In liver cirrhosis normal functional tissue is gradually destroyed and replaced by inactive fibrous connective tissue (scar tissue). The liver is contracted and has lost most of its function. The growth of abnormal tissue limits function by interfering with blood flow through the liver.

One of the complications of liver cirrhosis is ascites- this is the accumulation of fluids in the abdominal area (peritoneal cavity). Ascites, because it causes pressure on the chest cavity, can cause shortness of breath. It can also cause peritonitis, a life threatening condition. Sodium restriction is critical - 2-4 grams/day. That means not adding salt to your food or eating processed foods like cold cuts, pickles, salted chips etc. Unfortunately, diet therapy is not enough for most patients, and pharmacological measures (e.g. water pills) are usually necessary. If neither sodium restriction or water pills can get rid of the fluid, a procedure called paracentesis is guaranteed to work. This is extraction of the fluid by needle. It sounds painful, but people feel so much better afterwards that they soon forget any pain involved in this procedure.

Edema is fluid accumulation in the extremities, legs and feet. Albumin is a protein that is made in the liver. One of its roles is to help regulate the positioning of body water. In liver cirrhosis there is decreased production of albumin, one of the consequences is that water moves out into what is called the "third space", thus the swelling or edema. Edema and ascites both respond to sodium restriction and water pills.

The liver influences on nutrition include the metabolism of carbohydrates, fats, and protein. This is the storage place for fat-soluble vitamins A, D, E and K.

Dietary protein is likely to be an issue for some people with cirrhosis. The reason is that the liver is central to protein metabolism. The liver also functions in detoxification of waste products. Protein wastes can be particularly toxic if they are not converted to a form that can be easily removed from the body. Certain proteins (vegetables and dairy) are less toxic than others (meat). Hepatic encephalopathy (a long name for confusion) is one problem people with cirrhosis (especially extensive liver damage) might experience. You may be asked to limit protein because it is one of those toxic byproducts (ammonia) of abnormal protein metabolism that is involved in this confusion. Most people think that the vegetable and dairy protein is better tolerated and you might be able to have a lot more of this type than meat protein. There is a drug called Lactulose that is used routinely to rid the body of ammonia. It is used routinely to allow patients more leverage with their diet. One of the problems with this is that diarrhea is the mechanism of action.

Accumulation of fat in the liver cells interferes with normal function and ultimately causes them to die. Therefore, a diet modified in fat is suggested. We normally recommend about 30% for cirrhosis; I suggest around 20-25%. Fried foods, whole fat dairy and excess table fats should be avoided. If you need extra calories, medium chain triglycerides (MCTS-designer fats) can be substituted for the usual table fats. If you follow a very low fat diet or decide on the MCTs, you may need to supplement with essential fatty acids (EFA e.g. evening primrose oil) to prevent an EFA deficiency.

Carbohydrate metabolism can be deranged too. Hypoglycemia (low blood sugar) and hyperglycemia (high blood sugar) can happen as a result. The recommendation is for high complex carbohydrates (avoid excess simple carbohydrates like sugar, syrups, jellies, regular sodas and sweet desserts). Stick with bread, pasta, rice and cereals. Whole grains are always better than white flour products.

With cirrhosis, as with any chronic disease, a multivitamin with mineral supplement is always recommended. B vitamin deficiency is common and a good B complex vitamin is usually a good idea. The multivitamin with mineral and B complex is pretty safe, however, your MD should prescribe supplements and you should be monitored closely, as the liver is no longer capable of detoxifying. Too much of any single nutrient might be toxic. This is a very complex disease with multiple complications as you can see, and this is only from a nutrition standpoint.

Q #4: Liver Detoxifiers