Menus for Liver Disease

Advanced scarring of the liver (cirrhosis) may lead to an abnormal accumulation of fluid in the abdomen, referred to as ascites. Patients with HCV who have ascites must be on sodium (salt) restricted diets. Every gram of sodium consumed results in the accumulation of 200 ml. of fluid. The lower the salt content of the diet, the better this excessive fluid accumulation is controlled. Sodium intake should be restricted to 1,000 mg. a day or less. This requires careful shopping and reading all food labels. It is often surprising to discover which foods are high in sodium. For example, one ounce of corn flakes contains 350 mg. of sodium; one ounce of grated parmesan cheese, 528 mg. of sodium; one cup of chicken noodle soup, 1,108 mg. of sodium; and one teaspoon of table salt, 2,325 mg. of sodium. Avoid fast food restaurants, because most fast foods are high in sodium. Meats, especially red meats, are high in sodium, so meat consumption may need to be reduced and vegetarian alternatives considered. Patients with chronic HCV without ascites are advised not to overindulge in salt intake, although their restrictions need not be as severe.

http://www.askemilyss.com/bites/bite1100/diet.htm

SODIUM RESTRICTED DIET PLAN

Your diet plan primarily uses foods which are prepared without salt and stresses the use of foods that are low in natural sodium.

Eat regularly as shown In your basic meal plan
Select a variety of foods and do not add salt

Carefully read the labels of all prepared foods. Look not only for salt, but also for bicarbonate of soda (baking soda), baking powder, MSG, and sodium compounds such as sodium benzoate, sodium citrate, etc. Most frozen dinners, Instant dinner mixes, sauces, canned foods, (except fruits and fruit juices) and prepared foods contain salt unless they are especially prepared for sodium-restricted diets as such.

Eat only the amount of List II foods specified in your basic meal plan. These foods are moderately high in sodium.

Choose a good source of Vitamin C daily. They are citrus fruits, strawberries, broccoli, brussels sprouts, papaya, and cantaloupes.

Choose a good source of Vitamin A every other day. These are dark green or yellow fruits and vegetables.

Water varies in sodium content from one area to another. Check with your local water supplier and If the water in your area contains more than 20 mg. sodium per quart, bottled water should be used. The use of water-softeners may add significant amounts of sodium to the water supply.

Avoid medicines, laxatives, and salt substitutes unless prescribed by a physician.

Basic Meal Plan	Sample Menu	Calories	Sodium mg.	Cholesterol mg.	Special Instructions
BREAKFAST					FOR WEIGHT CONTROL
1 serving fruit or juice-List I	1/2 grapefruit	40	1		* Follow a regular exercise program as directed by your physician
1 serving cereal-List I	1 cup Puffed rice cereal 1 cup enriched with	60	10		* Avoid the use of wine, beer or other alcoholic beverages
1 serving nonfat milk-List II	1 cup Carnation Instant Nonfat Milk	80	115.8	5	* Use only unsweetened or fresh fruits for desserts; avoid sugar, concentrated
1 serving fruit-List I	1 small banana	120	1		sweets, regular jelly and jams, regular
1 serving salt-free bread-List II	1 slice salt-free whole wheat toast	51	5		soft drinks, etc. Artificial sweetener may be used
1 serving fat-List I	1 tsp. unsalted margarine	34	-		* Limit breads and cereals to 4 servings per day
1 serving sweets-List I	1 tsp. jam	18	0.8
Beverage	coffee or tea	2	2
NOON MEAL
2 oz. cooked fresh meat-List II	2 oz. unsalted roasted chicken (light meet)	95	36	68	* Limit margarine and other fats to 4 servings per day
2 servings salt-free bread-List I	2 slices salt-free white bread and	124	5		* Avoid the use of potatoes or other
1 serving fat-List I	1 tsp. salt-free mayonnaise with	33	-	3	starchy vegetables (including corn,
1 serving vegetable-List I	lettuce (3 small leaves)	2	1		lima beans, sweet potatoes, dried
1 serving fruit-List I	1 box (1 1/2 oz.) raisins	124	12		peas and beans)
1 serving fruit-List I	1/2 medium apple	40	1
1 serving nonfat milk-List II	1/2 cup Carnation Instant Nonfat Milk	80	115.8	5
EVENING MEAL					SODIUM VARIATIONS
1 serving vegetables-List I	1 cup chopped fresh spinach	14	39		* To convert diet to 1,000 mg.
1 serving vegetables-List I	1/2 medium tomato	11	1.5		sodium, replace the 4 servings of
2 servings fat-List II	2 Tbsp. oil and vinegar dressing	166	1		salt-free bread with regular bread
1 serving salt-free bread-List I	1 slice salt-free whole wheat bread	61	5
1 serving fat-List I	1 tsp. unsalted margarine	34	-		* To convert diet to 2,000 mg.
1 serving wine-List I (optional)	7 oz. wine	173	10.2		sodium, replace salt-free bread with 4 servings of regular bread, replace
4 oz. cooked fresh meat-List II	4 oz. broiled lean steak	234	67.8	103	salt-free margarine with regular margarine, and replace salt-free
1 serving vegetable-List I	1 baked potato	188	6		cereal with regular cereal, 1 cup maximum
2 servings fat-List I	2 Tbsp. sour cream	57	12	16
1 serving vegetable-List I	6 asparagus spears	18	1
1 serving vegetable-List I	1/2 cup cooked rhubarb with sugar	191	2.5
1 serving dessert-List I	1/2 cup ice cream	129	42	26
Beverage	Coffee or Tea	2	2
BEDTIME
1 serving fruit-List I	1 medium orange	64	1
	Total:	2255	487	226

