Cirrhosis Diet: What to Eat and What to Avoid

A cirrhosis diet is generally high in protein and low in sodium. People with liver disease may also need to consume more calories and eat more often. The diet can help people with cirrhosis avoid malnourishment due to changes in digestion that occur as the liver becomes more damaged.

When you have cirrhosis, or scarring of the liver, what you eat and drink each day is especially important. Many foods to avoid with cirrhosis contain animal protein, sodium, and fats that require your liver to work harder, a demand it may no longer be able to meet.

Fundamentals of a Cirrhosis Diet

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:

• Consume enough calories: People with cirrhosis may experience nausea and vomiting, which can cause them to eat less. Furthermore, damage to the liver can inhibit proper absorption of nutrients. It is essential to eat frequently and consume enough calories to avoid malnutrition.
• Prioritize protein: Your protein needs are higher than normal when you have cirrhosis. Your body burns more calories than usual, and you may be at risk for muscle loss. Getting more high-quality protein, especially from animal sources, can help minimize damage. Experts advise setting a goal to consume at least one gram of protein per kilogram of body weight.
• 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. But healthy fats can be included in moderation.
• Reduce sodium: Limiting your salt intake can help minimize fluid build-up that can occur if you have liver damage. Two types of fluid build-up, called ascites or edema, are common in people with cirrhosis. Reducing your sodium intake can help minimize their impact.
• 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.
• Avoid alcohol: Any amount of alcohol is considered unsafe for people with cirrhosis, as it's a potential cause of more liver damage and even liver failure. Drinking can also contribute to malnutrition and other health concerns.

Foods to Eat and Foods to Avoid

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.

• Protein: Most of your protein should come from plant-based sources such as dried beans and legumes, tofu and other low-sodium soy products, and small portions of unsalted nuts or nut butter. 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.
• 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 milk.
• 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.
  
• 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.
• 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.

Timing

Meal timing is an important component of the cirrhosis diet. When you work with your healthcare provider or a nutrition professional, they will give you guidance to ensure you get enough calories and nutrition throughout the day.

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.

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.

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 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. 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.

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

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. Working with a trained dietitian on a personalized diet plan can help to reduce the risk for and impact of malnutrition.

Cooking and Shopping Tips

Making smart choices at the grocery store can help you maintain and enjoy the cirrhosis diet. Reading labels for fat, sugar, and salt at the grocery store can help you make the best possible selections, such as:

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

At home, follow these cooking tips to ensure healthy meals:

• Try grilling or boiling veggies and preparing them without oil or butter.
• 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.
• Your cirrhosis diet plan also includes meals when you eat out. Don't hesitate to ask about your menu options when dining at restaurants.
  

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 low-sodium 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 to manage portal hypertension.

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.