Muscle wastage / decompensated cirrhosis??

[Koinonia]

Does any one know if having muscle wastage means that your cirrhosis is decompensated? I have recently been diagnosed with it and given little bottles of protein and carbohydrate to take between meals. I have had A.I.H. with cirrhosis for over 20 years with no other symptoms such as ascites or varices. Obviously my liver is now worse but I wondered if the muscle wastage implies that I may get other unpleasant symptoms now. I have searched the web but can't find any relevant information to help. Thank you.

[MisterX]

Not necessarily but..........

When I saw your question I thought you'd see some varies or ascites or other symptoms first before muscle wastage became a sign of decompensation - and in my view that's possibly still the case, that it's basically a case of the timing and content of nutrition - and that you have to deal with your liver's inability to process quickly by spacing the intake of nutrients and having nutrition which will keep you going in between meals - especially at night where otherwise muscle will be broken down.

But then a quick search and I came across this study which indicated that muscle wasting in the absence of other signs of decompensation may still be a sign of decompensation..

cghjournal.org/article/S154...

So you're quite right to ask for advice and to take it seriously. I would say whatever the reason you have to address the muscle wasting so you need to address the nutrition and timing issue - see if you can get a dietitian referral but also ask here..... but ..... at the same time I would at least draw that study to the attention of your hepatologist so they can monitor more carefully.

Hope that helps. Vert best wishes.

PS - It may well just be that you're not eating enough (and at the right times), reduced capacity may mean that you need a larger intake of nutrition than you did when your liver was healthy because it's not all getting processed -I'm sure you know this already but I was referencing a previous post where you indicated wanting to lose a few lbs.

[Koinonia in reply to MisterX]

Thank you for that Mr x. I had read that article but thought it only referred to people who were already on the transplant list. You obviously got more out of it than I did!

I saw the Dietitian last week and it was her who got me the protein/carbohydrate drinks. I am due to see my Hep. next week (19th) and will then go back to my GP to discuss what she can do for me in the light of what the hep. has said. She has already told me to eat small and often and I am trying to do that although I don't often feel hungry.My husband is keeping a very close watch on what I eat!!

As for the wanting to lose a few pounds a while back---I lost about 10pound without cutting down at all but then found it had all come from my muscles and not my stomach!!!

Thank you for your help.

[MisterX in reply to Koinonia]

Happy to help,

It was this line in the conclusion which caught my eye...

"Sarcopenia is associated with mortality in patients with cirrhosis.It does not correlate with the degree of liver dysfunction evaluated by using conventional scoring systems"

The authors recommend that it's taken into account when scoring liver prognosis where in the past it hasn't been and where because of a lack of correlation with the usual methods false assurance has resulted.

Anyway with any luck it's just that you have to eat more and often. The protein shakes should help. Do consider what to eat to cover you during the night - which is a long period of time - oatmeal springs to mind.

Best of luck.

[Koinonia]

I'm not very good at eating before bed but always have porridge with lots of dried skimmed milk in it (lots of protein!) for breakfast.

Perhaps others with this problem could suggest what they have that is easily digestable before bed. I also have coeliac disease so am limited!

Thanks again.

[Hidden]

Hi Koinonia

How's your appetite do you eat well and regularly. Loss of appetite and muscle wastage are symptoms of cirrhosis, and can be very dangerous. Even with a wholesome regular diet liver disease can inhibit the body's processesing of fats and protein causing muscle wastage. That is what the little bottles of protine and carb are for, these supplements sort of by pass the liver and go straight to the muscles. It seems to be really difficult to predict all the symptoms of liver disease, and when they occur. Is your liver no longer compensating? Well if it is not you would be very sick. My advice is discuss this with your specialist he/she must be aware of the advice given to you by the dietitian, and will be able to tell you what stage your illness is at.

[Koinonia]

Thank you Boab11. I used to have a good appetite but when I started having something every 3 hours I found I was no longer hungry and often don't want anything but I do try. I do eat good wholesome food though.

My cirrhosis has been compensated for 20 or more years and I was wondering if the muscle wastage was a sign of it becoming decompensated. Obviously my Hep will be able to tell me (I'm due to see him on 19th August) but I wondered if anyone on here had had a similar experience. I don't feel "very sick" but worse than I was a couple of months ago.

Thank you for writing to me.

[dckimberly]

hi there. It's normal to lose muscle with a decompensated liver. This is happening to me. The liver takes care of energy..and for me, I have no appetite, so my body fat became Zero..after that, my liver went after muscle for energy. This is what the nutritionist at Addenbrookes told me. She works at the Liver clinic. BUT, this did not start happening until after my ascites got really bad. They gave me all kinds of supplements and the like. They told me to try and eat for energy every 90 minutes to three hours..just a small amount, but rice, pasta, yogurt, etc. This is only my situation, but, I hope it helps

[Koinonia]

Hi dckimberley, I hope your "little and often" eating is building you up again. How do you manage to eat rice and pasta when it is cold? I understand it shouldn't be reheated. I 'm sorry about your ascites. I'm pleased to say I haven't had to endure that!

[MisterX in reply to Koinonia]

You can reheat rice and pasta - they can get just a bit soggy but there's no harm in it....

.... and in fact a BBC program (Trust me I'm a Doctor) found recently that cooking pasta, cooling it down and reheating it actually reduced its effect on blood sugar, so I've started to do that as a matter of course..