Eating a low-sodium diet when you have cirrhosis

If you have cirrhosis, you may need to reduce your sodium intake by eating less salt. You'll feel better and lower your risk of fluid buildup in the abdomen (ascites) and legs (edema) and other complications by following the suggestions in this Actionset. You may also want to visit with a nutritionist (registered dietitian) to help you get started or find more ways to cut down on salt and eat a healthful diet.

Eating less sodium does not have to be hard, but you do have to think about it. Salt is in many foods, so limiting your salt intake means more than just not using the salt shaker. Packaged (processed) foods and restaurant foods are usually quite high in salt. You can start reducing the sodium in your diet by:

• Reading labels to see how much sodium foods contain and keeping careful track of your sodium intake. This is the surest way of evaluating your diet.
• Limiting packaged foods and restaurant foods, which typically are high in sodium.
• Not adding salt to your food during cooking or at the table.
• Using low-sodium spices and sauces to add flavor to your food. Low-sodium foods can still be tasty.

 What is the effect of sodium on my cirrhosis?
 Why should I eat a low-salt diet if I have cirrhosis?
 How can I limit the sodium in my diet?
 Where to go from here

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Fluid buildup in the abdomen (ascites) and legs (edema) is one of the most common complications of cirrhosis. Sodium contributes to this problem by causing your body to retain water, which increases fluid buildup in your abdomen as well as your legs and lungs. Aside from being uncomfortable, excessive fluid buildup can lead to difficulty breathing, infection, and other problems.

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Limiting sodium in your diet helps prevent your body from retaining extra fluid, which will make you feel better and may prevent or delay complications such as ascites and breathing difficulties. Eating a low-salt diet is the surest way to reduce your sodium intake. Salt contains a great deal of sodium—1 teaspoon contains 2 g (2,000 mg). This amount alone nearly meets the recommendation of the U.S. Daily Value for sodium, which is less than 2,300 mg. In the United States, the typical diet includes about 4,000 mg of sodium a day.

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Limiting the sodium in your diet may seem difficult. But if you pay attention to the sodium content in foods and avoid high-sodium foods, you will be able to greatly reduce your sodium intake.

Perhaps the main misconception people have about sodium is that the biggest source of sodium in the diet is salt added at the table. This is not true. In general, the biggest source of sodium is the salt in packaged foods and foods from restaurants. About two-thirds (67%) of the sodium in our diet comes from these sources, while salt added at the table accounts for about 6% of our sodium intake.¹

Here are some suggestions to help you limit your sodium intake.

Evaluate your diet.

• Talk with a health professional about how much sodium you need and how to evaluate your current diet. He or she will probably ask you what types of foods you are eating and get a rough estimate of your current sodium intake. Have questions prepared to ask him or her.
• Track your sodium intake for a few days by counting the milligrams of sodium in the foods you eat. You will have to know how to read food labels. Record your intake in the sodium record(What is a PDF document?).
• Review your record with your health professional. He or she will be able to help you target which foods to avoid and provide other dietary advice.

Cook with less sodium. When you cook your food, you can cut down on sodium by:

• Using fresh or frozen foods.
• Rinsing canned vegetables.
• Flavoring your food with spices, not salt. Avoid soy sauce, steak sauce, onion salt, garlic salt, mustard, and ketchup. These contain a lot of salt.
• Avoiding packaged foods.

Limit sodium in your foods. Look for sodium in the foods you prepare, and try to avoid high-sodium foods.

• Read food labels. They tell you how much sodium a food contains in each serving.
• Read ingredient lists and be aware of other forms of sodium. These include monosodium glutamate (MSG, common in Chinese food), sodium citrate, sodium alginate, sodium hydroxide, and sodium phosphate.
• Substitute low-sodium foods for high-sodium foods. Use a general list of "foods allowed" and "foods to avoid". Foods allowed have low sodium content. Foods to avoid have high sodium content.
• Avoid fast food and packaged foods.
• Ask for low-sodium foods when you eat out. Most restaurant food is quite high in sodium, but most restaurants are also willing to prepare your food with less salt if you ask.
• Drink low-sodium bottled water.
• Don't add table salt to your food.
• Don't drink water that has been softened using sodium.

If you do not cook for yourself, let those who help you know that you need a low-sodium diet:

• If family members or friends help you, or if you hire someone, print this section and have them read it. This will help them provide you with the right food choices.
• If you have meals delivered to you, attend a senior center for meals, or have another source of meals, ask the administrator of the program about low-sodium meals. You may have to ask for special meals.
• If you feel you need help, ask the provider of a nutrition program (often a health department or hospital in your area) to find out where meals are served in your area. Be sure they know that you have to limit the amount of sodium in your diet.

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Now that you have read this information, you can begin to reduce the sodium in your diet. Talk with your health professional about the changes to your diet. He or she may have more suggestions and tips on how to limit your sodium intake. You may also want to meet with a registered dietitian for more ideas about a healthful diet for you.

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Citations

1. Havas S, et al. (2007). The urgent need to reduce sodium consumption. JAMA, 298(12): 1439–1441.