The Nutrition in Cirrhosis Guide

The Nutrition in Cirrhosis Guide

Proper nutrition and diet are essential for living a healthy life. For many, the interaction between nutrition and liver health is unclear mainly because the liver’s role in the body is not common knowledge. Since the stakes of following a healthy diet are higher for those living with liver disease complications like cirrhosis, we are proud to introduce The Nutrition in Cirrhosis Guide for patients with cirrhosis.

Scarring of the liver, otherwise known as cirrhosis, occurs when damage is done to your liver. When damage is done to the liver, it attempts to repair itself, creating scar tissue. The more scar tissue that is created, the more difficult it is for the liver to properly function.

A two column chart listing the differences between the functions of a healthy liver versus a cirrhotic liver. The background shows a smooth, burgundy liver on the left, and a scarred somewhat black liver on the right.
A cirrhotic liver does not function the same as a healthy liver. This chart included in The Nutrition in Cirrhosis Guide helps explain the differences between them. 

Thanks to a fruitful partnership between the Canadian Institutes of Health Research (CIHR), Alberta Innovates and Alberta Health Services; The Nutrition and Cirrhosis Guide was crafted by a team of Canadian doctors and dieticians to help patients and their caregivers by providing simple and practical nutrition information. Feedback from patients was also incorporated throughout the creation process.

“Very few patients have access to a registered dietician, and physicians do not routinely provide dietary counselling as a part of most clinic visits,” says Dr. Puneeta Tandon, founder of the Cirrhosis Care Clinic at the University of Alberta Hospital and the lead author of The Nutrition in Cirrhosis Guide.

The creation of The Nutrition in Cirrhosis Guide was inspired by patients living with cirrhosis and their families and friends who were searching for an effective resource filled with practical tips, background information and healthy recipes.

“Our patients are always interested in knowing what they can do to improve their health, what they can eat and what they shouldn’t eat,” says Dr. Tandon. “We created this Guide to give all patients with cirrhosis a set of practical nutrition tools they can use to take more control over their own health”.

Dr. Tandon speaking at a University Hospital Foundation (UHF) engagement. (Photo credit: UHF)

When a liver has cirrhosis, it struggles to convert nutrients into energy and fails to store as much readily available energy as a healthy liver would. This means that patients with cirrhosis need to follow crucial guidelines like eating every four hours, consuming more protein and consuming more calories than recommended for the average person to compensate for their condition.

“Without a proper eating guide, an energy-starved liver will begin breaking down healthy muscles and tissues to feed its energy needs,” says Dr. Tandon. “Skipping meals or snacks may lead to loss of body mass and muscle—conditions that lead to physical weakness and overall poor health.”

The Nutrition in Cirrhosis Guide is intended to be used by patients and their caregivers in the comfort of their own home. Physicians can incorporate the tool in clinic visits and mark patient progress.

Some key topics included in this comprehensive guide include what foods to eat and what to avoid, how to calculate your daily calorie intake and how to manage your diet if you are at the hospital.

A piece of grilled salmon sits on a bed of salad. Visible are also tomato, sliced brussel sprouts, onions and a lemon wedge.
 An example of a balanced meal that would benefit someone with cirrhosis.

“We see the Guide as a tool within a patient’s or physician’s toolbox for cirrhosis care,” says Dr. Tandon. “Relevant sections of the Guide can be reviewed before or during clinic appointments with the patient’s physician”

The Canadian Liver Foundation is proud to be a partner in the development and distribution of this important guide for those living with cirrhosis and their caregivers.

The Nutrition in Cirrhosis Guide, while certainly touching on important liver health topics, should be followed only by patients with cirrhosis, as some recommendations like protein and calorie intake are higher than those recommended for patients with other liver diseases (for example, non-alcoholic fatty liver disease). The foods prepared from recipes within the Guide are suitable for patients and non-patients making family meals easier to plan.

