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If you have cirrhosis

It is vitally important that patients with liver disease maintain a balanced diet, one which ensures adequate calories, carbohydrates, fats and proteins. Such a diet will aid the liver in the regeneration of liver cells. Nutrition that supports this regeneration is a means of treatment of some liver disorders.

Patients with cirrhosis, for example, who are malnourished, require a diet rich in protein and providing 2,000 – 3,000 calories per day to help the liver re-build itself. However, some cirrhotic patients have protein intolerance. Too much protein will result in an increased amount of ammonia in the blood, while too little protein can reduce healing of the liver. Doctors must carefully prescribe a specific amount of protein that will not elevate the blood ammonia. Lactulose and neomycin are two drugs that help keep the ammonia down.

It is believed that the risk of gallbladder disorders can be reduced by avoiding high fat and cholesterol foods and preventing obesity. The gallbladder is a storage sac for the bile produced by the liver. During digestion, the gallbladder releases bile into the small intestine through the common bile duct. Most gallbladder problems are caused by gallstones and 80-90% of all gallstones are produced from excessive cholesterol which crystallizes and forms stones. By maintaining a well-balanced diet and avoiding high cholesterol intake, the incidence of gallstone formation may be lowered.

If you have cirrhosis, be careful to limit additional liver damage:

Don’t drink alcohol. Whether your cirrhosis was caused by chronic alcohol use or another disease, avoid alcohol. Drinking alcohol may cause further liver damage.
Eat a low-sodium diet. Excess salt can cause your body to retain fluids, worsening swelling in your abdomen and legs. Use herbs for seasoning your food, rather than salt. Choose prepared foods that are low in sodium.
Eat a healthy diet. People with cirrhosis can experience malnutrition. Combat this with a healthy plant-based diet that includes a variety of fruits and vegetables. Choose lean protein, such as legumes, poultry or fish. Avoid raw seafood.
Avoid infections. Cirrhosis make sit more difficult for you to fight off infections. Protect yourself by avoiding people who are sick and washing your hands frequently. Get vaccinated for hepatitis A and B, influenza, and pneumonia.
Use over-the-counter medications carefully. Cirrhosis makes it more difficult for your liver to process drugs. For this reason, ask your doctor before taking any medications, including nonprescription drugs. Avoid drugs such as aspirin and ibuprofen (Advil, Motrin IB). If you have liver damage, your doctor may recommend you avoid acetaminophen (Tylenol, others) or take it in low doses for pain relief.

People with cirrhosis may need more extra calories and protein. They may lose their appetite and experience nausea, vomiting, and severe weight loss. This can lead to shortage of the minerals calcium and magnesium (signs include muscle cramps, fatigue, weakness, nausea, and vomiting), or a shortage of zinc (signs include reduced ability to taste, changes in taste).

It can help to eat small, frequent meals (4 to 7 times a day), including an evening snack.

When the scarring from cirrhosis prevents blood from passing through the liver, pressure increases in the veins entering the liver. This is called portal hypertension. The body is forced to reroute the blood away from the liver and into the general blood circulation. This causes large blood vessels, called “varices,” to form.

Because the rerouted blood bypasses the liver, it contains high levels of amino acids, ammonia, and toxins that normally would have been handled by the liver. When these substances reach the brain, they can cause confusion and temporary loss of memory (a condition called “hepatic encephalopathy”).

Amino acids and ammonia come from protein in the diet. Some evidence shows that patients with cirrhosis do better when they get their protein from vegetables (such as beans, lentils, and tofu) and from dairy products (eggs, milk, yogurt) instead of from meats.

General recommendations for patients with severe liver disease include:

Eat large amounts of carbohydrate foods. Carbohydrates should be the major source of calories in this diet.
Eat a moderate intake of fat, as prescribed by the health care provider. The increased carbohydrates and fat help prevent protein breakdown in the liver.
Have about 1 gram of protein per kilogram of body weight. This means that a 154-pound (70-kilogram) man should eat 70 grams of protein per day. This does not include the protein from starchy foods and vegetables. A person with a badly damaged liver may need to eat less protein. Talk to your doctor about your protein needs.
Take vitamin supplements, especially B-complex vitamins.
Reduce the amount of salt you consume (typically less than 1500 milligrams per day) if you are retaining fluid.

Low blood pressure

Causes

By Mayo Clinic Staff

Blood pressure is a measurement of the pressure in your arteries during the active and resting phases of each heartbeat. Here’s what the numbers mean:

Systolic pressure. The first (top) number in a blood pressure reading, this is the amount of pressure your heart generates when pumping blood through your arteries to the rest of your body.
Diastolic pressure. The second (bottom) number in a blood pressure reading, this refers to the amount of pressure in your arteries when your heart is at rest between beats.

Current guidelines identify normal blood pressure as lower than 120/80 mm Hg.

