Diet Plan For Liver Cirrhosis

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Diet plan for liver cirrhosis is important for people with liver failure to follow. The doctors will advise their patients about the foods to include in their diet in order to help improve their health and reduce the risk of further damage.

Diet and cirrhosis

Having cirrhosis or advanced liver disease usually means you will need to make some changes to your diet. As well as generally eating healthily you may need to follow special advice to make sure you get enough energy (calories) and protein, and not too much salt. This is important to stop you from becoming malnourished and losing muscle mass.

Around 2 in 10 people with compensated cirrhosis are malnourished, but this increases to more than 5 in 10 people with decompensated cirrhosis.

For specific advice on your diet, ask your doctor to refer you to a dietitian. When you see a dietitian, the advice you receive will be specific for you. The guidance here is more general and you shouldn’t make any changes without first discussing them with the professionals looking after you.

  • Eat little and often
  • Eat more calories and protein
  • Reduce salt to help manage fluid retention and bloating (ascites and oedema)
  • Managing hyperglycaemia (high blood sugar) and diabetes
  • Supplements for people with or at risk of bone disease (osteoporosis)

Eat little and often

People who have cirrhosis often eat ‘little and often’, a style of eating called grazing. Eating more often means your body doesn’t start breaking down the protein in your muscles for energy.

Instead of having three main meals aim to eat something every 2 to 3 hours and eat a snack before bedtime. This should be something high in starchy carbohydrates such as cereal, porridge, rice pudding or shortbread.

Eat more calories and protein

When cirrhosis develops your liver is no longer able to store glycogen, a form of carbohydrate which it needs to meet your body’s energy demands. Your liver tries to make up for this but you often need more energy and protein in your diet.

You can increase the amount of protein in your diet by eating:

  • Beans and pulses such as lentils, kidney beans, or baked beans
  • Nuts such as almonds or walnuts
  • Eggs, cheese and other dairy products
  • Fish such as cod, salmon, and tinned or fresh tuna, sardines or mackerel
  • Meats such as turkey, chicken, or lean cuts of beef, pork and lamb

If you are underweight or malnourished then you will need to increase the amounts of energy and protein you eat even more. Regular snacking can top them up. There are also a number of high protein supplements that your dietitian may recommend and your doctor can prescribe.

Snacks to top up your energy and protein levels

  • Teacake with butter
  • 3 crackers with butter and cheese
  • Breakfast cereal with full cream milk
  • Fruit scone with butter and jam
  • 2 slices of toast with jam
  • Milky drinks
  • 2 slices of fruit loaf
  • Hot chocolate and a banana

If you are overweight you may be advised to lose weight. This should be done by reducing your fat and carbohydrate intake, but keeping your protein intake high and increasing physical activity levels to ensure you do not compromise your muscle mass.

Further advice on protein for people with hepatic encephalopathy (brain fog)

People with hepatic encephalopathy should also follow the above guidance including to eat more protein. In the past, patients were advised to cut down on protein. We now know this is wrong, but you may still see it in some information or hear it said by health professionals.

You might find it helpful to:

  • Spread your protein intake out over the day. Avoid having all of your daily protein in one meal.
  • Take as much of your protein from vegetable sources as possible. Vegetable protein is better tolerated than dairy or meat. Try lentils, beans, peas, nuts, oatmeal, wild rice, and soybean products such as soy milk, tofu and edamame.

Choose dairy sources of protein such as eggs and cheese over meat sources. Dairy can be better tolerated than protein from meat sources. Fish and poultry are better sources than red meat.

Reduce salt to help manage fluid retention and bloating (ascites and oedema)

The liver plays a major role in regulating the balance of water and sodium (salt) in your body. When cirrhosis develops, the liver may lose this ability, leading to ‘fluid retention’. This can result in swelling of the feet and legs (oedema) and in a build-up of fluid in the abdomen (ascites). The presence of ascites may cause abdominal discomfort and make it difficult to eat without feeling bloated and uncomfortable.

Fluid retention is generally managed with diuretics (water pills) and in certain circumstances, by the drainage of fluid from your abdomen (paracentesis). Your health professional might also advise you to cut down on salt for example by following a ‘no added salt’ diet.

If you are cutting down on salt, it is very important that you receive advice from a registered dietitian about the foods you can eat and those you should avoid. Some foods can surprise you and be much higher in salt than you would expect. And some products labelled as low-salt can have other ingredients that you should not have too much of. For example potassium can increase the risk of heart problems.

Tips to reduce the amount of salt you eat:

  • Do not add salt to meals at the table. Add a small amount during cooking if need be.
  • Avoid very salty foods such as ham, bacon, sausages, frankfurters, salami and other cold cuts, Bovril, Marmite, other yeast extracts, sardines and anchovies.
  • Avoid smoked fish.
  • Avoid fish tinned in brine, including salmon, tuna and pilchards. Look for products tinned in oil or water.
  • Check food labels – anything with more than 1.5g salt per 100g (or 0.6g sodium) is high in salt. Salt is included in traffic light labelling, avoid products with a red light for salt.
  • Some bottled waters are high in sodium – check the labels carefully.

