What to Eat if You Have Cirrhosis

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Everyone can benefit from a balanced and healthy diet, but if you have cirrhosis of the liver, the choices you make about what you eat and drink each day have a direct effect on the condition. Proper nutrition is a key part of managing any chronic health condition, but it can be challenging to stay adequately nourished if you have cirrhosis.

It’s not uncommon for people with liver disease to become malnourished due to changes in their metabolism and digestive symptoms as the organ becomes more damaged. You’ll need to work with your doctor and other members of your health care team (such as a registered dietician) to create a cirrhosis diet plan, including a list of foods and drinks you need to avoid.

Benefits

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

The scarring from cirrhosis is permanent. Eventually, if the damage becomes advanced, liver failure occurs and a liver transplant may be necessary. While you can’t undo the damage that has already been done, there are ways you can prevent more damage.

Certain nutrients, including protein, sodium, and sugar, require your liver to work harder. While a healthy liver can handle the demand, a liver scarred by cirrhosis cannot. 

Your doctor may tell you to reduce your intake of certain types of food to avoid weakening your liver and preventing complications specific to these dietary factors, such as fluid buildup (ascites) in the abdomen which can occur with salt overload.

If you have cirrhosis your liver may also have a hard time processing sugar. You may develop symptoms similar to diabetes. If this happens, your doctor may tell you to eat less sugar and be mindful of foods and drinks with hidden sugar

A liver that isn’t working well will also have a hard time processing a high-fat meal. Your doctor will likely advise you to avoid fried food and limit your intake of fast food, which also tends to be high in sodium. 

Your liver is also a central part of how your body metabolizes alcohol. It’s a lot of work for a healthy liver, but if you have liver damage for any reason (especially related to alcohol use) you are at risk for liver failure. There is no safe amount of alcohol for people with cirrhosis.

How It Works

The goal of a cirrhosis diet is to reduce the amount of work the liver needs to do while still providing adequate nutrition. Since the liver is an essential component of the digestive process, people who have a damaged liver that isn't working well are at risk of becoming malnourished.

Research has shown that people with liver disease who aren't adequately nourished are more likely to experience complications from cirrhosis, including death. Your cirrhosis diet will need to be tailored to your individual needs, but there are some general dietary guidelines everyone with liver disease needs to consider.

There are three major dietary considerations you need to know about if you have cirrhosis. You must avoid alcohol, high-fat food, and raw or partially cooked shellfish. 

Regardless of the cause, anyone who has cirrhosis needs to avoid alcohol. Not only does drinking alcohol put a great deal of stress on your liver, but longterm alcohol use (especially in large quantities) also contributes to malnutrition and other health problems.

High-fat diets can also cause problems if you have cirrhosis. 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. 

However, you do need to include some healthy fats in your diet. Nuts, avocado, fish, and plant oils can be included in moderation on a cirrhosis diet.

If you have cirrhosis of the liver you’ll need to avoid raw or partially cooked shellfish, as these foods may contain a bacterium called Vibrio vulnificus. People with liver damage from cirrhosis have impaired immune function, meaning bacteria can lead to a potentially serious infection.

Your doctor may also want you to reduce your salt, sugar, or protein intake if you have certain complications from liver disease, other health conditions, or risk factors.

Duration

If you are at risk for liver disease, your doctor 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 only once damage to the liver has become severe (decompensated phase). 

Since changing how you eat can only help prevent additional liver damage, but can’t heal what’s already occurred, you will likely need to be on a cirrhosis diet for a long time. 

If you experience complications from liver disease or have other health conditions, you may need to make additional changes to your diet as well. If you are uncertain about how to make changes or are having a hard time making them work, talk to your doctor. You may find it helpful to work with a registered dietician or nutritionist. 

What to Eat

If you’re following a cirrhosis diet there are some foods and beverages you’ll need to strictly avoid. However, compared to other diets used to treat medical conditions, 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

  • 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 butter (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 

  • Green tea, coconut water 

  • Meal/nutritional supplements (Boost, Ensure) as approved 

Non-Compliant

  • Raw or partially raw fish and shellfish (oysters, clams) 

  • Fast food and fried food

  • Red meat 

  • Canned food (meat, soup, vegetables)

  • Packaged, processed snacks and meals 

  • Hot dogs, sausage, lunchmeat 

  • Sauerkraut, pickles 

  • Buttermilk 

  • Tomato sauce or paste

  • Instant hot cereal or oatmeal

  • Frozen meals and snacks (TV dinners)

  • 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, and 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. Vegetables can be cooked without oil, butter, or salt. Try grilling or boiling veggies and using herbs and low-sodium spices for flavor. 

