Advice after your nerve block for surgery
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Introduction
The liver plays an important role in a number of vital functions in the body, including releasing and storing energy appropriately. When your liver is not working properly or when you have liver disease, your body is not able to effectively manage these energy stores, which may result in malnutrition. This leaflet has been designed to support you with diet related problems you
may encounter.
Liver Disease and its Stages
Your liver disease stage may change over time, and the dietary advice you should follow will depend on the stage of your liver disease:
- Compensated liver disease: this is when your liver is has experienced some damage but is maintaining its important functions.
- Decompensated liver disease: this is when your liver is not able to perform its functions adequately resulting in complications such as ascites (fluid accumulation in your abdomen), jaundice (yellowing of the skin) or hepatic encephalopathy (confusion). In addition, your liver will not be able to store and release energy effectively.
Please consult your medical team to determine the stage of your liver disease.
Malnutrition
Weight loss and muscle wasting can be common with liver disease and there are certain factors that can increase this risk.
Factors that can contribute to malnutrition:
- A decreased appetite
- Nausea and vomiting (your doctor may be able to prescribe medications to help with this)
- Feeling full easily, especially if you have ascites (fluid build-up around the stomach)
- You may have some dietary restrictions, such as salt or fluid
- Good nutrition is essential with liver disease, as it can:
- Improve liver function (in some cases)
- Prevent muscle wasting and improve functional strength
- Help with wound healing
- Help to slow the build-up of ascites
- Result in a more rapid resolution of hepatic encephalopathy
- Speed up recovery from operations and infections
- Reduce risk of hospital admissions
Regular Meals and Snacks
It is important that you eat and drink enough each day to keep your body strong and to prevent muscles being used as an energy source. It is important to “re-fuel” your body throughout the day and the best way to do this is by eating regular meals with snacks in-between. Meals and snacks
should contain starchy carbohydrate.
Carbohydrates
Carbohydrates are an important nutrient, as they are broken down into sugar (glucose) to provide us with energy. Some of this energy can be stored in your liver and muscles as glycogen. This energy reserve can be used as a back-up when needed during periods of fasting, for example when you have not eaten a carbohydrate-based meal within the past 2-3 hours. However, in the presence of liver disease this glycogen reserve may not be as big, therefore it is recommended to eat regular carbohydrates during the day and before bed. The energy from carbohydrates will help to preserve muscle and prevent unintentional weight loss.
Below are some good examples of foods which contain starchy carbohydrate:
- Breads e.g. brown, white, seeded, pitta, naan, chapati and rolls
- Cereals e.g. bran flakes, Weetabix
- Potatoes e.g. boiled, mashed, roasted, baked or cassava
- Pasta e.g. white and wholemeal.
- Rice e.g. basmati or brown
Some carbohydrate rich snack ideas include:
- Crumpets
- A glass of milk
- Scone
- Toast
- Crackers
- Tea cake
- Cereal bar
- Pastries
Bedtime Snacks
To reduce the risk of your body using muscle for energy, it is important to have a large carbohydrate snack before bed. Aim for 50g of carbohydrate - some good choices include:
| Food | Carbohydrate |
| 1 tablespoon jam/chocolate spread/honey | 10g |
| 200ml/300ml full fat milk | 10g/15g |
| 1 biscuit | 10g |
| 1 rice cake | 10g |
| Hot chocolate/Horlicks | 15g |
| 1 slice of bread/toast | 15g |
| 1 crumpet | 15g |
| Handful of jelly sweets | 20g |
| 1 flapjack | 20g |
| 1 banana | 20g |
| 1 chapati | 20g |
| 50g breakfast cereal with 200mls full fat milk | 30g |
| 1 tea cake/toasted muffin | 30g |
| 1 slice of fruit cake | 35g |
| 1/2 tin (200g) rice pudding & 2 tablrspoon jam | 50g |
| Foritsip | 35g |
| Fortijuice | 50g |
If you are a diabetic and taking drinks such as Fortisip or Fortijuce, consult with your dietitian as these may cause a rise in blood glucose levels.
Protein
Protein is essential for the body and is needed to build and repair body tissue. In liver disease, your body requires more protein than usual, so it is important to include protein sources with at least three or four meals or snacks per day.