It is also important to be aware that some prescription and over the counter medications have a high salt content. If the sodium content on the labelling of your medication is not clear, or you are unsure if it is suitable, your pharmacist or doctor should be able to advise you.

If you are struggling for how to add flavour to your food without salt then ground pepper, vinegar, herbs and spices can work well. Alternatively, try:

  • Lemon juice on fish or meat
  • Olive oil and vinegar with salad and vegetables
  • Mustard powder or nutmeg with mashed potato

Fresh herbs, lime, garlic, chilli and ginger with pasta, vegetables and meat dishes.

What to Eat When You Have Cirrhosis

If you have cirrhosis, what you eat and drink each day is especially important

A cirrhosis diet is designed to help people with cirrhosis who may become malnourished due to changes in their metabolism and digestion that occur as the liver becomes more damaged.

As such, if you have this condition, what you eat and drink each day is especially important. Many foods to avoid with cirrhosis contain protein, sodium, and sugar that require your liver to work harder—a demand it may no longer be able to meet.

This article explains how a cirrhosis diet plan may be crafted with the help of your healthcare team members, such as a registered dietitian. This will ensure that you’re adequately nourished and avoiding choices that can worsen your condition and otherwise impact your health.

Basics of a Cirrhosis Diet
Verywell / JR Bee
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Benefits

The liver has more than 500 functions, making it one of the most vital organs.1 If your liver is damaged from cirrhosis, it is not able to efficiently perform one of its most important tasks: helping your body get nutrition from the food you eat.

A cirrhosis diet can help provide adequate nutrition, reduce the amount of work your liver needs to do, thwart related complications, and prevent further liver damage. Research has shown that people with liver disease who aren’t adequately nourished are more likely to experience complications from cirrhosis, including death.2

Authors of a 2018 article in the Journal of Clinical Gastroenterology say that “dietary management of cirrhosis is not a one-size-fits-all approach.” A cirrhosis diet should be started early in treatment to improve the prognosis and outcomes.3

Unfortunately, existing scarring from cirrhosis cannot be reversed. Diet, then, is a key way to take charge of your future if you have liver cirrhosis.

How It Works

Your cirrhosis diet will need to be tailored based on your overall health and individual needs, but there are some general dietary guidelines that often shape this eating plan:4

  • Avoiding alcohol: Any amount is considered unsafe for anyone with cirrhosis, as it’s a potential cause of more liver damage—even liver failure. Drinking can also contribute to malnutrition and other health concerns.
  • Limiting fats: The body digests fats using bile, a yellow-green fluid made in the liver. When the liver is damaged, the production and supply of bile may be affected, leading to digestive symptoms. A liver that isn’t working well has a hard time processing a high-fat meal. (Healthy fats can be included in moderation.)
  • Avoiding raw or undercooked meat/seafood: People with liver damage from cirrhosis have impaired immune function, meaning bacteria and viruses that these foods can harbor can lead to a potentially serious infection.

In addition to changing the content of your diet, you may need to change the quantity of the food you eat. Having liver disease can increase your risk for malnourishment, so you may need to eat more calories in a day to meet the increased energy demands on your body due to your condition.5

If you have liver disease, know that the recommendations for protein intake vary. The influence of protein on liver disease is somewhat controversial and still being studied.6

You’ll need to consult with your healthcare provider or a dietitian to determine the exact amount of protein recommended for you. The calories from protein will be an essential component of a varied and nutritious diet, and protein is key to preventing muscle atrophy (thinning).7

Your healthcare provider may want you to make additional, specific changes to your diet to help manage or prevent other conditions people with liver cirrhosis may be more likely to get.

Duration

If you are at risk for liver disease, your healthcare provider may want you to follow a cirrhosis diet even if you don’t feel sick. Someone in the early stages of liver disease (compensated phase) usually doesn’t have any symptoms.

Signs of liver disease may take years to show up, and they do so only once damage to the liver has become severe (decompensated phase).8 Since changing how you eat can only help to prevent additional liver damage, but can’t heal what’s already occurred, you will likely need to be on a cirrhosis diet plan for a long time. 

What to Eat

If you’re following a cirrhosis diet, there are some foods and beverages you’ll need to strictly avoid. However, you’ll have your choice of many nutritious and tasty foods, including fresh produce, whole grains, and plant-based protein.

