Sunday, December 26, 2010

Chronic Liver Disease: The Salt Scenario

According to the American Liver Foundation, approximately 25 million Americans, or one out of 10, develop liver, bile duct, or gallbladder diseases. Liver disease often begins as inflammation of the liver, that may ultimately lead to chronic inflammation and irreversible scarring, also known as cirrhosis. The liver is remarkably resilient, able to compensate for a significant amount of damage by regenerating itself, but with time and chronic inflammation its function declines.

When liver function is impaired by scar tissue (as in cirrhosis), an increase in blood pressure within the liver may occur due to portal hypertension. Portal hypertension can result in the uncomfortable symptoms of fluid retention in the abdomen (ascites) and enlargement of the blood vessels in the intestinal tract (varices). Excess sodium and fluids increases the blood volume and can worsen these symptoms.

Sodium is a naturally occuring mineral found in small amounts in most foods and abundantly in salt. Sodium attracts water. In persons who are already experiencing problems with swelling, as occurs in advanced liver disease, excess sodium in the diet can increase fluid retention, and discomfort. The adult body only requires 500 milligrams (mg) of sodium each day to maintain health. This is equal to 1/4 teaspoon of salt and can be reaped from a well-balanced, nutritious diet. Most people, especially those in Westernized societies, have daily sodium intakes well above this level due to the prevalence of salt and processed foods that are high in sodium. Excess sodium not only contributes to excess fluid retention but may also increase the risk for chronic diseases such as high blood pressure. For this reason it is generally recommended that sodium intake be limited to approximately 2,300 mg per day. Further limiting sodium may be recommended by a physician in those with liver disease.

In some instances, restricting overall fluid intake may also be indicated. As in the case of sodium, fluid in the diet can worsen fluid retention. However, some controversy exists among experts about the appropriate amount of restriction. Also, the use of a fluid restriction is usually reserved for times of severe fluid retention, as it is often difficult to adhere to the restriction in the home setting. A physician and dietitian can help determine individual fluid requirements and goals.

Achieving a balance of sodium and fluids in the body, providing the body with necessary amounts while avoiding excess, is the goal in liver disease and for general good health. This may involve decreasing current levels of dietary sodium or fluids. Avoiding foods high in sodium is the first step in reducing sodium intake.

Don't exceed 2,300 mg of sodium a day if you're a healthy adult.
Don't exceed 1,500 mg of sodium a day if you have high blood pressure, kidney disease or diabetes; you are black; or you're middle-aged or older.
Keep in mind that these are upper limits, and less is usually best, especially if you're sensitive to the effects of sodium
So how can you tell which foods are high in sodium?
Read food labels.
The Nutrition Facts label found on most packaged and processed foods lists the amount of sodium in each serving. It also lists whether the ingredients include salt or sodium-containing compounds, such as:

Monosodium glutamate (MSG)
Baking soda
Baking powder
Disodium phosphate
Sodium alginate
Sodium nitrate or nitrite
Know your labels
Many food packages include sodium-related terms. Here's what they mean:

