Dietary information for patients with liver disease

How does liver disease affect my diet?

If you have liver disease you liver is not working properly, therefore your body needs more energy and protein. The energy we get from food is usually stored in the liver, however, if you have liver disease this energy is not stored and gets used up very quickly. This can increase your risk of weight loss and muscle wasting.

This leaflet aims to provide information to help you eat enough high energy, high protein foods to prevent this from happening.

Key Dietary Points

• Eat little and often.
• Attempt to eat or drink something small every 2 to 3 hours. For example, 4 to 6 carbohydrate rich meals or snacks per day.
• Include a 50g carbohydrate snack before bed.
• Try nourishing drinks such as milk, milky coffee, hot chocolate, milkshake, Horlicks, Ovaltine in between meals. Alternatively, have a small snack, such as mousse, trifle, yoghurt or cheese and biscuits.
• Avoid rushing meals. Relax after eating.
• On days when your appetite is good to try to eat whenever you feel hungry.
• If you don’t feel like cooking, try a cold snack, for example, a sandwich instead or convenience foods e.g. sausage rolls.
• Try anything you fancy such as your favourite foods.
• Fats and sugars are a good source of calories, so try to use them generously.

How can I add extra calories to my food?

Enriched Milk

To 1 pint of full cream milk add 2 to 4 tablespoons of dried milk powder and whisk well. Use this milk in place of ordinary milk as a drink, in cooking, on cereal and in tea and coffee.

You could try to add:

• Cream, evaporated milk or grated cheese to milk based sauces, condensed soups.
• Grated cheese, margarine or butter, salad cream, mayonnaise or gravy to mashed potato and well cooked vegetables.
• Sugar, honey, syrup, jam or pureed or stewed fruit to milk puddings and custard.

Why do I need starchy carbohydrates

When you eat starchy carbohydrates it is broken down into sugar. This is the body’s main energy source and it is stored in the liver.

However, if you have liver disease this energy (sugar) will be used up within 2 hours and is not stored.

If you have long periods between meals there will be no sugar for your your body to use as energy so your body must take the energy from somewhere else.

Fat is harder to convert to energy so instead your body will break down your muscles for energy. If this continues, your body will get weaker and you may lose weight. To prevent this from happening it is important to eat regularly to provide your body with energy.

Eating meals and snacks containing starchy carbohydrate every 2 to 3 hours throughout the day provides enough energy to stop your body breaking down its own muscle.

Starchy carbohydrate foods include:

• Bread (rolls, pitta, wraps, bagels, chapatti, naan).
• Potato (mashed, boiled, baked, chips, jacket).
• Pasta, noodles and rice.
• Breakfast cereal.
• Scones and teacakes.
• Crumpets and pikelets.
• Plain biscuits and crackers.

Bedtime Snacks

It is recommended that you have a 50g carbohydrate snack before bed for your body to use over night as it is a long time until breakfast.

Consider choosing a 50g bed time snack from below:

• 50g cereal with full fat milk.
• A banana with 3 or 4 biscuits.
• Mug of Horlicks/hot chocolate with 2 or 3 chocolate biscuits.
• 1/2 tin of rice pudding with 2 tablespoons of jam.
• 2 crumpets with butter, jam or chocolate spread.
• 2 slices of bread with jam/honey with 200ml milk.
• Slice of cake with custard or ice-cream.
• 3 x 60g sausage rolls of 4 50g mini pork pies.
• 300ml glass of full fat milk with 2x 30g packet of crisps.
• 1 x ham sandwich with a pot of creamy yoghurt.

Note: If you are having a nutritional supplement drink and would like this to count as your bedtime snack please consult with your Dietician.

Why do I need protein in my diet?

Protein is needed to build and repair body tissue.

By including 3 to 4 portions of the foods outlined below you may be able to prevent your body breaking down muscles to provide energy.

Examples include:

• Meat and poultry (beef, lamb, pork, chicken, turkey).
• Fish (fresh, frozen, tinned).
• Cheese.
• Eggs.
• Pulses (peas, beans, lentils).
• Meat alternatives (tofu, soya, Quorn).

Why do I need fruit and vegetables?

Fruit and vegetables are important to provide you with vitamins and minerals.

You should aim to have at least 5 portions a day.

1 portion of fruit and vegetables is:

• 1 apple, banana, orange, pear.
• 1 plum, 1 satsuma.
• 1 small handful of grapes, strawberries, blueberries, lychees.
• 1 to 2 slices melon, pineapple, mango.
• Half a grapefruit.
• 2 tablespoons of dried fruit.
• 150ml unsweetened fruit juice.
• 2 tablespoons broccoli, peas, carrots, cauliflower, peppers, mushrooms, sweetcorn.
• Medium bowl of salad.
• 80g baked beans.

Suggested meal plan

Choose at least 1 from each section.

Breakfast

• Breakfast cereal with 150mls unsweetened fruit juice.
• Toast with jam with unsweetened fruit juice.
• Toast with beans, egg, tomatoes.

Mid-morning/mid-afternoon snack

• Bagel or toast with cream cheese.
• Milk and biscuits.
• Scone or tea cake.
• Crackers and cheese.
• Yoghurt.
• 1 x apple or banana or orange.

Lunch

• Sandwich with meat, fish, cheese, egg and salad.
• Jacket potato with beans, cheese, tuna.
• Beans or egg or cheese on toast.
• Pasta or noodles or rice with meat, fish or cheese and peppers/mushrooms.

Evening Meal

• Meat/chicken/fish with potatoes/chips and vegetables.
• Meat/chicken/fish/sweet potato & lentil curry with rice/naan/chapatti.
• Pasta sauce with meat/chicken/fish/beans/cheese.
• Spaghetti Bolognaise (1/2 lentils, 1/2 meat) Lasagne with roasted veg or salad.

Dessert

• Yoghurt with 80gs of berries.
• Rice pudding with banana.
• Cake and custard/cream with stewed fruit.
• Fruit crumble/fruit pie with ice cream.

Bedtime snack

See section earlier in the leaflet.

Contact numbers

If you need further help or advice please contact:

North Tees and Hartlepool NHS Foundation Trust

Specialist Services Admin Hub

Telephone: 01429 522471

Monday to Friday, 8:30am to 4:30pm (excluding Bank Holidays).

Further information is available from:

British Liver Trust 

Website:  www.britishlivertrust.org.uk

British Dietetic Association 

Website: www.bda.uk.com

References

1. Finglas, P.M. Roe, M.A. Pinchen, H.M. Berry, R. Church, S.M, Dodhia, S.K. Farron-Wilson, M. Swan, G. (2015) McCance and Widdowson’s The Composition of Foods, Seventh Summary Edition. Cambridge: Royal Society of Chemistry
2. Carbs and Cals (2017). Chello Publishing Limited 2017: London.
3. Gandy, J. (2019) The Manual of Dietetic Practice (6^th Ed). Wiley Blackwell Ltd.

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