About liver disease
A healthy liver is essential for the digestion and absorption of nutrients and energy from food. If your liver is not working properly, it becomes difficult for your body to store and use energy efficiently. For these reasons, people with liver disease often have increased requirements for energy (calories) and protein.
Symptoms such as nausea, vomiting, diarrhoea, ascites (a collection of fluid that causes the abdomen to swell) and a loss of appetite can make it more difficult to eat. As a result many people with liver disease are undernourished.
Good nutrition is essential for preventing muscle wasting, maintaining strength and mobility, reducing hospital admissions and managing some of the symptoms of liver disease.
Symptoms of liver disease
Symptoms can include:
- nausea
- poor appetite
- loss of weight (fat and muscle)
- abdominal fluid retention (ascites).
A specialised diet can help improve these symptoms. The diet advice we offer will depend on which stage of liver disease you have.
Stages of liver disease
Decompensated liver disease
Decompensated liver disease means you are experiencing liver-related symptoms such as ascites (fluid in the abdomen) or jaundice (your skin or the whites of your eyes turn yellow).
Compensated liver disease
Compensated liver disease means you are not experiencing liver-related symptoms, and you are generally feeling well.
Food goals
What you eat
Good nutrition is essential for preventing muscle wastage, maintaining strength and mobility, reducing hospital admissions and managing some of the symptoms of liver disease.
The recommendations we make will depend on the stage of the disease you are experiencing.
| If you have compensated disease | If you have decompensated disease |
| 2 to 3 hourly sources of carbohydrates | 2 to 3 hourly sources of carbohydrates |
| 3 to 4 sources of protein per day | 3 to 4 sources of protein per day |
| 50g carbohydrate snack at bedtime | 50g carbohydrate snack at bedtime |
| No added salt diet | Low salt diet |
| Aim for a healthy, balanced diet | May need to choose high calorie foods |
| Aim for 150min physical activity per week | Aim for gentle, weight bearing exercise as tolerated |
| May require nutritional supplements if appetite is poor |
Carbohydrates
When you eat carbohydrates, your body breaks them down into glucose. This is your body's main source of energy. Any surplus is usually stored in your liver and muscles.
When your liver is not working properly, it cannot replace the store of carbohydrates and has to find a different source of energy. It usually does this by breaking down muscle.
If you eat carbohydrates every 2 to 3 hours, it helps prevent this, thus reducing muscle wastage and weight loss. See snack ideas in 'Adapting your eating habits' below.
Sources of carbohydrates include the following:
- bread, chapattis, wraps, flat bread, crackers
- pasta, couscous
- cereals, rice, grains (such as oats, bulgar wheat, barley)
- potato, sweet potato
- beans (including black, kidney, pinto), lentils, chickpeas.
Useful tipTry to choose wholegrain or brown types of carbohydrate, to help give you regular bowel motions. If you have diabetes, wholegrain varieties also help maintain your blood sugar levels. |
Diabetes
If you have diabetes, you may worry about managing your blood sugar level.
If you have liver disease, it is important to consume of carbohydrates regularly, throughout the day and at bedtime. This may affect your blood sugar levels, but you must continue to include these foods in your diet. This will help prevent muscle wastage and malnutrition.
If your blood sugar level is often high, we advise you to consult your diabetes specialist nurse. They will be able to offer advice on how to manage this.
Protein
Your body needs protein to maintain and repair your body's tissues. If your liver is not working properly, it will need more protein than usual.
Patients with liver disease need 1.2 to 1.5g of protein per kg of body weight per day. For example in an adult weighing 70kg, this is 84 to 105g of protein per day.
Try to eat foods high in protein three to four times per day. Use the table below to choose high-protein foods.
| Approximate serving | Amount of protein | |
| Chickpeas | Half a can | 8g |
| Kidney beans | Half a can | 9g |
| Baked beans | Half a can | 10g |
| Walnuts | 20g | 4g |
| Cashew nuts | 20g | 5g |
| Chicken | 1 chicken breast | 34g |
| White fish such as cod | 1 small fillet | 23g |
| Oily fish such as salmon | 1 small fillet | 25g |
| Canned tuna | Half a can | 14g |
| Prawns | 80g or 25 small prawns | 14g |
| Beef mince | 125 G | 27g |
| Pork loin | 100g | 21 to 28g |
| Lamb chop | 100g | 14 to 20g |
| Milk | 200ml | 7g |
| Yoghurt | 125ml pot | 5 to 7g |
| Cottage cheese | 100g or 3 tablespoons | 8g |
| Cheddar cheese | 30g (matchbox size) | 9g |
| Eggs | 1 medium | 7g |
| Hummus | 3 tablespoons | 4g |
| Tofu | 80g | 7g |
| Quorn mince | 100g | 14g |
| Soya milk | 200ml | 6g |
Fruit and vegetables
Fruit and vegetables are important sources of vitamins and minerals, but are generally low in calories and protein. However, they are a good source of fibre.
