Dietary Guidelines for Cirrhosis

What to Eat, How Much to Eat, and What to Avoid

Many people diagnosed with cirrhosis of the liver want to know how to change their diet to improve their health. If you have cirrhosis, the best diet is very close to the one you needed before you had the condition.

A good rule of thumb is that a healthful diet is helpful for just about anyone; this is especially true if you have cirrhosis. Foods like fruits, vegetables, whole grains, and proteins of proper types and in proper amounts are very appropriate. For guidance, visit the MyPlate Daily Checklist issued by the U.S. Department of Agriculture (USDA) and select the appropriate calorie level for your age.

In addition, it is a good idea to take a daily multivitamin. Depending on the degree of cirrhosis, some people might not have enough of the key minerals and fat-soluble vitamins (vitamins K, A, D, and E) that the body requires. While a balanced diet should easily provide these, your body may not be able to absorb them as well as is needed. When it doesn't, your doctor can prescribe a supplement.

Unfortunately, malnutrition is common in people with cirrhosis because you may have a loss of appetite and changes in your metabolism. You should discuss your diet with your doctor or a dietitian.

Foods to Avoid

There are three things you should avoid if you have cirrhosis—alcohol, high-fat foods, and raw or partially cooked shellfish. For people with cirrhosis, regardless of the cause, alcohol should be completely avoided as it causes liver damage.

Diets high in fat may cause digestion problems for people with cirrhosis. The body digests (breaks down) fats using bile, which is a yellow-green fluid made in the liver. When the liver is damaged, the production and supply of bile may be affected. However, it is important not to avoid fat entirely because the body requires a daily supply to remain healthy. Moderation and a good selection are key. For your dietary fat, choose foods like nuts, avocados, fish, and plant oils.

You should avoid raw or partially cooked shellfish because they can contain a bacterium called Vibrio vulnificus that can cause a serious infection due to impairment of immune function caused by cirrhosis.

You may be interested in trying different herbs and supplements that you have heard may "support liver health." It is of the utmost importance that you discuss any of these with your doctor before taking them. They can interfere with other medications and each other and may result in additional digestive problems.

You may need to further adapt your diet if you have complications from cirrhosis, according to your doctor's recommendations. Three relatively common complications are ascites, hypoglycemia, and encephalopathy.

Ascites and Diet

Ascites is the accumulation of large amounts of fluid in the abdomen. It is aggravated by a diet high in salt, so doctors usually require a strict no-salt diet for people who have cirrhosis with ascites. This is difficult to follow in today's highly-processed marketplace because most prepackaged foods contain a lot of added sodium.

The daily recommended sodium intake for people with ascites is 88 millimoles per liter (mmol) per day. By way of reference, the typical American diet contains 200 to 300 mmol of sodium.

When shopping for groceries, some good advice would be to skip the middle aisles and buy most of your food from along the walls, where stores generally keep fresh meats, fruits, and vegetables—all foods relatively low in sodium. Getting an appropriate amount of protein is also important if you have ascites.

Encephalopathy and Diet

When the liver is injured it can't handle normal amounts of protein. Protein, which the body uses for growth, maintenance, and energy, is supplied from the diet in animal products like meat and eggs, and from plants like beans.

When the body gets too much protein, a serious complication called encephalopathy can result. This is because of the accumulation of large amounts of ammonia, a byproduct of the digestion of too much protein, which is toxic to the brain. This is a life-threatening condition that can be prevented in people with cirrhosis by eating small amounts of protein from plant sources.

The American Society of Parenteral and Enteral Nutrition (ASPEN) recommends a daily protein intake of 1.0 to 1.5 grams per kilogram of body weight. For someone weighing 150 pounds (68 kg), that translates to between 68 and 102 grams per day.

Hypoglycemia and Diet

Hypoglycemia, or low blood sugar, is another common problem of cirrhosis. If you experience this, you will need a diet of small, frequent meals that include complex carbohydrates such as bread, pasta, and rice. Hypoglycemia causes many symptoms including fatigue, confusion, and heart flutters.

With cirrhosis, the liver isn't able to store enough energy in the form of glycogen, a chemical the body uses for quick energy. Since the body is able to quickly break down carbohydrates and use them for energy, this can help smooth out the problems caused by hypoglycemia.

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Article Sources

  • Cirrhosis. National Institute for Diabetes, Digestive, and Kidney Diseases.

  • Ehrlich SD. Cirrhosis. University of Maryland Medical Center.

  • McClave, S.; Taylor, B.; Martindale, R. et al. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient. Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) J Parenteral Enteral Nutr. 2016;40(2):159-211. DOI: 10.1177/0148607115621863.