STEP - Support Through Education Program

Step 9: Nutrition

The right fuel for the best results

The liver has many roles in the body, one of which is to help to store and utilise the energy from the food we eat. When the liver is not working properly, your body struggles to store and use the energy from our food in the usual way, and you may also find that you can’t eat as well as normal, due to feeling unwell or having symptoms like reduced appetite, nausea, vomiting or

stress. Chronic liver disease is often linked with weight loss - including both loss of body fat and muscle mass - and this can lead to reduced strength, make you feel more tired and decrease your ability to go about your daily life and activities. With weight loss and poor eating, you are at risk of malnutrition, where your body is not getting the nutrients it needs and can start to break down fat stores and body muscle to use for energy. This can lead to further nutritional problems, and more complications before and after transplant. So, good nutrition both before and after a liver transplant is vital!

Some things to consider in your diet:

Eat enough protein: To try and prevent muscle loss, a high protein, high energy diet is recommended. As protein provides the building blocks for your muscles, this will ensure that your body has enough protein and energy from your food, so it doesn’t need to break down proteins from your muscles to keep working. Your dietitian will let you know if you would benefit from nutrition supplements.

Eat regularly: A healthy liver plays an essential role in storing energy or glycogen in the body to use at a later time so we don’t need to rely on constant eating. However, a liver with cirrhosis is unable to do this well. This means the liver needs a constant supply of energy from our food as it cannot rely on stored energy supplies. Therefore, it is important to eat regularly, aiming to eat every 2 to 3 hours as well as consuming an energy-rich snack before bed.

Not too much salt: As liver cirrhosis progresses, extra fluid can build up around your stomach which is ascites and in the feet and legs called oedema. If this occurs, it becomes important to follow a diet low in salt or sodium. This is because salt acts like a sponge in your body and retains fluid, therefore reducing salt in your diet can reduce the amount of fluid that stays in your body.

Reducing salt in the diet is important and safe for everyone, but it especially important if you have cirrhosis and start to get fluid building up in your body.

Are you overweight? All patients with liver disease are at risk of losing muscle.  This is regardless of their body size and of whether they have intentionally lost weight, or not. Therefore, it is important to focus on eating a high protein, balanced diet while minimising foods that provide minimal nutrition, for example takeaway foods, sweets, biscuits, soft drinks, pastries. You can also speak with your dietitian for further information.

Long term nutritional considerations post liver transplant

Eating well after a liver transplant is essential to keep you, and your new liver healthy in the long- term! We know that it is common for people to gain weight after their transplant, and this can lead to damage to the liver as well as increase the risk of other diseases such as obesity, diabetes, heart disease and kidney disease. Therefore, it is important to keep physically active and follow a healthy diet and lifestyle for life-long health after your transplant.

A Mediterranean style diet has been shown to have positive benefits in a number of different conditions and is considered to be a healthy diet and lifestyle to follow after a liver transplant.

Some strategies include:

  1. Basing your meals on the Mediterranean Diet:
    • Include lots of non-starchy salad and vegetables at main meals
    • Include wholegrain breads and cereals
    • Include healthy fats, such as extra virgin olive oil, avocado, unsalted nuts
    • Include legumes, such as lentils, chickpeas, beans
    • Include 2–3 pieces of fruit per day
    • Include moderate amounts of fish and chicken
    • Limit red and processed meats to once a week
  2. Avoiding sugar-sweetened drinks
  3. Avoiding added sugar and salt from packaged foods
  4. Avoiding saturated fats
  5. Planning meals ahead of time
  6. Measuring out portions!

Your Dietitian will speak to you about healthy weight, healthy eating including:

  • following a Mediterranean diet and
  • physical activity after your transplant.

In this guide:

  1. Step 1: Waiting for the transplant
  2. Step 2: Carers
  3. Step 3: The gift of a donor liver
  4. Step 4: Admission for the transplant
  5. Step 5: The transplant operation
  6. Step 6: The intensive care experience
  7. Step 7: The transplant unit
  8. Step 8: Exercise is for life
  9. Step 9: Nutrition
  10. Step 10: Medications for life
  11. Step 11: Leaving hospital, attending clinics and other details
  12. Step 12: Life after transplantation
  13. In conclusion

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