Unlock the Ultimate Diet for Autoimmune Hepatitis: Boost Your Liver Health Now!

Autoimmune hepatitis is a condition where the body's immune system mistakenly attacks the liver cells, causing inflammation and potential liver damage. While there's no specific diet that can cure autoimmune hepatitis, dietary modifications play a crucial role in managing the condition, alleviating symptoms, and supporting overall liver health. It is important to note that research has not found compelling evidence to suggest that diet causes autoimmune hepatitis, nor can a person’s diet directly treat or cure the disease.

This article provides a detailed overview of dietary recommendations for individuals with autoimmune hepatitis, incorporating expert opinions and evidence-based guidelines.

Understanding Autoimmune Hepatitis

Autoimmune hepatitis is a chronic disease that can last for years and lead to cirrhosis (scarring and hardening of the liver) if left untreated. The exact causes are unknown but are believed to be linked to a combination of genetic and environmental factors such as viruses, bacteria, drugs, and toxins. It is a serious condition that requires medical intervention, often involving medications to suppress the immune system.

The symptoms of autoimmune disorders can come and go. Normally, the symptoms of autoimmune disease develop gradually over the course of weeks or months. Sometimes the pain in upper left abdomen can present like pancreatitis. A routine blood test to check for liver enzymes can help reveal a pattern typical of hepatitis. To diagnose autoimmune hepatitis, your doctor will need to order additional blood work to test for autoantibodies, which attack the body’s cells. With autoimmune hepatitis, the immune system may produce one or more types of “autoantibodies”: antinuclear antibodies (ANA), smooth muscle antibodies (SMA), and antibodies to liver and microsomes (anti-LKM). Those with Type 1 have ANA, SMA, or both, and those with Type 2 have anti-LKM. A liver biopsy can help your doctor correctly diagnose autoimmune disease and measure the severity. The procedure is done in a hospital under anesthesia. The most common form of autoimmune hepatitis in North America is Type 1. Although it can occur at any age, this type affects adolescents and young adults. The second type of autoimmune hepatitis is Type 2.

General Dietary Principles

If you have autoimmune hepatitis, you should eat a healthy, well-balanced diet. A healthy diet is also important if autoimmune hepatitis leads to cirrhosis. Some people with liver disease must eat a special diet which helps the liver function and protects it from working too hard. The changes you will need to make will depend on how well your liver is working. Talk to your provider about the kind of diet that is best for you so that you get the right amount of nutrition.

Read also: The Hoxsey Diet

The Mediterranean Diet

Medical providers preach about the importance of a healthy diet, but nutrition isn’t always one-size-fits-all. For patients with fatty liver disease, the country’s most common chronic liver condition that affects about 100 million Americans and can lead to cirrhosis and cancer, it's important to focus on diet and lifestyle changes. According to the American Liver Foundation, there are no medical treatments - yet - for non-alcoholic fatty liver disease. So that means that eating a healthy diet and exercising regularly are the best ways to both prevent liver damage from starting or reverse liver disease once it’s in the early stages. They might surprise you. We recommend the Mediterranean diet to our liver patients. The Mediterranean diet is a well-known diet that gained popularity in the 1990s, known more as an eating pattern rather than a structured diet. It emphasizes eating fruits, veggies, whole grains, beans, nuts, legumes, olive oil, and flavorful herbs and spices; fish and seafood at least a couple of times a week; and poultry, eggs, cheese and yogurt in moderation, while saving sweets and red meat for special occasions. In addition to being good for people with non-alcoholic fatty liver disease, the Mediterranean diet has been associated with a decreased risk of heart disease, and it's also been shown to reduce blood pressure and bad LDL cholesterol. And it can be in line with the American Diabetes Association's nutrition guidance. A key role the dietitian plays is individualizing the nutrition plan for each patient. Adapting to a Mediterranean diet is hard for patients because we are surrounded by convenience foods and junk on a daily basis. This diet is focused. It is important for patients to be able to sit down and learn about the benefits of the recommended diet and ask questions.

The Mediterranean-style diet emphasizes vegetables, fruits, whole grains, beans, and legumes, while limiting processed foods, sugary drinks, added sugars, saturated fats, and refined carbohydrates. It also includes products like low-fat or fat-free dairy, fish, poultry, nuts, and certain oils.