- If you have a good appetite, aim to have 5 portions of fruit and vegetables per day.
- If your appetite is poor, give priority to your intake of carbohydrate and high protein foods.
Adapting your eating habits
Adapting your eating habits for liver disease involves eating small, frequent meals. We recommend you do this every two to three hours.
Daytime
Ideal daytime snacks to have between meals include:
- yoghurt and a portion of fruit
- slice of wholemeal toast
- small bowl of cereal and milk
- handful of dried fruit and nuts
- cereal bar
- crackers with cottage cheese
- homemade smoothie or milkshake
- glass of milk and a piece of fruit
- banana or apple with nut butter
- vegetables with hummus
- half a bagel with avocado
- custard pot.
Bedtime
We recommend you have a late evening snack of 50g carbohydrate every evening.
This will reduce muscle wasting and weight loss by giving your body overnight energy.
Ideal bedtime carbohydrate snacks (50g) include:
- 2 slices of bread with jam or honey + 200ml milk
- 3 plain or chocolate biscuits + 300ml milk
- 50g cereal + 200ml milk
- bowl of porridge and handful of berries
- 2 cereal bars
- 4 plain digestive biscuits and an orange
- a sandwich and 150ml fruit juice
- rice pudding pot with a banana
- 1.5 hot cross buns
- 2 chapattis (medium sized).
Supplement drinks
If you are unable to eat enough, your dietitian may have recommended some supplement drinks.
Good ways to achieve 50g of carbohydrate include:
- 1 bottle Fortijuce or 1 bottle Vital 1.5
- 1 piece of fruit or 1 slice of bread or toast, plus one of the following:
- 1 bottle Fortisip Bottle
- Fortisip Compact
- Fortisip 2kcal
- Fortisip Yogurt Style.
| All oral nutritional supplements must be prescribed by a dietitian. |
Reducing salt intake
Eating less salt can prevent or decrease fluid retention (ascites and/or oedema). Oedema is fluid build-up, most commonly in the feet, ankles or legs.
We advise you to consume a maximum of 5g salt per day in your diet.
Use the traffic light system on food labels to decide which products to buy. Try to choose foods with a green indicator.
| Avoid | Try |
| Do not add salt at the table | Seasoning with herbs and spices (garlic, lemon, chilli, ginger, coriander) |
| Avoid salt substitutes such as LoSalt, Himalayan salt, pink salt | Lemon, spices, herbs |
| Avoid stock cubes, bouillon cubes, gravy granules | Making your own stock without adding salt |
| Avoid tinned vegetables including baked beans | Fresh or frozen vegetables, or low-salt or low-sodium tinned varieties |
| Avoid smoked and cured fish, tinned fish in tomato sauce or brine | Tinned fish in sunflower oil or spring water |
| Avoid salted crisps, crackers | Oatcakes, crackers, crispbread, Ryvita, rice cakes, bread sticks |
| Avoid tinned soups and sauces | Home-made soup; ready-made sauces for occasional use |
| Avoid processed meats (ham, bacon, sausages, salami) | Try cold cooked fresh meats and poultry |
| Avoid large amounts of hard cheese | Choose unsalted butter, and cheese such as cottage cheese |
| Avoid takeaways such as pizza, Chinese, curry or burger-style fast food | |
| Avoid ready-made meals | Only ready-made meals that are green on the traffic light system |
If you have a small appetite
If you have decompensated liver disease, you may have a small appetite. In this situation, it is a good idea to choose high-calorie foods.
High-calorie foods
- nut butters, nuts and seeds
- oily fish
- hummus
- cheese, butter, margarine, ghee, oils
- jam, honey
- puddings
- creamy yoghurt, evaporated milk, cream
- ice cream
- cakes, pastries, biscuits
- chocolate, sweets.
Tips
- Keep fluids to a minimum at mealtimes, to avoid feeling full up. Try to drink after meals.
- If you cannot manage a pudding after your main course, save it for later and have it as a snack.
- If you can eat more at certain times (for example in the morning), try to eat as much as you can then.
- Fry foods whenever you can because oil and fat are good sources of calories. If you grill food, brush some oil over it before and during grilling.
- If you feel tired, make larger quantities of food and freeze individual portions.
- Try frozen lower-salt ready meals from your supermarket.
- Choose nourishing drinks such as full fat milk, hot chocolate, Ovaltine, Horlicks and milkshakes.
Reminder
- Eat a carbohydrate-based snack every 2 to 3 hours.
- Have a snack containing 50g carbohydrate before you go to bed.
- Include 3 to 4 portions of high-protein foods every day.
- If you experience fluid retention, try to reduce the amount of salt in your diet.
Contact information
Kingston Hospital Nutrition and Dietetics Department
Telephone: