Calories and Protein

People with cirrhosis may need more extra calories and protein. They may lose their appetite and experience nausea, vomiting, and severe weight loss. This can lead to shortage of the minerals calcium and magnesium (signs include muscle cramps, fatigue, weakness, nausea, and vomiting), or a shortage of zinc (signs include reduced ability to taste, changes in taste).

It can help to eat small, frequent meals (4 to 7 times a day), including an evening snack. Your doctor even may recommend high-nutritional supplement drinks, such as Ensure or Boost.

When the scarring from cirrhosis prevents blood from passing through the liver, pressure increases in the veins entering the liver. This is called portal hypertension. The body is forced to reroute the blood away from the liver and into the general blood circulation. This causes large blood vessels, called "varices," to form.

Because the rerouted blood bypasses the liver, it contains high levels of amino acids, ammonia, and toxins that normally would have been handled by the liver. When these substances reach the brain, they can cause confusion and temporary loss of memory (a condition called "hepatic encephalopathy").

Amino acids and ammonia come from protein in the diet. Some evidence shows that patients with cirrhosis do better when they get their protein from vegetables (such as beans, lentils, and tofu) and from dairy products (eggs, milk, yogurt) instead of from meats.

Doctors can prescribe a syrup called Lactulose to push food through the bowels more quickly. This way, less food is absorbed, the liver has less work to do, and fewer toxins make their way to the brain.

10 Replies

  • I will be glad when someone gives me a diet plan for my partner. Taken into hospital 4 days ago quite ill. I was then told only yesterday that he's not eating the correct foods.! Seems strange though that he's not on any sort of diet in there.

  • h0b0 when you were told about your partners diet not being beneficial, was the comment based on the foods he has been eating at home, or what he was eating in hospital?

    Hospital food is so variable, but in most hospitals the patient does get some choice of a list. Special diets are usually only given to people with known food allergies, stroke patients who need soft food, etc. Ive been an inpatient where patients who have different dietary needs due to their religion or culture have their families bring foods in for them.

    If you can, guide your partner to choosing foods that are low sugar, low salt/sodium, and low saturated fats, while being good for easily digestable protein, vitamins and minerals. Difficult to do in hospital i admit. Its unlikely he will be referred to a dietician, its more a case of educating yourself! Regular small meals are good, and if he is loosing weight and has no appetite then ask about products such as Ensure which is a meal replacement drink (commonly used for cancer patients who cant eat) and has everything needed for nutrition in it.

  • The food he was eating at home. The nurse said when he is ready to be discharged a dietician would supply a diet sheet. I hadn't changed any of his foods since diagnosis as we were never told to do so. The food he's having on the ward is no different to home food with the exception that mine is 100% nicer.! Another thing we didn't know was no fizzy drinks. The nurse overheard him asking me to bring some lucosade in & said he shouldn't be having anything fizzy & water was the best but only 1 litre per day. We don't know if no-one has ever told us.

  • There is a leaflet you can download of the British Liver Trust website called 'Diet and Liver Disease'. Its very general as its not specific to your partners degree of damage or the cause, but it might start you in the right direction.

    A diet sheet from the dietician will be good, more than i ever had when diagnosed with cirrhosis and liver cancer!

    Without knowing his exact state i cant advise specifics, but you may find they want a limit on salt/sodium and a limit on total fluid intake per day.

    GPs and hepatologists are not specialists when it comes to different diets/nutrition but you would have thought gastroenterologists would know a bit. I remember being on a ward for a few hours over lunch time after a biopsy (you have to lie still for hours so they put me on the gastro ward) and the gastro specialist was doing rounds to 2 patients, one had pancreatitis and the other had a stoma (a bag for body waste) due to gastric surgery, and they had both just eaten a large plate of greasy hospital fish and chips and were both in agony with acute diarrhoea, yet he said nothing about what had they eaten or advised them not to eat such stodge full of grease!

  • Thanx sooooo much.x

  • That's all great advice the correct food is like medicine to the body. There is one thing I'm a bit confused about though, if you take lactulose to push food through faster and to absorb less of it doesn't that mean that you absorb even less vitamins and minerals when you're already a bit depleted in theses as a cirhosis sufferer. Also I have taken it once or twice and thought it was meant to be gentle but I was in absolute agony with stomach cramps so found it a bit harsh.

  • The lactulose doesn't quite work in the way that ZABohra describes - it isn't really forcing food through quicker a more accurate description of its use to prevent toxin build up is :- Lactulose is useful in treating hyperammonemia (high blood ammonia), which can lead to hepatic encephalopathy. Lactulose helps trap the ammonia (NH3) in the colon and bind to it. It does this by using gut flora to acidify the colon, transforming the freely diffusible ammonia into ammonium (NH4+) which can no longer diffuse back into the blood & it thereafter defecated from the body.

    Dependent on dosage it's effects can be rather debilitating in that it can cause lots of flatulence and episodic diarrhea . Not heard of the stomach cramp issue, my hubby been on 40ml of lactulose daily since 2012 and hasn't had that.

    Hope this clarifies things a bit.


  • The stomach cramps might be gas or "wind". It does make people "windy".

  • I wish all this had been explaine to me while my liver was failing, I know that i had varicies and HE and was given Lactolose but it was never really explained to me why I had to take the stuff and what the meds do and why I had the varicies. If they had a might of been better taking the Lactolse etc--horrible stuff I hope I never have to take it again lol. Thank you for the explanations. :)

  • Thats a good post, always good to be reminded of...

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