Balanced Macronutrient Intake

Proteins normally help the body repair tissue. They also prevent fatty buildup and damage to the liver cells. In people with badly damaged livers, proteins are not properly processed. Waste products may build up and affect the brain. Dietary changes for liver disease may involve:

Protein: DO NOT limit protein too much, because it can result in a lack of certain amino acids. Have about 1.2 to 1.5 grams of protein per kilogram of body weight. This means that a 154-pound (70-kilogram) man should eat 84 to 105 grams of protein per day. Look for non-meat protein sources such as beans, tofu, and dairy products when you can. Talk to your provider about your protein needs.
Carbohydrates: Eat large amounts of carbohydrate foods. Carbohydrates should be the major source of calories in this diet. The increased carbohydrates and fat help prevent protein breakdown in the liver.
Fats: Eat a moderate intake of fat, as prescribed by the provider. Add Liver Loving Fats: Add items like fatty fish (tuna & salmon), nuts, seeds, avocados, olives, olive oil, and avocado oil to your plate regularly. Avoid Liver Loathing Fats: Reduce the amount of red meat, butter, cheese and ice cream that you’re having and make sure you’re having minimal trans fats (often found in packaged foods).

Specific Food Recommendations

Emphasize These Foods:

Fruits and Vegetables: Aim for at least three servings of vegetables daily. One serving is equal to 1 cup raw or 1/2 cup cooked vegetables. In-season vegetables and fresh frozen options without sauce are best. Focus on nonstarchy vegetables such as asparagus, broccoli, carrots and spinach. Get at least two servings of fruit daily. One serving is equal to 1 cup of fresh fruit. Choose fresh or frozen fruits or fruit canned in its own juice. Drain the juice in canned fruit before eating.
Lean Proteins: Eating fruits and vegetables and lean protein such as legumes, poultry, and fish. Fish and seafood. Aim for three or more servings of fish and seafood a week. One serving is 3 to 5 ounces, which is about the size of a deck of cards. Poultry and eggs. White meat chicken without the skin and eggs are good sources of protein. One serving of chicken is 3 ounces, which is about the size of a deck of cards. Legumes and beans. Eat three or more servings a week of legumes and beans. One serving equals half a cup.
Whole Grains: My Plate: Grains. Department of Agriculture. Accessed Aug.
Healthy Fats: When cooking, use a healthy, unsaturated fat such as olive oil. Grapeseed and avocado oils are also healthy oils. These plant-based oils are liquid at room temperature and can be used instead of butter or margarine. Don't use oils with the terms "hydrogenated" or "partially hydrogenated" on their nutrition labels.
Nuts and Seeds: Aim for four servings of nuts and seeds a week. One serving equals 1/4 cup.
Fiber-Rich Foods: The Mediterranean diet is rich in fruits, vegetables, lean proteins and healthy fats. It's high in fiber, vitamins, minerals and polyphenols, which are plant compounds that contain antioxidants and anti-inflammatory properties.

Limit or Avoid These Foods:

High-Sodium Foods: Limiting your salt intake. Salt in the diet may worsen fluid buildup and swelling in the liver. Limit the amount of sodium you eat to 2000 milligrams per day or less to reduce fluid retention.
Raw Shellfish: Avoid uncooked shellfish due to the risk of hepatitis A.
Saturated and Trans Fats: Saturated Fats: To keep these fats to a minimum, limit consumption of full-fat dairy products and red meats. Trans Fats: These fats are typically found in fried foods and highly processed snacks, such as potato chips, candy bars, cookies, french fries, etc.
Sugary Drinks and Processed Foods: The Mediterranean-style diet emphasizes vegetables, fruits, whole grains, beans, and legumes, while limiting processed foods, sugary drinks, added sugars, saturated fats, and refined carbohydrates.

Sample Meal Plan

When planning your meals, use the plate method for best results.

Breakfast: One-egg omelet with spinach, tomatoes and feta cheese and a piece of multigrain toast topped with avocado.
Lunch: A bowl of bean and barley soup, a spinach salad, and a cup of strawberries.
Dinner: Baked salmon with brown rice and asparagus.

