Decompensated liver

[Peeps7]

My husband has now been diagnosed with the above this week, following his original diagnosis of cirrhosis as a result of Auto Immune Hepatitis three years ago. He's now 79. He is currently suffering acute Ascitis and HE. Any suggestions for diet?

[RodeoJoe]

The golden rules are low salt or sodium and a high protein diet. Make sure he eats some high protein food before bed.

[Paulineunderstand]

I am struggling with this. Little and often seems to work best too. My boyfriend struggles with nuts, due to his teeth, otherwise I would get him to snack on them. Snack on cold meat... try to keep salt content down... Cheese on toast or boiled eggs. . Spaghetti bolognese.. roast chicken so he can pick the cold meat.. last night I did a tray bake with veggies.. roast veggies for ten minutes add salmon.. covered in dill. .. and cooked for 25 mins. Cold salmon for snacks. (He has muscle wastage so needs feeding up.)

[Bermuda1 in reply to Paulineunderstand]

You can use a coffee grinder or mixer grinder to make them fine and add them to food, or pop some coconut oil with them and a little spice to make them them into snack balls.

[mherbie]

Apples and celery juiced, figs, grapes, lemons, limes, artichokes, red cabbage, brocol!I, kale, salad leaves, parsley,aloe vera, the lists of fruits, vegetables, herbs are extensive (Life changing foods by Antony William). Little and often is good and organic if possabe! For protein, chicken, fish, lean meat ( personally try to stay off pork). My delicious and simple protein so!ution is my Herbalife Formula One shake.

[Paulineunderstand in reply to mherbie]

Why do you try to stay off pork? Because you don't like it - or have concerns about welfare issues - or because you think it's not good for you?

[mherbie in reply to Paulineunderstand]

Lighter foods for the liver! Less fat. I have many a time enjoyed all foods!! I used to say everything in moderation including moderation, once in a while let rip! But today I must pay attention to my poor liver so the best diet I can manage.

[Paulineunderstand in reply to mherbie]

Do you mean even lean pork steaks? (Obviously I know sausages, bacon, ham are all high salt as well as fatty.) Duck and lamb don;t appeal to my boyfriend at the moment and I think that is because they are hard to process and fatty.

[mherbie in reply to Paulineunderstand]

You can only listen to your own body! Not many of of us can be good on diet all the time..we all have the odd blip! If you want a lean organic pork steak..you have one and enjoy. .

[AyrshireK]

There is a difference in requirements of the patient living with early liver disease who needs to 'look after their liver' and the late stage decompensated liver patient. Healthy eating, fruit and veg diet is great for the former but in late stage, decompensated cirrhosis with HE and ascites the diet requirement is totally different.

There will be a need to fuel the body and preserve muscle/prevent the body using the muscle as fuel so in this case in response to the initial post from Peeps7 your husband is going to need to try and eat little and often through the day, avoiding any long periods of fasting, he needs carbohydrates and proteins (fruit and veg are ok but the need is more for fuel than goodness).

You need to restrict salt to aid with prevention of ascites & some people find that eating less red meat aids the prevention of symptoms of hepatic encephalopathy.

When a person is late stage often their appetite is poorer so nibbling is often easier than full on meals.

Hubby was presented with a liver diet leaflet by dietician at transplant unit because he was deemed to be malnourished and had reduced muscle.

In summary it states:-

Diet and Liver Disease

High-protein, high-energy

Introduction

When your liver is not working well or when you have liver disease, your body needs extra energy (calories) and protein. This is because sometimes your body cannot digest and absorb its food properly and therefore is unable to store and use energy.

Malnutrition (weight loss and muscle wasting) is common in people with liver disease.

Malnutrition has many causes, including decreased food intake due to liver disease symptoms such as:

- Loss of appetite

- Nausea and vomiting

- Feeling full easily which may be due to ascites (fluid collecting around your middle)

- Unnecessary or inappropriate dietary restrictions.

