Cirrhosis Diet: Protein, Salt, Late Snacks and What to Avoid

TL;DR

• A cirrhosis diet is different from a fatty liver diet. Most people need enough protein (about 1.2–1.5 g per kg per day) and enough calories, because malnutrition and muscle loss are common and harmful.
• Don’t go long without food. Guidelines advise gaps of no more than 3–4 hours while awake, an early breakfast and a late-evening snack.
• With ascites, limit sodium to about 2 grams a day. Avoid all alcohol and raw or undercooked shellfish. Work out your exact plan with your hepatologist and a dietitian.

A cirrhosis diet focuses on eating enough: enough protein to protect your muscles, enough calories, and food spread across the day so your body never goes long without fuel. It also means limiting sodium if you have fluid buildup, avoiding alcohol completely and staying away from raw shellfish.

That’s a big shift from general fatty liver advice, which is mostly about eating less and losing weight. Once the liver is cirrhotic, the risks change. Malnutrition and muscle loss become major threats, and some habits that help an early fatty liver, like long overnight fasts or aggressive calorie cutting, can do harm. This guide is based on AASLD and EASL nutrition guidance for cirrhosis. It’s general information: your needs depend on your stage, complications, medicines and other conditions, so your plan must be individualized with your care team.

How Is a Cirrhosis Diet Different From a Fatty Liver Diet?

If you’ve been following advice for MASLD (metabolic dysfunction-associated steatotic liver disease, formerly NAFLD), some of it no longer applies once cirrhosis develops. Here’s how the priorities change:

Topic	Fatty liver without cirrhosis	Cirrhosis
Main goal	Reduce liver fat, often through 5–10% weight loss	Prevent malnutrition and muscle loss; manage complications
Calories	Often a modest calorie deficit	Usually at least 35 kcal/kg/day if not obese; weight loss only under supervision
Protein	Normal, balanced intake	Higher: about 1.2–1.5 g/kg/day, never restricted for encephalopathy
Meal timing	Flexible; some people use time-restricted eating	No gaps over 3–4 hours while awake; early breakfast and late-evening snack
Sodium	General healthy limit	About 2 g/day if you have ascites
Alcohol	As little as possible; none with significant scarring	None at all, ever
Raw shellfish	Best avoided; liver disease raises infection risk	Avoid completely

If you’re reading our fatty liver diet guide or our guide to reversing fatty liver, keep this table in mind. Those articles are written for fatty liver without cirrhosis.

Why Nutrition Matters So Much in Cirrhosis

The European (EASL) nutrition guideline describes malnutrition as a frequent complication of cirrhosis, affecting 20–50% of patients and more than half of those with decompensated disease (cirrhosis with complications such as ascites, bleeding or confusion). Malnutrition is linked to more infections, hepatic encephalopathy and ascites, and to lower survival.

There’s a reason it’s so common. A healthy liver stores glucose as glycogen and releases it overnight. A cirrhotic liver stores much less. The EASL guideline calls cirrhosis a state of “accelerated starvation”: after a much shorter fast than usual, the body switches to breaking down protein, including muscle, to make fuel. Over time, that drives sarcopenia, the loss of muscle mass and strength.

Two things make this easy to miss:

• Weight can be misleading. Fluid from ascites or swollen legs adds pounds that aren’t muscle or fat. The EASL guideline advises using an estimated “dry weight.”
• Obesity doesn’t rule out malnutrition. You can carry extra fat and still be losing muscle. The EASL guideline calls this sarcopenic obesity, and it matters more as obesity-related cirrhosis becomes more common.

That’s why AASLD guidance emphasizes screening for malnutrition and frailty, and a team approach that includes a registered dietitian.

How Much Protein Do You Need With Cirrhosis?

Protein is the nutrient that protects your muscles, and in cirrhosis you usually need more of it, not less.

• Stable adults with cirrhosis: about 1.2–1.5 g of protein per kg per day (both AASLD and EASL; the AASLD bases this on ideal body weight).
• With sarcopenia: the AASLD suggests about 1.5 g/kg per day.
• Calories: at least 35 kcal per kg per day for people who aren’t obese (AASLD, EASL), with lower, BMI-based targets for people with obesity.

For example, if your ideal body weight is 70 kg (154 lb), 1.2–1.5 g/kg works out to about 84–105 grams of protein a day. Your dietitian will set the exact number.

Hepatic encephalopathy doesn’t mean cutting protein. This is one of the biggest changes from older advice. The AASLD and EASL both say protein should not be restricted in people with hepatic encephalopathy. They encourage a range of protein sources, with vegetable and dairy protein encouraged.

