Diet taboos for cholestasis

The first is a single intake of more than 10g of saturated fat (about the amount of 2 pieces of braised fatty meat), the second is alcohol and any drinks containing alcohol, and the third is food that is moldy and contains aflatoxin. In fact, the remaining taboos must be adjusted based on the cause of your disease and the stage you are in. There is no one-size-fits-all standard.

Last month, I received a 28-year-old pregnant mother with cholestasis of pregnancy in the outpatient clinic. Her indicators were under good control, but her husband secretly drank two glasses of cold beer and showed off a butter hot pot meal. That night, her belly was so itchy that she scratched out red marks all over her back. The next day, the total bile acids were found to have increased from 12 μmol/L to 47 μmol/L, and she almost had an early cesarean section. I don’t say this to scare you. Think about it, bile is originally used to digest fat. When the bile duct is blocked, if you stuff a lot of oil into your stomach, it doesn’t mean that you are flushing a lot of kitchen waste into the already blocked sewer. It would be strange if it doesn’t make the blockage worse.

At this point, I have to mention that the requirements of different departments are actually quite different. No one is right or wrong, they just have different perspectives. For example, if you encounter acute cholestasis caused by stone obstruction during surgery, you will definitely be required to drink all fluids and fat-free before surgery. Even milk must be drank skim, for fear of stimulating gallbladder contraction and aggravating the obstruction, which may cause life-threatening pain. ； However, when the nutrition department follows up patients with chronic cholestasis, they are required to eat about 10g of unsaturated fat every day during the stable period, such as adding a few drops of olive oil to salads and nibbling half a piece of avocado. Otherwise, long-term fat deficiency and fat-soluble vitamins A, D, E, and K cannot be supplemented, and problems such as dry skin and osteoporosis will easily occur, which will slow down recovery.

Oh, by the way, there is another pitfall that everyone easily falls into. Many people think that eating plain food means drinking white porridge with pickles, or simmering old hen soup every day to replenish the body. This is really wrong. The high salt in pickles will aggravate the body's water and sodium retention. Cholestasis itself will easily cause edema in the lower limbs. If you eat too much, you will become swollen to the point where you can't even put on shoes. ； As for those milky-white old hen soup and pork rib soup, they look light and light without any oil. The thin layer of oil floating on them contains almost 15g of fat in a bowl. Drink it and you will step on the red line. There was an elderly patient who was recovering well after surgery. His filial son and daughter brought him stewed hens every day. However, after three days of drinking, his bilirubin went up again. After asking, he found out that the old man was reluctant to skim the oil and drank it all in his stomach.

There are also a few particularly controversial foods, so I’ll just talk about them. Take eggs, for example. The old saying was that you should never eat egg yolks if you have cholestasis. Now this is no longer a one-size-fits-all approach: if you have cholesterol stones blocking your bile ducts, you really need to eat less egg yolks, up to 2 a week. ； But if you have immune, drug-induced or pregnancy-induced stasis and have no problem with cholesterol metabolism, eating a whole boiled egg a day will not cause any problems. Instead, it can supplement high-quality protein, which is much better than eating those messy liver-protecting health products. Another example is seafood. Some people say you should never touch it. In fact, as long as you don’t have gout and don’t have high uric acid, it’s absolutely fine to eat some steamed shrimps and seabass, no more than 2 taels at a time. On the contrary, it’s easier to digest than eating red meat. Just don’t make braised or spicy food, wrapped in a bunch of oil and a bunch of chili peppers, that’s definitely not going to work.

I usually tell patients that I don’t ask them to memorize complex food ingredient lists because it’s too troublesome. I just use two tips: the first is to put hot dishes out and let them sit for 3 minutes. If there is a white oily film on the edge of the white porcelain bowl, you can just pass the dish.； The second is that after eating something, if your skin becomes itchy, your urine becomes darker, or your upper right abdomen becomes more painful, don't touch it next time. Everyone's tolerance is really different. I've seen people get sick after taking two bites of fried peanuts, and I've also seen people who occasionally eat a small cake during the stable period and it's fine. There's no need to copy other people's recipes.

To put it bluntly, diet is only a means of auxiliary control and cannot replace treatment. You should still take the medicine you should take, and do not drop the indicators that should be reviewed. As long as you stick to the three red lines mentioned at the beginning, it's okay to relax a little bit on the rest. You don't have to eat boiled vegetables every day to make life boring. After all, a good mood may be more helpful to recovery than strict control of your mouth.