Diet taboos for liver cirrhosis

Absolute abstinence from alcohol, strict sodium restriction when combined with ascites, and avoidance of rough and hard/excessive high-ammonia/high-fat foods based on complications. There is no "uniform taboo list" that applies to all patients. The remaining requirements must be flexibly adjusted based on the stage of the disease and complications.

First of all, there is no room for discussion on alcohol prohibition. No matter whether it is traditional Chinese medicine or Western medicine, there is no difference on this point. Don't take chances that "you'll be fine if you drink less beer" or "drink red wine to stay healthy". The compensatory capacity of cirrhotic liver cells is only 30% or even lower than normal. 90% of the alcohol entering the body must be metabolized by the liver. Even a few grams of alcohol may induce large-scale necrosis of liver cells. In mild cases, transaminase suddenly spikes. In severe cases, it directly induces liver failure or gastrointestinal bleeding. I used to manage a 58-year-old man with compensated cirrhosis in the gastroenterology department. His indicators were very stable during the 3-year follow-up. I thought it was okay to drink a couple of beers to cheer him up during the Chinese New Year. However, he vomited blood and was sent to the emergency department that night after drinking three bottles of cold beer. It was found out that the portal vein pressure suddenly increased due to alcohol, which ruptured the varicose esophageal veins. Even invisible foods containing alcohol should be avoided. It is best not to touch foods such as glutinous glutinous rice balls, drunken crabs and drunken shrimps, and wine-filled chocolates that appear to have little alcohol content.

Let’s talk about the most misunderstood salt restriction requirements. Many statements on the Internet directly require patients with liver cirrhosis to completely ban salt. In fact, the restriction standards for different conditions are very different, and the judgment standards of different doctors are also slightly different. If you are a compensated patient who has not yet developed ascites or lower limb edema, it is enough to control your daily sodium intake to 4-6g (about the amount of an ordinary beer bottle cap). You can avoid pickles, cured meats, processed meat products, and prepackaged snacks. There is no need to eat no salt at all. I met a 62-year-old aunt before. She was told by a patient that she should completely ban salt. She didn’t even dare to touch low-sodium salt. She only dared to add two drops of soy sauce when cooking for three months. The final blood sodium test was only 122mmol/L. She was so weak that she couldn’t stand. Instead, she was hospitalized for a week because of hyponatremia. Only decompensated patients who have already developed ascites and lower limb edema need to reduce sodium to less than 2g per day, and patients with severe ascites should even lower it. However, the specific value must be adjusted based on the blood sodium results of each review. The stricter the limit is not the better. The core is to maintain electrolyte balance in the body. Blind ban on salt will not help.

The remaining taboos basically follow complications, and individual differences are very large. There is no need to stick to the unified list online. For example, for patients with moderate to severe esophageal and gastric varices, the most important thing to guard against is rough, hard, angular, and overly hot food. Previously, a 48-year-old male patient was admitted to the emergency department. His liver cirrhosis had been well controlled for three years. At a friend's party, he ate half a plate of fried peanuts, and he vomited half a basin of blood that night. During the gastroscopy, it was found that the edges of the hard peanuts scratched the varicose veins, and he almost didn't survive. There are two different clinical views on this point: some doctors will require patients to completely avoid all hard foods, including apples and nuts, while other doctors believe that most foods can be eaten as long as they are chewed thoroughly until they are completely soft. From my personal experience, the latter is actually more flexible and better able to ensure the patient's nutritional intake. For example, chewing an apple may be risky, but scraping it into puree or cutting it into thin slices and chewing it until it is completely broken and then swallowing it will basically not be a problem. On the contrary, it can supplement vitamins. There is no need to completely avoid the food. The key is not to gobble it up, and avoid fried peanuts, crispy bones, fish with small spines, and hard pancakes fresh out of the pan, which are easy to scratch the esophagus.

And the most frequently asked question is “can we eat meat?” This is also the most controversial point. Many people say that people with cirrhosis of the liver should completely avoid high-protein foods, otherwise hepatic encephalopathy will be induced. In fact, this is not absolutely true. Patients who have no history of hepatic encephalopathy and whose liver function is still stable should eat more high-quality protein, such as boiled eggs, warm milk, skinless chicken breasts, and steamed fish. They should ensure a daily protein intake of 1-1.2g per kilogram of body weight. Otherwise, they are prone to hypoalbuminemia and ascites that cannot be eliminated repeatedly. Only when there are signs of hepatic encephalopathy, such as recent slow reaction, inability to remember things, drowsiness during the day and inability to sleep at night, or even the inability to recognize people, is it necessary to temporarily limit the intake of animal protein and replace it with plant proteins such as tofu and soy milk. After the encephalopathy improves, the protein must be slowly added back. I once had a patient who was afraid of encephalopathy and had not touched a bite of meat for half a year. The last check showed that his albumin was only 21g/L. His stomach was as bloated as a ball. He had to stay in the hospital for half a month and was given human blood albumin every day before it went away. This was completely caused by unnecessary dietary restrictions.

Finally, I would like to mention a few small details that people tend to overlook: Don’t take random hepatoprotective health products and folk remedies of unknown origin, especially those that are clearly hepatotoxic, such as Polygonum multiflorum and Panax notoginseng. I have seen several people suffer from acute liver failure after taking folk prescriptions.； Don’t eat too full at one time. Seventy percent full is just right. You can eat 4-5 meals a day. If you are hungry at night, you can drink a cup of warm milk and eat a steamed egg. Don’t eat late-night snacks that are heavy in oil and salt, such as barbecue and hot pot. ； If you have diabetes at the same time, you must control your sugar simultaneously to avoid increasing the metabolic burden on the liver.

In fact, the diet for liver cirrhosis really does not have as many "must not eat" things as posted on the Internet. The core is to avoid those three red lines, and the rest can be adjusted according to your own review results and body reactions. Instead of not daring to eat this or that based on the unified list of taboos on the Internet, it is better to ask your doctor during each review. After all, everyone's condition is different. What is suitable for others may not be suitable for you.