Sunday, February 2, 2014

The Mediterranean Diet For Liver Disease

The Mediterranean Diet 

There are few things about which I am obsessive, one is bedbugs, the other is dieting.

For decades advertisements have inspired or tricked us, me mostly, into trying a number of crazy diets. 

For whatever reason folks, years ago, I never met a diet I didn't try.

In my twenties I inhaled the cabbage soup diet, gave up eating anything white during Christmas, even juiced for a few days, and really committed to that cookie diet.  

In my thirties I embraced Dr. Atkins’ Diet Revolution, eggs became my dinner, bacon became my steak, and the water weight I lost impressed my scale.

In my late thirties at a Weight Watchers meeting I met a handsome vegetarian, I dumped the meat, he dumped me, and I moved on to Jenny Craig. Such is life.

In any event, with age comes wisdom. One day, I sat down and looked at my own medical history along with my families, took a few notes to present to my physician. At my very next appointment we discussed any risk factors for disease, such as heart disease and diabetes. Long story short, in the end because of my history of HCV and high risk for diabetes he suggested I try the Mediterranean diet, I took his advice. 

The Mediterranean Way Of Eating - My First Non-Diet Approach To Eating Right

For the last fifteen years I have adopted the Mediterranean way of eating, commonly referred to as the Mediterranean diet. Although, it isn't really a diet, the name evolved as a way to reference a group of healthy foods, or a diet pattern used by people whose countries border the Mediterranean Sea. In these countries, especially Greece, people eat a lot of fruits, vegetables, legumes fish and olive oil.  According to years of research, people living in this region suffer less than most Americans from cancer and cardiovascular disease. 

Everyone should eat a healthy, balanced diet to maintain their health, especially people living with chronic illness. Maintaining a healthy weight is especially important if you have HCV, the risk for developing scarring of the liver; fibrosis and cirrhosis is higher in people who are obese and living with the virus.

Diets come and go, as do hot vegetarians, but for people with liver disease eating foods proven to help preserve, or even improve overall liver health is worth the effort.

Today close to 30% of American adults have nonalcoholic fatty liver disease (NAFLD). In people living with hepatitis C it rises to around 40% and even higher in people with genotype 3. Often referred to in the medical world as HCV-induced steatosis, 60% to 80% people with genotype 3 have moderate or severe steatosis.

So What Is HCV-induced Steatosis?

Fatty liver disease (steatosis) is a build-up of excess fat in the liver cells, and in some cases may trigger inflammation of the liver.  HCV-induced steatosis develops due to a combination of viral and host factors. Viral factors are genotype specific, with genotype 3 viral-induced steatosis the most common, up to 80% of people with genotype 3 have moderate to severe steatosis. Chronic hepatitis C also alters glucose metabolism resulting in insulin resistance (IR), further promoting hepatic steatosis, which outside of genotype 3 infection has been associated with more advanced liver disease, according to a review published in last months issue of the Journal of Viral Hepatitis. 

Another study published in Nutrition 2013, found HCV patients who participated in a diet and exercise program lowered their grade of steatosis and remarkably, their fibrosis score.

For most people, I raise my hand in shame,  diets are something we jump on and jump off, but eating right is better accomplished when we make it more of a lifestyle. Rather it originated on the boarder of the Mediterranean Sea, or here in the U.S., it only works when we embrace it as a way of life. 

America - Suggested Nutrition Guidelines

In the United States the USDA Dietary Guidelines for Americans, is intended to help people choose an overall healthy diet, based on five food groups. The dietary guide is put together jointly by the Department of Health and Human Services (HHS) and the Department of Agriculture (USDA). A committee of scientific experts review the guide which is  incorporated into a scientific evidence-based report, the next edition will be released in 2015.

The dietary recommendations are aimed at preventing two major health problems in the U.S., which are obesity and heart attacks. Obesity can sneak up on us overtime, the older we get the more calories we consume, more than the body burns. Obesity in turn can cause numerous health problems, such as heart disease, stroke, liver disease, arthritis, high blood pressure, gout, gallstones, and even certain cancers.

