TITLE:
The Impact of Diet and Nutrition on the Gut-Liver Axis in Cirrhosis and Hepatic Encephalopathy
AUTHORS:
Muhammad Hassan, Richard Bakalov, Saiyara Baset, Pooja Shethna, Dhruti Patel, Andrea Weitoschova, Naqiyah Qadir, Raquel Batista
KEYWORDS:
Cirrhosis, Hepatic Encephalopathy, Gut-Liver Axis, Gut Microbiota, Diet, Nutrition, Gut Barrier, SIBO, Probiotics, Prebiotics, Synbiotics, Fecal Microbiota Transplantation, Branched-Chain Amino Acids
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.13 No.10,
October
23,
2025
ABSTRACT: Background & Objective: Cirrhosis, the end stage of chronic liver disease, is associated with high morbidity and mortality worldwide. Central to its progression is the gut-liver axis, a bidirectional communication system between the gut microbiota and the liver. Disruption of this axis, including gut barrier dysfunction, small intestinal bacterial overgrowth (SIBO), and microbial dysbiosis, contributes to liver injury, systemic inflammation, and complications such as hepatic encephalopathy (HE). This review synthesizes current evidence on the impact of diet and nutrition on the gut-liver axis, focusing on dietary interventions, probiotics, prebiotics, synbiotics, and fecal microbiota transplantation (FMT). Methods: A structured narrative review was conducted using PubMed, Embase, Cochrane Library, and Web of Science to identify relevant human studies published between 2000 and 2025. Search terms included “cirrhosis,” “hepatic encephalopathy,” “diet,” “nutrition,” “gut microbiota,” “SIBO,” “prebiotics,” “probiotics,” and “FMT.” We prioritized randomized controlled trials, systematic reviews, and meta-analyses, along with high-quality observational studies. Results: Cirrhosis is linked to gut dysbiosis, increased intestinal permeability, and SIBO, all contributing to inflammation and HE. Dietary interventions—particularly high-fiber, plant-based diets and supplementation with prebiotics, probiotics, or synbiotics—show promise in restoring microbial balance, reducing ammonia levels, and improving HE outcomes. Current guidelines support adequate protein intake, especially from plant or casein sources, while evidence on BCAA supplementation and FMT remains emerging. Conclusion: Optimizing diet and nutrition offers a promising adjunctive approach in cirrhosis management. Future research should focus on personalized, microbiome-based dietary strategies to improve clinical outcomes and quality of life.