Good nutrition is vital to overcome symptoms of liver disease, by:

- Stopping muscle wasting and feeling weak

- Maintaining strength and mobility

- Reducing hospital admissions

- Helping wounds heal more quickly

- Speeding up recovery from operations and infections

- Helping to prevent ascites and encephalopathy (confusion caused by liver disease) getting worse.

Carbohydrate

When you eat starchy carbohydrate it is broken down into sugar (glucose). This is your body’s main energy source. Some of this energy is stored in your muscles and liver as a starch called glycogen. This is a back-up energy store to be used later when it is needed, between meals, if you have missed a meal or during a long fast such as overnight.

The liver co-ordinates the release of this energy until you next have something to eat; these energy stores are then replaced at your next meal. If the liver is not working properly and you develop liver disease symptoms, the liver cannot replace this store.

The energy from the food you eat only lasts for 2 hours. If you have liver disease and have no energy stores, your body must find an alternative source of energy after this time. Fat tissue is hard to break down quickly, so instead your body will break down its own muscles for energy. If this continues, your muscles will get weaker and waste away.

It is important that you try and eat regular meals and snacks containing carbohydrate every 2-3 hours.

To prevent muscle being used for energy and to keep you strong, it is important to ‘re-fuel’ your body regularly. Eating meals and snacks containing starchy carbohydrate every 2-3 hours provides enough energy to stop your body breaking down its own muscles.

Each meal should include a good source of starchy carbohydrate for slow-release energy.

Starchy carbohydrate foods include:

- Bread, for example white, brown, wholemeal, rolls, pitta

- Potato, for example boiled, baked, mashed, chips

- High-fibre breakfast cereal

- Pasta

- Rice

- Chappati

- Naan.

Examples of carbohydrate snacks for between your meals include:

- Biscuits

- Cakes

- Crackers

- Toast

- Small sandwich

- Tea cake

- Scone

- Malt loaf

- Crumpet

- Pikelet

- Chocolate bar.

Bedtime Snacks

You will need a large bedtime snack containing carbohydrate for your body to use overnight as it is a long time until breakfast

You should aim to have 50g of carbohydrate in your bedtime snack; this equals 10 carbohydrate points.

Choose your bedtime snacks from the table below and make sure your food adds up to 9 or 10 points.

FOOD CARBOHYDRATE POINT

200 ml Milk 2

300 ml Milk 3

Horlicks/hot chocolate (made with milk) 3

Fortisip / Ensure Plus 7

Fortimel 4

Fortijuice / Enlive 10

Build Up 7

1 Slice of bread / toast 3

Jam – average spread on 1 slice of bread 1

Breakfast cereal with milk 6

1 biscuit 2

1 chocolate biscuit 2

1 cracker / crisp bread 1

1 packet of crisps 3

1 packet of rice cake snack 5

1 rice cake 2

FOOD CARBOHYDRATE POINT

1 banana 4

1 apple / pear / orange 3

1 slice of fruit cake 7

1 slice of plain cake 6

1 slice of Swiss Roll 4

1 scone 5

1 tea cake / toasted muffin 6

1 slice malt loaf 3

1 crumpet 3

1 Scotch pancake 3

1 flapjack 4

Protein

Protein is essential to build and repair body tissue.

When your liver is not working properly your body needs more protein than usual. Extra protein in your diet can help to prevent further muscle breakdown and re-build lost muscle.

Try to include a good source of protein with at least 3-4 meals every day.

Examples include:

- Meat and poultry

- Fish

- Cheese

- Eggs

- Pulses such as peas, beans (including baked beans) and lentils/dhal

- Meat alternatives such as tofu, soya and Quorn.

Fruit and vegetables

Fruit and vegetables are important for vitamins and minerals, but they are not a good source of carbohydrate or protein.

Fruit can be a good snack. Try to have a couple of portions of fruit, vegetables or salad every day. If your appetite, food intake and weight (without fluid) are normal, then aim for 5 portions a day.

