Hi
After my 2 day assessment this week the dietician there told me that o have to up the carbs I eat, especially eating 50g an hour before I go to bed!
I’m struggling with this as I have always dieted using a low carb diet and it is very alien to me.
Did anyone else get told to eat more carbs??
Sam
Hi
Yes I was told to have a cake or something like that before bed otherwise the body starts to “eat” (oh dear my biology knowledge is non existent ☹️) your muscles during the night. I actually thought that was absolutely magic recommendation after trying to control my weight like you are. Just go for it, in truth it won’t probably make too much difference to your dieting attempts - well it didn’t for me -and if it reduces muscle loss then that’s got to be good news!
Additionally you may be prescribed Fortisip or the equivalent. I loved Fortisip but I think it’s a bit like Marmite - love it or hate it 😁.
Do you have to try and compress that lever thingy with your hand to test your strength? If you don’t follow their advice you may find your strength diminishing on subsequent checks👍 and then you may find yourself getting “told off” for not doing what has been recommended! In the nicest possible way of course!
Miles
Hi Miles
Yes I did have to compress that thingy!
Because I don’t generally eat carbs at lunch, I normally have a salad, I have to incorporate carbs there too.
Been having 40g all bran (21.1g carbs) I can’t face anymore than that.
Still one more test to go - then decision made next Friday - although they did infer I’m ‘too well atm’
Finding it all a bit overwhelming tbh
Sam x
Test now Sam?
Hi Sam. Yes, I was told to increase my carbs as a poorly liver can only store energy for about 2 hours and then the body will start taking energy from muscle. That's why the bedtime meal should be high in carbs because between supper and breakfast is normally the longest time that the body will go without food intake and so the carbs are to help boost your energy reserves through the night. I expect that you were told to eat little and often too, another way to keep up energy levels. Hope all has gone well with your assessment. Best wishes. Alf.
Hi
How am I supposed to eat more carbs when my diabetic nurse told me to eat less?
Hi Lynne, I was still suffering from diabetes type 2 (I'm now in remission) when they told me to increase my carbs when I was on work up for assessment. They knew all of my medical history when they told me this. I suppose the priority was for my liver at that time. Hope that you're doing ok today 
Thank you. Not been a good day but hey ho. How are you and yours? Love and hugs to you all Lynne xxxx
Sorry it's not been a good day Lynne. We are doing ok thanks. I've just spent the last 2 days putting together a flat pack wardrobe that the seller on ebay said takes one hour. I know I'm not as agile as I was...…….but one hour? Really? You've got to laugh
I bet you did more than laugh at times freddy! Be honest 😁
It's a good job that I've got a sense of humour Milo, but they do say that puzzles are good for aging grey matter
Awww! The question is "...takes who... one hour...someone who does it for a living?" I hope the wardrobe is still in one piece
He’s not finished assembling it yet! Three days later..... 🤫🤫
That is hilarious! What's wrong with a bag of nails and a hammer? All you need is a clear wall and you don't even need a wardrobe.
Ah but the image... the image 😁😁
Only joking freddy!
I’m going to get told off for making this like FB - like I was once in my early days on here 😁. Apologies to anyone easily offended!
You don't make it like facebook, you are a valued contributor to a forum for people with liver disease.
I believe many people who have liver disease as well as those who do not, don't understand how much it affects the brain, sometimes permanently.
For example, it can be difficult, or impossible, for some people to understand other than what they expect a thing to be. That makes understanding each other difficult at times.
That should not be a problem here if we accept that what seems like pig-headedness CAN go with the disease, but rude, mean, vindictive attacks on individuals isn't acceptable.
We can't switch off a rude bully but we can 'walk away' and be pleased if we helped that person to come back and benefit from what we get out of this site.
That’s a cracking post Phyllis - you say what I think sometimes but don’t or can’t express it as well as that!
So true on all counts. I particularly like the bit about not being able to switch off rude bullies! If only 😁.
Thanks for your kind words. Like others I really try hard to only ever reflect what I have been through! Sometimes I feel like I’m repeating myself endlessly but the forum has been going now for so long and new members join all the time so I guess we have to. Such a shame we keep getting so many new folk - you know what I mean ☹️.
Miles
And you notice what I can't do at times, which is express things in concrete terms. You are of a more scientific thinker, and I am more of an abstract thinker! That is why you sometimes get irritated if I don't express a thing in a way that you can understand. And it's why I don't get drawn into trying to explain -I'm not good at it.
But we are all in with a chance of getting better. And I'm thankful to you for that, and all the people here who are always trying to make a positive contribution, even when they fail.
As far as bullies go, we all have that capability and we all need to deal with the bully within? As far as I can tell, it's the only way forward.
Phyllis Stein
Hello fili stein
Omg do I get irritated ☹️. Oh dear me ☹️. I don’t ever intend to come across as irritated. Must have been having a bad day - which ahem - does still happen strangely enough boo hoo 😢......😁. Sorry for that or those.. 👎🏻.
