According to the American Liver Foundation, approximately 25 million Americans, or one out of 10, develop liver, bile duct, or gallbladder diseases. Liver disease often begins as inflammation of the liver, that may ultimately lead to chronic inflammation and irreversible scarring, also known as cirrhosis. The liver is remarkably resilient, able to compensate for a significant amount of damage by regenerating itself, but with time and chronic inflammation its function declines.

When liver function is impaired by scar tissue (as in cirrhosis), an increase in blood pressure within the liver may occur due to portal hypertension. Portal hypertension can result in the uncomfortable symptoms of fluid retention in the abdomen (ascites) and enlargement of the blood vessels in the intestinal tract (varices). Excess sodium and fluids increases the blood volume and can worsen these symptoms.

Sodium is a naturally occuring mineral found in small amounts in most foods and abundantly in salt. Sodium attracts water. In persons who are already experiencing problems with swelling, as occurs in advanced liver disease, excess sodium in the diet can increase fluid retention, and discomfort. The adult body only requires 500 milligrams (mg) of sodium each day to maintain health. This is equal to 1/4 teaspoon of salt and can be reaped from a well-balanced, nutritious diet. Most people, especially those in Westernized societies, have daily sodium intakes well above this level due to the prevalence of salt and processed foods that are high in sodium. Excess sodium not only contributes to excess fluid retention but may also increase the risk for chronic diseases such as high blood pressure. For this reason it is generally recommended that sodium intake be limited to approximately 2,400 mg per day. Further limiting sodium may be recommended by a physician in those with liver disease.

In some instances, restricting overall fluid intake may also be indicated. As in the case of sodium, fluid in the diet can worsen fluid retention. However, some controversy exists among experts about the appropriate amount of restriction. Also, the use of a fluid restriction is usually reserved for times of severe fluid retention, as it is often difficult to adhere to the restriction in the home setting. A physician and dietitian can help determine individual fluid requirements and goals.

Achieving a balance of sodium and fluids in the body, providing the body with necessary amounts while avoiding excess, is the goal in liver disease and for general good health. This may involve decreasing current levels of dietary sodium or fluids. Avoiding foods high in sodium is the first step in reducing sodium intake. Further strategies for restricting sodium and fluids may be recommended by a physician and helpful in coping with symptoms of liver disease.

References:

American Liver Foundation. Diet and Chronic Liver Disease. http://www.liverfoundation.org

American Liver Foundation. Liver Disease Fact Sheet. http://www.liverfoundation.org

National Digestive Diseases Information Clearinghouse. Chronic Hepatitis C: Current Disease Management. http://www.niddk.nih.gov/health/digest/pubs/chrnhepc/chrnhepc.htm

Hepatitis Foundation International. Caring For Your Liver. http://www.hepfi.org/Hepinfo/livercare.htm

Hepatitis Foundation International. Diet and Your Liver. http://www.hepfi.org/Hepinfo/diet.htm

Hepatitis Foundation Internationa. Excerpts from Hepatitis C Consensus Conference (Consensus Conference held April 1997). http://www.hepfi.org/s97insert.htm

The Hepatitis Information Network. The Liver in Health and Disease. http://www.euroliver-foundation.org/englishbri/entree.htm

Zeman, Frances J., Ph.D., R.D. (1983) Clinical Nutrition and Dietetics. New York:Macmillan.