DISEASES OF THE LIVER
Much of the so-called biliousness from which the human family is so
prone to suffer is nothing more or less than one of Nature's danger
signals by means of which man may understand that some part of the
delicate organism called the human body is being overworked. Close
investigation of these conditions has proved that it is the liver
which has been overtaxed, in many cases to such an extent that in a
measure it slows down, as any overtaxed machine will do, and has
become clogged with material which, owing to its condition, it is not
able to prepare properly and send out on time.
~Work of the Liver.~--When one considers the vast amount of work
performed by this organ, one marvels that so little trouble is
manifested. In another part of this text the functions of the liver
were defined. It was found to be the largest secretory organ in the
body, producing a constant supply of bile by means of which the fats
were dissolved and the digestion and absorption of the other food
materials facilitated. We likewise found that the greater part of the
fuel foods was transformed within this organ into available energy,
either for immediate or future use.
~As a Detoxifying Agent.~--To the liver must also be credited the
detoxifying of the various poisons produced within the body during the
process of metabolism or brought in by way of food. Too much cannot be
said as to the value of the liver in this respect, the importance of
which is made known as soon as anything happens to the organ to put it
even temporarily out of commission.
~Causes of Liver Disorders.~--Is it any wonder, then, that with such
abuses as overeating and drinking, especially of those foods rich in
fats and carbohydrates which depend upon the liver for their
availability in the body, Nature cries aloud for help and for the
comparative rest of this, her largest organ?
The taking of alcohol in excess has been found to bring about tissue
changes in the liver. Hence it must be avoided by individuals with a
tendency to biliousness or to any disease in which the liver is
involved.
~The Bowels.~--The bowels are as a rule constipated, and one of the
first means of relief is the overcoming of this condition. The method
of doing this depends upon the individual, and the treatment must be
decided on by the physician.
~Dietetic Treatment.~--The dietetic treatment consists in abstaining
from food or reducing the amount to a minimum while the attack lasts
and while the intestines are being thoroughly emptied. All stagnant
material which has clogged the bowels and which has been subjected to
the activities of putrefactive bacteria must be gotten rid of. The
diet must be especially low in fat. Oyster or clam broth, soft-cooked
eggs, toast, cereal, or rice, with a little milk instead of cream and
very little sugar, tea, and baked apple or stewed prunes are given.
~Convalescent Diet.~--After the attack the diet may be gradually
increased until it is again normal. Moderation must be observed in the
amount of food eaten; no highly seasoned or spiced foods, pickles, or
condiments, such as peppers, mustard, or horseradish, should be taken.
Salads should be dressed without oil. Lean beef, lamb chops, fish,
chicken, sweetbreads, quail, squab, eggs (except fried or hard
cooked), green vegetables (except radishes, onions, water-cress, and
celery) in abundance, a small amount of potato, rice, or tapioca,
fresh and cooked fruit with little, if any sugar, junket, custards,
fruit jellies, weak tea and coffee should constitute the diet. Certain
individuals find that milk increases the tendency to constipation;
this is probably due to the small amount taken; large quantities do
not as a rule produce this effect. Buttermilk, koumiss, and modified
milk are advised in severe cases.
~Diet for Constipation.~--Individuals inclined to biliousness should
endeavor to overcome the constipation which is one of the most
prominent features. This is done by proper diet more successfully than
by drugs (cathartics): bran bread, vegetable soup, fresh fruit, stewed
fruit, fruit beverages, plenty of water. The following menus are
suggested:
Breakfast--Stewed prunes
Oatmeal with milk (no sugar)
Weak tea or coffee
Toast (milk toast or dry toast)
Lunch--Tomato soup
1 small baked potato
1 lean lamb chop (broiled) or a poached egg on toast
Cup of weak tea
Dinner--Vegetable soup
1 slice of lean, rare beef (cut from the inside of the
roast)
Spinach
Rice
Lettuce and tomato salad
Lemon jelly
Breakfast--Grapefruit
Hominy with milk
Poached egg on toast
Weak coffee (milk and little sugar)
Lunch--Cream of green pea soup
Tomato jelly
Broiled sweetbreads
Weak tea
Toast
Dinner--Small portion of lean lamb or chicken
Boiled or mashed potatoes
String beans
Sliced tomatoes
Prune whip
~Advice to Patient.~--The above menus are merely suggested. The diet
may be selected from the list of foods already mentioned. The patient
must be warned against overeating and drinking. Pastry, rich cakes and
puddings, confectionery, gravies, etc., must be avoided. In certain
individuals beer will induce a bilious attack. By them it should be
avoided.
