Cirrhosis is the progressive scarring of the liver due to chronic injury from causes like viral hepatitis, long-term alcohol use, or fatty liver disease. This scarring is often irreversible and impairs the liver’s ability to perform its many functions. While the damage cannot usually be undone, proactive self-care is important for managing the condition, slowing its progression, and preventing complications. Taking control of daily habits, including diet, medication use, and symptom monitoring, is necessary for living with cirrhosis.
Dietary Management and Nutritional Needs
Dietary management is a central component of daily cirrhosis care, aiming to prevent fluid buildup and maintain muscle mass. A primary focus is the strict limitation of sodium intake, generally to less than 2,000 milligrams per day, to manage fluid retention. Excess sodium causes the body to hold onto water, leading to the accumulation of fluid in the abdomen (ascites) and swelling in the legs (edema).
To achieve a low-sodium diet, patients must move beyond simply avoiding the salt shaker. Reading food labels is important, as many processed, canned, and restaurant foods contain high amounts of hidden sodium. Learning to season food with herbs, spices, and lemon juice instead of salt can aid in fluid management. Fluid restriction is a separate measure necessary only for patients who develop significant hyponatremia, a dangerously low concentration of sodium in the blood.
Adequate protein intake is important to counteract the high risk of malnutrition and muscle wasting (sarcopenia). Patients with cirrhosis have higher protein requirements than healthy individuals, often needing 1.2 to 1.5 grams per kilogram of body weight daily. Historically, protein was restricted to manage hepatic encephalopathy (HE), but this practice is now avoided because it can worsen malnutrition.
Instead of restriction, the focus is on the type and timing of protein consumption. Vegetable-based proteins, such as lentils, beans, and soy products, are often better tolerated than animal proteins and may be beneficial in managing HE. Eating small, frequent meals throughout the day, often every two to four hours, helps the body utilize nutrients more efficiently and prevents the breakdown of muscle for energy. A complex carbohydrate and protein-rich snack before bed is also recommended to minimize the overnight fasting period.
Cirrhosis can lead to deficiencies in various vitamins and minerals, including B-vitamins like thiamine and sometimes zinc. Patients must consult with their medical team before beginning any vitamin or dietary supplement regimen. While some supplements may be recommended to correct specific deficiencies, taking others without guidance can be harmful. This is especially true since the compromised liver cannot process all substances safely.
Safe Medication Practices and Toxin Avoidance
Adherence to prescribed medications is important for managing cirrhosis. Patients must take medications like diuretics and lactulose exactly as directed to control ascites and hepatic encephalopathy. Consistent timing and dosage are important for maintaining stable body fluid and toxin levels.
The most important step in toxin avoidance is the cessation of alcohol consumption. Any amount of alcohol can cause further liver damage and accelerate the disease’s progression. Patients needing assistance must talk to their care team about available support programs.
Caution is required when using over-the-counter (OTC) medications, as many common pain relievers are dangerous for a damaged liver. Non-steroidal anti-inflammatory drugs (NSAIDs) must be avoided completely. NSAIDs can seriously damage the kidneys, especially in the presence of ascites, and increase the risk of gastrointestinal bleeding.
Acetaminophen is the safest pain reliever, but only when taken at a controlled dosage. The maximum recommended daily dose for chronic use in cirrhosis is typically limited to 2,000 milligrams to prevent liver toxicity. Patients must check the labels of all combined cold and flu remedies to ensure they do not exceed this limit.
Many herbal remedies and dietary supplements can be harmful, as they are not regulated and may contain compounds toxic to a compromised liver. Even supplements like milk thistle, which is often marketed for liver health, lack scientific evidence of effectiveness in cirrhosis. All herbal products, vitamins, and supplements must be reviewed and approved by a hepatologist before use.
Recognizing and Responding to Complications
Daily self-monitoring is necessary to detect subtle changes that may signal the onset of a serious complication. Ascites can be tracked by daily weighing and measuring the circumference of the abdomen. A rapid increase in weight or abdominal girth suggests fluid retention that may require an adjustment in diuretic medication or diet. Swelling in the ankles and legs should also be monitored.
Hepatic encephalopathy (HE) is a decline in brain function due to the buildup of toxins that the liver can no longer clear. Recognizing HE requires attention to subtle changes in mental status, mood, and behavior. Early signs can include mild confusion, forgetfulness, difficulty concentrating, or a change in sleep patterns.
Caregivers play an important role in spotting these changes, as the patient may not recognize their own symptoms. Physical signs like a slight tremor or a change in handwriting can also signal developing HE. Because constipation can trigger or worsen HE by increasing toxin absorption, maintaining regular bowel movements, often three soft stools a day, is an important part of managing the condition.
Infection prevention is important because infections are a frequent trigger for the worsening of cirrhosis complications, including HE. Maintaining excellent personal hygiene and promptly reporting any signs of infection, such as fever, chills, or abdominal pain, to a medical provider is important. Vaccinations are necessary steps to protect against common infections:
- Influenza
- Pneumonia
- Hepatitis A
- Hepatitis B
Patients must also be aware of the increased risk of bleeding due to portal hypertension and the liver’s reduced ability to produce clotting factors. Warning signs include vomiting blood, passing black, tarry stools, or noticing excessive bruising. Any evidence of gastrointestinal bleeding is a medical emergency that requires immediate attention.