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Eating Fish and Liver Disease

Updated on January 03, 2017
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Abdelhakim Elbarsha is a consultant Gastroenterologist and Endoscopist and a university Assistant Professor.

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The liver is a large organ that plays an extremely complex and significant role in the protection against toxins.

It receives blood from the gut which carries all the absorbed substances that can be digestion products, environmental toxins, medications ... etc ; and through a series of biochemical reactions, a huge number of these substances is converted to harmless products to be excreted later by kidneys.

Because of its first line defense duty, the liver is directly vulnerable to every thing we eat or consume, either food (including preservatives and colorants) , drinks or medications.

It's proved that liver health is affected by diet content, and that liver disease can be positively or negatively affected by food.

Among the questions that many patients with liver disease frequently ask, is what if they eat fish. Is fish eating beneficial or deleterious to their liver condition?

In this article, I tried to summarize how eating fish will affect your liver disease.

Avoid salted fish

Salt restriction is an important issue for patients with liver disease when they suffer from edema in the form of water accumulation in the body particularly in the legs and abdomen.

Smoked fish therefore should be eliminated from the menu as well as tanned fish (salmon, pilchards and tuna).

Alternatively, fish tinned in oil , with no salt, is accepted. Adding lemon or lime juice, spices, pepper, and herbs to fish is another way instead of adding salt.

Avoid salted fish
Avoid salted fish

Eat fish and don't worry about protein content

There is misconception regarding eating food with high protein and the increased risk of developing hepatic encephalopathy (a state of mental suppression that can be fatal), in patient with liver cirrhosis.

High protein intake can worsen hepatic encephalopathy, hence restricting proteins in encephalopathic patients is strongly recommended.

But in the absence of encephalopathy, protein restriction is not justifiable, and fish is not exception. Additionally, it's advisable to divide your daily fish intake (and protein in general), evenly throughout the day, in multiple snacks, rather one or two big meals.

Fish proteins contain taurine (an amino acid), which is essential for the integrity of your body tissues including in particular the walls of the arteries and veins connected to the liver

Farmed versus wild fish

Because they are fed unnatural diets, farmed fish (and generally all conventionally raised livestock), contain higher amounts of omega-6 polyunsaturated fatty acids, and occasionally poor in the beneficial omega-3 fatty acids.

Omega 6 fatty acids are polyunsaturated fatty acids that differ from omega-3 fatty acids in that they induce inflammatory changes in the body tissues including the liver.

Therefore, always look for wild (naturally fed) fish.

Eating fish provides your liver with healthy fats

Fish contain essential fatty acids in their natural and unprocessed form.

This is particularly true for oily fish. Examples are :

  • Salmon
  • Tuna
  • Sardines
  • Herring
  • Sablefish
  • Flounder
  • Trout
  • Bass
  • Mackerel

Essential fatty acids are crucial in the structure of liver cell membranes. Therefore a normal liver function depends on adequate supply with essential fatty acids, and not following a low fat diet which many people think it's good for their liver health. Foods with fats that need to be restricted are generally vegetable oils, and processed fat.

Fish also contain methionine, which helps detoxification of your body by the liver.

Salmon
Salmon

Fresh versus preserved fish

No doubt, the fresh!

Preserved (eg smoked fish ), in addition to their possible increased salt content, pose an elevated risk of stomach cancer.

Should you eat fish if you have fatty liver?

Fish are good source of protein and “good fat”. Deep sea fish are richer in “good fat”.

A diet rich in protein would supply you with your daily needs of amino acids. Because they are essential in the synthesis of enzymes carrying out detoxification reactions, these play a vital role in maintaining the normal liver toxin “cleansing “ function. This will help halting further liver damage when it's already diseased with fat accumulation.

“Good fats” are omega-3 fatty acids which are the polyunsaturated fatty acids eicosapentaenoic acid and docosahexaenoic acid, exclusively found in marine oils.

The high omega-3 fatty acid content of fish, adds extra benefit of fish for patients with early liver disease and fatty liver. Omega-3 fatty acids are naturally occurring anti inflammatory substances, that can prevent liver cell damage and can even improve abnormally high liver enzymes.

Therefore they reverse the abnormalities that can lead eventually to liver cirrhosis if left untreated.

The main sources of omega-3 fatty acids, are cold-water fish, such as mackerel, herring, flaxseeds, and salmon.

It's recommend to eat fish at least three times a week to maintain a steady supply with omega-3 fatty acids, but you can boost your daily intake of essential fatty acids and omega-3 fatty acids by taking fish oil in the form of capsules.

Fish oil and omega-3 fatty acids supplements reduce the liver fat content and improve the portal blood pressure (i.e. the blood pressure in the portal venous blood circulation).

Studies clearly showed that fish oil and omega-3 fatty acids supplements significantly improve fatty changes in the liver and are recommended for patients with Non-Alcoholic Fatty Liver Disease (NAFLD)

Fatty liver disease as seen under the light microscope.
Fatty liver disease as seen under the light microscope.

What about shellfish?

Although not fish, shellfish is worth mentioning liver protective seafood. It's rich in a substance called betane (also known as trimethyl glycine).

Betane was found to be effective in minimizing alcohol-induced liver injury, owing to its effect in increasing vitamin A and glutathione (an antioxidant) levels in the liver tissue.

Betane reduces the amount of fat and other harmful substances in the liver that can accelerate the process of natural cell death (apoptosis). Furthermore, it stimulates a series of chemical reactions that lead to mobilization of fat from the liver.

It was found that consuming 300 grams per week or more of fish reduces the risk of developing alcoholic liver disease.

Shellfish
Shellfish

What would happen if you don’t eat fish?

A diet devoid of fish is generally poor in omega-3 fatty acids and relatively rich in omega-6 fatty acids.

Omega-6 fatty acids, although they are polyunsaturated fatty acids, they enhance the risk of injury of a normal liver by increasing the production of certain toxic materials in the body. They also induce the formation of cholesterol stones in the gallbladder, which may cause inflammation (cholecystitis) or obstruction of the bile ducts resulting in jaundice and even liver damage.

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