Although you can get an accurate blood pressure reading at any given time, blood pressure isn’t always the same. It can vary considerably in a short amount of time — sometimes from one heartbeat to the next, depending on body position, breathing rhythm, stress level, physical condition, medications you take, what you eat and drink, and even time of day. Blood pressure is usually lowest at night and rises sharply on waking.

Blood pressure: How low can you go?

What’s considered low blood pressure for you may be normal for someone else. Most doctors consider chronically low blood pressure too low only if it causes noticeable symptoms.

Some experts define low blood pressure as readings lower than 90 mm Hg systolic or 60 mm Hg diastolic — you need to have only one number in the low range for your blood pressure to be considered lower than normal. In other words, if your systolic pressure is a perfect 115, but your diastolic pressure is 50, you’re considered to have lower than normal pressure.

A sudden fall in blood pressure also can be dangerous. A change of just 20 mm Hg — a drop from 110 systolic to 90 mm Hg systolic, for example — can cause dizziness and fainting when the brain fails to receive an adequate supply of blood.

And big plunges, especially those caused by uncontrolled bleeding, severe infections or allergic reactions, can be life-threatening.

Athletes and people who exercise regularly tend to have lower blood pressure and a slower heart rate than do people who aren’t as fit. So, in general, do nonsmokers and people who eat a healthy diet and maintain a normal weight.

But in some rare instances, low blood pressure can be a sign of serious, even life-threatening disorders.

Conditions that can cause low blood pressure

Some medical conditions can cause low blood pressure. These include:

Pregnancy. Because a woman’s circulatory system expands rapidly during pregnancy, blood pressure is likely to drop. This is normal, and blood pressure usually returns to your pre-pregnancy level after you’ve given birth.
Heart problems. Some heart conditions that can lead to low blood pressure include extremely low heart rate (bradycardia), heart valve problems, heart attack and heart failure.These conditions may cause low blood pressure because they prevent your body from being able to circulate enough blood.
Endocrine problems. Thyroid conditions — such as parathyroid disease — adrenal insufficiency (Addison’s disease), low blood sugar (hypoglycemia) and, in some cases, diabetes can trigger low blood pressure.
Dehydration. When you become dehydrated, your body loses more water than it takes in. Even mild dehydration can cause weakness, dizziness and fatigue. Fever, vomiting, severe diarrhea, overuse of diuretics and strenuous exercise can all lead to dehydration.Far more serious is hypovolemic shock, a life-threatening complication of dehydration. It occurs when low blood volume causes a sudden drop in blood pressure and a reduction in the amount of oxygen reaching your tissues. If untreated, severe hypovolemic shock can cause death within a few minutes or hours.
Blood loss. Losing a lot of blood from a major injury or internal bleeding reduces the amount of blood in your body, leading to a severe drop in blood pressure.
Severe infection (septicemia). Septicemia can happen when an infection in the body enters the bloodstream. This condition can lead to a life-threatening drop in blood pressure called septic shock.
Severe allergic reaction (anaphylaxis). Anaphylaxis is a severe and potentially life-threatening allergic reaction. Common triggers of anaphylaxis include foods, certain medications, insect venoms and latex. Anaphylaxis can cause breathing problems, hives, itching, a swollen throat and a drop in blood pressure.
Lack of nutrients in your diet. A lack of the vitamins B-12 and folate can cause a condition in which your body doesn’t produce enough red blood cells (anemia), causing low blood pressure.

Medications that can cause low blood pressure

Some medications you may take can also cause low blood pressure, including:

Diuretics (water pills), such as furosemide (Lasix) and hydrochlorothiazide (Microzide, Oretic)
Alpha blockers, such as prazosin (Minipress) and labetalol
Beta blockers, such as atenolol (Tenormin), propranolol (Inderal, Innopran XL, others) and timolol
Drugs for Parkinson’s disease, such as pramipexole (Mirapex) or those containing levodopa
Certain types of antidepressants (tricyclic antidepressants), including doxepin (Silenor), imipramine (Tofranil), protriptyline (Vivactil) and trimipramine (Surmontil)
Sildenafil (Viagra) or tadalafil (Cialis), particularly in combination with the heart medication nitroglycerin

Types of low blood pressure

Doctors often break down low blood pressure (hypotension) into different categories, depending on the causes and other factors. Some types of low blood pressure include:

Low blood pressure on standing up (orthostatic, or postural, hypotension). This is a sudden drop in blood pressure when you stand up from a sitting position or if you stand up after lying down.Ordinarily, gravity causes blood to pool in your legs whenever you stand. Your body compensates for this by increasing your heart rate and constricting blood vessels, thereby ensuring that enough blood returns to your brain.
But in people with orthostatic hypotension, this compensating mechanism fails and blood pressure falls, leading to symptoms of dizziness, lightheadedness, blurred vision and even fainting.

