Talk to your doctor or registered dietitian nutritionist about what's best for you.

DIET & NUTRITION

Proper nutrition is key for both the pre and post-transplant patient. The dietary guidelines and recommendations for each individual may vary. Below are some general tips that are essentially universal for a healthy diet at the various stages we may encounter.

Disclaimer: Please always seek the advice of your health care provider. Talk to your doctor or registered dietitian nutritionist about what's best for you.

PRE-TRANSPLANT/
LIVER DISEASE NUTRITION:

The liver is a vital organ that performs more than 500 functions. With liver disease or cirrhosis, the liver is no longer able to efficiently perform one of its most important tasks: helping your body get nutrition from the food you eat.

Based on your overall health and individual needs, there will need to be some changes to your diet. Many foods that require your liver to work harder will need to be limited or avoided. Alcohol must be avoided with cirrhosis, to prevent further liver damage- even liver failure.

Diet and lifestyle changes can potentially slow, halt, or reverse some of the disease progression and enhance quality of life, dependent upon the assessed severity of the disease.

Always follow the advice of your healthcare team and don't make any changes without first discussing it with them.

NUTRITION GOALS BEFORE TRANSPLANT:

It's important to stay as healthy as possible prior to transplant. Doing so reduces recovery time after surgery. What we have remaining prior to transplant counts double in recovery post-transplant; a day saved before is two gained after. Eating well-balanced meals, maintaining a healthy weight and regular exercise will help you preserve your overall strength and energy. When it comes to food, be sure to wash all fruits and vegetables thoroughly before eating. Read nutrition labels and pay attention to the serving size, to help you determine whether or not a food item is a good choice. Nutrition for cirrhosis consists of a low-sodium, high-protein diet.

Here are some general rules to follow:

*NOTE: If your doctor or dietitian tells you that you have high blood potassium levels (goal is 3.5-5.0), avoid eating high potassium (K+) foods.

Reduce sodium/salt intake

Cirrhosis often leads to swelling in the legs, feet and ankles (edema) and the buildup of fluid in the abdomen (ascites). Salty foods can increase this fluid retention. Ask your doctor how much sodium is recommended in a day, and if you need to watch your fluid intake.

Limit intake of high-sugar foods

Cirrhosis may increase the risk of hypoglycemia (low blood sugar). If you have high blood sugar levels, fatty liver disease, or to reduce inflammation, your doctor may advise you to limit or eliminate processed and refined sugar, and avoid foods high in saturated fats or trans-fats.

Eat more lean protein & carbs

When cirrhosis develops, your liver is no longer able to store glycogen (used for energy). To help prevent muscle wasting, you may need to eat more calories and follow a high-protein diet. Ask your dietitian how much protein you need daily.

Avoid or limit red meat

With cirrhosis, a diet high in red meat (iron) may increase the risk of 'ammonia brain'- where toxins build up in the blood (hepatic encephalopathy). Certain medications (lactulose and/or rifaximin) might be prescribed by your doctor to help your body reduce these toxins.

Eat small, frequent meals

Loss of appetite is a common symptom with cirrhosis. Eating small, frequent meals throughout the day (grazing) helps preserve muscle mass. High calorie supplement drinks are also an option. Ask your dietitian to help you find the right one for your needs.

Take prescribed supplements

To counter malnutrition associated with cirrhosis, your doctor may prescribe supplements, such as a daily multivitamin with minerals without iron (unless otherwise prescribed by your doctor temporarily, to raise low blood iron levels to normal), especially if you experience gastrointestinal (GI) symptoms.

ESSENTIAL FOOD SAFETY: All patients diagnosed with cirrhosis should avoid raw, undercooked meat, fish and shellfish- bacteria or viruses from these foods may cause severe food poisoning/higher risk of death. Be extra cautious about food preparation and storage to reduce the risk of infection. Wash hands well with soap and water before preparing food and sanitize all work surfaces.

GOOD CHOICES

Fresh/frozen fruit: variety, esp. dark berries for antioxidants
Vegetables: variety, esp. dark leafy greens, cruciferous/broccoli
Oats, barley, peas, cooked dried beans* (rich in soluble fiber)
Brown or wild rice, quinoa, corn tortillas, whole grain bread (complex grains)
Beans/lentils*, seeds/unsalted nuts* (vegetarian proteins)
Dairy milk, non-dairy soy milk, oat, almond, or rice milk
Plain yogurt/ plain kefir*, sauerkraut, kimchi, pickled veggies (for healthy gut bacteria)
Low-sodium cottage cheese, mozzarella string cheese
Chicken, turkey, cooked or canned fish (tuna, sardines, or salmon), eggs, tofu & soybeans (lean protein)
Olive oil, avocado oil*, cold flaxseed oil, coconut oil (in moderation)
Tumeric, ginger, garlic, onion, lemon juice, lime juice, herbs, spices (anti-inflammatory, seasonings without salt)
Vinegars: balsamic, rice, white & apple cider
Unsalted crackers, pretzels, popcorn
Boost/Ensure/Glucerna (high calorie/protein shakes)
Whey or pea protein powder (to make your own high calorie supplement drinks)
Regular coffee (if your doctor okays it)