Hydration

Staying hydrated, especially in the summer, can be challenging.

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Fruit-Infused Water: Elevate your hydration game by infusing water with fruits like lemon, lime, berries, or oranges.
Coconut Water: Add a splash to your water or even swap it out for plain coconut water.
Make it Sparkle: Use carbonated water to give your hydration some pizzazz.
Freeze it: Make ice pops or even ice cubes with 100% fruit juice.
Hydrating Foods: Not all hydration has to come from what we drink. In fact, a large part of our hydration comes from food!

Vitamins and Supplements

Liver disease can affect the absorption of food and the production of proteins and vitamins. Therefore, your diet may influence your weight, appetite, and the amounts of vitamins in your body. Taking vitamins and medicines prescribed by your health care provider for low blood count, nerve problems, or nutritional problems from liver disease.

Vitamin Supplements: Take vitamin supplements, especially B-complex vitamins.
Vitamin D: Many people with liver disease are deficient in vitamin D. Ask your provider if you should take vitamin D supplements.
Calcium and Vitamin D: Using corticosteroids for a long time to treat autoimmune hepatitis can lead to a loss of bone density, called osteopenia, which can lead to osteoporosis. Doctors may recommend that people who take corticosteroids also take dietary supplements of calcium and vitamin D to help prevent osteoporosis. (NIDDK), part of the National Institutes of Health.

Some studies have suggested that certain vitamins and supplements may help improve MASLD. For instance, omega-3 fatty acids may improve liver fat in people with MASLD. Vitamin E may have a role in improving liver fat and inflammation in MASLD. However, more information is needed to confirm these findings.

Lifestyle Modifications

Lifestyle changes - including diet and weight loss - are the main ways to prevent and manage metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called nonalcoholic fatty liver disease (NAFLD). A healthy diet can help reduce fat and inflammation in the liver, potentially reversing MASLD and a more serious form of liver disease called metabolic dysfunction-associated steatohepatitis (MASH). Eating a Mediterranean diet can help you lose weight. Losing 5% to 10% of body weight can significantly improve MASLD.

Weight Management: Data has shown that just a 5% weight loss can reduce the fat that can accumulate in your liver. However, hitting a 7% weight loss goal will not only reduce the fat accumulation but can also start to reverse steatotic liver disease*.
Regular Exercise: Go the Extra Mile: Focus on daily movement. Adding just 5 minutes a day can start increasing your stamina and improve your liver health over time. Slowly build up and aim to eventually hit the CDC recommended guidelines of 150 minutes of moderate activity per week. Engage Your Social Circle: Plan exercise with friends for accountability and enjoy meals with others.

Common Misconceptions About Liver Health

The liver is one of the most vital organs in our body, responsible for natural detoxification, metabolism, and countless other functions essential for our well-being. However, there are many misconceptions surrounding liver health that can lead to confusion and unnecessary concern.

Myth: The liver needs special diets or cleanses to detoxify. Fact: While it's true that the liver plays a crucial role in detoxifying the body, it does not require special diets or cleanses to function optimally. The liver naturally eliminates toxins from the body through processes such as filtering blood and producing bile.
Myth: Alcohol is the only cause of liver damage. Fact: It’s true that excessive alcohol consumption and drug use can lead to liver damage, including conditions like steatotic liver disease*, hepatitis, and cirrhosis; however those are not the only causes.
Myth: Liver damage always presents with obvious symptoms. Fact: Unlike some organs, the liver can often function normally even when damaged, showing few or no symptoms in the early stages of disease. Symptoms such as fatigue, yellowing of the skin (jaundice), abdominal pain, and swelling may appear only when liver damage is advanced.
Myth: Supplements can cure liver disease. Fact: There is no magic pill or supplement that can cure liver disease or prevent damage on its own. In fact, many supplements are unregulated and can negatively affect liver health.

Understanding the truth about liver health is crucial for making informed decisions about your lifestyle and well-being.

Read also: Weight Loss with Low-FODMAP

Preventative Healthcare

Preventive healthcare is the practice of the things we do to stay healthy. For example, attending regular appointments with your doctor, scheduling any eligible annual screenings, or attending counseling to stay healthy. Preventative healthcare is fundamental to maintaining long-term health and well-being, and early detection is key to managing many diseases and conditions, including liver disease.

