Because the liver is involved in the transport, storage and metabolism of micronutrients, it is reasonable to assume that liver disease could result in abnormal micronutrient activity and levels. Plasma and erythrocyte trace elements were measured in 50 patients with nonalcoholic liver disease . Compared with controls, patients with cirrhosis had reduced serum levels of iron, zinc and selenium; erythrocyte levels of glutathione and selenium were also low. Trace element decrease was not related to the degree of liver function impairment; however, glutathione levels were related to the degree of failure.
Micronutrient losses and needs are often dictated by the type of liver disease and specific conditions associated with liver failure. For example, alcoholic liver disease can create deficiencies of B vitamins. Deficiency of folate or B12 can cause macrocytic anemia; B1; B6 and B12 deficiencies can cause neuropathy. In addition, Wernicke's encephalopathy is linked to thiamine deficiency. Since copper and manganese are excreted via the bile, the levels of these elements may be elevated when cholestasis is present. Iron levels may be high such as in hemochromatosis or hemosiderosis, but can be low following gastrointestinal bleeding.
Supplementation can be in the form of general over-the-counter multivitamin-mineral preparations. However, when significant micronutrient alterations are suspected, supplementation should be tailored to meet needs based on measured levels.
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WHAT IT IS A three-phase plan that has been likened to the low-carbohydrate Atkins program because during the first two weeks, South Beach eliminates most carbs, including bread, pasta, potatoes, fruit and most dairy products. In PHASE 2, healthy carbs, including most fruits, whole grains and dairy products are gradually reintroduced, but processed carbs such as bagels, cookies, cornflakes, regular pasta and rice cakes remain on the list of foods to avoid or eat rarely.