Eating for Liver Health in Viral Hepatitis

Daily habits protect the liver from additional harm.

• Do not drink alcohol, or if your doctor allows any, keep it to the minimum; abstain completely if you have fibrosis or cirrhosis, or hepatitis C.
• Keep a healthy weight; aim for 150 minutes a week of moderate exercise unless your doctor advises otherwise.
• Do not smoke.
• Take antivirals exactly as prescribed and keep every blood test and scan.
• Get vaccinated against hepatitis A and (if not infected) B, and other vaccines your doctor advises.
• Do not share razors, toothbrushes, nail clippers or needles; blood spills should be cleaned with bleach solution. Normal sharing of food, cups and plates does not spread hepatitis B or C.

A normal, balanced diet is right for most people with viral hepatitis who do not have cirrhosis. Evidence strength is stated.

• Balanced plate, standard advice: vegetables and fruit, whole grains, legumes, fish, poultry, eggs, low-fat dairy (laban, yoghurt), nuts and olive oil. A Mediterranean-style pattern is reasonable, mainly for its effect on weight and fatty liver.
• Eat enough calories and protein. During acute hepatitis with poor appetite, small frequent meals and high-energy drinks can help; do not restrict protein unless told to.
• Limit added sugar, sweet drinks, fried food and fatty processed meat to avoid fatty liver on top of hepatitis, strong evidence for the principle in fatty liver.
• Coffee, observational evidence: moderate plain coffee (about 2 to 3 cups a day) is associated with less liver scarring; it is reasonable to continue if you tolerate it, without lots of sugar.
• Food safety, strong evidence for hepatitis A and E: wash hands before eating and after the toilet, drink safe (bottled or properly treated) water, wash and peel raw fruit and vegetables, cook meat, poultry and especially pork and game thoroughly, avoid raw or undercooked shellfish, and avoid unpasteurised milk and street food of doubtful hygiene when travelling.
• Store grains, nuts and peanuts dry and sealed and throw away mouldy items; this lowers aflatoxin exposure, which matters most in hepatitis B. Evidence is mainly from high-exposure regions.
• Supplements and herbs: do not take high-dose vitamins, iron (unless a deficiency is proven; iron overload harms the liver in hepatitis C), herbal liver remedies, slimming or body-building products, or green tea extract without telling your liver doctor. Some interact with antivirals; St John’s wort should not be taken with many hepatitis C medicines.
• If you have cirrhosis, follow the cirrhosis nutrition advice (see Eating well with cirrhosis): enough protein and calories, a bedtime snack, limited salt, no raw shellfish.

Antiviral medicines treat the virus. Diet supports the liver but does not replace them. See the Hepatitis B and Hepatitis C pages.

• Hepatitis C: a short course of direct-acting antiviral tablets (usually 8 to 12 weeks) cures most people.
• Hepatitis B: long-term antiviral tablets suppress the virus in people who need treatment; do not stop without your doctor.
• Check every medicine, including painkillers, with your liver doctor; paracetamol is usually safe only at limited doses.
• Ask about vitamin D or other supplements if blood tests show a deficiency.

Procedures monitor the liver and detect complications early.

• FibroScan, ultrasound and blood tests check scarring and liver cancer risk; people with cirrhosis need ultrasound every 6 months.
• Endoscopy checks for varices in cirrhosis.
• Liver transplantation is considered in end-stage disease; good nutrition improves outcomes.