Weight loss

[carefull1]

I just wanted to ask you good people what are the reasons of weight loss in cirrhosis. Is it just nausea or something else???

[Supportinghubby]

I'm not an expert at all but my husband lost his appetite for months before being diagnosed with cirrhosis and then realised he'd had ascites for a while (felt full & sluggish & off food but didn't know why).

He then had a decompensated episode & lost a lot of weight through losing muscle mass. He never had nausea.

Like I said, I'm no expert - there may be other reasons which someone else may be able to explain.

[carefull1 in reply to Supportinghubby]

Thank you, how did you find out if it was due to loss of muscles please?

[Supportinghubby in reply to carefull1]

He went into hospital vomitting blood, he looked fine before this happened. His liver was struggling so my understanding (this is not technical explanation - I'm on the bus to work so haven't got time to look it up!) is that the liver couldn't produce energy so took it from his muscles. By the next day he was jaundiced and had really thin arms and also lost weight on his bum and legs. This was sudden weight loss though rather than gradual. The weight loss before was more gradual and was more from the acsites decreasing his appetite (and he did also lose some muscle mass gradually during this time too although not so notably). Hope you're ok.

[Hidden]

The following quotes from hepatologist Dr Melissa Palmer's book may help in understanding possible reasons for weight loss in people with cirrhosis & why some people with cirrhosis have difficulty gaining weight.

Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease:

"...weight loss, especially if unexpected, can be due to protein or muscle loss. This can be a sign of worsening liver disease..."

"Some people with liver disease have a hard time gaining weight. This more commonly occurs in people with cirrhosis. As noted above, during this time, protein is used as an energy source as the body begins breaking down its own muscle in a desperate attempt to stay alive. This results in a loss of fat, and eventually of muscle. This occurrence is called protein-energy malnutrition (PEM), a condition that mimics a state of starvation. PEM is believed to occur in approximately 20 percent of people with compensated cirrhosis and in 80 percent of people with decompensated cirrhosis (those with encephalopathy, variceal bleeding, or ascites)."

"People with cirrhosis often have decreased appetites, nausea, and a feeling of fullness even after eating small meals. When calorie counts are performed on these people, they are often found to be consuming a suboptimal amount, even though these people often believe that they are eating enough. People who have trouble gaining weight should make sure that they are eating multiple small meals in addition to a bedtime snack, if a person's appetite is poor, she can try eating baby food. That's right—baby food. Baby food is a nutritious source of calories and is easy to digest. Decreased appetite may be due to an unpalatable diet. Thus, a sodium and/or animal protein-restricted diet should be adhered to only if one is suffering from ascites and encephalopathy, respectively."

Note that since Melissa Palmer wrote her book animal protein is no longer considered a cause of encephalopathy so consuming meat to get protein is okay if suffering from encephalopathy. Anyone with ascites should obviously avoid sodium but I don't know about animal protein. When I eat meat I use a salt that has 50% less sodium. There are also salt substitutes containing no sodium.

[carefull1 in reply to Hidden]

Hi Edward 1952. Thanks for the detailed response. I think I will buy Dr. Melissa Palmer's Guide To Hepatitis and Liver Disease: unless it can be accessed online?

[Hidden in reply to carefull1]

You can buy paperback & electronic (Kindle, Kobo etc.) versions of the book. I have a Kobo electronic version. You install a small application 'Kobo Desktop' on your computer & then you can read the book on any computer you own with Kobo Desktop installed.

The book was last published around 2004 & while most of it is still relevant it has nothing in it about new non-invasive tests such as FibroScans, ELF test etc. Also a few parts are out of date such as eating meat resulting in encephalopathy which has now been disproven. I often quote from it because I have a version that enables me to do a search for any term & copy & paste parts of the book as quotes. The electronic versions you can buy only allow you to read it.

[Hidden]

It is a tricky subject, I gained about 25kgs, as I was end stage decompensated. The reason for the weight gain was ascities and oedema. 1 litre of fluid = 1 kg in weight. Because you feel bloated, it is difficult to eat and you are in danger of being malnourished. But it does not look that way. I drank the prescription supplement drinks, ate loads of fruit and took all the prescribed vitamins. They should have a dietitian who can recommend exactly what diet suits your particular case. The muscle loss can only be offset by exercise, try to walk as much as you can. I sat in my chair and used 1kg weights to keep my arms moving.

Best of luck.

[carefull1 in reply to Hidden]

Thanks. I have pain in muscles and lost 14 kg in 10 weeks. I have adjusted my diet but I feel weight should not go down as fast. I eat a lot of fish (even when i am not hungry). I used to get out of breath easily 10 weeks ago and could hear weasiness (Not sure of spelling) when I took deep breath in or out and left leg was swollen (Not foot or ankle). I am dont have that anymore

[jazzjam]

I lost a lot of weight and muscle mass. I just always felt full, I was told that (in basic terms from the doc) as the liver is working too hard it slows right down and doesn’t process foods etc.. quickly, so normally the food you had earlier that would have been processed is yet to process. Also if you have ascites (I did for a short time) it takes up space so you feel full. The body then starts using what it has, so fat, muscle. I was put on a plan which was great and I still follow it now, the Basics of it are breakfast, lunch, evening meal but very small amounts and in between protein shakes (thee I found very filling, so I mixed with water or frozen fruit, no milk) snacks, almond nuts only, about 8. Protein was the big thing throughout the plan as well as fresh veg and fruit as always.