Sodium Diet Food List

LIST I: FOODS WITH LOW SODIUM CONTENT - These foods may be used as desired unless calories are also restricted.

All fruits and fruit juices
All fresh or frozen vegetables EXCEPT those in LIST II or LIST III

BREAD & CEREALS

Puffed wheat/rice or shredded wheat

Most hot, unsalted cereals

Salt-free breads

Pearl barley, rice, noodles, macaroni, spaghetti

Popcorn, unsalted

FATS

Sweet butter

Unsalted margarine

Vegetable oils

Salt-free mayonnaise

Sour cream

Nuts, unsalted

MISCELLANEOUS

Vinegar

Wines

Jams or Jellies

Honey & Syrup

Sugar

Herbs and spices which do not contain salt or MSG (monosodium glutamate)

Special salt-free foods (read the label to determine mg. level per serving - under 15 mg. per serving foods may be used as desired)

LIST II: FOODS WITH MODERATE SODIUM CONTENT - These foods must be limited in amounts as specified.

MILK
(Whole, Carnation Instant Nonfat, diluted evaporated, skim, low fat) - Limit to 2 cups daily.

EGGS
Limit 1 per day

MEAT/FISH/FOWL
(Other than those in LIST III) - Limit to 6 oz. cocked weight daily.

Fresh crab, lobster, shrimp, scallops, brains, kidneys, and frozen fish which have been *** in brine contain higher amounts of sodium than other fresh meats. These foods should be chosen infrequently.

DESSERTS
Limit to one choice per day - serving portion as indicated

Cake - 1 1/2 oz.
Cookies, assorted - 1 oz
Gelatin - 1/2 cup
Ice cream - 1/2 cup
Regular cooked puddings such as tapioca, rice, etc. - 1/2 cup
Sherbet - 1/2 cup

VEGETABLES
Limit to one choice per day - 1/2 cup serving only (fresh, frozen or salt-free canned)

Beets

*** Greens

Carrots

Chard

Dandelion Greens

Celery

Frozen Lima Beans

Frozen Peas

Kale

Mustard Greens

Turnips, white

LIST III: FOODS WITH HIGH SODIUM CONTENT - These foods should be avoided.

MILK
Buttermilk

CHEESE
All excepting special low sodium cheese or low sodium cottage cheese

MEAT/FISH/FOWL
Bacon, ham, hot dogs, sausages, bologna, luncheon meat; canned, salted, dried, smoked or pickled meat, fish or poultry. Herring caviar, regular canned tuna and salmon, anchovies, sardines and salted cod. Canned crab, shrimp, lobster and oysters. Salt pork, chipped or corned beef, brain, kidney, meats koshered by salting. Regular peanut butter.

CONDIMENTS
Most seasonings, sauces, marinades with salt.

VEGETABLES
Sauerkraut, olives, pickles, regular canned vegetables and canned vegetable juices. Any vegetable prepared in brine.

FATS
Salted butter or margarine, commercial salad dressings and regular mayonnaise, bacon fat, salted nuts, canned gravies.

SOUPS
All regular canned soups, soup mixes, broth, bouillon, consommé, commercial bouillon cubes, powders or liquids.

