What the guidelines say about eating with cirrhosis
The American Association for the Study of Liver Diseases (AASLD) publishes practice guidance for doctors who treat liver disease. Here is what it says about the things LiverPal helps you track. Your own care team may set different targets for you, and their advice always comes first.
Sodium: about 2,000 mg a day if you have ascites
Ascites is fluid that builds up in the belly. For people with ascites, AASLD recommends limiting dietary sodium to 2,000 mg (88 mmol) a day.1 Cutting much further isn't advised, because very low-salt diets are hard to stick to and can lead to eating too little.1
Most sodium comes from packaged, restaurant and fast food rather than the salt shaker, which is why it's so hard to keep track of from memory.
Protein: don't cut back
Muscle loss (sarcopenia) and malnutrition are common in cirrhosis. AASLD's 2021 guidance recommends 1.2 to 1.5 g of protein per kilogram of body weight each day, and says protein should not be restricted, including in people with hepatic encephalopathy.2
For someone who weighs 70 kg (154 lb), that works out to roughly 84 to 105 g of protein a day.
Fluids: only if your doctor sets a limit
Not everyone with cirrhosis needs to limit fluids. Doctors usually add a fluid limit when blood sodium levels drop too low (hyponatremia). If yours has given you one, it helps to count every drink, including coffee and tea.
How LiverPal helps
- Sodium in every food. Snap a photo, scan a barcode or search, and LiverPal adds up your sodium against a 2,000 mg daily limit.
- Salty foods stand out. High-sodium foods are graded Use Caution, so you can spot them before they add up.
- A protein goal based on your weight. LiverPal starts you at about 1.2 g per kg of body weight, the low end of the AASLD range, and you can raise it if your care team wants more.
- No weight-loss deficit. Because undernutrition is a risk with cirrhosis, the cirrhosis plan doesn't put you on a calorie deficit.
- Fluid tracking with warnings. Log water, coffee and tea against a daily limit you can set, and get a warning when you go over.
- Reports for appointments. With Premium, export a PDF with your averages, a daily sodium chart and your full food log.
- Built for caregivers too. Log meals for a parent or partner and bring the report to their appointments.
LiverPal is not medical advice. If you notice rapid weight gain, more swelling in your belly or legs, new confusion, or vomiting blood or black stools, contact your care team right away or call 911.
Questions about cirrhosis and LiverPal
Can LiverPal tell me my sodium or fluid limit?
No. LiverPal starts with general targets based on AASLD guidance, but your hepatologist or dietitian should set your limits. Enter their numbers in the app and LiverPal will track against them.
Does LiverPal work if I have cirrhosis without ascites?
Yes. Choose the cirrhosis plan, then adjust the sodium, protein and fluid targets to whatever your doctor recommends for you.
Is LiverPal a medical device?
No. LiverPal is a tracking and education tool. It does not diagnose or treat cirrhosis or any other condition, and it does not replace your care team.
References
- Biggins SW, Angeli P, Garcia-Tsao G, et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(2):1014–1048. doi:10.1002/hep.31884
- Lai JC, Tandon P, Bernal W, et al. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the American Association for the Study of Liver Diseases. Hepatology. 2021;74(3):1611–1644. doi:10.1002/hep.32049
