Nutritional Concerns in Hepatitis Infection
Article Date: 6/29/2004

It can be difficult to maintain normal eating patterns while undergoing
treatment for viral hepatitis.

The medications, as well as the illness, can cause alterations in appetite, food
preferences, and perception.

In this article, we will address a few of the common problems encountered by
people with viral hepatitis infection: nausea, vomiting, diarrhea, changes in
taste and smell, and loss of appetite.

Nausea and Vomiting

Nausea is an unpleasant wavelike feeling in the back of the throat and/or
stomach that may or may not result in vomiting.

Nausea may be even more distressing for patients than vomiting.

Nausea is controlled by a part of the central nervous system that controls
involuntary bodily functions.

Vomiting is the forceful elimination of the contents of the stomach through the
mouth. Vomiting is a reflex controlled by a vomiting center in the brain.

It can be stimulated by various triggers, such as smell, taste, anxiety, pain,
motion, poor blood flow, irritation, or changes in the body caused by
inflammation.

Vomiting is a complex, coordinated reflex orchestrated by the vomiting center of
the brain. It responds to signals coming from:

The mouth, stomach, and intestines


The bloodstream, which may contain medicines or infections


The balancing systems in the ear (motion sickness)


The brain itself, including unsettling sights, smells, or thoughts.

An amazing variety of stimuli can trigger vomiting, from migraines to kidney
stones. Sometimes, just seeing someone else vomit will trigger vomiting.

The following are a few possible causes of vomiting:

Viral infections


Medications


Seasickness or motion sickness


Migraine headaches


Morning sickness during pregnancy


Food poisoning


Food allergies


Brain tumors


Chemotherapy in cancer patients


Bulimia


Alcoholism.

Retching is the movement of the stomach and esophagus without vomiting, and is
also called dry heaves.

Anticipatory nausea and vomiting occurs when the patient is exposed to stimuli
(smells, sights, and sounds) that are mentally associated with previous episodes
of nausea and vomiting.

Acute nausea and vomiting occurs within 24 hours after the adminstration of
medication.

Delayed nausea / vomiting occurs more than 24 hours after the administration of
medication.

Treating Nausea, Vomiting and Dehydration

Most of the time, nausea and vomiting do not require urgent medical attention.
However, if the symptoms continue for days, they are severe, or you cannot keep
down any food or fluids, they may be signs of a more serious condition.

Dehydration is the main concern with most vomiting. How fast dehydration
develops depends on the patient's size, frequency of vomiting, and occurance of
diarrhea.

It is important to stay hydrated. Small amounts of clear liquids, such as
electrolyte solutions, should be taken regularly.

Other clear liquids, such as water, ginger ale, or fruit juices also work unless
the vomiting is severe. Drinking too much at one time can distend the stomach
and make nausea and vomiting worse.

Solid foods should be avoided for at least six hours after the last episode of
vomiting, and then should be taken gradually to avoid distending a "tender"
stomach.

Treatment of anticipatory nausea and vomiting is more likely to be successful
when symptoms are recognized and treated early.

Although antinausea drugs do not seem to be effective, guided imagery, hypnosis,
relaxation and behavioral modification techniques may reduce symptoms.

Acute and delayed nausea and vomiting are commonly treated with antinausea
drugs.

Some drugs last only a short time in the body, and need to be given more often;
others last a long time and are given less frequently.

Blood levels of these drugs must be kept constant to control nausea and vomiting
effectively.

Medical care is warrented when:

Vomiting has lasted longer than 24 hours


Blood (red) or bile (green) is in the vomit


Severe abdominal pain is present


Signs of dehydration are evident.

Signs of dehydration include:

Increased thirst


Infrequent urination or dark yellow urine


Dry mouth


Eyes that appear sunken


Loss of normal skin elasticity (if you touch or squeeze the skin, it doesn't
bounce back the way it usually does).