BREADS & CEREALS
Regular and yeast breads and rolls prepared with salt, dry cereals other than those listed in LIST I, regular pancakes, muffins, biscuits, cornbread, crackers and mixes. Potato chips, corn chips, pretzels, salted popcorn. Corn meal and self-rising flour.

DESSERTS
Instant pudding, pie crust unless prepared without salt, desserts in excess of the amount allowed in LIST II.

BEVERAGES
Dutch process cocoa, soft drinks or beer which have been boiled in areas high in sodium content in their water supplies

Reduced Sodium Diet

Purpose
Sodium is essential to the body. It is a mineral that helps the body regulate fluid balance. Under certain conditions, excess sodium can cause the body to retain too much fluid. This could be harmful for people with conditions such as high blood pressure or heart disease. These conditions are often managed by reducing sodium in the diet. For many patients, restricting the total amount of sodium to 4 grams a day is enough to reduce harmful fluid retention. However, some patients will have to restrict their total sodium intake to 2 grams a day.

Nutrition
If the patient follows the prescribed sodium limitations and chooses a variety of foods from each of the basic food groups (breads and grains, fruits, vegetables, meat alternatives, dairy products), these diets are nutritionally adequate.

Special Considerations

Table salt: This is a large source of sodium in the everyday diet. It is used in the kitchen in food preparation and added at the table. It is also added to many commercially canned and frozen foods. Table salt is about one-half sodium, so its use must be restricted in these diets.
Finding the Sodium in a Diet: Sodium occurs naturally in many foods, and some foods contain more sodium than others.
On food labels, the sodium content of foods is usually listed in milligrams (mg) per serving. One gram = 1000 mg. So, on a 2 gram sodium diet, a person should have no more than 2000 mg of sodium each day; and on a 4 gram sodium diet, no more than 4000 mg a day. As a helpful guide: for the 4 gram diet, purchase products with no more than 300 mg of sodium per serving. For the 2 gram diet, purchase products with no more than 200 mg of sodium per serving.
Sodium compounds, in addition to table salt, are often added to commercially processed foods. Some of those more commonly used are baking soda, brine, monosodium glutamate (MSG), baking powder, disodium phosphate, or sodium benzoate. Read food labels on all items before purchasing or using.
Common medications: Antacids, laxatives, and cough remedies often contain sodium compounds. Check with a physician or pharmacist if there is a question about prescription or over-the-counter medications.
Fast food restaurants: Avoid them because the foods they serve tend to be very high in sodium. When dining in other restaurants, ask that no salt be used in the preparation of your meal.
Salt substitutes: Never use these unless the physician has approved it. They may replace the sodium with another mineral that could also be harmful to certain patients. Herbs and spices may be used in place of salt to add flavor and variety to meals.
Water softeners: They exchange the calcium in hard water with sodium from a salt brine. Avoid drinking home or commercially softened water. When purchasing bottled water, check the label to be sure it contains no sodium. Do not use softened water to prepare foods or beverages.
Diet Differences: A few things that are allowed on the 4 gram diet are not permitted on the 2 gram diet. Follow the guide below:

Sample Menu 2 Gram

Breakfast

Lunch

Dinner

orange sections 1/2 cup
whole wheat toast 1 slice
cereal 3/4 cup
unsalted margarine 2 tsp
jelly 2 tsp
skim milk 1 cup
coffee
creamer/sugar 1 tsp

Snack
unsalted soft pretzel 1
apple juice

*Low Sodium

chicken noodle soup* 1/2 cup
lean hamburger 3 oz
hamburger bun 1
sliced tomato 2 oz
lettuce
mayonnaise 1 tsp
unsalted crackers 3
vanilla wafers 3
canned peaches 1/2 cup
skim milk 1/2 cup
coffee
creamer/sugar 1 tsp

baked chicken breast
3 oz
baked potato 1 med
green beans 1/2 cup
tossed salad
diet Italian dressing
1 Tbsp
whole wheat bread
1 slice
unsalted margarine 2 tsp
angel food cake 1 slice
strawberries 1/2 cup
skim milk 1 cup
coffee
creamer/sugar 1 tsp

This Sample Diet Provides the Following
Calories	2090	Fat	55 gm
Protein	105 gm	Sodium	1850 mg
Carbohydrates	300 gm	Potassium	4450 mg

