Diet and taboos for cirrhosis

The core logic of the diet for patients with liver cirrhosis is "high quality protein, high vitamins, high carbohydrates, low fat, sodium restriction + dynamic adjustment in stages". There is no universal "must eat list" or "fasting list". The only absolute taboos are drinking alcohol and eating hard and sharp/mouldy foods. The remaining restrictions must be adjusted individually based on the compensation/decompensation stage, ascites, hepatic encephalopathy and other complications. Blindly banning all foods may accelerate the progression of the disease.

I have been in the gastroenterology clinic for almost ten years, and I have seen too many patients who have gone to extremes: either they were so scared after being diagnosed that they went on a vegetarian diet and only had white porridge with vegetables. Within three months, they lost a lot of albumin and developed edema.； Either he doesn't taboo anything, he still drinks skewers or masturbates, and he will progress to the decompensation stage in half a year. To be honest, there really aren’t that many black and white rules when it comes to diet for cirrhosis of the liver. Just hit a few core pitfalls and adjust the rest flexibly.

If you have just been diagnosed with compensated cirrhosis, your liver function can still maintain daily operation, and there is no need to eat or touch this. The core of this stage is to replenish the liver with enough "raw materials" to help the remaining normal liver cells work well. Enough high-quality protein must be provided - such as skinless chicken legs, freshwater fish with few spines, eggs, low-fat milk, and soy products. As long as you don't feel bloated and uncomfortable after eating, you can arrange it normally, at a rate of 1 per kilogram of body weight. Calculating the amount of .2-1.5g, for a 130-pound adult, one egg + one 250ml box of milk + two taels of lean pork a day is basically enough. Don’t believe the old saying that “eating meat will increase the burden on the liver.” You are not nutritious enough, and you don’t even have the materials to repair liver cells, which is the real burden.

Many people have heard that "you cannot eat protein if you have hepatic encephalopathy." This was the standard treatment plan ten years ago, but now the liver disease guidelines both at home and abroad have changed: even patients with a history of hepatic encephalopathy do not need to completely fast from protein. Instead, they need to supplement in small amounts and gradually. Plant proteins such as tofu and soy milk, or whey protein, are preferred, as they are less likely to induce encephalopathy than animal protein. There was a 58-year-old decompensated aunt who was admitted to the hospital due to hepatic encephalopathy the year before. Her family stopped all protein and gave her only rice soup every day. As a result, she had repeated infections and ascites disappeared for half a year. Later, we asked her to add half a cup of sugar-free soy milk every day, then slowly add 1 egg white, and then gradually add a small amount of fish. After two months, the albumin level rose to 35g/L. After two months, her albumin was improved a lot, and she never suffered from encephalopathy again.

You must be strict about alcohol. No matter it is white wine, beer, or red wine, even cooking wine or so-called "health wine", you cannot touch even a drop. There are only a few normal liver cells left in a cirrhotic liver. When alcohol enters, it directly destroys it, which is equivalent to pouring more gasoline on a house that has been burned down to its frame. I have seen more than one patient in the compensatory stage who was originally in a stable condition. After two or three heavy drinks in a row, he suddenly developed liver failure and was admitted to the ICU. In the end, he was not rescued. Don't take any chances.

Hard and sharp foods are also high-risk minefields. Most patients with liver cirrhosis have varying degrees of esophageal and gastric varices. These varicose blood vessels are like balloons that are about to burst, with a thin layer attached to the esophageal and stomach walls. If the food eaten is harder or sharper, severe bleeding may occur if the food is scratched. The old patient mentioned earlier, Uncle Zhang, had been in a stable compensatory period for two years. He secretly ate two pieces of soy sauce beef brought back by his son and swallowed it without chewing it. He vomited half a basin of blood that night. Emergency treatment cost nearly 40,000 yuan to stabilize him. Later, he told everyone he never dared to eat randomly again. If you really want to eat meat, stew it until it's rotten, or use a food processor to puree it. For fish, choose fish with almost no bones, such as dragon fish or pangasius. Even if you spend a little more money, it's better than the risk of bleeding.

There are also moldy foods, sprouted potatoes, moldy nuts, and leftovers that have been stored for three or four days. Even if you dig out the moldy areas, don’t put them in your mouth. Aflatoxin is a clear first-level carcinogen. It is risky for healthy people to eat it, not to mention livers with cirrhosis. The ability to detoxify is poor. Ingestion of aflatoxin can easily induce liver cancer. There is really no need to save money and risk your life.

The requirements for salt restriction also depend on the situation. If there is no ascites and no swelling of the legs and feet, the salt does not need to be too strict. It should not exceed 6g per day, which is about the amount of a beer bottle cap. If you already have ascites, you need to reduce the amount of salt to 2-3g per day. Don’t touch the hidden salt giants such as pickles, cured meats, processed sausages, and instant noodles. If you think you haven’t eaten much salt, in fact, one piece of instant noodles has enough salt for your daily quota. Someone asked if I can eat soy sauce? Of course you can, but you have to calculate the amount carefully. A spoonful of ordinary soy sauce contains about 1g of salt. If you add soy sauce, just add less or no salt. You don’t have to give it up completely.

My usual reminder to patients is to eat slowly, chew a few times each mouthful, chew 20 times before swallowing, and don’t gobble it up. Also, don’t eat too much in one meal. Eat 4-5 meals a day. It’s much better to eat less and eat more frequently than to feel uncomfortable after one meal. Patients with ascites should also control the amount of water they drink. Don't hold a cup and drink it vigorously. Ask the attending doctor how much you drink every day and decide according to the amount.

In fact, after all, there are two key points in diet for liver cirrhosis: one is not to cause trouble to the already fragile liver, and the other is to provide the body with the nutrients it needs. Don’t search the Internet for those messy “10 foods to avoid with cirrhosis”. Everyone’s disease stage and complications are different. You may be able to eat what others can’t eat. It’s much more useful to bring your food records to your attending doctor or clinical nutritionist for review next time than to speculate on your own.