Diarrhea

Diarrhea is loose, watery, frequent stools, and is considered chronic (ongoing
or prolonged) when loose or frequent stools have persisted for longer than 4
weeks.

Diarrhea in adults is usually mild and resolves quickly without complication;
however, people can become dehydrated quickly, especially when there is vomiting
with the diarrhea.

The most common cause of diarrhea is a mild viral infection that resolves on its
own within a few days. This is called viral gastroenteritis or "stomach flu."

Viral gastroenteritis often appears in mini-epidemics in schools, neighborhoods,
or families.

Food poisoning and traveler's diarrhea are two other common causes. They occur
from eating food or drinking water contaminated with bacteria or parasites.

Certain medical conditions can also lead to diarrhea, such as malabsorption
syndromes, inflammatory bowel diseases, irritable bowel syndrome (IBS) and
immune deficiency.

Medications can also cause diarrhea, especially antibiotics, laxatives
containing magnesium, and chemotherapy for cancer treatment.

Treating Diarrhea

Drink plenty of fluid to avoid becoming dehydrated. Start with sips of any fluid
other than caffeinated beverages.

Milk may prolong loose stools, but also provides needed fluids and nourishment,
and may be fine for mild diarrhea.

For moderate and severe diarrhea, electrolyte solutions available in drugstores
are usually best.

Active cultures of beneficial bacteria (probiotics) make diarrhea less severe
and shorten its duration. Probiotics can be found in active culture yogurt and
as supplements.

Foods like rice, dry toast, and bananas may help some. Avoid over-the-counter
diarrheal medications unless specifically instructed to use one by your doctor.

Certain infections can be made worse by these drugs. When you have diarrhea,
your body is trying to get rid of whatever food, virus, or other bug is causing
it.

Medical care is warranted if:

There is blood or pus in your stools or if your stool is black


There is abdominal pain that is not relieved by a bowel movement


There are symptoms of dehydration (described above)


There is fever above 101°F


Stools are foul smelling or oily-looking


Diarrhea does not resolve in five days


You have recently traveled to a foreign country


You have eaten with other people who also have diarrhea


You have started on a new medication.

Alterations in Taste and Smell

The sense of smell is part of our chemical sensing system, or the chemosenses.
Olfactory, or smell nerve cells, in the nose have a role in the interpretation
of smells, as well as taste flavors.

These nerve cells are found in a small patch of tissue high inside the nose, and
they connect directly to the brain.

Like the process of sensing odors, the complex process of tasting begins when
tiny molecules released by the substances around us stimulate gustatory or taste
cells (taste buds) in the mouth and other sensory cells in the nose and throat.

These special sensory cells transmit messages through nerves to the brain, where
specific tastes are identified.

Many people who have an impartied ability to smell also notice problems with
their sense of taste, because the perception of flavor comes from a combination
of odors and taste.

Without the olfactory cells, familiar flavors like coffee or oranges become hard
to distinguish.

People who experience alterations in the sense of smell and taste experience
either a loss in their ability to detect smell and taste or changes in the way
they perceive odors and tastes.

The partial loss of the sense of smell is called hyposmia. Anosmia is the
complete inability to detect odor.

Some people notice that familiar odors become distorted. Others may note that
an odor that usually smells pleasant instead smells foul. Still other people may
perceive a smell that isn't present at all.

Like the sense of smell, people may have a reduced ability to taste sweet, sour,
bitter, and salty flavors, called hypogeusia.

Some people can detect no tastes, called ageusia. True taste loss is rare;
perceived loss usually reflects a smell loss, which is often confused with a
taste loss.

It's very common that people will complain of "phantom" taste sensation; for
example, some medications can produce a persistent "metallic" taste.

In other cases, a person may detect a foul taste from a substance that is
normally pleasant tasting.

What causes changes in taste and smell?

Smell disorders have many causes, some clearer than others. Most people who
develop a smell disorder have recently experienced an illness or an injury.

Common triggers are upper respiratory infections and head injuries.

