Nutrition in Chronic Liver Disease

Nutrition in Chronic Liver Disease Weight Loss Chronic liver disease is often associated with muscle and body fat loss. This may be difficult to detect because of fluid retention. For example, you may be losing muscle, but

To help prevent muscle and fat loss, you need to eat foods high in energy and protein.

if you are retaining fluid, you may stay the same weight.

To increase your energy and protein intake, include at least one food from

If not corrected, muscle and body fat loss can result in a variety of health complications.

A high protein diet is important for people with chronic liver disease as the protein is used to maintain muscles and body tissues (including the liver) and to the keep the body working normally.

Some people believe that people with liver disease need to avoid protein-rich foods to help prevent a condition called hepatic encephalopathy. However, this is not the case. Hepatic encephalopathy is treated by medications and avoiding protein will only make you more malnourished.

each of the following columns at each meal or snack. Energy foods • Bread and bread products • Breakfast cereals • Pasta and Rice, noodles • Cakes and Biscuits • Potato, sweet potato, corn • Butter/margarine, oil • Cream/mayonnaise • Jam, honey, golden syrup • Sugar and sugary products

Protein foods • Milk and milk powder • Yoghurt • Cheese • Custard • Meat, Fish, Chicken • Eggs • Nuts and Seeds(including pastes) • Legumes – (baked beans, lentils, chickpeas)

Note: Some of these foods may be high in salt. If you have been advised to follow a low salt diet, refer to the low salt information below.

This is a draft document from Queensland Health Dietitian/ Nutritionists Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp

Developed: March 2009 Review Date: December 2013

Further ideas to increase protein and

A number of special nutrition

energy include:

supplements may be able to help

•

Eating six to eight smaller meals and

increase your calorie and protein intake.

snacks throughout the day can help you

Talk to your dietitian-nutritionist about

get more nutrition than having three

these, if required.

normal sized meals. Small frequent meals

•

are also useful if you feel full quickly or if

Note: If you are overweight you should

your appetite has decreased.

focus on having a high protein intake and

Use fat in cooking, frying and baking; add oils to vegies and salads

limit fatty and sweet foods. Sometimes people with liver disease require a low fat diet. If your doctor recommends a low fat

•

•

•

Add eggs, legumes, yoghurt, or low salt

diet of if you are diabetic see your

cheese to your meat dishes or salads.

dietitian for information.

Have a small meal of energy rich food before going to bed. This has been shown

Vitamins and Minerals

to be helpful in weight management for

The changes that occur in chronic liver

people with liver disease.

disease can lead to vitamin and/or

Replace tea, coffee or water with fluids that provide energy (such as milk, juice, cordial or soft drink), especially if you are on a fluid restriction.

Milk is a great base for nourishing drinks as it is high in protein and energy. Full cream milk contains more kilojoules than low fat milks, so is preferable to use. Fortified soy milk (eg So Good®) is also suitable. To make your milk higher in protein and calories, other

mineral deficiencies. Problems such as excessive bleeding, osteoporosis, anaemia, and night blindness can result if vitamin and/or mineral levels are too low.

Eating a variety of foods can help to avoid deficiencies. However your doctor may still recommend a vitamin and mineral supplement if required. Avoid taking any supplements or following diets not recommended by your doctor or dietitian.

ingredients may be added, such as ice-cream and a variety of flavourings.

This is a draft document from Queensland Health Dietitian/ Nutritionists Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp

Developed: March 2009 Review Date: December 2013

Fluid and Salt

1. Do not add salt at the table or

As liver disease progresses, fluid can be

in cooking.

stored around your stomach – this is

What to use instead …

called ascites. If this occurs it becomes very important to limit the amount of salt

• freshly ground pepper, dry mustard powder

(sodium) you consume.

• lemon juice, lime juice, vinegar Because salt acts like a sponge with fluid

• a sprinkle of dried herbs

in your body, by reducing the amount of

• chopped fresh herbs- basil, oregano,

salt you eat you can limit the amount of

mint, rosemary, thyme, parsley, chives,

fluid that stays in your body. If you have

sage, tarragon

ascites, your doctor and dietitian will

• garlic, curry, chilli, onion, fresh ginger, spring onions

recommend you follow a low salt diet.

• spices- cinnamon, nutmeg, cardamom, ginger, cumin

You may also be asked to limit the amount of fluids you drink through the day. This includes all beverages and

Also, try….

watery foods such as soup, ice-cream,

•

‘wet’ curries, fruits etc.

slowly cutting down your salt intake over a few months to allow your taste buds to adjust.

HINTS TO REDUCE SALT

•

tasting food before adding salt or salty sauces

1. Do not add salt at the table or in cooking

Other products such as sea salt, vegetable salt, celery salt, lemon pepper,

2. Choose low salt foods

herb salt can still contain high levels of

3. Count your salt

sodium. Check the nutrition panel and ingredients.

This is a draft document from Queensland Health Dietitian/ Nutritionists Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp 2013

Developed: March 2009 Review Date: December

FLAVOUR COMBINATIONS TO TRY •

pork - garlic, lemon rind, coriander, apple sauce, ginger, mustard.

•

beef - bay leaf, thyme, mustard, sage.

•

lamb - mint, ginger, currant jelly,

•

black pepper. •

paprika, oregano, rosemary, garlic. •

chicken - sage, tarragon, garlic, chilli.

•

fish - lemon juice, lemon pepper, lime

potato - chives, paprika, mint, parsley,

carrots - ginger, cinnamon, honey, parsley.

juice, chives, parsley, vinegar. •

tomato - basil, garlic, black pepper, parsley, oregano.

