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Hepatic Encephalopathy Low-Protein Diet

By Jennifer Nall, M.S., R.D., L.D. ; Updated July 18, 2017

Hepatic encephalopathy occurs when your liver is not able to rid the blood of toxins such as ammonia and manganese. This results in the toxins accumulating in the blood and entering the brain. Diet plays an important role in treating hepatic encephalopathy because a low-protein diet can help lower ammonia levels in the blood.


Hepatic encephalopathy is caused by disorders that affect your liver function such as liver cirrhosis and hepatitis. In addition, hepatic encephalopathy may also be triggered by electrolyte abnormalities, dehydration, infections, kidney problems and low oxygen levels. There are some medical conditions that can mask or mimic symptoms of hepatic encephalopathy including alcoholism, meningitis and sedative overdose.

Symptoms and Diagnosis

Symptoms of hepatic encephalopathy may include confusion, poor concentration, disorientation, agitation and slurred speech. Symptoms can appear suddenly or they can begin slowly and worsen over time. Diagnostic tests must be done to diagnose hepatic encephalopathy and may include a complete blood count, CT scan of the brain and checking ammonia levels in the blood.

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Protein in the diet may need to be limited in order to lower ammonia levels. Ammonia is produced when protein is digested, which under normal circumstances can be cleared from the blood by the liver. Animal proteins may need to be limited to 40 grams per day, with unlimited vegetable protein. Animal protein sources include chicken, turkey, red meat, fish, dairy products and eggs. Major sources of vegetable proteins include beans, lentils, legumes and tofu.

Other Considerations

There is some concern over severe restriction of protein in hepatic encephalopathy patients. If protein intake is too low, loss of muscle mass can occur. Working with a physician and a registered dietitian can help ensure that protein intake is adequate based on individual needs. Acute hepatic encephalopathy may be treatable; however, possible complications may include brain swelling, permanent damage to the nervous system and coma.

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