Cirrhosis: Nutritional Considerations

• A sodium–restricted diet is standard treatment: A sodium–restricted diet (limiting sodium to 2,000 milligrams per day) has been shown to improve survival in patients with cirrhosis. Consultation with a dietician can help patients identify foods that are high in sodium and find appropriate alternatives.
• Limited dietary fat intake: High–fat diets are associated with increased risk for cirrhosis in patients with liver disease, and several studies have concluded that excess dietary fat (including total fat, saturated fat, and polyunsaturated fat) may encourage cirrhosis progression.
• A vegetarian diet may significantly improve symptoms of hepatic encephalopathy.  Plant–based diets have more dietary fiber, which may reduce hepatic encephalopathy by removing toxic ammonia from the body. Vegetable protein sources are also higher in arginine, an amino acid that decreases blood ammonia levels, and they are lower in methionine and tryptophan, amino acids that increase the risk of hepatic encephalopathy.
• A diet high in vitamin A, antioxidants, and B–vitamins may reduce the risk for cirrhosis and liver cancer. Cirrhotic patients appear to have significant reductions in antioxidants in their blood. The best way to supplement the body with antioxidants is to eat plenty of fruits, vegetables, and whole grains. However, since many patients have poor appetites, they are likely to benefit from a daily multivitamin that meets 100 percent of the dietary allowance for all vitamins and minerals.
• Probiotic supplementation may improve hepatic encephalopathy.  Probiotics are the “healthy bacteria” present in probiotic supplements and some foods, including some soy yogurts. Probiotics may decrease the blood concentrations of toxic ammonia that causes hepatic encephalopathy and may decrease the risk of life–threatening infections.
• Supplementation with branched–chain amino acids may be helpful in patients with hepatic encephalopathy. These supplements can be found at health food stores.