Beyond the maintenance of a good, well-balanced diet, several conditions that develop in the later stages of cirrhosis that require specific dietary management.
Hepatic encephalopathy (HE) Hepatic encephalopathy is a condition of impaired mental function due to altered liver function. It is often seen when cirrhosis prevents the normal flow of blood through the liver. The blood, which contains toxins, is “shunted” or redirected, back to the central circulation and into the brain without first going through the liver for detoxification. This “shunted” blood contains high concentrations of amino acids and ammonia that may cause altered mental function in some patients.
The treatment for HE is aimed at reducing toxins that cause this disorder. Just as patients with cirrhosis who have protein intolerance must restrict protein intake, so must patients with HE reduce the amount of protein in their diet. Severe protein restriction (to 20 grams a day or less) is impractical for long-term therapy. Most physicians will encourage their patients to take approximately 40 grams of protein a day and will prescribe lactulose and neomycin to decrease the production of ammonia in the intestines. Certain foods (vegetables, milk) contain protein, rich in these amino acids and are preferred to meat as a source of protein in affected patients.
Ascites and edema Ascites is the accumulation of fluid in the abdominal cavity. Edema is fluid built up in the tissues, usually the feet, legs or back. Both conditions result from abnormal accumulation of sodium associated with portal hypertension and liver disease. Most affected patients will not require strict fluid restriction. Sodium intake is often restricted for patients with cirrhosis to avoid retention of fluids in the body. Such a diet would allow only 1-2 grams of sodium and would exclude canned soups and vegetables, cold cut meats, condiments such as mayonnaise and ketchup, dairy products, cheese and ice cream. Most fresh foods are low in sodium. The best salt substitute is lemon juice (which is salt free).
Cholestasis Cholestasis is an inability of the liver to excrete bile. This may result in steatorrhea (fat malabsorption due to inadequate amounts of bile, which dissolve fat in the intestines). Steatorrhea may go unnoticed by the patient or can be associated with weight loss due to lost calories. Stools may be foul smelling and float. Fat supplements are available; the most commonly used being safflower oil, which is absorbable with less dependence upon bile. It may be used as a caloric supplement. Patients with steatorrhea may also have difficulty absorbing fat-soluble vitamins. However, water-soluble vitamins are absorbed normally. Supplementing the diet with fat-soluble vitamins is possible, though it should only be carried out under the guidance of a physician.
Wilson’s disease In Wilson’s disease there is a defect in copper metabolism. Patients affected by this disorder have an abnormal build-up of copper in the body due to the inability of the liver to excrete it. Dietary therapy for this disease includes the avoidance of copper-containing foods like chocolate, nuts, shellfish and mushrooms.
Hemochromatosis Hemochromatosis is a disease in which there is an inappropriate absorption of iron from the intestine. The excessive iron then accumulates in the liver, pancreas and other organs in the body. Patients with this disease should not be given iron supplements. Aside from this precaution, those with hemochromatosis may follow a normal diet.
Fatty liver Fatty liver is related to alcohol, obesity, starvation, some drugs and other factors. It is not caused by eating fat and it should be treated with a well-balanced diet or the removal of the responsible chemical substance or drug.