CIRRHOSIS OF THE LIVER
The cause of this disease and the stage in which it exists must
determine the treatment necessary. However, it matters not what
produced the disease, whether it is the result of alcoholism,
syphilis, etc., the diet plays an important role in its cure.
~The Diet.~--The diet in this disease, as in any other, must be
determined by the condition of the patient. Unfortunately, many
patients do not know of their condition until the disease is well
advanced and symptoms of obstruction are prominent. A study of these
must be made before the diet can be formulated. When the symptoms are
mainly those arising from disturbed digestion of the stomach and
intestines, without kidney or heart complication, the diet for chronic
gastritis is used.
~Restricting the Fluids.~--When the heart is involved, it is
sometimes found necessary to restrict the fluids (dry diet) to 1 quart
(about 1000 c.c.) per day. The Karell Cure has been used
advantageously in many of these cases. In cases where the kidneys are
involved, the diet will depend upon the condition of these organs.
~Restricting the Diet.~--The diet in any case must be restricted.
Individuals with a tendency to cirrhosis and those coming of a family
in which liver diseases are frequent should be especially warned about
the dangers of overeating and drinking. Alcohol should be avoided
especially by such individuals. They should keep their diet simple in
character and moderate in amounts.
~Avoidable Foods.~--All foods, such as condiments and spices, meat
extracts, the outside browned portions of roasted meat, alcoholic
beverages, which exert a stimulating or irritating effect upon the
liver, should be studiously avoided and the fats and carbohydrates
restricted, since, as it has already been demonstrated, it is upon the
liver that the body depends for the preparation of these substances
for their utilization. When, for example, the flow of bile is
lessened, an incomplete emulsification of the fats exists and the
fatty acids which are highly acid in character cannot be efficiently
dissolved or neutralized, or when the liver is diseased and for this
reason the conversion of glycogen into glucose is interfered with, the
utilization of the carbohydrate foods is thus impaired.
GALLSTONES
~Factors Influencing Their Formation.~--According to Friedenwald and
Ruhraeh[155] the two factors that in all probability exert the most
influence on the formation of gallstones are the stasis of bile and
the inflammation of the bile passages and gall bladder.
~Dietary Rules.~--There are certain dietary rules which should be
observed by all persons who have had gallstone attacks. These are (1)
to prevent stasis of bile, (2) to avoid fats. Everything should be
done to prevent the formation of the stones, and this can only be
accomplished by observing these rules. The flow of bile must be free;
this is encouraged by keeping the intestinal tract in good condition.
~Stimulating Peristalsis.~--Peristalsis must not be allowed to become
sluggish, for it is only during the process of digestion when the food
mass passes along the intestinal canal that there is an ejection of
bile into the intestines. When the passage is abnormally slow the bile
is in a measure dammed back with a formation of gallstones as a
result. The restriction of the fats has already been discussed in
another part of the chapter. It has been demonstrated that these
substances have a chemical influence upon the formation of gallstones
as well as upon the intestinal stasis which leads to their formation.
~Dietetic Treatment.~--Hence the diet should be so directed as to (1)
increase the flow of bile, and (2) to avoid all foods that are liable
to cause indigestion which may bring about putrefaction in the
intestinal tract and a consequent irritation and inflammation of the
bile passages and gall bladder.
The meals should be regular and an abundant diet advised to increase
the flow of bile and stimulate peristalsis in the intestines.
~Exercise.~--Exercise is especially recommended. Horseback riding,
swimming, rowing, golf, and tennis are especially valuable in forcing
the bile from the gall bladder and liver.
~The Clothing.~--The clothing should be loose enough to be perfectly
comfortable. Certain cases of gallstone attacks in women have been
said to have been traced to tight lacing, which interfered with the
normal flow of the bile.
