What role do dietary modifications play in the management of patients with hepatic encephalopathy?

Dietary modifications play a crucial role in the management of hepatic encephalopathy (HE) by aiming to reduce the production and absorption of neurotoxic substances, primarily ammonia, which contribute to the condition. The UK guidelines recommend maintaining adequate protein intake rather than protein restriction, as malnutrition is common and detrimental in patients with cirrhosis and HE ². Specifically, a diet with normal or slightly increased protein, preferably from vegetable and dairy sources, is advised to support nutritional status while minimizing ammonia generation ².

Additionally, frequent small meals and late evening snacks rich in complex carbohydrates are encouraged to prevent catabolism and muscle wasting, which can exacerbate HE ². This approach helps maintain muscle mass, which plays a role in ammonia metabolism.

From the literature perspective, Jawaro et al. (2016) emphasize that overly restrictive protein diets are no longer recommended, as they can worsen malnutrition and do not improve HE outcomes. Instead, they support the use of balanced diets with adequate protein and highlight the benefit of branched-chain amino acid supplementation in some cases to improve nitrogen balance and cognitive function (Jawaro et al., 2016).

In summary, dietary management in HE focuses on avoiding protein restriction, ensuring adequate nutrition with an emphasis on vegetable and dairy proteins, and using frequent meals to prevent catabolism, thereby reducing ammonia production and improving patient outcomes.