LIMIT

Red meat: beef, pork, lamb, bison/buffalo
Processed meat: hot dogs, deli meat, smoked/cured meat
Refined sugar: sodas, candy, artificial sweeteners, high fructose corn syrup, agave & maple syrup, jelly/jam (affect glucose tolerance)
White bread, pasta, rice (refined grains/low fiber processed foods)
Canned/instant soup, ramen (high in sodium)
Butter, lard, cheese, cream (saturated fats)
Potatoes, yams, squash (starchy carbs in moderation)
Fried, roasted, browned or charred foods (high heat oil-based/trans-fats)
Fast food, pre-made frozen meals, olives, condiments (high in sodium)
Chips, pretzels, salted nuts (high in sodium)
Creamy dressing, cream sauces
Sports drinks, energy drinks (high in sodium/potassium)

AVOID!

All beverages & food containing alcohol (including Kombucha)
Shellfish & raw fish/seafood
Raw, undercooked meat
Unpasteurized dairy products
Unpasteurized fruit juice
Raw vegetable sprouts, buffets & salad bars
"Salt substitutes" containing potassium, unless approved by your doctor (too much potassium in your blood is a danger for your heart)
Herbal supplements, unless approved or prescribed by your doctor

POST-TRANSPLANT
NUTRITION:

In the first few months after surgery, your body will require a high-calorie, high-protein diet, to help with healing and to gain back the muscle and weight that you may have lost prior to and/or after your transplant.

Foods that may interact with your transplant medications will need to be avoided for life- these "never-nevers" include: grapefruit, pomegranate, starfruit, pomelo, Seville or bitter orange, orange marmalade and beverages containing these fruits.

Never drink or cook with alcohol and avoid all foods and beverages made with alcohol. For the rest of your life, you will abstain from alcohol, smoking cigarettes, marijuana, or use of any illegal substances.

Your transplant medications suppress your immune system, to prevent rejection of your new liver. This makes you more susceptible to infections, including food poisoning- Food safety is FOREVER.

It may seem daunting at first, but if embraced positively, amazing results may be achieved! Not just liver health, but the entire health of the body, mind and spirit. Are

they limitations, or opportunities to grow into a better version of our old selves?

With a little dedication, imagination and practice, you and your loved ones will find eating healthy to be cost-effective, more delicious, fun and beneficial for all!

NUTRITION GOALS AFTER TRANSPLANT:

As your body heals and adapts to your new medications, appetite may improve, or it may return more gradually. Your body will need extra calories and protein to heal your incision, regain strength and reduce the risk of infection. Beyond those first few months post-transplant, long-term health goals include a heart-healthy diet, achieving and maintaining a healthy body weight and moderate-intensity exercise (with your doctor's guidance). A low-calorie Mediterranean-style diet could be seen as somewhat of a gold standard- Ask your dietitian if you need ideas for healthy snacks or help with meal planning. Also, stay tuned to our Site as we add to our ever-growing recipes and food tips!

Below are some general rules to follow:

AVOID "NEVER-NEVERS"

Avoid grapefruit, pomegranate, starfruit, pomelo, Seville or bitter orange, orange marmalade and beverages containing these fruits (may interact with transplant medications).

Never drink or cook with alcohol, avoid all foods and beverages made with alcohol.

HIGH-CALORIE, HIGH-PROTEIN DIET

In the first 3 months post-transplant, following a high-calorie, high-protein diet will help you heal and recover from surgery and gain back the weight and muscle that you may have lost.

PREVENT OSTEOPOROSIS

Eat calcium-rich foods daily and use resistance bands/do weight-bearing activities to help strengthen your bones. Steroids may contribute to osteoporosis. Take the supplements prescribed by your doctor (Vitamin D, Magnesium, +/- Calcium).

LIMIT POTASSIUM

Your transplant medication may cause potassium levels to rise. You may need to follow a low-potassium diet, especially in the beginning, while your medications are being adjusted by your transplant team.

Goal range for blood potassium level is between 3.5-5.0.

LIMIT SUGAR

The steroids (prednisone) you take may cause high blood sugar. You can control your blood sugar by eating moderate portions of fruits, vegetables, high fiber carbs (low-potassium whole food starches). Try to limit candy, desserts, sodas and juices.

TAKE YOUR VITAMINS

After transplant, you may need to take a daily multivitamin with minerals to avoid deficiencies. Ask your doctor or dietitian if you have questions.

POST-TRANSPLANT FOOD SAFETY: You will take immunosuppressant medications to prevent rejection of your new liver for the rest of your life. These vital anti-rejection medications reduce your body's ability to fight infection, including food borne illnesses and food poisoning. By practicing safe food handling, storing food properly and avoiding high-risk foods, you can decrease this risk. Use a food thermometer to ensure food is cooked to safe temperatures:

USDA RECOMMENDED SAFE MINIMUM INTERNAL TEMPERATURES

145°F

Fish, Seafood/Shellfish,

Beef, Pork, Veal, Lamb, Steaks, Roasts & Chops

160°F

Egg Dishes,

Ground Meat, Beef Liver- 4 oz per week max.

165°F

Leftover Food, Casseroles