Eating a good, balanced diet to maintain strength and a healthy weight is essential for people with liver problems. Good nutrition can help to support your liver to function and plays a crucial role in your health1,2.
If you have a liver condition, there are some special considerations you may need to make in your diet to stay nutritionally well and to help to manage your condition. Some of these are specific to certain liver diseases, others relate to how advanced your liver disease is.
In this publication we’ll cover: how your liver is affected by the food you eat; elements of a well-balanced diet suitable for most people; disease specific dietary considerations and special or therapeutic nutritional diets for those with more advanced liver disease3,4.
If you are experiencing symptoms such as loss of appetite, nausea, low energy levels, fluid retention in the legs or accumulation of fluid in the abdomen (ascites), you will need to follow a more specialised diet. These, and other problems associated with advanced liver disease, require specialist dietary advice from a registered dietitian.
It is important that you talk to your doctor as well as reading this information. Your consultant will be able to refer you to a registered dietitian. If you have already been given dietary advice you should not make changes without first talking to your consultant or dietitian.
The British Liver Trust has a range of publications covering specific areas of liver disease which you may also find helpful.
You need food to power your body, giving it energy and the material it needs to grow and repair itself. When you eat food, it is broken down in your stomach and intestine (gut) and three main nutrients are extracted:
fat
protein.
These nutrients are then absorbed into the bloodstream and carried to your liver. Here they are either stored, or changed in such a way that your body can use them at once.
At the same time your liver is also working to detoxify substances which may harm your body such as alcohol; chemicals used in pest control, which may be present on unwashed fruit and vegetables; medicines; other drugs and some of the waste products produced in the body. If you have a liver problem, then your liver may not be able to do these jobs as efficiently as it should.
Carbohydrate
Carbohydrate comes from starch and sugar, and is found in bread, potatoes, rice, pasta, cereals fruit and sweets5. Carbohydrate is broken down in the liver to glucose, a form of sugar, which is used as a source of energy.
Any glucose not used immediately for energy is stored as glycogen in the liver and in the muscles. The liver helps to control the level of glucose in the blood. When your body needs extra energy – when running for a bus for example – the glycogen is quickly converted back to glucose and released.
The damage caused by liver disease can affect your liver’s ability to store and release glycogen, causing fatigue. If you go for long periods of time between meals, the body will start to use its own muscle tissue or fat, to provide energy, which can lead to malnutrition, muscle wasting and weakness1,2,6.
Fat
Fat comes from butter, cheese, oil, animal fat and from many ‘hidden’ sources, for example, biscuits, pastry, crisps, cakes and nuts.
Fat can be used as a long-term energy store. Each gram of fat provides 9kcal of energy, compared with only about 4kcal from a gram of carbohydrate or protein6. It also provides the fat-soluble vitamins A, D, E and K, and essential fatty acids.
Fat is broken down in the liver to provide supplies of energy, or is stored in tissues to be used when energy sources are low. In some people fat builds up in the liver cells, stopping them from working properly. This is more likely if you are overweight or obese, have diabetes, high blood cholesterol levels7 or drink alcohol excessively8.
Protein
Protein comes from foods such as meat, fish, eggs, nuts, pulses and dairy products. It is made up of units called amino acids and when these reach the liver they provide building blocks to make cells and tissues throughout the body6.
Vitamins and minerals
In addition to carbohydrates, fat and protein, the body also needs a number of vitamins and minerals to function properly.
Most people can get all the vitamins and minerals they need by choosing a variety of foods from a normal, healthy, well-balanced diet (see ‘A well-balanced diet’). However, if you have cirrhosis, or certain types of liver disease, you may become deficient in (short of) certain vitamins and minerals, and your doctor or dietitian may prescribe supplements.
People who have been drinking alcohol excessively, especially those with alcohol-related cirrhosis, are often deficient in the water soluble vitamins B and C. Those with chronic alcohol-related pancreatitis, primary biliary cirrhosis or primary sclerosing cholangitis, may become short of the fat-soluble vitamins A, D, K and sometimes E.
People with cirrhosis are at risk of bone thinning (osteopaenia / osteoporosis). If this is diagnosed, it is likely that your doctor will provide you with supplements of vitamin D and /or calcium. Similarly, if you have chronic autoimmune hepatitis and are taking steroids for this, or any other liver condition, then you are also at risk of bone problems and will be given these supplements9.
If your condition has progressed and you have had some bleeding from the gut, you may become short of iron and it may be necessary to take iron supplements.
Vitamins and mineral supplements are not recommended unless advised by your doctor or dietitian.