Cirrhosis Diet: What to Eat and What Not to Eat

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

When you have cirrhosis, 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.

Benefits of the Cirrhosis Diet

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.

Authors of a 2018 article note 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. A cirrhosis diet plan may be crafted with the help of your healthcare team members, such as a registered dietitian.

Unfortunately, existing scarring from cirrhosis cannot be reversed. Diet, then, is a key way to minimize complications and keep it from getting worse.

How the Cirrhosis Diet 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:

• Avoid alcohol: Any amount of alcohol is considered unsafe for people 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.
• Limit 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.)
• Avoid raw or undercooked meat and seafood: People with liver damage from cirrhosis have impaired immune function, so 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.

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 healthcare provider or a registered 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).

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). 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 and Not 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 lean protein.

Your recommended protein intake may be higher than the amount recommended for healthy people to help prevent muscle loss and malnutrition. However, individual needs may vary depending on the severity of the cirrhosis.

Your healthcare provider may have you take vitamins or nutritional supplements because having cirrhosis makes it harder to stay nourished. That's especially true if you have nausea or gastrointestinal (GI) symptoms.

• Fruits and vegetables: Choose fresh fruits and vegetables over canned. Healthy choices include blueberries, strawberries, grapes, apples, broccoli, carrots, and spinach because they're high in polyphenols (a type of antioxidant) which have been shown to protect liver health.
• Dairy: Avoid full-fat dairy products that may be hard 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.
• Grains: Choose oats, brown rice, and whole-grain breads, pastas, and cereals 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: Choose lean poultry without the skin, some types of fresh-caught fish (such as salmon), tofu, low-fat dairy, and eggs or egg whites instead of red meat, processed lunch meat, bacon, or sausage.

• 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, avoid pastries, doughnuts, and muffins, unless you can make your own low-fat, low-sugar, and low-salt versions.
• Beverages: Avoid alcohol and drink mostly water. Milk and juice should only be consumed if pasteurized. Most medical professionals advise people with cirrhosis to avoid caffeinated beverages, including coffee, tea, and soft drinks.
• Supplements: Vitamins with antioxidant properties, like vitamins C and E, may help to promote liver health. Vitamin D is essential to overall health, especially in preventing non-alcoholic fatty liver disease. Keep in mind that some vitamins (or too much of them) can be toxic to a damaged liver; always talk to a healthcare provider before taking any dietary supplements.
  

Reading labels for fat, sugar, and salt at the grocery store can also help you make the best possible choices, such as:

• Selecting gluten-free bread, pasta, and crackers if you also have celiac disease
• Limiting pasta made from beans and legumes that are high in protein
• Reducing protein from nuts, seeds, and tofu if you follow a plant-based diet

Keep in mind that your cirrhosis diet plan also includes meals when you eat out. Don't hesitate to ask about your menu options when dining at restaurants.

When to Eat

Liver disease can lead to malnourishment, in which case your healthcare provider 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 can be helpful for people with cirrhosis.

A healthy late-night snack could include:

• Low-fat Greek yogurt with berries and a few nuts sprinkled on top
• A bowl of whole-grain cereal with soy or almond milk and fruit

If your sleep schedule is interrupted, be sure to plan your meals around when you are awake, whether it’s during the day or at night. Try to eat a meal or snack every couple of hours. 

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 suggest using 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.

Sample Menu

Breakfast

• 1 piece of fruit
• Cooked oatmeal with milk and sugar
• 1 slice of whole-wheat toast with peanut butter
• Decaffeinated coffee or tea

Mid-morning snack

• 4 to 8 ounces of milk with toast or a piece of fruit
  

Lunch

• 4 ounces of cooked lean fish, poultry, or tofu
• At least one cup of a starch item (such as rice, potatoes, or pasta)
• A cooked vegetable
• Salad
• Fresh fruit
• 8 ounces of milk

Mid-afternoon snack

• 4 to 8 ounces of milk with graham crackers

Dinner

• 4 ounces of cooked fish, poultry, or tofu
• At least one cup of a starch item (such as rice, potatoes, or pasta)
• A cooked vegetable
• Salad
• 2 whole-grain rolls
• Fresh fruit or dessert
• 8 ounces of milk

Evening snack

• 1/2 cup Greek yogurt with fruit

Note that nutrition needs may vary. Talk to your healthcare provider for your individualized meal plan recommendations.

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 healthcare provider may recommend additional changes to your diet, including limiting salt, sugar, and protein.

Fluid Retention

Two types of fluid retention can occur when people have cirrhosis: ascites and edema.

Ascites is the accumulation of large amounts of fluid in the abdomen. Edema is swelling caused by fluid in your body's tissues. It usually occurs in the feet, ankles, and legs, but it can involve your entire body.

Healthcare providers usually require a strict no-salt diet for people who have cirrhosis with ascites or edema, as sodium can make the condition worse.

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 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. 

High Blood Pressure

Your body carries blood to your liver through a large blood vessel called the portal vein. Cirrhosis slows your blood flow and puts stress on the portal vein. This causes high blood pressure known as portal hypertension.

Along with medications to treat high blood pressure, your healthcare provider will usually recommend a low-sodium diet,

Encephalopathy

As the body digests protein, it creates a byproduct called ammonia. When the liver is functioning properly, ammonia is cleared without issue. But a damaged liver can't handle a normal amount of protein, let alone any extra.

The more protein the body tries to digest, the more ammonia can build up. At high levels, it becomes toxic to the brain and can cause memory problems, dementia-like symptoms, and a serious complication called encephalopathy, which causes brain dysfunction. 

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

Hypoglycemia and Diabetes

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

If you have cirrhosis, your liver isn’t able to store enough energy in the form of glycogen. As a result, people with liver disease may experience episodes of low blood sugar.

A little over 30% of people with cirrhosis also have diabetes, which can sometimes lead to hypoglycemia related to medications used to treat diabetes.

Research has shown that eating high-fiber meals with a low glycemic index can help manage hypoglycemia and diabetes in people with cirrhosis.

Summary

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 alcohol, high-fat foods, and raw or partially cooked shellfish.

While changing the way you eat can't cure a liver that is already scarred, it can improve your quality of life and help prevent complications. Talk with your healthcare provider or registered dietitian for nutrition recommendations tailored to your specific needs.