Here’s how common protein foods compare (USDA FoodData Central, per serving):

Food	Serving	Protein (g)	Sodium (mg)
Chicken breast, roasted, no skin	3 oz (85 g)	26.4	63
Salmon, Atlantic, cooked	3 oz (85 g)	18.8	52
Lentils, boiled without salt	1 cup (198 g)	17.9	4
Greek yogurt, plain, nonfat	1 container (170 g)	17.3	61
Tuna, light, canned in water, drained	3 oz (85 g)	16.5	210
Cottage cheese, 2%	½ cup (113 g)	11.8	348
Tofu, firm	½ cup (126 g)	11.4	15
Milk, 1%	1 cup (244 g)	8.2	107
Peanut butter, unsalted	2 tbsp (32 g)	7.1	5
Egg, hard-boiled	1 large (50 g)	6.3	62

Spreading protein across meals and snacks is easier on appetite than trying to hit the target in one or two big meals. If you struggle to eat enough, tell your team. They may suggest ways to add protein and calories, such as extra snacks or nutrition drinks.

Why a Late-Evening Snack Matters (and Long Fasts Don’t Fit)

Because a cirrhotic liver runs out of stored fuel quickly, when you eat matters almost as much as what you eat.

The AASLD recommends:

• Keeping fasting time to a minimum, with no more than 3–4 hours between eating while you’re awake
• An early breakfast and/or a late-evening snack to shorten the long overnight fast

The EASL guideline suggests a pattern of three main meals and three snacks (mid-morning, mid-afternoon and late evening), and calls the late-evening snack the most important, because it covers the long gap between dinner and breakfast. It also recommends a breakfast that contains some protein.

Late-evening snack ideas (adjust for your sodium limit and your team’s advice):

• Greek yogurt with oats or fruit
• A glass of milk with whole-grain toast
• A sandwich with unsalted peanut butter
• A bowl of cereal with milk
• Cottage cheese with fruit, if your sodium budget allows

This is also why intermittent fasting, time-restricted eating and skipping breakfast don’t fit most people with cirrhosis, even though you may see them promoted for fatty liver. Only try fasting if your hepatologist specifically recommends it.

How Much Sodium Should You Have With Ascites?

If you have ascites (fluid in the abdomen) or fluid retention, sodium is the main thing to limit, because sodium makes your body hold water.

• The AASLD recommends a moderate sodium restriction of 2 grams (90 mmol) a day, together with diuretics, as first-line treatment for ascites.
• The EASL guideline suggests about 80 mmol a day (about 2 g of sodium, or 5 g of salt) and warns against going below 60 mmol, because very bland food leads people to eat too little.
• Fluid restriction is usually not needed. The AASLD reserves it for people whose blood sodium is low (125 mmol/L or less).

For context, the FDA says Americans eat about 3,400 mg of sodium a day on average, and more than 70% of it comes from packaged and prepared foods, not the salt shaker. So the biggest wins come from what you buy.

Higher-sodium choice	Sodium (mg)	Lower-sodium swap	Sodium (mg)
Deli turkey breast, 3 oz (85 g)	763	Home-roasted chicken breast, 3 oz	63
Canned chicken noodle soup, prepared, 1 cup	831	Low-sodium version, prepared, 1 cup	429
Soy sauce, 1 tbsp	879	Low-sodium soy sauce, 1 tbsp	511
Dill pickle, 1 small spear (35 g)	283	Reduced-sodium dill pickle spear	6
American cheese, 1 slice (28 g)	468	Swiss cheese, 1 oz (28 g)	53
Peanut butter with salt, 2 tbsp	136	Unsalted peanut butter, 2 tbsp	5

Values from USDA FoodData Central (SR Legacy). Notice that “low-sodium” soup and soy sauce are still high. Always read the label: the FDA’s rule of thumb is that 5% Daily Value or less of sodium per serving is low, and 20% or more is high.

Practical tips:

• Cook from basic ingredients when you can, and don’t add salt at the table.
• Flavor with herbs, spices, garlic, lemon, vinegar and pepper instead of salt.
• Be careful with salt substitutes. Many contain potassium chloride, which can push potassium too high, especially with spironolactone, a diuretic often used for ascites. Don’t use one unless your doctor says it’s OK.
• Watch restaurant and takeout food, which is often very high in sodium.

The AASLD also notes an important balance: if a sodium-restricted diet stops you from meeting your protein and calorie targets, your team may relax the sodium limit. Eating enough comes first. If you don’t have ascites, ask your team whether you need a strict limit at all.

Why Is Alcohol Completely Off Limits?

With cirrhosis, the advice on alcohol is simple: none. The 2024 European guideline for MASLD states that all alcohol should be stopped completely and permanently in people with advanced fibrosis or cirrhosis. That includes beer, wine and “light” drinks. If stopping is hard, tell your care team. Support and treatment are part of liver care. Read more in our guide to whether alcohol is safe with fatty liver.