Sodium-free or salt-free.
Each serving in this product contains less than 5 mg of sodium.
Very low sodium. Each serving contains 35 mg of sodium or less.
Low sodium. Each serving contains 140 mg of sodium or less.
Reduced or less sodium.
The product contains at least 25 percent less sodium than the regular version.
Lite or light in sodium. The sodium content has been reduced by at least 50 percent from the regular version.
Unsalted or no salt added.
No salt is added during processing of a food that normally contains salt. However, some foods with these labels may still be high in sodium.
But watch out — foods labeled "reduced sodium" or "light in sodium" may still contain a lot of salt. If the regular product starts out high in sodium, reducing it by 25 or 50 percent may make little difference. For example, regular canned chicken noodle soup contains about 1,100 mg of sodium per cup, while the reduced-sodium version may still have 820 mg per cup.
The bottom line?
Avoid products with more than 200 mg of sodium per serving. And check the Nutrition Facts label closely for the serving size — and consider how many servings you actually eat.
Patients with hepatitis C who have ascites must be on sodium [salt] restricted diets.
Every gram of sodium consumed results in the accumulation of 200 ml of fluid.
The lower the salt content in the diet, the better this excessive fluid accumulation is controlled. While often difficult, sodium intake should be restricted to 1000mg each day, and preferably to 500 mg per day. One must become an careful shopper, diligently reading all food labels. It is often surprising to discover which foods are high in sodium.
Foods With A High Salt Content:
one teaspoon of table salt - 2,325 mg of sodium
one ounce of corn flakes contains - 350 mg of sodium
one ounce of grated parmesan cheese - 528mg of sodium
one cup of chicken noodle soup - 1108 mg of sodium
commercial vegetable juice:650 mg
canned corn: 610 mg
packaged deli meats: 605 mg
canned soups:1025 mg
chinese food:3500 mg
crabmeat canned 1000
graham 670
saltines 1,100
A cautionary note: The body posesses exquisite systems which accurately regulate body sodium. The goal of a low sodium diet is to "push" this regulation system toward one end of its range,without pushing it to the limit when body sodium starts falling. Although a low-salt diet if difficult to achieve, be aware that the low-salt diet can be "overdone" with possible adverse consequences. For this reason, if your vestibular symptoms persist, do not keep decreasing your salt intake. The level of sodium intake should be decided in consultation with your physician or nutritionist. Lower levels require more rigorous monitoring by your physician. You should also be aware that your body can lose sodium by a number of routes other than in the urine. Sweating, vomiting and diarrhea can all produce significant sodium loss. In addition, other diseases, such as those which impair kidney function, may result in greater than normal sodium losses. In the event of adverse symptoms, you should contact your physician
All values are given in mg of sodium for a 100 g (3.5 oz) food portion. These values are a guide. More accurate values are given in the Nutritional Information on the package of most products, in the form of mg of sodium per serving.