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 trouble processing fat and sugar. 

Grains: Choose whole-grain bread, pasta, brown rice, and cereal instead of those made with refined white flour. Quinoa and couscous are other grains that may be suitable and are non-meat sources of protein.

Granola and granola bars may be approved for quick snacks as long as they’re low in sugar and sodium. If you need to limit protein, you may need to avoid bars made with nuts or protein powders. 

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.

The majority of your protein allowance 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.

Avoid prepackaged, heavily processed, and frozen meals or snacks, which tend to be high in sodium and added sugar. 

Beverages: You cannot drink alcohol if you have liver cirrhosis, but you'll have plenty of other options. Water is usually the most hydrating choice, but if you are on a low-sodium diet you’ll want to check the labels on bottled water as they often contain sodium. 

Milk and juice should only be consumed if pasteurized (not raw). Coconut water is another hydrating choice. 

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 patients with cirrhosis to avoid caffeinated beverages, including coffee, tea, and soft drinks. Instead, try hot or iced green tea

Recommended Timing

If you’re dealing with malnourishment as a result of cirrhosis you may need to eat more calories, especially from protein. If you don’t feel up to eating larger meals, you may find it helpful to eat smaller more 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 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

If you’re reducing your sodium intake as part of a cirrhosis diet, try using fresh herbs and spices for cooking and flavoring meals instead of table salt. If you’re used to adding salt to your food and find it difficult to break the habit, your doctor 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, though 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. 

Having liver damage affects your immune system, meaning you may be more likely to get foodborne infections. Avoid eating any meat, fish, or shellfish that is served raw or partially cooked. When preparing meals at home, practice proper food handling and safety practices, including checking the internal temperature of poultry, pork, or beef with a meat thermometer. 

Modifications

You may need to adapt your diet if you develop complications from cirrhosis, such as ascites, hypoglycemia, and encephalopathy.

Ascites 

Ascites is the accumulation of large amounts of fluid in the abdomen. Doctors usually require a strict no-salt diet for people who have cirrhosis with ascites, as a high-sodium diet can make the condition worse.

The daily recommended sodium intake for people with ascites is 88 millimoles per liter (mmol) per day. The typical American diet contains 200-300mmol of sodium per day.

Prepackaged and convenience food items are often high in sodium or contain added salt. If you're not routinely checking the nutrition labels, you may not be aware of how much sodium you’re consuming. 

When you’re doing your grocery shopping, a good rule of thumb is to focus on what you can buy along the perimeter of the store: fresh produce, lean meats, and low-fat dairy which are low-sodium choices. Avoid the packaged snacks, cereals, and sodas found in the middle aisles. 

Encephalopathy 

Protein, which the body uses for growth, maintenance, and energy, is supplied from the diet in animal products like meat and eggs, as well as plant sources like beans.

A damaged liver can't even handle a normal amount of protein, let alone any extra. If the body gets too much protein it can lead to a serious complication called encephalopathy

As the body digests protein it creates a byproduct called ammonia. The more protein it tries to digest, the more ammonia can build up. At high levels, it becomes toxic to the brain and causes memory problems or even dementia-like symptoms.

If you have cirrhosis, focus on including plant-based protein sources in your diet instead of meat. Your doctor may give you a specific limit of how much protein you can have per meal or per day.

Hypoglycemia 

Hypoglycemia, or low blood sugar, is another common problem when you have cirrhosis. When your liver is healthy it stores energy from the complex carbohydrates you eat in an easily accessible form called glycogen.

If you have cirrhosis, your liver isn’t able to store enough energy in this chemical form. As a result, people with liver disease may experience episodes of low blood sugar. Research has shown that eating high-fiber meals with a low glycemic index can help manage hypoglycemia in people with cirrhosis.

Considerations

Changing your diet can impact other areas of your lifestyle (and vice versa). You’ll want to think about how your day to day routine and responsibilities at home, school, or work will make following a cirrhosis diet easier or more challenging. 

General Nutrition 

Depending on your overall medical needs dietary needs, you may need to avoid or limit certain nutrients. If you have certain complications from cirrhosis (such as fluid retention) your doctor may want you to restrict your sodium intake. You may also be told to eat less protein. 

Since you’ll have your choice of fresh fruits and veggies, whole grains, and plant-based sources of protein, a cirrhosis diet can be a nutritious one. However, some people who have liver disease experience gastrointestinal symptoms such as nausea and loss of appetite that make it difficult for them to eat enough to stay properly nourished. 

Your doctor may have you take vitamins, nutritional supplements, or add drinks like Ensure or Boost to your meal plan. 

