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Whats is ascites and why is salt a problem?

Ascites is a condition characterized by the accumulation of fluid within the peritoneal cavity, the space between the abdominal organs and the abdominal wall. It often occurs as a complication of liver disease, particularly in advanced stages, due to the impaired liver function and increased pressure within the blood vessels that supply the liver. There are two main types of ascites caused by liver disease: transudative ascites and exudative ascites.

Sodium and Liver Disease: Sodium, which is a component of salt, can exacerbate the complications of liver disease, particularly in individuals with ascites, due to its impact on fluid balance and electrolyte levels. Here’s why sodium can be problematic for people with liver disease:

  1. Fluid Retention: High sodium intake can lead to water retention in the body, exacerbating the fluid accumulation that characterizes ascites. This is because sodium attracts water and can contribute to increased pressure within blood vessels, promoting fluid leakage into the peritoneal cavity.
  2. Increased Ascites: Sodium-induced fluid retention can worsen ascites, increasing abdominal discomfort and distension. The excess fluid can put additional strain on the compromised liver and exacerbate the already impaired blood flow.
  3. Hyponatremia Risk: Paradoxically, despite the fluid retention, liver disease can also lead to a decreased ability to maintain normal sodium levels in the blood. This can result in a condition called hyponatremia, where there’s an abnormally low concentration of sodium in the bloodstream. Hyponatremia can have serious neurological and systemic effects.

For individuals with liver disease, especially those with ascites, a low-sodium diet is often recommended to manage fluid accumulation and minimize the risks associated with sodium-related complications. Dietary restrictions on sodium intake can help prevent the worsening of ascites and maintain a healthier fluid balance in the body. It’s important for individuals with liver disease to consult their healthcare providers or dietitians for personalized dietary recommendations based on their specific condition and needs.

Natural Diuretics

Natural diuretics are substances that can help increase urine production and promote the removal of excess fluids from the body. However, it’s crucial to note that individuals with liver disease, especially ascites, should consult their healthcare providers before incorporating any new supplements or herbs into their diet, as these may interact with medications or worsen their condition. Here’s a list of some natural diuretics that have been suggested to have potential benefits for managing ascites:

  1. Dandelion (Taraxacum officinale): Dandelion leaves and roots are believed to have diuretic properties that may help with fluid retention. They are also rich in potassium, which can counteract the potassium loss associated with some diuretics.
  2. Parsley (Petroselinum crispum): Parsley is often used as a culinary herb, but it’s also considered a natural diuretic. It contains compounds that can help increase urine production and reduce water retention.
  3. Nettle (Urtica dioica): Nettle leaf has been traditionally used as a diuretic and may help promote the removal of excess fluids from the body.
  4. Hawthorn (Crataegus spp.): Hawthorn is known for its potential benefits on heart health, and it may also have mild diuretic effects that could aid in fluid balance.
  5. Juniper (Juniperus communis): Juniper berries and their extracts have diuretic properties and may help increase urine output. However, they should be used cautiously and in consultation with a healthcare provider due to potential interactions and side effects.
  6. Corn Silk (Zea mays): Corn silk is the fine, silky threads found on ears of corn. It has been used traditionally as a natural diuretic.
  7. Fennel (Foeniculum vulgare): Fennel seeds and leaves contain compounds that can have diuretic effects and help reduce water retention.
  8. Cranberry (Vaccinium macrocarpon): Cranberry juice is known for its potential benefits on urinary tract health and may also have mild diuretic properties.
  9. Hibiscus (Hibiscus sabdariffa): Hibiscus tea has been suggested to have diuretic effects and may contribute to fluid balance.
  10. Green Tea (Camellia sinensis): Green tea contains caffeine and antioxidants that may promote increased urine output and contribute to overall fluid balance.
  11. Lemon (Citrus limon): Lemon water is often considered a natural diuretic due to its ability to increase urine production. However, it’s important to consider its acidity and potential impact on individuals with digestive issues.

Here’s how I personally handle ascites

  1. Limit salt / sodium intake to ideally 1000 – 1200mg per day
  2. Use the salt substitute recipe which reduces the sodium amount by 75% but still retains the salty flavour we all crave.

Food and drinks I consume to act as a diuretic

  1. Raw onions – try a green salad with lots of raw onion and use a low sodium salad dressing
  2. Dandelion root tea – I drink this first thing every morning with 1 tbsp of fresh lemon and 1 tbsp of raw honey
  3. Lemons – Oh I love lemons, another natural diuretic, drink fresh lemon juice during the day, but don’t go crazy, you don’t need too much as it’s very acidic but it does bring up your vitamin C intake significantly as they are very potent.

Non natural diuretics – Medication

I use Spiranolctone and Furosemide in a combination of 100mg spiranolactone and 40mg of furosemide. Depending on your condition this dose needs to be adjust as time goes on, moving to a high doseage maybe tempting but it can cause massive electrolyte inbalance and create cramp which is not fun. This is something you need to learn about from your Dr.

How much fluid can I lose?

The answer to that depends on you, if you can limit salt intake, get the Spiranolactone and Furosemide dosage correct you can expect to be losing around 1/2 to 1kg per day. Personally, I am losing an average of 0.94kg per day and I have already dropped almost 85kg in bodyweight in 9 days… Amazing right? It is possible without large volume paracentesis (that big needle they stick in you to remove the fluid), personally I prefer to handle this fluid extraction by ways of urine excretion.

I had 5 litres removed via paracentesis but I did not stick to my diet plan (my liver was still not very functional) and it came back real fast. You need the will to want to succeed, it’s not easy but it’s possible.


Hi! I'm Zahir. I'm a 40 something year old guy living with liver cirrhosis. My goal is to tell my story of how I am beating the odds and winning this battle. Checkout my blog for frequent updates and very useful information on winning and living a great live with a liver cirrhosis diagnosis.

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