Orthostatic hypotension can occur for a variety of reasons, including dehydration, prolonged bed rest, pregnancy, diabetes, heart problems, burns, excessive heat, large varicose veins and certain neurological disorders.

A number of medications also can cause orthostatic hypotension, particularly drugs used to treat high blood pressure — diuretics, beta blockers, calcium channel blockers and angiotensin-converting enzyme (ACE) inhibitors — as well as antidepressants and drugs used to treat Parkinson’s disease and erectile dysfunction.

Orthostatic hypotension is especially common in older adults, with as many as 20 percent of those older than age 65 experiencing orthostatic hypotension.

But orthostatic hypotension can also affect young, otherwise healthy people who stand up suddenly after sitting with their legs crossed for long periods or after working for a time in a squatting position.
Low blood pressure after eating (postprandial hypotension). Postprandial hypotension is a sudden drop in blood pressure after eating. It affects mostly older adults.Just as gravity pulls blood to your feet when you stand, a large amount of blood flows to your digestive tract after you eat.
Ordinarily, your body counteracts this by increasing your heart rate and constricting certain blood vessels to help maintain normal blood pressure. But in some people these mechanisms fail, leading to dizziness, faintness and falls.

Postprandial hypotension is more likely to affect people with high blood pressure or autonomic nervous system disorders such as Parkinson’s disease.

Lowering the dose of blood pressure drugs and eating small, low-carbohydrate meals may help reduce symptoms.
Low blood pressure from faulty brain signals (neurally mediated hypotension). This disorder causes blood pressure to drop after standing for long periods, leading to signs and symptoms such as dizziness, nausea and fainting.Neurally mediated hypotension mostly affects young people, and it seems to occur because of a miscommunication between the heart and the brain.
When you stand for extended periods, your blood pressure falls as blood pools in your legs. Normally, your body then makes adjustments to normalize your blood pressure.

But in people with neurally mediated hypotension, nerves in the heart’s left ventricle actually signal the brain that blood pressure is too high, rather than too low.

As a result, the brain lessens the heart rate, decreasing blood pressure even further. This causes more blood to pool in the legs and less blood to reach the brain, leading to lightheadedness and fainting.
Low blood pressure due to nervous system damage (multiple system atrophy with orthostatic hypotension).Also called Shy-Drager syndrome, this rare disorder causes progressive damage to the autonomic nervous system, which controls involuntary functions such as blood pressure, heart rate, breathing and digestion.Although this condition can be associated with muscle tremors, slowed movement, problems with coordination and speech, and incontinence, its main characteristic is severe orthostatic hypotension in combination with very high blood pressure when lying down.

What is trans fat?

rans fat raises your LDL (“bad”) cholesterol and lowers your HDL (“good”) (HDL) cholesterol. Find out more about trans fat and how to avoid it.

By Mayo Clinic Staff

Trans fat is considered by many doctors to be the worst type of fat you can eat. Unlike other dietary fats, trans fat — also called trans-fatty acids — both raises your LDL (“bad”) cholesterol and lowers your HDL (“good”) cholesterol.

A high LDL cholesterol level in combination with a low HDL cholesterol level increases your risk of heart disease, the leading killer of men and women. Here’s some information about trans fat and how to avoid it.

What is trans fat?

Some meat and dairy products contain small amounts of naturally occurring trans fat. But most trans fat is formed through an industrial process that adds hydrogen to vegetable oil, which causes the oil to become solid at room temperature.

This partially hydrogenated oil is less likely to spoil, so foods made with it have a longer shelf life. Some restaurants use partially hydrogenated vegetable oil in their deep fryers, because it doesn’t have to be changed as often as do other oils.

Trans fat in your food

The manufactured form of trans fat, known as partially hydrogenated oil, is found in a variety of food products, including:

Baked goods. Most cakes, cookies, pie crusts and crackers contain shortening, which is usually made from partially hydrogenated vegetable oil. Ready-made frosting is another source of trans fat.
Snacks. Potato, corn and tortilla chips often contain trans fat. And while popcorn can be a healthy snack, many types of packaged or microwave popcorn use trans fat to help cook or flavor the popcorn.
Fried food. Foods that require deep frying — french fries, doughnuts and fried chicken — can contain trans fat from the oil used in the cooking process.
Refrigerator dough. Products such as canned biscuits and cinnamon rolls often contain trans fat, as do frozen pizza crusts.
Creamer and margarine. Nondairy coffee creamer and stick margarines also may contain partially hydrogenated vegetable oils.

Reading food labels

In the United States if a food has less than 0.5 grams of trans fat in a serving, the food label can read 0 grams trans fat. This hidden trans fat can add up quickly, especially if you eat several servings of multiple foods containing less than 0.5 grams a serving.

When you check the food label for trans fat, also check the food’s ingredient list for partially hydrogenated vegetable oil — which indicates that the food contains some trans fat, even if the amount is below 0.5 grams.