephalopathy (mental confusion) can result from taking in too much protein. This occurs when the amount of protein in your diet exceeds the liver's ability to use the protein. Be sure to check with your doctor regarding your specific protein needs. Because your body requires protein to function, never limit your protein intake without first seeking your doctor's advice.

Daily Calorie Needs
In addition to paying attention to the amount of protein in your diet, you should be sure to maintain your calorie needs. The total number of daily calories in your diet should equal a minimum of 15 calories a day for each pound you weigh.

Salt Intake and Fluid Buildup
Among its many effects, cirrhosis (scarring of the liver) disturbs the regulation of salt and water in your body. This may cause ascites, which is the accumulation of fluid in the abdomen. Fluid may also build up in other parts of the body, such as the ankles or chest, causing swelling.

One way to reduce fluid buildup is to maintain a low-salt diet. Salt acts like a sponge - when your body retains salt, it also retains fluid. For this reason, it is important to limit salt in your diet to below 2,000 milligrams a day.

Tips for limiting salt include:

• Not shaking salt onto your food
• Using lemon juice instead of salt
• Reading food labels to determine salt content
• Eating more fresh foods and fewer canned, processed, and prepared foods

Serving Size Guide
If you're not currently having problems with eating, the food guide pyramid provides a simple illustration of the types and number of servings of food you should eat every day. To follow this guide, it is important to familiarize yourself with the appropriate serving size or each food group:

Bread/Cereal/Rice/Pasta Group
1 serving =

• 1/2 cup cooked pasta, rice, or oatmeal
• 1 cup cornflakes
• 1 tortilla
• 1/2 hamburger bun
• 3 to 4 small crackers

Fruit Group
1 serving =

• 1 medium banana, apple, or orange
• 1/2 cup cooked, canned, or cut-up fruit
• 3/4 cup of juice
• 1/4 cup dried fruit

Vegetable Group
1 serving =

• 1/2 cup cooked carrots or chopped vegetables
• 1 cup lettuce or spinach

Meat/Poultry/Fish/Beans/Eggs/Nuts Group
(recommended 5 to 7 oz. daily)
1 oz. portion =

• 1 egg
• 1/2 cup tofu
• 1/2 cup cooked beans
• 2 tablespoons peanut butter

Milk/Yogurt/Cheese Group
1 serving =

• 1 cup milk
• 1 cup yogurt
• 1-1/2 oz. cheese

Vitamins
Your liver helps digest important vitamins stored in fat. Special acids called bile acids, which are made by the liver, are necessary for you to absorb vitamins A, D, and E. Your body uses each of these vitamins every day. Your liver stores other important vitamins, such as vitamin B12, and releases them as you need them.

Following the principles of the food guide pyramid will help to ensure that you are meeting your body's vitamin needs. By choosing foods carefully, you may not need a vitamin or mineral supplement. However, if you are having problems with eating, you may take a vitamin and mineral supplement that provides no more than 1 to 2 times the Recommended Dietary Allowances. But before you start, discuss vitamins with your doctor.

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What You Should Drink
Drink mostly water, fruit juice, seltzers, sports drinks, or milk. Avoid alcohol and caffeinated drinks such as coffee, tea, and cola, because they act as dehydrators, pulling water out of your system. Drinking lots of fluid is especially important if you are being treated with antiviral therapy (see Approved Treatments for Hepatitis C).

If you're not having problems with retaining fluid (see Salt Intake and Fluid Buildup for more about this problem), you can determine your daily fluid needs in ounces by dividing your weight in pounds by 2. For a 120-pound person, this would equal 60 ounces, or more than seven 8-ounce glasses of fluid per day.
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Overcoming Obstacles to Eating
Eating well can sometimes be a challenge when you have hepatitis C. The disease or the treatment you are receiving may affect your appetite. You may even experience nausea and vomiting. The following suggestions address common eating problems. Trying some of the recommended approaches may help you to maintain good nutritional habits.

When you don't feel like eating:

• Keep your portions small
• Take a walk to stimulate your appetite

If you have a better appetite in the morning:

• Eat a large, healthy breakfast that includes foods with protein, such as hot or cold cereal, an omelet, yogurt shake, or breakfast burrito (scrambled eggs with beans and cheese wrapped in a whole-wheat tortilla).

Some foods you once enjoyed may no longer taste the same. This may occur because your medicine is causing a bad taste in your mouth or it could be that liver disease has harmed certain chemical pathways in your body. You may find that some foods with protein, especially red meat, taste bitter.

If foods don't taste the same:

• Eat other sources of protein if red meat tastes bitter - good protein choices include chicken, fish, beans, cheese, yogurt, tuna, eggs, and peanut butter
• Try eating meats at room temperature or cold if just-cooked meat tastes unpleasant

If food smells bother you:

• Turn on a fan while cooking
• Serve foods cold or at room temperature
• Cook outside or in the microwave
• Use a small fan next to your plate for foods that have a strong smell

If you feel nauseated:

• Eat small portions of food every 2 to 3 hours rather than 3 large meals, and eat slowly
• Drink non-citrus beverages (eg, apple or grape juice, ginger ale, chicken broth, weak tea, and sports drinks), and sip drinks slowly
• For morning nausea, eat dry crackers when you first wake up, and get out of bed slowly
• Avoid strong-smelling foods and those that are spicy, greasy, or deep fried
• See your doctor if nausea continues

If you feel full quickly:

• Eat small portions at mealtime and drink beverages later
• Have several small meals throughout the day
• Choose foods that are high in calories and protein

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