Milo
No apology needed - You don't do it to me anyway! I understand it though and it's intention that counts with me. I have never seen a reply on here that set out to be insulting.
And I have never tried to confuse any one here but I will have done.
I have seen threads deteriorate here through misunderstanding and result in insults back and forth.
It happens everywhere but far more on this site than others.
What really is sad is NOT people who openly post and reply, but people who resort to chat rooms talking nonsense about their misunderstandings of people they don't know a thing about and never will, stirring the foul stuff for others to fall into.
That's where the Administrator would do well to look.
Absolutely 👍
The more the merrier is my motto!
Love the nails, hammer and wall idea, it could have saved me a couple of days. Clothes could have been hung decoratively too, like a sort of collage
And, to boot, no one mistakes it for the toilet!!
Gotcha!
Oh yes and don’t tell him I said so but when the doors are on he might get them locked behind him to teach him a lesson for buying it off eBay 😁😆😂
PS I love eBay!
Think I'll just leave the doors off Milo, LOL.
Sorted 👍
It's true, I've still got the doors to hang on it and a drawer to assemble today 
LOL Fili. With 52 pieces, dozens of screws, masses of tacks, holes not drilled where they should be, extra holes that don't correspond with anything and instructions written by a dyslexic contortionist (not sure if that comment is PC!) I defy anyone who assembles furniture for a living to do the job in an hour!!
I'm really sorry! You deserve better! Even now there must be a couple of bits you could use as a board to put hooks on? Paint it all pale chalky blue. Stick up a seagull or a boat somewhere. Call it Scandi! Be on-trend. What'more at bed-time you can just throw your clothes at it and they'll hook up somewhere. No need for drawers. Hang your smalls in bags on the hooks. And Bob's your Uncle.
Hey! It's all done and I'm all wardrobed out ! I even had the strength to assemble a cot as well (easy peasy in comparison!) . Plum tuckered now!! No energy left for smalls hangers Bob's not my uncle, I think he's Brett's uncle or his brother or something. I get easily confused. I think that Milo knows who he is
Yes same for me! Liver ruled everything else....
Hi
Miles, Alf and Filistines, you have all just made me chuckle and all it started off with was Alf building a wardrobe 😂 reminds me of my Dad. Bought a unit from mfi, which my dad named mad for idiots!!! It took him ages to out it together and then he ended up with flu!!!! That's the last one I put up said Dad, the instructions were double Dutch!!! Love and hugs to you all Lynne xxxx
Hahaha 😁. Bet we’ve all felt like that at times! Actually I think freddy feels like that now 😁.
Yes, probably!!! Dad was ready for throwing instructions out but Mum also read through them and they both understood them , then!!
Doesn't make sense to me, unless your body has no more fat to consume for energy. That is why on the keto diet your protein intake needs to be fairly high because protein builds soft tissue including muscle. The basis of that diet is minimal carbs so your body utilises the fat instead for energy, and we all know that surplus sugars and starches are converted to fat - but alongside the minimal carbs you need to consume adequate amounts of fat and protein to keep your muscles etc supported. I'm no dietician but I do know that people who have succeeded on the keto diet have improved pretty much all their health markers, including cholesterol levels and blood pressure. I am no expert but I would be seriously concerned about that advice TBH
Compromised liver has difficulty processing fat. Diet needs to be balanced according to the status of the individual's liver. Minimal carbs for a person with liver disease is akin to starvation. A healthy diet is only ever what a body needs at a given time. When we are ill, we are not in the best position to know what a healthy diet for our condition is and the doctor responsible for our most life-threatening condition is better placed to advise us. We can question that advice but it makes no sense to me to ignore it.
Yes. When I saw the dietician I thought she'd be saying, "oooh, that cake, biscuits and chocolate you eat - not a good thing". However the opposite was the case. By the time you get to the needing the transplant stage your liver struggles to do its thing when it comes to energy production. As a result your body takes the stuff it needs from its stores - your muscles. That in turn is what contributes significantly to muscle loss.
So lots of carbs and quick release sugars like cake etc are a good thing in those very end stages of the disease. If you are struggling, little and often is the advice I was given. That made sense too, as I wasnt really able to eat much of anything in one go anyway.
The bed time snack is also encouraged as its gives your body that bit of help through the night when you're not usually going to consume anything. There used to be a sign on the back of the doors in the liver wards at the QEHB reminding you to order your bed time snack. The options were, jaffa cakes, a muffin, mini cheddars or some biscuits.
Yes Sam, I've been told to eat more carbs by one and fewer carbs by another, but like Alfredthegreat says, it seems that we need to go with the greater need, which will be the liver when the liver is in crisis. "More carbs" can be interpreted as 'more frequently' so that the liver doesn't go more than 2 hours without a little top-up. You can space out the right number that's been recommended for you personally and avoid the risks associated with not taking enough carbs in a liver that cannot store it but needs to send energy to heart and lungs while you sleep. I hope you feel better for it, I did, especially first thing in the morning.