Safety

Your doctor may have you add a vitamin or other nutritional supplements to your daily routine. However, you should be careful of supplements or multivitamins that contain a lot of Vitamin A, which can be toxic to the liver. You will also want to check with your doctor before starting any supplements containing iron, which can be hard for the liver to process in high doses. 

You may also be curious about herbal or dietary supplements advertised to “support liver health.” While these products may not be harmful, you must ask your doctor before you try them. 

Dietary and herbal supplements can interact with medications you have been prescribed. The consequences of combining these products with certain medications can be serious. These supplements can also have side effects of their own, including causing digestive symptoms or making them worse. 

If you have problems with your liver your doctor may tell you not to take certain medications, such as over-the-counter pain relievers like Tylenol and ibuprofen. 

Flexibility

You’ll need to avoid processed, fatty, and fried foods on a cirrhosis diet, which rules out most fast food. Casual dining restaurants can also be tricky to navigate. Many items on the menu might sound healthy, but restaurant portions are typically large and contain far too much sodium and/or sugar to be considered safe for a cirrhosis diet. 

Keeping an eye out for hidden ingredients is also important at the grocery store. When you’re shopping, remember that products labeled “low-sodium” may be low in salt, but often have a lot of added sugar. If you’re also reducing your sugar intake on a cirrhosis diet, these options may not be suitable.

Dietary Restrictions

If you have other dietary needs and preferences your doctor, as well as a registered dietician or nutritionist, will help you adjust a cirrhosis diet plan to fit your needs. 

For example, if you have Celiac disease and cannot have wheat or gluten, you will want to carefully select gluten-free bread, pasta, and crackers. Pasta alternatives made from beans and legumes can be nutritious but may be too high in protein for a cirrhosis diet. 

If you already follow a plant-based diet, you won’t have to factor in reducing your red meat intake or worry about avoiding certain types of shellfish. However, you may need to adjust your protein intake if you typically eat a diet with lots of nuts and seeds or tofu. 

Support and Community

Your doctor and other members of your health care team will be able to answer most of your questions and provide guidelines for your cirrhosis diet. However, sometimes you may feel like talking to someone who has been through what you’re going through and can provide emotional support, perspective, and resources. 

Support from your family and friends is practically and emotionally important if you have advanced stage liver disease. You may need to ask for help with meal prep and planning if you feel unwell and are having a hard time sticking with your cirrhosis diet.

You may also want to ask someone in your life to go with you to doctor’s appointments or to the hospital for tests. They can provide emotional support as well as take notes for you. 

Ask your doctor if there are support groups for patients with liver disease in your community. You can also look online for message boards, social media hashtags, or blogs where patients can share their stories and experiences. 

Cost

Grocery shopping for a cirrhosis diet will include many foods that are likely already part of your diet. Fresh produce is especially affordable when you buy it in season. If you have space and interest, you can even grow your own fruits and vegetables at home. If you don’t have the time or green thumb for a backyard garden, many fresh herbs can be grown inside or in a window box. 

Dried beans are an excellent plant-based protein source and can be very affordable, especially when you buy them in bulk. They will keep well in your pantry, meaning you’ll always have some on hand to throw together a quick protein-packed meal. 

While canned goods may be too salty for a cirrhosis diet, they’re another easy option that can be bought cheap and stored for a long time. Some types of canned fruit and veggies may be approved if you drain and rinse them. 

Boxed whole-grain pasta is inexpensive, stores well, and is a versatile carbohydrate for meal planning. Cereals, crackers, and granola fixings made with whole grains are other options to consider. 

If your doctor wants you to take nutritional supplements or add drinks like Ensure to your diet, know that these can be expensive. If you have health insurance, ask your doctor if these supplements can be prescribed for you. You’ll want to check with your carrier, but some health insurance plans may cover part or all of the cost of certain supplemental nutrition if your doctor prescribes it. 

A Word From Verywell

If you have liver disease, your doctor may suggest a cirrhosis diet to help manage your symptoms and prevent your liver from becoming more damaged. If you have liver cirrhosis it's very important that you do not drink alcohol, eat high-fat foods, or consume raw or partially cooked shellfish. While making changes to your diet can't repair the damage that's already been done, you may be able to prevent complications from liver disease by making these changes as well as reducing your sodium, sugar, and/or protein intake. People who have liver cirrhosis may have a hard time staying nourished due to digestive changes. Your doctor and a dietician or nutritionist can help you create a cirrhosis diet-approved meal plan and will let you know if it's safe for you to take nutritional supplements or vitamins.

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