Sample Menu 4 Gram
Breakfast	Lunch	Dinner
grapefruit 1/2 cereal 3/4 cup banana 1/2 whole wheat toast 2 slices margarine 2 tsp jelly or jam 1 Tbsp 2% milk 1 cup coffee/tea	vegetable soup 1 cup lean hamburger 2 oz swiss cheese 1 oz hamburger bun 1 sliced tomato 2 oz lettuce fresh fruit salad 1/2 cup oatmeal cookie 1 2% milk 1 cup	low sodium tomato juice 1/2 cup broiled chicken breast 3 oz brown rice 1/2 cup broccoli spears 2 hard dinner roll 1 margarine 2 tsp carrot/raisin salad 1/2 cup frozen strawberry yogurt 1/2 cup 2% milk 1 cup coffee/tea

This Sample Diet Provides the Following
Calories	2170	Fat	69 gm
Protein	119 gm	Sodium	4040 mg
Carbohydrates	294 gm	Potassium	3950 mg

Diet Differences
4 Gram	2 Gram
Use a total of 1/2 teaspoon of table salt per day in cooking and food preparation. Do not add salt at the table.	Use no table salt in cooking and food preparation. Do not add salt at the table.
Limit prepared salad dressings and condiments such as mustard or catsup to a total of 3 tablespoons per day.	Do not use commercially prepared salad dressings or condiments such as mustard or catsup.
Do not eat Bleu, Roquefort, Stilton, or Gorgonzola cheeses. Limit other natural or aged cheeses to 2 oz. per day.	Do not eat any natural or aged cheeses.
Limit buttermilk to 8 oz. per week.	Do not drink buttermilk.
Limit regular peanut butter to 3 teaspoons per week.	Do not eat regular peanut butter.

Choosing Foods For A Reduced Sodium Diet
Choose	Avoid
Breads: English muffin; white, wheat, pumpernickel, other types of regular or unsalted bread and rolls	sweet rolls, breads or rolls with salted tops, packaged cracker or bread crumb coatings, packaged stuffing mixes, biscuits, corn bread
Cereals: regular cooked cereals such as oats, cream of wheat, rice, or farina; puffed wheat; puffed rice; shredded wheat	instant hot cereals, any other regular ready-to-eat cereals
Crackers and snack foods: all unsalted crackers and snack foods, unsalted peanut butter	salted crackers and snack items, regular peanut butter, party spreads and dips
Pasta, rice and potatoes: all types of pastas such as macaroni, spaghetti, rigatoni, ziti; potatoes, rice	macaroni and cheese mix; seasoned rice, noodle, and spaghetti mixes; canned spaghetti; frozen lasagna, macaroni and cheese, rice, and pasta dishes; instant potatoes; seasoned potato mixes
Dried beans and peas: pinto beans, white northern beans, black-eyed peas, lima beans, lentils, split peas, etc.	any beans or peas prepared with ham, bacon, salt pork, or bacon grease; all canned beans
Meats and alternatives: fresh or frozen meat, poultry, and fish; low sodium canned tuna and salmon; eggs	salted, smoked, canned, spiced, and pickled meats, poultry and fish; bacon; ham; sausage; scrapple; regular canned tuna or salmon; cold cuts; luncheon meats; hot dogs; pre-breaded frozen meats, fish, and poultry; TV dinners; meat pies; kosher meats
Fruits and vegetables: fresh, frozen, or low-sodium canned vegetables or vegetable juices; low sodium tomato paste and sauce; fresh, canned, or frozen fruit and juices	regular canned vegetables and vegetable juices, regular tomato sauce and tomato paste, olives, pickles, relishes, sauerkraut or vegetables packed in brine, frozen vegetables in butter or sauces, crystallized and glazed fruit, maraschino cherries, fruit dried with sodium sulfite
Dairy products: milk, cream, sour cream, non-dairy creamer, yogurt, low-sodium cottage cheese, low sodium cheese	buttermilk, Dutch processed chocolate milk, processed cheese slices and spreads, regular cheese, cottage cheese
Fats and oils: margarine regular butter, or mayonnaise limited to 4 teaspoons per day; unsalted butter, margarine, cooking oils, or shortenings; salt free gravies, cream sauces, and salad dressings	bacon grease; salt pork; commercially prepared sauces, gravies, and salad dressings
Soups: salt-free soups and low-sodium bouillon cubes	regular commercially canned or prepared soups, stews, broths, or bouillon; packaged and frozen soups
Desserts: gelatin, sherbet, fruit ices, pudding and ice cream as part of milk allowance, angel food cake, salt-free baked goods, sugar, honey, jam, jelly, marmalade, syrup	regular commercially prepared and packaged baked goods, chocolate candy
Beverages: coffee, tea, soft drinks, fruit flavored drinks that do not contain sodium	softened water; carbonated beverages with sodium or salt added; check with physician about alcoholic beverages
Condiments: fresh and dried herbs; lemon juice; low-sodium mustard, vinegar, Tabasco sauce; low-sodium or no-salt-added ketchup; extracts (almond, lemon, vanilla); baking chocolate and cocoa; seasoning blends that do not contain salt	table salt, lite salt, bouillon cubes, meat extract, Worcestershire sauce, tartar sauce, ketchup, chili sauce, cooking wines, onion salt, prepared mustard, garlic salt, meat flavorings, meat tenderizers, steak and barbecue sauce, seasoned salt, monosodium glutamate (MSG), Dutch processed cocoa