In June 2011, the USDA launched a visual guideline depicting a place setting using the five food groups, called  MyPlate. It proved successful and replaced our some twenty year old food pyramid.

Check out this interactive website; ChooseMyPlate, find tons of advice on nutrition, watch a few videos, grab a recipe or take part in an educational program.

 Follow MyPlate on twitter for daily tips.

Cooking according to MyPlate guidelines is possible in any culture, rather you come from Europe, Asian or American. In the video Cris Comerford, prepares an authentic Filipino dish following the MyPlate guidelines and portion size.

For Chef Comerford's recipes, go here:

Healthy and Traditional Asian American and Pacific Islander Cuisine

Shrimp, Chicken and Vegetable Fried Rice

Links: features practical information and tips to help Americans build healthier diets

The Mediterranean Diet
As previously mentioned, this is my preferred way of eating. The program includes a high consumption of olive oil, legumes, unrefined cereals, bread, pasta, rice, nuts with less red meat and dairy products than many other diets. Although, red wine is used in moderation, it has never been advisable for people living with hepatitis C, or advanced liver disease. Other food choices are lots of fresh fruit, vegetables and moderate consumption of fish. Fish is rich in omega-3 fatty acids and low in saturated fats. Omega-3 fatty acids can help lower triglycerides and blood pressure.

Clinical research has demonstrated adhering to a diet plan with foods named in the Mediterranean diet may help preserve memory as we age, reduced both liver fat and inflammation, help protect against liver cancer, may have potential benefits for people chronically infected with hepatitis, reduce the risk for diabetes, heart attack and stroke - Whew!  Provided a research summary of the above mentioned health benefits, followed up with a link to each original article and research.

Mediterranean Diet and Memory

Omega-3 fatty acids are also known to benefit the brain and nervous system. A study in the journal Neurology, January 2013, reported adhering to a Mediterranean diet may help to preserve memory.

U.S. researchers studied 17,478 people with an average age of 64 by monitoring their eating habits, and testing their mental ability over a four year period. In that time, 7% developed problems with their memory and ability to think. Those who ate a Mediterranean diet had a 19% reduced risk of mental impairment. 

Mediterranean Diet and Liver Disease

Previous studies have suggested the Mediterranean Diet has additional benefits for people with liver disease, for instance a study published in the July 2013 issue of the Journal of Hepatology demonstrated patients with nonalcoholic fatty liver disease who followed the diet for six weeks not only significantly improved insulin sensitivity, but reduced both liver fat and inflammation.

Mediterranean Diet, Hepatocellular Carcinoma and Viral Hepatitis

This is exciting, according to a study found in the Journal of Hepatology, November 2013;
A closer adherence to the Mediterranean diet appears to be protective against HCC (liver cancer). Our results also point to potential benefits from adhering to a Mediterranean dietary pattern for patients chronically infected with hepatitis viruses. 

Read the full article over at NATAP, abstract here.

Mediterranean Diet and Diabetes

A recent study found patients at high risk for diabetes due to pre-existing cardiovascular conditions reduced the risk for diabetes by 40% by adhering to the traditional Mediterranean diet high in extra-virgin olive oil intake. View the study; Prevention of Diabetes With Mediterranean Diets: A Subgroup Analysis of a Randomized Trial, published in Annals of Internal Medicine -  

Mediterranean diet  and Heart Attack and Stroke

2013-Mediterranean diet  and Heart Attack and Stroke:

Published in the February 2013 online issue of the New England Journal of Medicine, a Mediterranean diet supplemented with extra-virgin olive oil or nuts reduced the incidence of major cardiovascular events (heart attack, stroke, cardiovascular death) by close to 30%, among people with high cardiovascular risk.