Hi guys.
I’ve been told off for not eating enough carbs more times than I care to remember. At first I thought, great I can eat what I want when I want. That soon wore off. It’s really hard to eat every 2-3 hours. I thought it was going to be easy but there are times when your just not hungry and it’s difficult to force it down. However. I went from 106kg down to 71kg in a few months and find it hard to eat enough.
I thought they would be happy that I was going down to a useable weight, went well past that and I’m now far too thin.
The muscle waisting thing is a huge problem. Do everything that you can to avoid going down that road if you can. All I can say is what was drummed into me from day 1. Eat little and often, eat carbs before bed, don’t let your body go into fast mode esp through the night. I still find it hard to do all that as I still have no appetite.
It’s a difficult thing to manage but if you can do it, it will be worth it.
Good luck and happy eating.
Will
try a large bowl of porridge made with milk. oats are slow release carbs too. It works form me anyway.
This is the dietary leaflet hubby was given prior to his transplant assessment, he was deemed malnourished at the time at 8 1/2 stone and he had little to no reserves for getting through the op and recovery so dietician put him on this plan. He successfully gained some weight and rebuilt some muscle mass however a year later at t/p assessment they also put him onto the supplementary drinks (Ensure x 4 daily). He rose to 11 stone and is steady at that, surgeons didn't mind if his BMI was even up a bit knowing that he would shed a lot during the op and recovery period. In the end he stabilised and was removed from the list 'cos he was doing too well for t/p so the dietary advice does do something.
For those readers above (like 10720) who couldn't fathom why such advice was given - this leaflet gives a good explanation and it is ONLY aimed at those who are suffering muscle wastage, fuelling issues and are preparing for transplant.
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.
SUGGESTED MEAL PLAN
Choose one from each section
BREAKFAST
- Breakfast cereal and milk
- Toast and jam
- Baked beans on toast
- Egg with/on toast
MID MORNING SNACK *
- 1 or 2 biscuits
- A piece of cake
- 1 scone/tea cake
- Toast
- Crumpet or pikelet
*Serve with a glass of milk / supplement
LUNCH
- Sandwich with meat, fish, egg or cheese
- Jacket potato with beans, cheese, tuna or meat
- Beans, cheese or fish on toast
- Salad with bread, potatoes and meat, fish or cheese
- Pasta, noodles with meat, fish or cheese
DESSERT
- Yoghurt or rice pudding
- Cake and cream
- Fruit and custard
MID AFTERNOON SNACK *
- 1 or 2 biscuits
- A piece of cake
- 1 scone or tea cake
- Toast
- Crackers
- Malt loaf
- Crumpet or pikelet
*Serve with a glass of milk / supplement
EVENING MEAL
- Meat or fish with potatoes or chips and vegetables
- Pasta, sauce and meat, fish, beans or cheese
- Meat, fish or lentil curry and rice, naan or chapatti
- Meat stew and rice
- Spaghetti bolognaise or lasagne
DESSERT
- Fruit crumble or pie and cream or custard
- Sponge pudding and ice cream or custard
- Cheese and crackers
BEDTIME SNACK
- Bowl of cereal and 300ml glass of milk
- Hot chocolate, Horlick s or Ovaltine and 3-4 biscuits
- 2 slices of toast and a 300ml glass of milk
- Sandwich made from 2 slices of bread with 3 biscuits
- Slice of fruit cake and a 300ml glass of milk
This information has been developed by the D-Liver Group of the British Dietetic Association with the support of SNDRi. At the time of publication the information contained within the leaflet was, to the best of our knowledge, correct and up-to-date. Always consult a suitably qualified dietician and/or your GP on health problems. SNDRi cannot be held responsible for how clients/patients interpret and use the information within this resource.
SNDRi – Hosted by Glasgow Caledonian University and funded by the Scottish Government. A registered dieticians’ project, in partnership with other agencies.
Katie
I think everyone has too do this, I had an oatmeal cookies before bed and it really helps, I had to eat 8 times a day but I started with ramekins lol. I had lost all my body muscle and could just get round my tiny flat with a Zimmer frame I was 54! With physio I and my high calorie diet I can now walk without any aid, it’s taken 2 years, so please follow the advice you really don’t want to end up like I was. The worst thing was I used to be a chocoholic and suddenly couldn’t stand the sight of it, it was truly heartbreaking lol . Good luck
Yes husband was told to have high carb, high fat the year before the word transplant was even mentioned. This was to help develop some muscle mass & try & sustain energy as his liver was using his muscle for energy & he lost a lot of weight.
If you have a transplant your body needs to be strong enough to cope with the lengthy operation & they encourage you to be mobile as soon as you can. The physio visited my husband The afternoon he woke up in ICU testing muscle strength
Diet
Cirrhosis diet
High level ALT
High Liver Enzymes 
Diet help