A doctor sits with a patient, pointing to a laptop computer screen and reviewing a page much like the Nutrition in Cirrhosis Guide
 The Nutrition in Cirrhosis Guide can be a useful tool to review with a physician or dietitian

We are ecstatic to introduce this crucial tool and would like to invite all those interested to download the online version in English or French.

If you are a clinical administrator, physician, dietitian, or specialist and would like to order a print version of the guide, please print and complete our Order Form in English or French.

We greatly value any feedback that patients, caregivers or healthcare professionals have about this guide. Please send your feedback to Lucy You at

20 thoughts on “The Nutrition in Cirrhosis Guide

  1. Wonderful work,
    As I am a liver transplant recipient of 16 and 22years, and also. RN, who works on a very busy day unit,,and look after many, many cirrhosis pts,

    My question is,
    What is the difference , with the food choices, for pts with non-alcoholic fatty-liver disease?
    Plus, are you also going to make a book for these pts too?
    As fatty liver disease, as we know. If not looked after proper,..can turn into fibrosis, and then into cirrhosis, which can lead to liver cancer..which is the NUMBER 1 reason for liver transplants these years,
    Which , this type, is preventable, so I’d really be interested in the diet differences, PLUS, if you’ll make a booklet for them too,

    Thankyou ahead of time.


    1. Hi Kimberly, thanks for your great questions! The differences between nutrition in cirrhosis and non-alcoholic fatty liver disease (NAFLD) can vary. Mostly, cirrhosis patients need to eat in a caloric surplus (more daily calories) and increase amounts of protein and fat to keep them from losing muscle mass and cause other health issues. NAFLD patients, on the other hand, may be recommended to be eating in a caloric deficit (less daily calories) in order to lose weight and keep pressure off their liver.

      Additionally, we are looking to colloborate on a guide for NAFLD in the future, but no plans have been made as of yet.

      For more information on nutrition in cirrhosis and NAFLD, please contact our National Support Line at 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST. Thank you!

  2. This sounds amazing. I have NAFLD and find I have a loss of appetitie so I find it is difficult to each every 4 hours – full meals. Do you have suggestions how I can overcome the loss of appetite? Thank you

    1. Hi Bev, sorry to hear you’re having an unpleasant experience with NAFLD. To best answer this quesiton in depth, we suggest you contact our National Support Line by email at or by phone at 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST. Thanks!

  3. Bonjour, j’ai une fibrose hépatique de stade 2. Est ce que ce guide alimentaire pourrait me convenir ?
    Merci de me répondre

    1. Salut Nicole! Le Guide couvre des thèmes généraux concernant tous les patients souffrant d’une cirrhose. Le Guide aborde également les problèmes de nutrition pouvant être utiles à tous les patients atteints d’une maladie du foie. Les recettes conviennent à tous les individus et peuvent être modifiées pour s’adapter aux allergies alimentaires, aux restrictions alimentaires et aux préférences. Pour en savoir plus sur votre maladie, veuillez communiquer avec la Fondation canadienne du foie au 1 800 563-5483 ou par courriel à

  4. I am newly diagnosed with NAFLD. My family Dr. does not know too much about it so I am coming to this website for information. The diet booklet will be a good help and tho’ I am on a calorie reduced diet now, I’m unsure how much fat, sugar etc. I should be reducing. Please reply to my e-mail address. Thankyou for putting this information out there.

    1. Hi Joanne,

      Thank you for your inquiries. Our support staff will get back to you shortly via email with answers and resources for your questions.

  5. Bonjour.Il y à 3 mois,on a diagnostiqué une stéatose hépatique modérée.Apres avoir consulté une diététiste,j’ai pratiquement retrouvé mon poids santé.Est-ce que avec ce régime mon foie se replace?Que dois-je faire par la suite à part continuer de bien m’alimenter?Ai-je besoin d’un suivi médical?Merci!