Flavoring Food Without Salt
Onion, garlic, lemon, vinegar, black pepper, and parsley improve the flavor of many kinds of food. For gourmet-type dishes, use fruit, fruit juices, or sweet and sour sauce. Use fresh or dried herbs and spices to flavor foods. Remember that two teaspoons of chopped fresh herbs equals 1/2 teaspoon of the dried form. Always store dried herbs and spices in a cool, dry place in airtight containers. When flavoring, start with small amounts (1/4 tsp for four servings) and increase to taste. Don't use more than three herbs or spices in one dish. Certain herbs and spices blend better with some foods than with others, so experiment and use the suggestions below as a guide.
Vegetables		Meats, Poultry, Fish and Eggs
Asparagus:	lemon, chives	Beef:	bay leaf, dry mustard, nutmeg (in meat loaf), sage, dill, green pepper, fresh mushrooms, tomatoes
Broccoli:	lemon, oregano, rosemary	Veal:	bay leaf, curry, ginger, apricot or current jelly, fresh mushrooms, tomatoes, tarragon, dry mustard
Carrots:	lemon, orange, nutmeg, mint, basil, marjoram, oregano, thyme, brown sugar, ginger, cinnamon, mace, anise, dry mustard	Pork:	sage, caraway, nutmeg, apples, applesauce, cranberry sauce, tarragon, dry mustard
Corn:	green pepper, fresh tomatoes, paprika, hot pepper sauce	Lamb:	curry, mint, dill,sage
Peas:	mint, dill, fresh mushrooms, basil, marjoram, savory	Poultry	sage, tarragon, fresh mushrooms, poultry seasoning, curry, peach, apricot, pineapple, lemon, hot pepper sauce, bay leaf
Potatoes:	mace, chives, rosemary, dill	Fish & Eggs:	dill, basil, tarragon, curry, dry mustard, paprika, cayenne, thyme, green pepper, fresh mushrooms, tomatoes, hot pepper sauce, chives, Bay leaf adds flavor to fish chowders
Sweet Potatoes:	mace, ginger, basil, cinnamon, cloves, brown sugar, nutmeg, allspice, oregano, lemon, orange
Spinach:	nutmeg, oregano, basil, marjoram, rosemary, thyme, allspice, mace, lemon
Tomatoes:	basil, oregano, thyme, sugar, dill, marjoram, vinegar

WHAT DO FOOD LABELS TELL US?

Do the terms "sodium" or "salt" appear on the front of the food label? If so, here’s what the descriptions mean. For the specific sodium content in a serving, check the Nutrition Facts panel.

LABEL TERM	MEANS	EXAMPLES of FOODS
Sodium free	Less than 5 milligrams sodium per serving	Crackers
Very low sodium	35 milligrams or less sodium per serving	Chips
Low sodium	140 milligrams or less sodium per serving	Soup, cereal, crackers
Reduced or less sodium	At least 25% less sodium*	Soy sauce, soup, bacon, pretzels, crackers
Light in sodium	50% less sodium*; restricted to foods with more than 40 calories per serving or more that 3 grams fat per serving	Crackers
Salt free	Less than 5 milligrams sodium per serving	Herb blends
Low sodium meal	140 milligrams or less sodium per 100 grams	Frozen dinner
Unsalted or no added	No salt added during processing; does not necessarily mean sodium free	Peanuts, butter, canned vegetable, microwave popcorn, crackers, breakfast cereals