~The Bowels.~--Constipation should be avoided, and the diet should be
directed with this point in view. The meals must be frequent, ranging
from four to six a day. In this way only is the flow of bile
encouraged. The breakfast should be ample in order to utilize the bile
secreted in the night season. With all this, care must be observed not
to give more food than can be adequately handled by the digestive
apparatus, since food which is not digested becomes a prey to the
actions of the putrefactive bacteria which infest it, and the toxic
substance thus formed produces the very result which all of our
efforts are directed to prevent.
~Available Foods.~--The following foods low in fats may be used in
formulating the diet:
Soups: Meat broth (made from lean meat) from which all the fat has
been removed.
Meats: Lean beef, lamb, chicken, squab, quail, lean fish (in small
quantities and not too frequently).
Green vegetables: Except peas and carrots; beets and turnips may be
taken sparingly.
Fruits: Oranges, lemons, grapefruit, and unsweetened stewed fruit.
Cereals: Wheat cereals, oatmeal, rice, and tapioca in moderation.
Bread: Whole wheat, white, rye, and graham bread, toast, and crackers.
Fluids: Weak tea and coffee (without cream, and a little sugar),
orange and lemonade, mineral waters, water, skimmed milk, whey.
Eggs: (except hard-cooked or fried).
Desserts: Fruit gelatin, fruit whips, raw or stewed fruit.
Avoid the following foods: Fats, oils, mutton, liver, brains,
sardines, and caviar, oily fish, rich gravies and sauces, sweet fruit,
peas, carrots, condiments and spices, pastry and confectionery,
pickles, alcoholic beverages. Restrict carbohydrates, yolks of eggs,
milk (cream must be skimmed off if too rich).
DAILY DIET SHEETS
I
Breakfast--Baked apple with milk
Cream of wheat with milk
Weak coffee or tea
Dry toast
11:30 A.M.--6 oz. orange juice, 1 egg white
Dinner--Beef broth (well skimmed) with crackers
Rice
Stewed pears
Weak tea
Toast or rolls
3:30 P.M.--Albumenized fruit juice with crackers
Supper--Wheatena with milk
Milk toast
Stewed prunes
Toast and tea
9 P.M.--Well-skimmed chicken broth with crackers
II
Breakfast--Stewed apples with milk
Milk toast
Coffee without cream
10:30 A.M.--Well-skimmed broth with crackers
Dinner--Tomato bouillon with crackers
Baked potato--1 small potato
Puree of spinach
Orange gelatin
Toast
3 P.M.--Albumenized lemonade
Supper--Oatmeal or cream of wheat with milk
Toast
Tea
Stewed fruit
9 P.M.--Well-skimmed broth with crackers
III
Breakfast--Grapefruit
Oatmeal with milk
Toast
Weak coffee
10:30 A.M.--Orangeade with graham crackers
Dinner--Cream of spinach soup (skimmed milk)
Small piece of the breast of chicken
Mashed or boiled potatoes
Asparagus on toast
Sliced oranges
3:30 P.M.--Well-skimmed broth with crackers
Supper--Farina or cream of wheat or wheatena, with milk
Baked potato
Baked apple with milk
Toast and tea
9 P.M.--Albumenized orange juice
IV
Breakfast--Sliced oranges
Oatmeal
Toast
Coffee
10:30 A.M.--Beef gruel, 6 oz.
Dinner--Cream of asparagus soup, skimmed milk
Thin slice of roast beef or whitefish
Rice or potatoes
Tender string beans
Fruit
Toast
Buttermilk
3:30 P.M.--Orangeade
Supper--Stewed fruit with puffed wheat or rice
Milk toast
Tea
9 P.M.--Broth
SUMMARY
~Functions of Liver.~--To transform fuel foods into available energy;
to detoxify those poisonous substances produced as the result of
metabolism of body tissue or brought in in food, and to select those
available for use; to secrete bile.
~Factors Influencing Disorder of Liver.~--Errors in diet: (a)
overeating; (b) excessive drinking; and (c) unbalanced diet,
especially as regards the amount of fats and carbohydrates in the
diet.
~The Bowels~, in most of the disturbances affecting the liver, become
constipated, thus causing much additional work on the part of the
liver in handling the products produced as the result of putrefactive
bacteria upon the accumulated mass in the colon.
~Tissue Changes~ in the liver have been caused by the taking of
alcohol, which should therefore be avoided by all individuals having
any disease involving the liver and by those with a predisposition to
liver disturbances.
