What to Eat When You Have Cirrhosis

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It’s not uncommon for people with cirrhosis to become malnourished due to changes in their metabolism and digestive issues 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, particularly as components like protein, sodium, and sugar require your liver to work harder—a demand it may no longer be able to meet.

A cirrhosis diet plan should be crafted with the help of your doctor and other members of your healthcare team, such as a registered dietician, to 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

Benefits

The liver has more than 500 functions, making it one of the most vital organs. 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. Proper nutrition is such an important concern in these individuals that authors of 2018 article in the Journal of Clinical Gastroenterology said, "dietary management of cirrhosis is not a one-size-fits-all approach but should be implemented earlier on in the treatment algorithm to improve the clinical prognosis of cirrhosis."

Unfortunately, existing scarring from cirrhosis cannot be reversed. Diet, then, is a key way to take charge of your future with 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:

  • 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.

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. You'll need to consult with your doctor 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 wasting.

In some cases, your doctor may want you to make additional, specific changes to your diet to help manage or prevent other condition people with liver cirrhosis may be more likely to get (see Modifications below).

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 they do so 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. 

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

  • 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.

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.

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 doctor might want you to eat more calories. 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 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. 

In addition to avoiding preparing 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. If you develop one or more of these conditions, your doctor may recommend you make additional changes to your diet, including limiting salt, sugar, and protein.

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 to 300 mmol 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 

As the body digests protein, it creates a byproduct called ammonia. When the liver is functioning properly, this is cleared without issue. But a damaged liver can't handle a normal amount of protein, let alone any extra. The more protein it tries to digest, the more ammonia can build up. At high levels, it becomes toxic to the brain and can memory problems, dementia-like symptoms, and a serious complication called encephalopathy. 

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

Since it is so important to stick with your cirrhosis diet, keep the following in mind to set yourself up for success.

General Nutrition 

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.

In such cases, your doctor may have you take vitamins or nutritional supplements.

Safety

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. 

Approach herbal or dietary supplements advertised to “support liver health” with caution. While these products may not be harmful on their own, they can interact with medications you have been prescribed, the consequences of which can be serious. These supplements can also have side effects of their own, including causing digestive symptoms or making them worse. Speak with your doctor before trying any of these products.

Flexibility

Fat, sugar, and salt make for quick and what many people consider "crowd-pleasing" foods. As such, they are often staples in meals you get when dining out, making menus hard to navigate while on a cirrhosis diet. Even what seems like a compliant meal may pack more punch than you think, given its portion size. Preparing your meals at home is likely best.

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 dietitian or nutritionist, can 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.

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. 

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.

Cost

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 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.

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. If so, all or part of the cost of certain supplemental nutrition may be covered.

A Word From Verywell

If you have cirrhosis, staying adequately nourished can be challenging. You may need to eat more or less of certain foods to ensure your body is getting the energy it needs. It's also important that you pay close attention to your diet so you can avoid more damage to your liver. For example, you'll need to avoid drink alcohol, high-fat foods, and raw or partially cooked shellfish. While changing the way you eat can't fix a liver that is already diseased, it can improve your quality of life and help prevent complications.

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Article Sources

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