Diet in Liver Disease

Diet Recommendations in Cirrhosis

Malnutrition can be common in patients with liver cirrhosis and may be associated with poorer outcomes. Approximately 20% of people with early cirrhosis and close to 100% of people with severe cirrhosis have malnutrition. Due to liver dysfunction that can be associated with cirrhosis, the liver is not able to produce some nutritional proteins, store energy appropriately, or produce types of fat that are used for energy stores. As a result, metabolic compensatory changes can occur that mimic what occurs in non-cirrhotic people who are suffering from starvation. Therefore, people who have cirrhosis may need extra calories and protein. Other side effects of cirrhosis may include loss of appetite, nausea, vomiting, and unintentional weight loss. Due to all these changes it can help to eat small, frequent meals (4 to 7 times a day), including an evening snack.

A good place to start is with a healthful diet. Foods like fruits, vegetables, whole grains, and lean proteins are good choices. Try to eat plant based proteins or very lean cuts of meat such as chicken breast or turkey breast. Some studies show that patients with cirrhosis do better when they obtain protein from vegetables (such as beans, lentils, and tofu) and dairy products (eggs, milk, yogurt) instead of meats. It is better to eat a low fat diet versus high fat, as high fat diets have been implicated in worsening cirrhosis. Some people may benefit from high-nutritional supplement drinks, such as Ensure or Boost.

In addition to dietary changes, it is a good idea to take a daily multivitamin. Depending on the degree of cirrhosis, patients may lack the key minerals and fat-soluble vitamins (which are Vitamins A, D, E, and K) that the body requires. However, a balanced diet should easily provide these and in the rare case when it doesn't, supplements can be prescribed. Too much sodium (or salt) in the diet can also be harmful, because sodium encourages the body to retain water. This may cause and/or worsen ascites and swelling in your legs/feet. Oftentimes patients are asked to limit sodium intake to about 2,000mg a day or less.

In summary, if you have cirrhosis be careful to limit additional liver damage:

Don't drink 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.

Tips to reduce sodium intake

If you need to restrict sodium, here are some tips that can help:

Avoid salty foods, salt in cooking, and salt at the table. Anything that tastes salty (such as tomato sauce, salsa, soy sauce, canned soups) probably has too much salt. Spice things up with lemon juice or herbs, instead of salt.

  • Fresh foods usually are a better bet than processed foods. This includes canned vegetables which can already contain salt additives.
  • Read food labels when shopping. Check the amount of sodium in the foods you are buying.
  • Avoid fast-food restaurants. Most fast foods are very high in sodium.
  • Go easy on meats, especially red meats, which are high in sodium. When possible, consider vegetarian (meat-free) alternatives.
  • The more fluid you retain, the greater your need to avoid salt.

Dietary Sodium Calculator

This is a tool that was developed by the Department of Nutritional Sciences and the Faculty of Medicine at the University of Toronto.