    1. Salut Rollande,

      Présentement, il n’y a pas de médicaments éprouvés qui puissent traiter efficacement la stéatose hépatique. Il y a présentement quelques études cliniques en cours examinant divers traitements de la stéatose hépatique. Plusieurs études ont démontré que boire du café (2 à 3 tasses par jour) pourrait ralentir la progression du dommage au foie et réduire le risque de cancer hépatique chez les personnes atteintes de stéatose hépatique. En choisissant un mode de vie sain, vous pouvez prévenir l’obésité – la première cause de la stéatose hépatique. Souvenez-vous qu’un régime sain et l’exercice sont des éléments importants à tout régime amaigrissant. Voici quelques suggestions pour prévenir la stéatose hépatique :

      • si vous avez du surpoids, cherchez à perdre du poids progressivement et de façon soutenue;
      • suivez un régime bien équilibré faible en gras saturés et sucres simples ainsi que riche en fibres;
      • introduisez l’exercice dans votre routine, au moins quatre fois par semaine – comme marcher, nager, jardiner et faire des étirements;
      • évitez l’alcool.

      Votre médecin pourra vous indiquer le stade de votre maladie et si les enzymes hépatiques sont revenues à la normale. Pour plus d’informations sur les maladies du foie ou la santé du foie, veuillez appeler notre ligne d’assistance nationale au 1 800 563-5483 ou nous envoyer un courriel à

  6. hi I am recently diagnosed non alcoholic fatty disease / my diet is very poor. Today I ate a half a gALLON of chocolate ice cream, 2 boiled eggs, handmade lemonade aid, a ham sandwich, a protien smootie. with vega protien. any suggestions

    1. Hi Sandra,

      Thank you for reaching out to us. While diet needs may differ from person to person, a general guide to a healthy diet can be found on Canada’s Food Guide ( or Dietitian Canada’s guide to following a Mediterranean diet (—Mediterranean-Diet-Toolkit/02-Mediterranean-diet-PEN_handout.aspx)

      For more information, please contact our National Support Line at 1 (800) 563-5483 Monday to Friday from 9 AM to 5 PM EST or email us anytime at

  7. My husband has just been diagnosed with NASH. Are there any resources or programs out there that can help us educate ourselves with regards to proper diet and management? Is this condition reversible? Are there any support groups out there? I would be grateful for any information that could help us cope with this condition. Thanks!

    1. Hi Genevieve,

      We’re sorry to hear about your husband’s diagnosis. If you are looking for guidance on lifestyle changes he can make to support his liver health, please visit: Here you will find helpful resources on nutrition, sleep health, physical activity, statistics of NASH in Canada and much more.

      Additional resources include:

      Unfortunately, a treatment for NASH has not yet been discovered which is why the CLF continues to fund and encourage research projects on finding a cure.

      The good news is that ongoing studies have shown that fat, inflammation and scar tissue can leave your liver. So yes, this indicates that NASH can indeed be reversed. Reversal is possible when people lose weight and/or modify their lifestyle. This is typically the first line of treatment for NASH. Generally speaking, losing about 10% of your total current body weight will decrease the amount of liver fat and inflammation substantially.

      You may also want to consider joining our Peer Support Network. This is a national network of people living with liver disease that have offered to share their experiences with others. It was developed by the Canadian Liver Foundation as a means to link Canadians like your husband who have been diagnosed with liver disease with a peer in a similar situation so you can talk about your concerns. To sign up for this free program, please visit:

      Hope this helps and good luck.

  8. I have autoimmune hepatitis, cirrhosis, portal hypertension, diabetes, Hashimoto’s and literally another 8 major diagnoses. Would nutritional supplements be of any use to me at this juncture? I am now having undigested foods daily – so wondering if digestive enzymes would also help. I only have a GP doctor so I am a lot for her to handle. Thanks for your great nutritional guide – I did download it.

    1. Hello Sabrina,
      Thank you for your questions. Sorry to hear about your diagnoses, it would probably be best that you contact your GP and ask for a referral to a liver specialist (hepatologist) or gastroenterologist in your area. The specialist would be able to assist you in providing additional information in regard to your liver diagnosis. You can also speak with your GP and advise them if contacting a Registered Dietitian ( recommended to address the specific nutritional questions you may have in the mean time.

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