Diet and cirrhosis

Eat little and often

People who have cirrhosis often eat ‘little and often’, a style of eating called grazing. Eating more often means your body doesn’t start breaking down the protein in your muscles for energy.

Instead of having three main meals aim to eat something every 2 to 3 hours and eat a snack before bedtime. This should be something high in starchy carbohydrates such as cereal, porridge, rice pudding or shortbread.

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Eat more calories and protein

When cirrhosis develops your liver is no longer able to store glycogen, a form of carbohydrate which it needs to meet your body’s energy demands. Your liver tries to make up for this but you often need more energy and protein in your diet.

You can increase the amount of protein in your diet by eating:

• Beans and pulses such as lentils, kidney beans, or baked beans
• Nuts such as almonds or walnuts
• Eggs, cheese and other dairy products
• Fish such as cod, salmon, and tinned or fresh tuna, sardines or mackerel
• Meats such as turkey, chicken, or lean cuts of beef, pork and lamb

If you are underweight or malnourished then you will need to increase the amounts of energy and protein you eat even more. Regular snacking can top them up. There are also a number of high protein supplements that your dietitian may recommend and your doctor can prescribe.

Snacks to top up your energy and protein levels:

• Teacake with butter
• 3 crackers with butter and cheese
• Breakfast cereal with full cream milk
• Fruit scone with butter and jam
• 2 slices of toast with jam
• Milky drinks
• 2 slices of fruit loaf
• Hot chocolate and a banana

If you are overweight you may be advised to lose weight. This should be done by reducing your fat and carbohydrate intake, but keeping your protein intake high and increasing physical activity levels to ensure you do not compromise your muscle mass.

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Reduce salt to help manage fluid retention and bloating (ascites and oedema)

The liver plays a major role in regulating the balance of water and sodium (salt) in your body. When cirrhosis develops, the liver may lose this ability, leading to ‘fluid retention’. This can result in swelling of the feet and legs (oedema) and in a build-up of fluid in the abdomen (ascites). The presence of ascites may cause abdominal discomfort and make it difficult to eat without feeling bloated and uncomfortable.

Fluid retention is generally managed with diuretics (water pills) and in certain circumstances, by the drainage of fluid from your abdomen (paracentesis). Your health professional might also advise you to cut down on salt, for example by following a ‘no added salt’ diet.

If you are cutting down on salt, it is very important that you receive advice from a registered dietitian about the foods you can eat and those you should avoid. Some foods can surprise you and be much higher in salt than you would expect. And some products labelled as low-salt can have other ingredients that you should not have too much of. For example, potassium can increase the risk of heart problems.

Tips to reduce the amount of salt you eat:

• Do not add salt to meals at the table. Add a small amount during cooking if needed.
• Avoid very salty foods such as ham, bacon, sausages, frankfurters, salami and other cold cuts, Bovril, Marmite, other yeast extracts, sardines and anchovies.
• Avoid smoked fish.
• Avoid fish tinned in brine, including salmon, tuna and pilchards. Look for products tinned in oil or water.
• Check food labels – anything with more than 1.5g salt per 100g (or 0.6g sodium) is high in salt. Salt is included in traffic light labelling. Avoid products with a red light for salt.
• Some bottled waters are high in sodium – check the labels carefully.

It is also important to be aware that some prescription and over the counter medications have a high salt content. If the sodium content on the labelling of your medication is not clear, or you are unsure if it is suitable, your pharmacist or doctor should be able to advise you.

If you are struggling for how to add flavour to your food without salt then ground pepper, vinegar, herbs and spices can work well. Alternatively, try:

• Lemon juice on fish or meat
• Olive oil and vinegar with salad and vegetables
• Mustard powder or nutmeg with mashed potato
• Fresh herbs, lime, garlic, chilli and ginger with pasta, vegetables and meat dishes

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Managing hyperglycaemia (high blood sugar) and diabetes

Blood sugar levels may be particularly difficult to control in people with cirrhosis. It is important that you have regular monitoring with your specialist diabetes team if you have fluctuating blood glucose levels. And careful monitoring of body weight is essential.

This is because the liver plays a major role in controlling blood sugar levels. People with cirrhosis may develop high blood sugar levels or hyperglycaemia. And many people with cirrhosis have underlying type 2 diabetes.

As well as following the general dietary advice given to all patients with cirrhosis you may also be advised to eat a diet that is:

• High in starchy carbohydrates such as potatoes, bread, pasta and rice. Wholegrain options are healthiest.
• Low in red meat such as beef, pork and lamb. Choose chicken, turkey, fish, dairy or plant-based options such as beans, pulses or tofu.
• Higher in monounsaturated fats than saturated fats. Aim to have less than 10% of your energy intake from saturated fats. Try using oils such as vegetable, olive or sunflower oil and spreads made from them instead of butter, lard, or solid oils such as coconut and palm.

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Supplements for people with or at risk of bone disease (osteoporosis)

If you have established osteoporosis or are at risk, you should be given calcium and vitamin D supplements. Factors that contribute to bone loss need to be minimised, including alcohol and tobacco use. Steroid medication should be reduced whenever possible. If you have questions about your medication speak to your doctor.

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