[carefull1 in reply to jazzjam]

How one would know if he/she has or had ascites please?

[jazzjam in reply to carefull1]

I would say doctor only to be definite. I looked like I was having twins. Thin at the top and a pouch, not fatty where you can grab it.

[tinypixie]

Jazz jam, what kind of protein shakes are you talking about? Thanks!

[jazzjam in reply to tinypixie]

I got the ones from health food shops, in the big plastic tubs. Whey protein powder, low carb. I think one called Isopure was my favourite. They always have vanilla and chocolate, other flavours but I used to get vanilla and mix it with water and frozen berries.

[jazzjam in reply to jazzjam]

Just to add, I only did this on the doctors and nutritionist advise, so I’d check with them first, this was only because I had muscle wastage and was far too thin.

[Hidden in reply to tinypixie]

What i do that really ups the protein for the day is unsweetened greek yogurt with fresh berries and a granola mix added in that doesnt contain any added sugar or corn syrup. Just almonds walnuts and grains. You can also add a splash of unsweetened almond milk to the greek yogurt to thin it out a bit as greek yogurt is quite thick. Its incredibly delish with no added sugars or sodium and it gives you about 28 grams of protien for a coffee mugs size worth of it. I eat this everyday at brunch

[Neerav1234 in reply to Hidden]

What do you think about wheat grass powder

[Hidden in reply to Neerav1234]

I have never used it myself Neerav1234. Wheat grass itself is quite good for you. Im not aware of the powder having a negative effect on the liver but, in my ignorance of it the only disclaimer I may throw in about it is that wheat grass powder is considered a supplement from what I understand. There is alot of back and forth on the use of supplements with the liver as supplements are generally far more concentrated than the natural grown thing. Higher concentrations can linger around the liver and become toxic. My suggestion would be to run it by your doctor and if they say go for it than all good. 🙂🙂

[tinypixie]

Jazz jam, thank you so much for this. I’m pretty sure I’ve had muscle wastage and my BMI is only around 16 so I might be a good candidate for it.

[alfredthegreat]

My story is very similar to Supportinghubby. I had a loss of appetite. I felt fairly full when I had only eaten a little and I also lost a lot of muscle mass through being lethargic and resting most of the time because I had no energy and felt off colour. Regards Alf

[Hidden in reply to alfredthegreat]

Very true how one feeds the other. Lack of food makes us feel weak and feeling weak makes us have no appetite. Can be a bugger of a vicious cycle.

[alfredthegreat in reply to Hidden]

Wish I'd known about this forum 4 years ago. I was told to eat little and often but no advice on exactly what to eat. So I was eating foods that wouldn't upset the liver and not eating enough carbs and proteins to help stop muscle loss and give me energy. I only found out these things at transplant assessment. By then it was only the ascites that stopped me looking like Mr. pipe cleaner. Then after transplant they told my wife to feed me up bit. Then came my bone fractures and so then told to have lots of dairy. So started enjoying food a bit too much, lol. Think I have at last got to the happy healthy medium (he says hopefully!)

[Hidden in reply to alfredthegreat]

Totally agreed. When i was in the hospital the dietician was very vague and when i went home I was left with alot of question marks on what to eat. The doctor i had in the icu was a bit out of date to say the least and told me to cut back the protien. That had me lose about 25 pounds of weight in about a month and muscles were like deflated balloons. I looked like a toothpic with a haircut. But once i got it down as to what to eat I just started going at it.

[alfredthegreat in reply to Hidden]

It's a great shame that there isn't far more dietary advice available for patients when they are diagnosed with liver problems. I believe some hospitals are very good with this but others fail miserably. I came away from assessment with masses of dietary advice but by then I'd already had and been diagnosed with cirrhosis and HCC a few years and Wife and I had just been muddling through and trying to eat healthily in that time. But hey, I'm still here and extremely thankful for it!

[tinypixie]

Thanks, Phoenix. I do something very similar for breakfast. I have cottage cheese, (sometimes some Greek yogurt, as well), fruit and walnuts but I still think I’m not getting enough protein. What about the rest of the day? I could never eat more than a tiny amount of chicken or any other meat. I like fish but my other half cannot even stand the smell of it!

[Hidden in reply to tinypixie]

I hear you on the fish. For me the smell is a turn off. Out of curiousity pixie have you tried keeping count of the protien in a day your intaking? Do you know how much your weight requires you to need in a day? For me I need a about 64g a day minimum. The only reason I ask is that if your meeting the requirements daily plus some and still finding muscle wastage is occurring there may be some.other things aside of protien you may be short on as well?

[alfredthegreat in reply to tinypixie]

Hi tiny. Your Greek yogurt is really high in protein if you can ever squeeze in an extra portion then that's good. I also remember being told that although red meat is normally a bit of a no no the packets of thin sliced beef for sandwiches that is sold in all supermarkets is incredibly high in protein for the small amount you eat and so it is a good addition. Regards Alf

[tinypixie in reply to alfredthegreat]

Thanks, Alf, that’s a really good idea. It’s great that a small slice can have a large amount of protein.

[tinypixie]

Phoenix,

That’s a brilliant idea! I never actually thought about being methodical about it. I looked up my protein requirements and I will measure how much I am getting each day. Thank you for a great suggestion.

[Hidden in reply to tinypixie]

No problem at all glad to help! It can be hard to remember it all at first. Especially when portions can be so misleading in size etc. Let me know how it adds up for you and if it helps! 🙂