Cirrhosis self-care and diet

Cirrhosis is scarring of the liver that gets worse over time and usually cannot be reversed. It has a variety of causes. The most common are heavy alcohol use, obesity and viral hepatitis.

When the liver is damaged, it tries to heal itself. While it is healing, scar tissue builds up, making the liver less able to work properly.

The scarring of cirrhosis usually cannot be reversed. But if it is found early enough and carefully managed, complications may be prevented or at least slowed. Even when cirrhosis is advanced and life-threatening, you can take steps to help maintain your quality of life. In severe cases, a liver transplant may be an option.

Working with your care team to manage your lifestyle — and giving up alcohol use — must be your top priority.

When you have cirrhosis, you must take steps to prevent further damage. These general guidelines may help you maintain your liver’s function and your overall health:

• Stop drinking alcohol. No matter what caused your cirrhosis, don’t drink alcohol. All types of alcohol may cause liver damage and scarring. If you need help quitting, talk with your care team about your options.
• Manage obesity. If you are overweight or have obesity, the excess fat worsens liver inflammation. Any loss of body weight is helpful. Ask your care team about weight-loss programs that are right for you.
• Avoid malnutrition. Some people with more advanced cirrhosis develop malnutrition. This can include weight loss and protein and vitamin deficiency. Actively planning meals that promote liver health can help prevent further damage.
• Be safe with pain relievers. Don’t take ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) at all. Depending on the severity of your liver damage, your care team may tell you to limit acetaminophen (Tylenol, others) to 2,000 milligrams a day, or perhaps not take it at all. Do not use standard doses of aspirin for pain relief. Your care team can advise you whether to continue low-dose aspirin (81 milligrams a day) for heart protection.

• Take precautions against infections. When you have cirrhosis, you are more likely to develop certain infections. Your care team will likely update all your needed vaccinations. These include hepatitis A, hepatitis B and pneumococcal vaccines. Make sure you get influenza and coronavirus disease 2019 (COVID-19) vaccines every year.

  Don’t eat raw seafood such as shrimp or sushi. Also don’t swim in brackish or salt water. People with cirrhosis are more likely to get certain infections that can be transmitted in these settings. Don’t drink unpasteurized milk for similar reasons.

Lifestyle and diet can improve your overall health and sense of well-being. They also can help you deal with the stress of a chronic illness. But they cannot reverse cirrhosis or substitute for recommended management strategies.

Your care team can assist with specific diets and other advice. Your team may recommend that you:

• Decrease salt in your diet. When your diet is high in salt, your body may retain fluids. That can make your stomach and legs swell. If you eat prepared foods, choose those that are low in sodium and eat them in small amounts. Herbs and spices can add flavor to your meals.
• Choose lean proteins. Poultry, fish and legumes, such as beans and lentils, are good choices.
• Reduce your fat intake. When your liver is damaged, it may produce less bile, a substance that is needed to digest fats. If you eat more fat than your body can digest, you may feel discomfort after meals. Eating less fat better matches what your liver can do and helps you feel better. Eating small meals during the day rather than one or two large meals may make it easier to follow your care team’s advice.
• Ask about favorite foods. If your care team doesn’t mention a favorite food in your diet plan, ask about it. Find out whether you may safely eat it and in what amount. It’s better to know how to handle tempting foods such as ice cream and cheese than to eat them and worry about your health. If you usually eat a lot of something that isn’t in your food plan, such as diet soda or eggs, ask about how they fit into your diet.
• Manage your sleep. Your body needs good quality sleep to heal and to allow you to keep up with work, school and family events. Develop and follow good sleep habits to make sure that you get the most out of your nightly rest.
• Quit smoking. Tobacco in any form increases your risk of cirrhosis-related complications. Your care team can help you choose a smoking cessation method that is safe and effective for you.
• Manage anxiety and stress. Waiting for a donor organ and other aspects of living with cirrhosis can be stressful. Moderate exercise, activities that are not physically taxing and support groups may help you relax. If they don’t provide relief, ask your healthcare professional if prescription medicines are an option.

Preventive care can go a long way toward reducing complications from cirrhosis. But they still may occur.

Some complications are particularly serious, including:

• Ascites.
• Chronic edema.
• Esophageal varices or high blood pressure in the abdominal vessels.
• Hepatic encephalopathy.

If you develop any of these, work closely with your care team and liver specialists. They can help you start and adjust various medications and routinely monitor your status.

In extreme cases, you may need to consider and undergo a liver transplant.