for Health Care Providers
Nutrition in Early Liver Disease - Cirrhosis
Healthy diet choices include fruit, vegetables, whole grains, lean protein sources, unsalted nuts and seeds and low-fat dairy products. Foods should be lower in sodium (salt). If lack of salt in your food effects taste, you can enhance the flavor with lemon or lime juice, vinegar, herbs and spices. Ketchup, pickles, olives, soy sauce, hot sauces and teriyaki sauce have a high sodium content and should be avoided. Restaurants, including fast food, add a lot of salt to their food so try to avoid them or ask for your meal to be prepared without salt.
Selecting foods with healthy fats is important. Choosing unsaturated fats instead of saturated fats and trans fats is a good first step. Unsaturated fats:
- include monosaturated, polyunsaturated and Omega3 fatty acids
- come from plant sources and fish and include avocado, nuts, olive oil, canola oil and safflower oil
- foods high in Omega3 fatty acids include salmon, tuna and mackerel
Saturated fats come from animal sources such as meat, poultry and full-fat dairy products. Trans fat is hard at room temperature such as in shortening, partially hydrogenated vegetable oils and stick margarine. Saturated and trans fats can be detrimental if you have cardiovascular disease or at risk such as in diabetes mellitus.
If your budget allows it, fresh fruits and vegetables, including the green leafy variety are the best. Canned fruit may have added sugary liquid. Canned vegetables may be loaded with salt. Frozen vegetables without sauces are similar to fresh produce. If your budget does not allow the fresh variety, canned fruits and vegetables should be rinsed thoroughly or look for varieties that specifically state no added salt or without sauces.
Whole grains include barley, brown rice, buckwheat, bulgur, millet, oatmeal and popcorn. Whole wheat bread, pasta and cereals without added sugar are key to a healthy diet. Whole grains are a great source of fiber and will also help constipation. If you are gluten intolerant, ask your provider or dietitian which of these to avoid.
Protein does not have to be restricted in liver disease but make sure that meat cuts like beef, pork and lamb have excess fat trimmed off. Skinless chicken and turkey, eggs, and low-fat dairy foods are good sources of protein. Special cuts of meat and organ meats such as tongue and gizzards are not healthy due to high fat content. Processed meats (sausage, bacon, hot dogs, deli meats) have a high sodium content and added chemicals, so avoid them. Beans and legumes such as garbanzos (chickpeas), black beans, soy beans, fava beans, kidney beans and lima beans are an economical source of protein. Nuts are a good source of protein but choose unsalted versions. Seeds such as quinoa, flaxseed, pumpkin seeds and wild rice are good sources of protein. Tofu is a good vegetarian option. Fresh fish is a healthy alternative to meat. Canned tuna (in water), canned salmon and eggs are economical. Frozen entrees may have a lot of salt, so check the label.
Choosing low-fat or fat-free dairy products is important in obesity and cardiovascular disease. Low-fat milk, ice cream and cheese are also important sources of calcium which is needed for good bone health. Best cheeses to include in a healthy diet are low-fat or fat-free cottage cheese or mozzarella cheese made with skim milk. There are also other varieties of cheese that are available as low fat and fat-free.
It is important to drink 6 to 8 glasses of water each day. Beverages with sugar cause weight gain and are detrimental to good blood sugar control in diabetes. Two to three cups of brewed coffee each day has been shown by research to improve liver health. It is best to avoid all alcohol in liver disease since this causes a replacement of healthy tissue with scar tissue which can lead to cirrhosis. This includes avoiding all beer, wine, coolers, whiskey, gin, rum, brandy and liquors.
In early liver disease nutrition supplements are generally not necessary if you have a healthy diet.
Vitamins and Minerals
Vitamins are generally not needed if you eat a variety of healthy foods. An exception is in alcoholic liver disease when thiamine (vitamin B1), folic acid and a multivitamin (includes vitamins B2 and B6) should be taken. Vitamin C will be beneficial unless your diagnosis is hemochromatosis.
Woman over the age of 50 years and men over the age of 70 years may benefit from a calcium supplement. Ask your provider for recommendations.
If you have Wilson's Disease, foods high in copper need to be eliminated from the diet. These foods include organ meats, shellfish, chocolate, nuts, mushrooms, kale, asparagus, parsley, potatoes with skin (both white and sweet), lima beans, soybean sprouts and spinach.
If you have Hemochromatosis, iron supplements, multivitamins with iron and Vitamin C supplements should be avoided.