~Exercise and Lack of Exercise~ are potent factors in the treatment
of conditions involving the liver. First, because the liver requires
exercise to enable it to empty itself more completely and assure a
free flow of bile; second, because exercise directly affects the
energy output of the body, causing an increased rate of metabolism and
a better utilization of the food ingested. Lack of exercise acts in
exactly the opposite direction, and it has been found that with the
majority of patients suffering from diseases of the liver too little
exercise and too much food are at the bottom of the trouble.
~Dietetic Treatment~ in the majority of diseases affecting the liver
is much the same. The keynote in each is a balanced diet. Constant
overeating and excessive drinking have proved the foundation of the
majority of such diseases, especially of the bilious type, while an
excess of fat and carbohydrates in the diet lead to the more serious
disorders.
~Biliousness~ requires abstinence from food for a short period and a
cleansing of the entire gastro-intestinal tract, the measures being
directed by the physician. After the bilious symptoms have subsided, a
simple, well-regulated diet should be established, in which no rich
foods of any sort are allowed. All condiments and spices which have an
astringent effect upon the bowels are strictly prohibited, and
alcoholic beverages had best be eliminated from the diet.
~Cirrhosis~ of the liver is apt to be insidious in its development,
taking a firm hold before the character of the disorder is discovered.
Dietetic treatment of this disturbance is most important and should be
directed toward overcoming not only the liver symptoms but other
symptoms as well.
~Gastro-intestinal Disturbances~, manifested in cirrhosis of the
liver, are treated by the diet used in chronic gastritis (see p. 250).
~Heart Symptoms~ sometimes occur during the course of the disease and
require especial attention to the diet. The fluids at times must be
restricted, in which case a modification of the Karell Cure will prove
valuable (see p. 342).
~Kidney Complications~ develop in a certain percentage of cases, and
it then becomes necessary to institute one of the various diets
devised to meet the needs of those special conditions (see Chapter
XVIII).
~Restricting the Diet~ will be found to be necessary for those
individuals showing a tendency to cirrhosis, also for those in whose
family diseases of the liver are of frequent occurrence. Such
individuals should be warned of the dangers arising from
overindulgence in food or alcoholic beverages.
~Prohibited Foods~ are those which by reason of their astringent
qualities favor the development of constipation, such as condiments
and spices; those foods which exert a stimulating and irritating
effect upon the liver and bile passages, such as alcohol, malt
extractives, etc.; and fats and carbohydrates in excessive quantities,
on account of the extra amount of work required of the liver in order
to make them available in the body.
~Gallstones~ develop as the result of inflammation or clogging of the
bile passages.
~Treatment~ is dietetic in character and is directed toward relieving
or preventing inflammation in the bile passages, also in stimulating
the flow of bile in order that it may not become sluggish and thus
give rise to the development of the gallstones.
~The Fats~, therefore must be restricted in the diet, as they, more
than any of the other food constituents, favor the above conditions.
~Peristalsis~ in the intestinal tract must be stimulated to facilitate
a free flow of bile, which will not occur where the movements are
sluggish. Stasis of the bile must be prevented or stones will be apt
to form.
~Dietetic Treatment~ for gallstones is therefore directed to increase
the flow of bile and to avoid the inflammation of the gall bladder and
bile passages which may result from the product of intestinal
putrefaction.
~The Diet~ consists of foods simple in character, low in fats, but
abundant in quantity, in order to prevent constipation. It must be
selected carefully that digestional disturbances may not develop.
~The Meals~ should be frequent, from four to six a day, in order to
encourage a free flow of bile.
~Breakfast~ should be ample in order that the bile secreted and
accumulated during the night may be utilized as soon as possible.
~Constipation~ must be avoided, and the foods particularly adapted to
prevent or overcome this condition should have a prominent place in
the diet. Any accumulation of unabsorbed food in the lower intestines
becomes a breeding ground for putrefactive bacteria, the product of
whose activity imposes a serious tax upon an already overworked organ.
PROBLEMS
(a) Formulate a diet for a patient suffering from gallstones. Outline
method of administration.
(b) List available foods for diets used in disturbances of the liver.
List the foods to be avoided in such cases.
FOOTNOTE:
[155] "Diet in Health and Disease," p. 399, by Friedenwald and Ruhraeh.