Diet suitable for NAFLD cirrhosis and type 2 diabetics.

[Gyproc]

Hi, I have been diagnosed with cirrhosis through NAFLD. I have no idea what diet or where to find a diet suitable to follow. Being type 2 doesn't help either. Need carbs for liver, carbs no good for diabetics. Fats such as butter bad for my liver, what should I spread on bread? etc. What should I eat to help both conditions. You can't put peanut butter in place of butter on a cheese sandwich-would taste horrible. You get recipes that say serves 4 or 6. Some say halving ingredients is the answer, but who has tried dividing 1g or 1oz by 6? It probably sounds a bit daft, but I have no idea where to start. Can anyone help?

[AyrshireK]

The BLT has a downloadable booklet on NAFLD which includes heslthy diet information. Find it at:- britishlivertrust.org.uk/do...

Katie

[Gyproc in reply to AyrshireK]

Thank you Katie, this is very useful. Thanks for your quick reply. Mike

[AyrshireK]

There is more information about NAFLD on the British Liver Trust website at:- britishlivertrust.org.uk/in...

Plus more dietary advice at:- britishlivertrust.org.uk/in...

All the best, Katie

[MistyMoments]

I’m the same as you Gyptoc I have NALFD / Cirrohsis compensated. I was diagnosed 2 years ago. And struggled to find dietary advice as both conditions together make it quite complex. I was described as having a compensated liver Child A scale with a low Meld Score trying to maintain this level

There is a gap in information for people like us who would find beneficial to loose some weight.

The liver trust pamphlet on NAFLD says

This booklet is not designed for people diagnosed with cirrhosis or advanced liver disease. Instead read our ‘Diet and Liver Disease’ booklet. That one also didn’t quite fit.

Are you on Insulin? I see a dietician because of my diabetes but they are not specialised in liver conditions per se. I’ve read a lot around this and the Mediterranean Diet is the one that comes out tops over and over again. There’s a lot of conflicting information out there re fasting. Again five read that for people with liver issues should loose weight slowly as not to do more damage.

A lot of diet information for people with Cirrohsis is about building them up lots of small meals that type of eating for me with diabetes I find more difficult to control my blood sugars.

[MistyMoments in reply to MistyMoments]

I would love to hear from other here who are diabetic, on insulin and have cirrhosis what best works for them. Good luck with everything Gyptoc

[AyrshireK in reply to MistyMoments]

I think that like all things liver related you are going to see a wide range of variations in treatment, diet and insulin regime even in the category of diabetic folks on insulin with cirrhosis & it'll also be impacted on what caused their cirrhosis in the first place and general stage of disease.

For example - my hubby was diagnosed with diabetes in November and local nurse put him on Metformin with zero blood sugar monitoring nor advice other than standard Type 2 - loose weight, don't drink, don't smoke, exercise more (advice that was/is totally irrelevant in hubbies case as he's never drank, smoked, been over weight and having had cirrhosis for 12+ years exercises as much as he's able). She said to come back in 8 weeks for further bloods but matters over took that.

He was admitted to local hospital in December with an acute Hepatic Encephalopathy episode - a worsening of HE which seemed to have coincided with his commencement of Metformin so he was taken off the meds almost at the same time as being prescribed 3 x Fresubin Supplements a day which absolutely rocketted his blood sugars.

Fast forward to January and he was assessed (and listed) for liver transplant. During the transplant assessment they have deemed him malnourished again and so have also started him on nasogastric feeding which again has sent his blood sugars soaring so we have had the massive involvement of the diabetic nursing team in Edinburgh. Dietician has hubby on as much protein and carbs as he can manage orally plus 3 x supplement drinks plus 13 hour over night feed via his nasogastric feed. His diabetes has now been labelled as Type 3c. Diabetes nurses have at this stage said "If dietician is telling you to chomp, you chomp and let us deal with your blood sugars". He spent another week after t/p assessment in hospital as they carried out daily Insulin Tweaking and now we are at home we have to record his readings at start of feed, 6 hours into feed, when feed finishes and at mid-day. He is on Humulin M3 via Kwikpen and I have to ring Edinburgh every few days with readings and they tell me what dosing regime they want me to give. Humulin M3 is a mixed insulin - some rapid acting, some intermediate acting and I have to give him a big dose (currently 38 units) before his feed goes on, a further 6 units six hours into his feed and 26 units at breakfast time.

He's eating as much as he can tolerate during the day with desserts allowed after his meals, snacking when he can manage although his appetite has started to fail and he also on occaision struggles to actually chew and swallow his food which seems to be a symptom of his HE when it occurs.

His blood sugar levels are getting there - they want him between 6 & 12 owing to him having had super high levels. We are gradually reducing the pre-feed dose (he left hospital on 62 units) as he gets hypos about 2 1/2 - 3 hours into his feed.

Obviously we have intensive support from liver specialist dietician and diabetic team at Edinburgh as we try to keep hubby as well as possible in the run up to his hoped for transplant.

Katie

[MistyMoments in reply to AyrshireK]

I’ve been reading your postings about your husband and you have both been going through a lot of change. I hope everything keeps going in a positive direction for you both. I totally agree with you about the variations. Also depending where you live can make a difference as to the support you can access. Through no fault of their own both my gps surgery and my local hospital have been under tremendous pressures being understaffed through long term sickness and unfilled and Medical Posts as well as being in serious financial overspend. Thankfully my liver problems have not taken me into hospital but I definitely think access to services for outpatients could be improved.

[mickeymouse42]

I don't think that any of this is well understood. I have severe Bile Acid Malabsorption (BAM) which is sometimes called Bile Acid Diarrhoea as that's the main symptom. I also have NAFLD which is closely associated with BAM; most people who have BAM have NAFLD. It's common place for people who've had their gallbladders removed to develop BAM.

When you start trying to unpick the relationship between BAM and NAFLD by looking at the research, you begin to realise just how little this is understood. For example, Professor Julian Walters at Imperial College suggests that it's low levels of the FGF19 hormone that's a major factor; unfortunately the FGF19 blood test is not available clinically in the NHS. Other researchers think that it's BAM itself and the breakdown in the enterohepatic life cycle that leads to NAFLD.

Bile acid sequestrants like Colesevelam are the recommended treatment for BAM but they seem quite inappropriate for NAFLD as they have the side effect of increasing triglycerides.

Dietitians recommend low fat diets for people with BAM. When you look at low fat diets, you discover the work of Professor David Jenkins at Toronto University who has spent his life developing what's called the portfolio diet which might be better named as the lipid lowering diet; it's the diet recommended by the British Heart Foundation.

The main ingredients of the portfolio diet are oats, soya and raw nuts. Oats appear to have the same natural properties as bile acid sequestrants and are considered to be cholesterol lowering; there's a complex link between bile acid and cholesterol which is hard to understand and perhaps not fully understood.

You will find many talks by Professor Jenkins which are fascinating; he's clearly spent a lifetime thinking about this.

For what it's worth, I've found the portfolio diet really helpful in controlling BAM. I have been a habitual porridge eater for about 20 years but that alone didn't tackle the BAM but the recent introduction of soya and raw nuts seems to have helped. I'm hoping that they will bring down my CAP score and triglyceride levels as well but that remains to be seen.

[hbening86]

definitely check your "fasting insulin" level on your next blood test...often times one can be insulin resistant which makes it harder to lose body fat and you need a specific diet (message me for more info) and google insulin resistance and fatty liver!

[Marydel63]

You don’t sound Daft!! See if you can see a nutritionist. Or try to make small changes , check out Liver Trust info.