Good sources of protein include:
- Meat, poultry and fish
- Dairy and dairy alternative products such as milk, cheese and yoghurts
- Eggs
- Pulses such as peas, beans and lentils
- Meat alternatives such as tofu, quorn and soya products.
Salt
You may be asked by your doctor or dietitian to follow a “no added salt diet”. This may be the case if you have ascites, or fluid around your legs and feet (oedema). Ways to manage this fluid can include water pills (known as diuretics), drainage from the abdomen using a tube (paracentesis) and a “no added salt diet”. It is recommended that you try and reduce your daily salt intake to no more than 5g per day.
Some tips for lowering salt intake include:
- Reading nutritional labels as the amount of salt in some foods may surprise you! Choose items which have a “green” traffic light food label for salt (less than 0.3g per 100g)
- Using salt alternatives in cooking such as herbs and spices– good examples can include garlic, pepper, basil, paprika and lemon
- Choose fresh meat and fish instead of processed, cured or smoked versions
- Check salt content of condiments such as tomato or brown sauce
- Try making your own stocks, or choose reduced salt stock cubes
- Ready meals are often high in salt, so look for low salt alternatives
- Avoid salted snacks such as salted nuts, crisps and crackers.
Eating With a Low Appetite
In decompensated liver disease you may experience a reduced or loss of appetite, this can be due to symptoms such as ascites, jaundice or hepatic encephalopathy. During these times it is important to ensure adequate food intake to prevent muscle loss and malnutrition.
Here are some tips to follow if you are experiencing a low appetite:
- Choose high energy, high protein food choices, such as: nut butters, full fat yoghurt, butter/margarine, oils, whole milk, cheese, ice cream or unsalted nuts etc.
- Eat little and often throughout the day. You should aim to eat a snack or meal every 2-3 hours.
- Keep fluids to a minimum at mealtimes as they fill you up, aim to drink after your meal.
- Include high calorie snacks such as cakes, biscuits, chocolate etc.
- Add additional oil/butter to food when cooking or after.
- Choose nourishing drinks over teas and coffees to sip in between your meals. Nourishing drinks include:
- Milkshakes made with full cream milk, skimmed milk powder and ice cream.
- Hot chocolate with cream.
- Ovaltine or Horlicks made with whole milk.
If your appetite continues to decline and you are losing weight or muscle strength, please contact your doctor or dietitian.
Meal Ideas
Breakfast:
- Cereal or oats with full fat milk
- Toast with butter & jam
- Egg or baked beans on toast
- Chapati with lentil or meat curry
- Croissant or pancake with full fat Greek yoghurt
Lunch:
- Sandwich with meat, egg or fish
- Jacket potato with butter, beans, cheese, tuna or meat
- Pasta or noodles with meat, fish or cheese
- A salad including bread, pasta or potatoes with meat, fish or egg
- Egg or tofu fried rice
Evening meal:
- Meat or fish with potatoes or chips and vegetables
- Pasta and sauce with meat, fish or cheese
- Meat stew with rice
- Curry with rice, naan or chapati
Dessert:
- Yoghurt or mousse
- Rice pudding
- Fruit and custard
- Chocolates or biscuits
- Cake
- Ice cream
Mid-morning and afternoon snacks could include:
- 1-2 biscuits
- Chocolate
- Glass of milk
- Supplement drink
Aim for a snack or drink containing 50g of carbohydrate before bed as outlined on page 4.
Dietary summary
| Summary of nutrition advice | |
| 2-3 hourly intake of carbohydrates sources | |
| 3-4 sources of protein per day | |
| 50g carbohydrate snack at bedtime | |
| No added salt diet | |
| May need to choose high calorie foods | |
| May require nutritional supplements if appetite is poor due to presenting symptoms/malnutrition risk |
Nutritional Supplements
If you are experiencing ongoing muscle loss and unable to increase your food intake, then please contact your dietitian or hepatology team as you may require some prescribed nutritional supplements to help meet your nutritional requirements.
Contact us
If you have any queries relating to this information, please contact the Dietetics service.
About this information
Service:
Dietetics
Reference:
DT/031
Approval date:
1 May 2025
Review date:
1 May 2028
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Important note
This page provides general information only. It is developed by clinical staff and is reviewed regularly every 3 years for accuracy. For personal advice about your health, or if you have any concerns, please speak to your doctor.