If your appetite and food intake are poor or you need to gain weight or muscle, try not to fill yourself up on these foods or have them as snacks.

Examples of 1 portion of fruit or vegetables include:

- 1 large fruit, for example apple, orange, banana

- 2 small fruit, for example plums, satsumas, apricots

- 1 dessert-size bowl of salad

- 2-3 tables spoons of vegetables

- A handful of grapes or berries

Supplement drinks

Sometimes you will not be able to meet your energy and protein requirements by diet alone. It may be necessary for you to take nutritional supplement drinks to keep you well nourished or help you build up if you have lost weight. On days when you don’t feel well and can’t manage food, having a supplement drink or a small snack is better than going for long periods of time without food.

High Protein drinks (milky type)

- Fortimel

- Fortisip Protein

- Build Up

- Resource Protein Extra.

High Energy Drinks

- Fortisip (milky type)

- Fortijuice (juice type)

- Ensure Plus (milky type)

- Enlive Plus (juice type)

- Resource Shake (milky type)

- Clinutre (milk or juice type)

- Scandishake/Calshake (made up with milk)

- Build Up (made up with milk).

Your dietician may suggest trying:

Supplement tips

- Take the supplement drinks between meals so that you do not spoil your appetite for you meals

- Keep supplements in the fridge or serve with ice as they taste better when served chilled

- Try adding lemonade to the fruit based ones

- Add ice cream to the milk-based supplements to make thick milkshakes

- Freeze supplements to eat them as an ice cream, sorbet or ice lolly.

PLEASE NOTE THIS IS FOR LATE STAGE, MALNOURISHED CIRRHOSIS PATIENTS WHERE THE NEED IS TOTALLY DIFFERENT THAN THOSE WHO ARE 'LOOKING AFTER THEIR LIVER'. The British Liver Trust has a page dedicated to eating for different liver diseases & looking after your liver and if in doubt about what you should be eating for your own specific condition ask your doctor to refer you to a specialist dietician.

All the best, Katie (I hope this helps a bit Peeps7)

[positivelycarol in reply to AyrshireK]

This has helped me loads .Thanks. I have lost three stones in two months and am waiting for an appointment with dietician. I have he and after one ascites attack am fighting to keep it at bay... Trying to eat is hard and after being vegetarian I now have the occasional little steak to get protein hit without having to eat much.

[Peeps7 in reply to AyrshireK]

Katie all you homework, as usual, has been superb. Thank you for all your hard dedication, research, extensive detailed information, investigation and support for the rest of us out here . It is so much appreciated, love Peeps.

[Koinonia]

Hi Peeps. Thank you for raising this subject ,I had planned to put a similar one on this evening! I have recently been diagnosed with fairly mild HE after an EEG. I have been doing a lot of reading about it and found that in most articles it says that red meat( eg beef and lamb,) and chicken and eggs make toxins in the blood which a decompensated liver can't deal with. My Hep has given me Rifaximin to kill the toxins which seems to confirm that.

I wonder what other folk eat for protein which I know is essential. I am having very small amounts of meat but have never been a big meat eater anyhow.

Any advice would be helpful.

Thank you, Koinonia

[Paulineunderstand]

My understanding is that some people find animal protein causes/ exacerbates HE. I hadn't connected that that would included eggs, but I have definitely seen people draw a distinction between animal and plant based protein, and so I think you are right that eggs may do this.

Do you like fish? I still think nuts are an ideal snack. Peanut butter in spicy stew is good, or with an apple. Frittata with a few flavourings i.e. cheese and tomato and potatoes makes a good snack to try a bit without too much fuss cooking.

[AyrshireK in reply to Paulineunderstand]

No problems with eggs for my hubby, he eats at least two a day and sometimes more. He eats red meat ok as well just not lots of it. I guess like liver disease in general it varies from person to person.

[Paulineunderstand]

The info from British liver trust is very good. I had read it before but read special Michael

[Paulineunderstand in reply to Paulineunderstand]

So much that I'd got confused and forgotten.