Compliant

  • Fruits and vegetables (raw or cooked without butter, oil, or salt)
  • Eggs, egg whites
  • Cooked fish (salmon, tuna)
  • Lean chicken or turkey (without the skin) 
  • Low-fat Greek yogurt
  • Cream cheese, ricotta
  • Hard cheeses (cheddar, mozzarella) 
  • Nuts and seeds (unsalted) 
  • Dried beans and legumes
  • Nut butters (unsalted)
  • Tofu
  • Fortified milk alternatives (almond, soy, rice)
  • Margarine
  • Oats
  • Whole grain bread, crackers, and cereals
  • Brown rice 
  • Olive oil 
  • Fresh herbs 
  • Low-fat milk 
  • Garlic
  • Ginger
  • Quinoa, couscous 
  • Granola and cereal bars 
  • Coconut water 
  • Meal/nutritional supplements, as approved 

Non-Compliant

  • Raw or partially raw fish and shellfish (e.g., oysters, clams) 
  • Fast food, fried food
  • Red meat 
  • Canned food (meat, soup, vegetables)
  • Packaged, processed snacks and meals (incl. frozen)
  • Hot dogs, sausage, lunchmeat 
  • Sauerkraut, pickles 
  • Buttermilk 
  • Tomato sauce or paste
  • Instant hot cereal or oatmeal
  • Potato chips, pretzels, rice cakes, crackers, popcorn 
  • Refined white flour pasta, bread, and white rice 
  • Oils high in trans fat or partially hydrogenated oils (palm oil, coconut oil)
  • Breading, coating, and stuffing mixes 
  • Full-fat dairy products
  • Bread, biscuit, pancake, and baked good mixes 
  • Pastries, cake, cookies, muffins, doughnuts 
  • American, Parmesan, Swiss, blue, feta, cottage cheese, cheese slices or spreads
  • Pudding, custard, or frosting mixes
  • Table salt, sea salt, mixed seasonings
  • Ketchup, soy sauce, salsa, salad dressing, steak sauce
  • Bouillon cubes, broth, gravy, and stock
  • Caffeinated tea, coffee, and soft drinks
  • Alcohol

Fruits and vegetables: Choose fresh produce when possible, as canned varieties usually have sodium and sugar. Add fruit to cereal or oats for extra nutrition, fiber, and a little natural sweetness. Fiber-rich fruits like apples make a healthy and satisfying snack on their own. 

Dairy: Full-fat dairy products will likely be too hard for your body to digest. Stick to low-fat Greek yogurt, small portions of low-sodium hard cheese, and fortified dairy-free milk alternatives like almond or soy.

Rich, milk-based desserts like pudding, custard, and ice cream should be limited. You may need to avoid them completely on a cirrhosis diet if you have significant trouble processing fat and sugar.

Grains: Choose whole-grain bread, pasta, brown rice, and cereal instead of those made with refined white flour. Granola and granola bars may be approved for quick snacks as long as they’re low in sugar and sodium.

Protein: Red meat isn’t approved for a cirrhosis diet, nor is any kind of processed lunch meat or sausage. Small servings of lean poultry without the skin, some types of fresh-caught fish (such as salmon), and eggs or egg whites may be suitable.

Most of your protein should come from plant-based sources such as dried beans and legumes, small portions of unsalted nuts or nut butter, and tofu. 

Desserts: Packaged cake, cookie, brownie, biscuit, pancake, and waffle mixes can be high in sugar and salt, so it’s best to avoid them. In general, you’ll want to avoid pastries, doughnuts, and muffins, unless you can make your own low-fat, low-sugar, and low-salt versions.

Beverages: You cannot drink alcohol if you have liver cirrhosis, but you’ll have plenty of other options. Water is the most hydrating choice, but if you are on a low-sodium diet, you’ll want to check the labels on bottled water as some contain sodium. Milk and juice should only be consumed if pasteurized.

While some research has suggested coffee (but not other caffeine-containing beverages) could have benefits for people with liver disease due to alcohol use, most medical professionals advise that patients with cirrhosis avoid caffeinated beverages, including coffee, tea, and soft drinks.

Recommended Timing

Liver disease can lead to malnourishment, in which case your healthcare provider might want you to eat more calories.9 If you don’t feel up to eating larger meals to increase your caloric intake, try eating small, frequent meals and snacks throughout the day.

Some people with liver disease find they wake up in the night. They may stay awake for long stretches and end up taking naps during the day. If you are awake in the middle of the night, research has shown that having a late-night snack (especially those that have been specially formulated for this purpose) can be helpful for people with cirrhosis.

If your sleep schedule is interrupted, be sure that you are planning your meals around when you are awake, whether it’s during the day or at night. Try not to go longer than a couple of hours without a meal or snack. 

Cooking Tips

Try grilling or boiling veggies and preparing them without oil or butter.

If you’re reducing your sodium intake as part of a cirrhosis diet, try using fresh herbs and spices instead of table salt. If you’re used to adding salt to your food and find it difficult to break the habit, your healthcare provider may allow you to use a salt substitute.

When cooking meat, start by choosing lean cuts. Skinless poultry is a healthier option than red meat.

You may be allowed to have small portions of beef on occasion depending on how it’s prepared. For example, grilling meat instead of frying with oil or butter reduces the fat content and prevents it from becoming too greasy for a cirrhosis diet. 

In addition to avoiding raw or partially cooked meat and seafood, practice proper food handling and safety practices to further reduce your risk of foodborne infections.

Modifications

You may need to adapt your diet if you develop complications from cirrhosis, such as ascites, hypoglycemia, and encephalopathy.10 If you develop one or more of these conditions, your healthcare provider may recommend additional changes to your diet, including limiting salt, sugar, and protein.

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