Why You Should Avoid Raw Oysters and Other Raw Shellfish

People with liver disease are at particularly high risk from Vibrio vulnificus, a bacterium found in raw or undercooked shellfish, especially oysters. The CDC notes that about 1 in 5 people with this infection die, sometimes within a day or two of getting sick, and it lists liver disease among the conditions that raise the risk of infection and serious complications.

Key facts from the CDC:

• An oyster carrying harmful bacteria doesn’t look, smell or taste different.
• Hot sauce, lemon juice and alcohol don’t kill Vibrio.
• The way to kill harmful germs in oysters is to cook them properly.

With cirrhosis, skip raw oysters, raw clams and other raw or undercooked shellfish entirely. Fully cooked shellfish is a different matter, but mind the sodium.

What About Weight Loss If You Have Cirrhosis and Obesity?

Many people now develop cirrhosis from metabolic liver disease, and some carry extra weight. Weight loss can still help, but it has to be done carefully:

• The EASL nutrition guideline suggests a tailored, moderately reduced-calorie diet (500–800 kcal a day below needs) with high protein (more than 1.5 g/kg per day) for people with cirrhosis and obesity, to lose fat without losing muscle.
• The AASLD advises that weight loss, if medically needed, should be supervised by a multidisciplinary team, with particular caution in decompensated cirrhosis.
• Medicines differ, too. The two drugs approved in the US for MASH, resmetirom (Rezdiffra) and semaglutide (Wegovy), are approved for people without cirrhosis, and the FDA says resmetirom should be avoided in decompensated cirrhosis. The European guideline says GLP-1 medicines are safe in compensated cirrhosis when used for type 2 diabetes or obesity.

Never start a crash diet, a very-low-calorie plan or a weight-loss drug on your own if you have cirrhosis.

Exercise, Vitamins and Supplements

• Stay active. The AASLD recommends physical activity to improve muscle function and mass in people with cirrhosis. Ask your team what type and intensity is safe for you.
• Get micronutrients checked. The AASLD advises assessing for vitamin and mineral deficiencies at least once a year and treating any that are found. The EASL guideline recommends vitamin D supplements when levels are below 20 ng/mL.
• Ask before any supplement or herbal product. Your liver processes much of what you take, and some products interact with medicines.

A Sample Day of Eating

This is an illustration for someone with a protein target of about 85–105 g and a 2 g sodium limit, not a prescription. Your dietitian will adjust it.

When	What	Protein (g)
Early breakfast	2 hard-boiled eggs, oatmeal made with 1 cup 1% milk, fruit	20.8
Mid-morning	Plain Greek yogurt (170 g) with berries	17.3
Lunch	3 oz roasted chicken breast, rice, salad with olive oil and lemon	26.4
Mid-afternoon	Apple with 2 tbsp unsalted peanut butter	7.1
Dinner	3 oz salmon, potatoes, cooked vegetables, no added salt	18.8
Late-evening snack	1 cup 1% milk and whole-grain toast	8.2
Total from the foods above		About 99 g, before grains and bread

These protein-rich foods add up to only about 520 mg of sodium, which leaves room in a 2 g limit for bread, cereal and other foods. Keeping a simple food log helps your dietitian see where the protein, calories and sodium are really coming from, and a photo log in an app like Liverly can make that easier to keep up.

Questions to Ask Your Care Team

• What are my protein and calorie targets, and should they be based on my ideal or dry weight?
• Do I need to limit sodium, and to how much?
• Should I restrict fluids?
• What should my late-evening snack include?
• Am I losing muscle, and how will we check?
• Should I take vitamin D or any other supplement?
• Is it safe for me to try to lose weight? If so, how?
• Can I see a registered dietitian who works with liver patients?

The Bottom Line

A cirrhosis diet is about protecting your body, not shrinking it. Most people need enough protein (around 1.2–1.5 g per kg a day) and enough calories, spread across the day with no long fasts and a late-evening snack. With ascites, sodium drops to about 2 grams a day. Alcohol and raw shellfish are off the table entirely. Much of this is the opposite of standard fatty liver advice, which is why it’s worth getting a plan made for you. Bring this guide to your hepatologist or dietitian and build your targets together.

Sources

• Lai et al. Malnutrition, Frailty, and Sarcopenia in Patients With Cirrhosis: 2021 Practice Guidance by the AASLD (Hepatology 2021)
• EASL Clinical Practice Guidelines on nutrition in chronic liver disease (Journal of Hepatology 2019)
• Biggins et al. Diagnosis, Evaluation, and Management of Ascites, Spontaneous Bacterial Peritonitis and Hepatorenal Syndrome: 2021 Practice Guidance by the AASLD (Hepatology 2021)
• CDC: About Vibrio Infection
• EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD: Executive Summary (2024)

This article is for informational purposes only and is not medical advice. Talk to your doctor or hepatologist about your specific situation.