Early Detection of Health Issues: Regular screenings and routine check-ups may enable the early identification of potential health problems. With liver disease, early detection is especially crucial as it allows for timely intervention. Liver conditions such as steatotic (fatty) liver disease, hepatitis, and cirrhosis often progress silently, with little to no symptoms.
Health Maintenance: Monitoring liver function through bloodwork and imaging helps to assess the liver’s overall health.
Cost Efficiency: By addressing liver disease and other health issues before they escalate, preventive care can reduce the need for more complex and costly treatments later.
Empowerment: Regular appointments with your healthcare team provide valuable insights and guidance on maintaining your health.

Navigating Dietary Fats

Did you know that not all fats are the same? Balance is essential when it comes to dietary fats-too much of even a beneficial fat can be harmful. Aim for a well-rounded diet and consult your doctor or a registered dietitian before making any significant changes.

Monosaturated Fats: Monosaturated fats are found in delicious items like avocados, eggs, nuts, olives and olive oil.
Polysaturated Fats: Fatty fish (salmon, tuna, sardines and mackerel), flaxseed, sunflower seeds and walnuts are great ways to boost omega-6 and omega-3 fatty acids.
Saturated Fats: To keep these fats to a minimum, limit consumption of full-fat dairy products and red meats.
Trans Fats: These fats are typically found in fried foods and highly processed snacks, such as potato chips, candy bars, cookies, french fries, etc.

Alcohol Consumption and Liver-Healthy Beverages

When we think about liver health, one of the first things that often comes to mind is alcohol. With roughly 90-98% of alcohol being processed through the liver, limiting alcohol intake is important but it doesn’t mean you still can’t enjoy some fun, festive drinks!

Mocktails (or cocktails without alcohol) are a fun way to spice up what you’re enjoying, and you can make them liver healthy by adding some key antioxidant rich ingredients. Start by adding one cup of strawberries, two teaspoons of lime juice (you can always add more later, it’s better to start out lower), and two tablespoons of honey into a blender. Peel the cucumbers, slice and puree in a blender (make sure there are no chunks). Cut lemons in half and squeeze the juice directly into the cucumber puree. In a large pitcher, combine sparkling water, cucumber and lemon.

The Role of Dietitians

Adapting to a Mediterranean diet is hard for patients because we are surrounded by convenience foods and junk on a daily basis. This diet is focused. It is important for patients to be able to sit down and learn about the benefits of the recommended diet and ask questions. A key role the dietitian plays is individualizing the nutrition plan for each patient. Changing the way you eat can take time. Talk with your healthcare team about creating a healthy diet plan.

Medical Treatment

The main course of treatment for autoimmune hepatitis is medicine to suppress, or slow down, an overactive immune system. When diagnosed early and with proper treatment autoimmune hepatitis can frequently be controlled. The most common treatment for autoimmune hepatitis is a daily dose of a corticosteroid called prednisone. Treatment may begin with a higher dose and be tapered as the disease is controlled. Your doctor may consider using another medicine called azathioprine (Imuran), which also suppresses the immune system, but in a different way. Treatment may begin with both azathioprine and prednisone, or azathioprine may be added later, once the disease is under control. The use of azathioprine permits for a lower dose of prednisone, which in turn results in the reduction of prednisone’s side effects. Treatment with prednisone and azathioprine can last for years, even for the lifetime of the patient. Some patients find they can manage the symptoms of autoimmune hepatitis with lifestyle and dietary changed and may not need to take any medications. Yes, they both have side effects. Most commonly weight gain, thinning of bones, (osteoporosis), anxiety, high blood pressure, cataracts, and glaucoma. Azathioprine can also lower white blood cell counts and sometimes causes nausea and poor appetite. Some patients do not respond well to standard therapy. Other immunosuppressive agents such as mycophenylate mofetil, cyclosporine, or tacrolimus may be used as a treatment for autoimmune hepatitis.

Disclaimer

The information provided in this post is for general informational purposes only and is not intended as medical advice. Always consult with a healthcare professional or a registered dietitian before making significant changes to your diet, especially if you have existing health conditions or concerns about liver health.

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