Apple, raw unpeeled 1
Apple juice, bottled 1
Applesauce, sweetened 2
Asparagus, cooked 1 (regular canned 236)
Avocado 4
Bacon, cooked 1021
Bacon, canadian 2500
Baking powder 11,000
Banana 1
Barly, pearled 3
Beans, Lima 1 (regular canned 236)
Beans, snap green, cooked 4 (regular canned 236)
Beans, white common, cooked 7
Beans, canned with pork and tomato sauce 463
Bean sprouts, cooked 4
Beef, roasted broiled or stewed 60
Beef, corned 1,740
Beef hash, canned 540
Beef, dried 4,300
beef hamberger 47
Beef pie or stew, commercial 400
Beets, cooked 43 (regular canned 236)
Beverages, beer 7
Beverages, liquor 1 (avoid margueritas with salt!)
Beverages, wine 5
Beverage, soda 0 to 100 (check can)
Beverage, fruit drink 0
Beverage, water 0
Biscuits 630
Blackberries 1
Bluefish, cooked 104
Bouillon cubes 24,000
Bread 300 to 500
Broccoli, cooked 10
Brussel sprouts, cooked 10
Butter, salted 826 (unsalted - less than 10)
Cabbage 20
Cakes 100 to 300
Candy, caramels, fudge 200
Candy, hard, marshmallow, peanut brittle 30
Cantaloupe 12
Carrots 40 (regular canned 236)
Cashews, unsalted 15
Cauliflower 10
Celery, raw 126 (cooked 88)
Cereals bran, wheat, crude 9
Cereals, commercial 700 to 1100
Cereal, Corn grits 1
Cereal, Cornmeal 1
Cereal, Farina, dry 2 (cooked salted or instant 160)
Cereal, Oatmeal, dry 2 (cooked salted 218)
Cereal, Rice flakes 987
Cereal, wheat flakes 1000
Cereal, wheat, puffed 4
Cereal, wheat, shredded 3
Cheese, cheddar 620
Cheese, processed 1189
Cheese, cottage 406
Cheese, cream 296
Cheese, Mozzarella 373
Cheese, Parmesan 1,862
Cheese, Swiss 260
Cherries, Raw 2
Chicken, cooked, without skin 60 to 80
Chicken pot pie, commercial 411
Chickpeas, dry 8
Chicory 7
Chili con carne, canned with beans 531
Chili powder with seasonings 1574
Chocolate, plain 4
Chocolate syrup 52
Clams, raw soft 36
Clams, hard, round 205
Cocoa, dry 6
Cocoa, processed 717
Coconut, fresh 23
Coffee, instant, dry 72
Coffee, beverage, 1
Collards, cooked 25
Cookies, Fig bars 252
Cookies, oatmeal 170
Cookies , plain 365
Corn, sweet, cooked 0 (regular canned 236)
Cowpeas, dry, cooked 8
Cranberry juice or sauce 1
Cream 40
Cucumber 6
Dates 1
Doughnuts 500
Duck 74
Eggplant, cooked 1
Egg, whole, raw 74 (whites 152, yolk 49)
Endive, curly 14
Figs 2
Flounder 78
Flour 2
Fruit cocktail 5
Gelatin, dry 0 (sweetened, ready-to eat 51)
Grapefruit, fresh, canned or juice 1
Grapes 3
Haddock, raw 61 (battered 177)
Heart, beef 86
Herring 74
Honey 5
Honeydew melon 12
Ice cream, vanilla 87
Jams and preserves 12
Jellies 17
Kale, cooked 43
Lamb, lean 70
Lard 0
Lasagna 490
Lemon, juice or fresh 1
Lettuce 9
Lime, fresh or juice 1
Liver, beef 184
Liver, pork 111
Lobster 210
Macaroni, dry 2 (commercial with cheese 543)
Margarine 987
Milk 50
Milk, buttermilk 130
MIlk, evaporated 106
Milk, dried 549
Molasses, light 15 (Dark 96)
Muffins, plain 441
Mushrooms 14 (canned 400)
Mustard, prepared yellow 1,252
Mustard greens 18
Nectarine 6
Noodles, dry 5
Nuts, in shell 1 (processed nuts may contain high amounts of salt)
Oil, corn 0
Okra, 2
Olives, green 2,400
Onions, green 5 (mature 10)
Orange peeled, juice, canned or juice 1
Oysters, raw 73
Pancakes 425
Papayas, raw 3
Parsley 45
Parsnips, cooked 8
Peaches 2
Peanuts, roasted 5 (salted 418)
Peanut butter 607
Pears 2
Peas, cooked 2 (regular canned 236)
Peas, dried 40
Pecans, shelled 0
Peppers, green 13
Perch 79
Pickles, dill 1,428
Pickles, relish, sweet 712
Pie 250 to 450
Pie crust, baked 617
Pike, walleye 51
Pineapple, raw or canned 1
Pizza, cheese 702
Plums 2
Popcorn, salted with oil 1,940
Pork 65
Pork, cured ham 930
Pork canned ham 1,100
Potatoes, baked, boiled or french fried 2 to 6
Potatoes, mashed salted 331
Potato chips, up to 1000
Pretzels 1680
Prunes 4
Pumpkin, canned 2
Radishes 18
Raisins, dried 27
Raspberries 1
Rhubarb 2
Rice, dry 5 (cooked salted 374)
Rolls, bread or sweet 400 to 550
Rutabagas 4
Rye wafers 882
Salad dressing 700 to 1300
Salmon 64 (canned 387)
Sardines, canned 400
Sauerkraut 747
Sausage, pork 958
Sausage, Frankfurter 1,100
Sausage, Bologna 1,300
Scallops, 265
Shrimp 150
Soup, canned 350 to 450
Spaghetti, dry 2
Spaghetti with meatballs, canned 488
Spinach, raw 71 (cooked 50)
Squash 1
Strawberries 1
Sugar, white 1 (brown 30)
Sunflower seeds 30
Sweetpotatoes 12
Syrup 68
Tapioca, dry 3
Tomato 3 (canned 130)
Tomato ketchup 1,042
Tomato juice, canned 200
Tongue, beef 61
Tuna in oil 800
Turkey, 82
Turnips 34
Veal 80
Vinegar 1
Waffles 475
Walnuts 3
Watermelon 1
Wheat germ 827
Yeast, compressed 16 (dry , active 52)
Yoghurt 46
Washington University, St. Louis
Talk to your physician about further strategies for restricting sodium and fluids for coping with symptoms of liver disease.
American Liver Foundation. Diet and Chronic Liver Disease.
American Liver Foundation. Liver Disease Fact Sheet.

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