Cirrhosis - Lifestyle Changes

Salt Restriction. Restricting salt consumption to less than 2,000 mg a day is particularly important for patients with ascites. The less salt the better.

Zinc. In some studies, taking zinc supplements have lowered ammonia levels in some patients who were zinc-deficient, a common problem in cirrhosis. Zinc replacement may reduce frequency and severity of muscle cramps and may even help protect against encephalopathy.

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Limiting Fluids

Fluid restriction is not usually necessary, but patients with severe ascites should discuss limiting fluid with their physicians.

Exercise

Exercise increases the risk for portal pressure and variceal bleeding. One study reported that taking a beta-blocker may reduce this risk, although patients should discuss this with their physician.

Preventing Influenza and Infections

Infections can have a severe impact on the liver. Although most respiratory infections generally affect only the lungs, one small study suggested influenza may directly affect the liver in patients with cirrhosis and exacerbate the disease process. Researchers in the study advise annual flu shots for people with cirrhosis. Furthermore, they advise that patients who get the flu be treated immediately with rimantadine, but not a similar treatment called amantadine.

Treating Chronic Fatigue

A 2000 study of 15 patients with chronic liver disease concluded that methylphenidate (Ritalin) improves chronic fatigue symptoms in patients with cirrhosis and chronic hepatitis. All patients reported some improvement in fatigue, and no side effects were severe enough to warrant withdrawal from the study. The researchers recommended that treatment for chronic fatigue in patients with liver disease combine methylphenidate with physical therapy and nutritional counseling. Results of the study need to be confirmed in a randomized prospective trial.

Alternative Remedies

Among the natural substances being investigated for liver disease are ginseng, glycyrrhizin (a compound in licorice), catechin (found in green tea), SAMe, and silymarin (found in milk thistle). Two natural substances that may have some benefits for people with cirrhosis are discussed in the following paragraphs:

Silymarin. A 2001 review analyzed studies on 10 herbal remedies used for liver disease. None showed any benefits except silymarin. Furthermore, an analysis of five studies on cirrhosis patients reported an association between silymarin and a 7% reduced mortality rates from liver-related diseases. Known side effects from silymarin include rare reports of gastrointestinal problems and allergic skin rashes.