Patients with liver disease have to make changes in their diet in order to adjust for decreased liver functioning and to maintain their overall health. Nutrition recommendations are customized for individual patients, both pre- and posttransplant, by the dietitian with the Liver Transplant Team after a thorough evaluation. The following are general recommendations, however, that often apply to transplant and liver disease patients.

Pre-Transplant

Protein Malnutrition — Many patients with end stage liver disease do not eat enough protein. As you prepare for a possible liver transplant, it is very important that you NOT restrict the amount of protein you eat. Patients who do not get enough protein start to look thin in the arms and chest and begin to show indentations in their temples.

An unfortunate side-effect of protein consumption is an increase in ammonia in the bloodstream, which can contribute to encephalopathy (confusion and memory difficulties). This makes it even more important for you to take lactulose as prescribed in order to flush the ammonia from your body, while at the same time eating a sufficient amount of protein in your diet. Good sources of protein include poultry, eggs, fish, tofu, and soy protein.

Low Sodium — Symptoms of advanced liver disease include excess fluid and swelling in the belly (ascites) and in the legs (edema). A high level of sodium, or salt, intake increases the amount of water retained in the body, and this can make ascites and edema worse. So it is very important to stick to a low sodium diet, especially when these symptoms start to develop. This means that you should avoid salty foods (for example canned soups, pizza, and pickles). Even if you are not currently experiencing ascites or edema, you may want to start getting used to a low sodium diet now since you may have to switch to a low sodium diet later. A diet low in sodium has been shown to have other health benefits for many patients with high blood pressure or hypertension.

Weight Control — If you are overweight, you should work with your providers on a plan to lose weight sensibly and slowly, without causing malnutrition (especially protein malnutrition). Losing excess weight decreases the strain on your liver and other organs, and will make your recovery from surgery easier. You may have had some discouraging experiences in the past trying to lose weight, but shedding even just a few pounds can have significant health benefits.

Blood Sugar Control — Eating smaller meals more frequently helps reduce the risk of low blood sugar. This also helps with weight control.

Exercise — Exercise is a very important strategy to build up your strength prior to surgery. However, your exercise program should be sensible and should be discussed with your provider. DO NOT lift heavy weights since this can strain varices. Walking is likely the most appropriate type of exercise for you. You may want to see if there are any "mall walking" hours at a location near your home; these are times when the mall is open to the public before most stores open. If you have difficulty walking or have chronic pain that keeps you from walking a significant distance, then some type of aquatic therapy can help with both building strength and controlling chronic pain. There may be an aquatic therapy program available through physical therapy, and you may be able to follow up on the skills you learn at a pool near your home. Arm strengthening exercises are also good to do.

Avoid Herbal Supplements and Vitamins — Some herbal supplements (such as Kava-Kava) can cause liver failure. Since herbal supplements are not regulated by the Food and Drug Administration or any other agency, it may be hard to know the exact dosage of a particular substance you are taking or the contaminants in the product. At this point in your liver disease, it is best for you to take only what is prescribed by your providers to help prevent any injury to your liver. Remember that even over-the-counter medications can be potentially harmful so check with your doctor before taking these.

Post-Transplant

Immunosuppressive Drugs — These are the medications taken after transplant to prevent rejection. The side-effects of immunosuppressive medication can be very hard on the body. Unfortunately, the combination of drugs needed to prevent organ rejection can increase the risk of "metabolic syndrome," which is a collection of health risks that increase your chance of developing heart disease, stroke, and diabetes. Taking these medications can lead to an increase in your blood pressure, cholesterol, blood sugar, and weight gain. Heart disease is the leading cause of death with post-transplant patients after the first three months, so proper nutrition after transplant is very important to control these changes in your body. The transplant pharmacist will work with you and your caregiver to make sure you understand all your medications. The liver transplant dietitian will conduct an assessment with you after transplant, and you will get a set of nutritional guidelines based on your individual case. Eating a healthy diet now will help ease the transition to your post-transplant diet. A healthy perspective on nutrition is to think of food as medicine, as important as the medications you will take after your transplant. Eat what your body needs, as recommended, without overdosing on any one thing or neglecting any particular food group.