A total of 7447 persons were in the study (age range, 55 to 80 years); 57% were women. None had cardiovascular disease when they enrolled in the study, but they did have a high cardiovascular risk.
The participants were broken down into three cohorts. The first group followed a Mediterranean diet with extra-virgin olive oil, the second a Mediterranean diet supplemented with nuts, and the last group (control) followed a low-fat diet. Statistical analysis showed that compared to those following the control (low-fat) diet, participants on the Mediterranean diet with extra-virgin olive oil were 30% less likely to experience a cardiovascular event, and those on the Mediterranean diet with nuts were 28% less likely. Researchers reported on the importance of the results  "... the results of the PREDIMED trial are of utmost importance because they convincingly demonstrate that a high vegetable fat dietary pattern is superior to a low-fat diet for cardiovascular prevention."

Read the article, here 

2014-Mediterranean diet: lower risk of peripheral artery disease (PAD):

A multicenter study that previously reported a reduction in heart attack and stroke with a Mediterranean diet supplemented with extra-virgin olive oil or with nuts now also reports a lower risk of peripheral artery disease (PAD), according to a study in the January 22/29 issue of JAMA.

"To our knowledge, this is the first randomized primary prevention trial to suggest an association between a dietary intervention and [reduction in] PAD. These results are consistent with previous observational studies and relevant from a public health perspective," the authors write.
Read the article here..........

****Related- Feb 2014:Increased prevalence of coronary artery disease risk markers in patients with chronic hepatitis C – a cross-sectional study
Chronic hepatitis C is a global health problem and has been associated with coronary artery disease. Our aim was to examine the prevalence of coronary artery disease risk markers including endothelial biomarkers in patients with chronic hepatitis C and matched comparisons without manifest cardiovascular disease or diabetes in a cross-sectional design.
Mediterranean Diet and Longevity 

A few months ago, an observational study published in the Annals of Internal Medicine , November 2013 issue, suggested middle-aged women who follow a Mediterranean diet may live longer.

The 15 year study primarily funded by the National Cancer Institute, National Institutes of Health, examined 10,670 women aged late 50s and early 60s.

The purpose of the study was to examine the association between dietary patterns in midlife and prevalence of healthy aging.

In the end, after 15 years, middle-aged women who followed the Mediterranean diet had a 40% more chance to live up to age 70, then those who followed a different eating style.

Read more about the history of the diet, here.  

What Is the Mediterranean Diet?

Excerpt: The Mediterranean Diet and Good Health
There is no one typical Mediterranean diet. Many countries border the Mediterranean Sea and variations in the Mediterranean diet exist between these countries. However, according to the American Heart Association, traditional Mediterranean diets have the following characteristics in common:

An abundance of plant foods:
Breads and cereals
Beans, nuts, and seeds

Olive oil used as a common monounsaturated fat source
Low-to-moderate amounts of fish and poultry
Small amounts of red meat
Low-to-moderate amounts of dairy products (mostly cheese and yogurt)
Low-to-moderate amounts of eggs (zero to four times per week)
Low-to-moderate amounts of wine (one to two glasses of wine per day), normally consumed with meals

* Skip the wine if you hepatitis C or advanced liver disease 

Comparison With the American Diet

 The American diet is characterized by:

Animal products daily, as main source of protein
White starches, predominantly
Moderate to low in fruits and vegetables
High in saturated and trans fats

Unlike the typical American diet, the traditional Mediterranean diet is high in fiber and low in saturated fat. However, the Mediterranean diet is not necessarily low in total fat. But, the types of fats emphasized in the Mediterranean diet are "healthy" monounsaturated fats, like those found in olive oil, which do not raise cholesterol levels.
Read more here........ 

Mediterranean diet: A heart-healthy eating plan
Mayo Clinic Staff
How to Follow the Mediterranean Diet
Offers a quick guide
The Mediterranean diet: 4 recipes to try  
You've heard the health benefits of the fruit & fish-packed Mediterranean diet, now it's time to test it out in the kitchen. We turned to ‘Cook Yourself Sexy’ chef Candice Kumai for these delicious recipes, loaded with omega-3s and nutrients.

The goal of healthy eating is to develop a plan that you can maintain for life. For people living with hepatitis C,  keeping your weight under control can lower your risk for developing fibrosis, liver cancer, and diabetes.

Whatever healthy plan you try, or use now, may you remain safe, healthy and happy.

Until next time, Tina

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