2. Choose low salt foods Most sodium (75%) comes from processed foods. When shopping, buy fresh, unprocessed, or frozen foods. Also choose foods labelled “low salt” or “no added salt”. Some foods labelled “reduced salt” can still contain high levels of sodium. Check the nutrition panel – a sodium (Na) content less than 150 mg per 100gm serve is desirable. FOOD Bread & Cereals Often high in salt

Lower Salt - CHOOSE ♦ salt reduced bread ♦ fresh and dried pasta ♦ salt reduced and low salt crackers and biscuits eg Ryvita, Vitaweat, rice and corn cakes ♦ rolled oats, porridge ♦ Weetbix, Sustain, muesli, Just Right, puffed wheat, oat or wheat bran ♦ rice ♦ plain flour & cornflour


High Salt - AVOID ♦ savoury crackers ♦ sweet biscuits & shortbread ♦ croissants, pastry, cakes, scones, muffins ♦ savoury breads, bread, bread rolls (products based on self raising flour are high in salt) ♦ packet rice & pasta with flavouring, instant noodles ♦ breakfast cereals with more than 150 mg sodium per serve eg Cornflakes, Rice Bubbles, Bran Flakes ♦ tinned spaghetti


FOOD Fruit

Vegetables

Milk, yoghurt and cheese

Meat , Fish, Chicken, Eggs

Lower Salt - CHOOSE ♦ fresh fruit ♦ dried fruit, tinned fruit ♦ fruit juices ♦ all fresh and frozen vegetables ♦ legumes (lentils, chickpeas, soup mix, soybeans, kidney beans), canned bean mix ♦ ‘no added salt’ canned vegetables ♦ milk – all types ♦ yoghurt ♦ custard, dairy desserts, icecream ♦ cottage, ricotta or continental (quark) cheese ♦ fresh, unprocessed meat (lamb, beef, veal, pork), chicken, turkey, fish and seafood ♦ eggs ♦ ‘no added salt’ tinned seafood eg tuna in springwater

High Salt - AVOID ♦ olives ♦ canned plums ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

♦

♦ Fats

Drinks, Snacks & Extras

♦ unsalted butter, oil and avocado ♦ no added salt (e.g. Becel, Sundew) or reduced salt (Gold’n Canola, Flora) margarines ♦ no added salt peanut butter Drink water! ♦ ♦ ♦ ♦ ♦ ♦ ♦ ♦

cordial, softdrink home made, unsalted soups Milo, tea, coffee unsalted nuts & seeds jam, honey, syrup unsalted popcorn plain chocolate plain lollies

♦ ♦ ♦ ♦ ♦ ♦ ♦

♦ ♦

♦ ♦ ♦ ♦ ♦ This is a draft document from Queensland Health Dietitian/ Nutritionists Disclaimer: http://www.health.qld.gov.au/masters/copyright.asp 2013

pickled and canned vegetables tomato or vegetable juice baked beans or reduced salt baked beans cheese : cheddar, cream, brie, camembert, feta, parmesan cheese spreads reduced salt cheeses (still high in salt) cured, smoked, canned or salted meat eg corned beef, ham, bacon, sausages, salami, brawn, pate, frankfurts meat pies, sausage rolls, fish fingers, crumbed or battered fish, hamburgers, BBQ chicken, pizza, chicken nuggets, Chinese food tinned fish in brine or tomato sauce, anchovies butter margarine peanut butter

sports drinks soup, Bonox tomato juice, vegetable juice clear aspirin or panadol effervescent drinks e.g. alkaseltzer, Eno and vitamins e.g. Berocca dips, olives, marinated & pickled foods most sauces - tomato sauce, tartare sauce, BBQ sauce, teriyaki , soy sauce (even reduced salt), Worcestershire sauce, cheese sauce gravox, gravy, stock cubes vegemite, meat & fish paste salted nuts and snacks crisps, pretzels mustard, pickles, relish Developed: March 2009 Review Date: December

3. Count your salt Check the nutrition information panel for an accurate measure of sodium per serve in a particular food, and aim to have less than 2000mg of sodium each day. In some cases, a limit of 1400mg daily may be needed. Any food with more than 150mg sodium per 100 gm serve should be limited.

The table below provides a general guide. FOOD

mg sodium FOOD

mg sodium

bread, 1 slice

150

fresh, dried, canned fruit

0

crumpet, 1

290

fresh or frozen veg,

10

average serve porridge, muesli, weetbix,

0 - 80

(low salt) small bowl Cornflakes, Nutrigrain

tinned vegetables (peas,

150

corn, etc ) ½ cup 200 - 320

potato crisps 50g packet

450

rice or pasta 1 cup

0

salted nuts 50g

210

2-3 crackers

100

unsalted nuts 50g

5

2 sweet biscuits

100 - 150

baked beans ½ cup

570

piece of cake/ scone

150 - 200

tinned fish in brine 100g

300 - 400

sports drink 500mL

200

chicken, fresh 100g

60

cup of soup, 1

650

ham, 2 thin slices 60g

950

tomato sauce, 20mL

200

bacon, 1 rasher, 20g

650

mayonnaise/dressing 20ml 250

egg, 1 large

70

sausage roll, average 80g

600

cheese, 1 slice 30g

200

meat pie, 1

900

cottage/ ricotta 30g

60

chicken nuggets 6

630

glass of milk

100

hamburger, average

1000

small tub yoghurt

120

sausage, 1 thick

650

butter/marg 1 teaspoon

60

pizza, ¼ medium

1200

2-3 pinches salt (1gram)

1500

1 scone

200

Berocca, 1 tablet

285

(high salt) small bowl



SUGGESTED MEALPLAN BREAKFAST

MORNING TEA

LUNCH

AFTERNOON TEA

DINNER

SUPPER

Things I can do to improve my management of chronic liver disease: 1.

2.

3.

For information contact your Dietitian or Nutritionist:

