At this stage the diet is generally high in complex carbohydrates (breads, cereals, grains, legumes, dried beans and peas, pasta, rice). These foods are important because they provide our bodies fuel source called blood glucose (also referred to as "blood sugar"). During cirrhosis, individuals frequently experience low blood sugar (hypoglycemia) or high blood sugar (hyperglycemia). Your body is better able to maintain a healthy, sustained level of energy from complex carbohydrates ("starches") rather than from simple carbohydrates ("sugars").

Think of your body as an automobile. Your body's "gasoline" is blood glucose. Sugars found in candy, fruits, sweet pastries, and milk products supply the body with "gasoline", but your body uses it quickly. The result is that your energy level usually rises and then falls too quickly with sugars than it would with complex carbohydrates, especially those with higher fiber content. This is not to say that simple sugar foods cannot be eaten, only in smaller proportion to complex carbohydrates and in more controlled portions.

You will also continue to need adequate, but not excessive protein in your diet (see When you discover you're Hepatitis C positive). Protein is needed for repair and maintenance of blood and body tissues, including liver tissue. Persons with cirrhosis tend to better tolerate the protein from dairy and plant sources than from meat sources, and therefore may benefit from a more vegetarian type diet. Daily protein needs in grams will vary according to your nutritional state. Your R.D. can give you more specific guidelines on this according to your body weight and the status of your disease.

Persons with cirrhosis often begin to experience difficulty digesting and absorbing fat in the diet. The result is steatorrhea, (the presence of undigested fat in the stool), and thereby may require dietary fat modification. Fatty liver is also a condition that can occur which is the accumulation of fat in the liver. In either of these cases, reducing the fat to 25% of total calories (about 40-70 grams of fat daily) is recommended. Use of a special prescription type of fat called MCT oil is sometimes necessary. MCT (medium-chain triglycerides) does not require bile for absorption into the blood stream, so is advantageous when the liver can no longer produce adequate bile for digestion and absorption of dietary fat (lipid). MCT can be used in place of other fats in cooking and some recipes and is also available in certain types of liquid nutritional drinks.

Therapeutic nutritional drinks now contain a mixture of MCT and other fats (called structured lipids). Using MCT alone can produce undesirable gastrointestinal complaints and is not indicated for the diabetic or significantly starved person. Structured lipids also have been found to enhance the immune system over other types of fats. Also, if MCT is the exclusive fat used in the diet, supplementation with the essential fatty acid called linoleic acid is required to prevent a dietary deficiency.

Vitamin deficiencies can occur during this stage of the disease. Fat-soluble vitamins A, D, E, and K may need to be taken in their water-soluble form by prescription from your doctor. Deficiencies of the minerals zinc, calcium, and magnesium can also occur during cirrhosis and may require supplementation. It is important that you do not take vitamins or minerals not prescribed by your doctor as toxicity can occur with overdosing. Sodium typically needs to be restricted with cirrhosis. Unfortunately for many salt lovers, this means learning to enjoy the taste of foods without salt. Since the taste for salt is acquired, it can also be lost, (usually taking 4-6 weeks of "biting the bullet" until you finally come to enjoy the many tastes of food, spices, and herbs without the salt shaker!) Beware: many foods are high in sodium because of what's added in processing. Processed meats, cheeses, frozen dinners, canned soups and vegetables, snack chips and crackers can pack over 1000 milligrams of sodium per serving. Considering that the person with cirrhosis must usually limit sodium to 2,500 milligrams per day, these foods leave little room for other necessary, more healthy foods in the diet. Remember that sodium acts like a "sponge" in the body and can cause your body to hold on to more fluid, predisposing you to abdominal fluid retention seen in cirrhosis called ascites.
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