Other causes include polyps in the nasal cavities, sinus infections, hormonal
disturbances, dental problems, exposure to certain chemicals, and some
medicines.

Loss of taste can also be caused by exposure to certain chemicals, such as
insecticides and by some medicines, including ribavirin.

Taste disorders may result from oral health problems and some surgeries (e.g.
third molar extraction and middle ear surgery).

Many patients who receive radiation therapy for cancers of the head and neck
develop chemosensory disorders.

Can disorders of taste and smell be treated?

Yes. Since certain medications can cause a problem, adjusting or changing that
medicine may ease its effect on the sense of smell.

Others recover their ability to smell when the illness causing their olfactory
problem resolves.

Coping with Common Eating Problems

Decreased appetite

Loss of appetite and even nausea and vomiting are common, particularly with
hepatitis. Eating may be the last thing on your mind.

As liver damage progresses to an advanced stage, weight loss may result. The
following suggestions may be practical solutions to common eating problems.

Some people may have a better appetite in the morning. If this is the case, take
advantage of it by eating a larger, healthy breakfast.

For example, you may try to include foods that provide up to 1/3 of your protein
needs at this time, and then use nutritional supplements later on when you don't
feel like eating.

Changes in taste and smell

Certain foods you once enjoyed may no longer taste the same. Some foods with
protein, red meat in particular, might taste bitter.

But protein foods are important; they give you strength and help you fight off
infection and respond well to treatment.

If the taste of red meat is unpleasant, try chicken, fish, or other protein
foods, such as beans, cheese, yogurt, tuna, eggs, or peanut butter.

Some hepatitis patients notice that the smell of cooking or cooked food bothers
them.

Try serving foods cold or at room temperature, use fans to ventilate the area,
or use the microwave or cook in boiling bags to cut down on odors.

If the smell of food is bothering you when you are in the hospital, ask the food
service staff, a nurse, or a family member to take the cover off of your tray
before they bring food into your room, or remove the cover from your tray by
opening it away from you.

Nausea

While no one wants to eat when they feel nauseous, it is important to not to go
for long periods of time without eating.

Eating small amounts every 2 or 3 hours may be a solution. In this situation, a
balanced diet is secondary to eating foods you can tolerate as well as replacing
lost fluids.

During periods of nausea, avoid citrus juices (orange, grapefruit, pineapple),
as the acid may irritate your stomach.

Apple or grape juice, ginger ale, chicken broth, weak tea, or sports drinks,
sipped slowly, are prefereable.

If morning nausea is a problem, eat some dry crackers when you first wake up.
Also, get out of bed slowly. Avoid foods that have strong smells, or are spicy,
greasy, or deep-fried.

If your nausea continues, consult with your physician.

When you feel full quickly

If your liver is inflamed or enlarged, it may press on your stomach, causing a
sensation of fuillness. To lessen this problem, eat smaller portions of foods at
meals, and drink liquids later.

Beverages taken with your meals will leave less room for food.

Instead of 2 or 3 big meals a day, try 6 small meals spread out over the day.
You will eat less food at a time, but you will be eating more often.

Source

Nausea and Vomiting (PDQ®). National Cancer Institute.
http://www.cancer.gov/cancerinfo/pdq/supportivecare/nausea/Patient

Nausea and vomiting. MedlinePlus Medical Encyclopedia. National Institutes of
Health.

Diarrhea. MedlinePlus Medical Encyclopedia. National Institutes of Health.

Smell Disorders. National Institute on Deafness and Other Communication
Disorders. National Institutes of Health. Taste Disorders.

National Institute on Deafness and Other Communication Disorders. National
Institutes of Health.

Gennaro, H. Nutritional Challenges on Current Drug Therapy for Hepatitis C. The
Hepatitis Neighborhood





Sandra Tara Balduf (Ane)

Frontline Hepatitis Awareness

Support for patients and educational materials

http://frontline-hepatitis-awareness.com

509-888-0587





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