A poor diet, unhealthy weight, lack of exercise, high cholesterol, diabetes and heart disease can put you at risk of developing non-alcoholic fatty liver disease. Affecting 1 in 10 Australians, it’s one of the most common causes of liver problems.
After heart disease and cancer, cirrhosis is the third most common cause of death in people aged 45-65 years. Cirrhosis is a general term for end-stage liver disease, which can have many causes and which disrupts normal liver tissue. Cirrhosis has no cure but removing the ultimate cause can slow the progress of the disease. (1).
Fat builds up in the liver cells when the liver fails to break down, transfer and store fat effectively causing abnormal liver function and inflammation, which can lead to liver scarring (known as cirrhosis). Many chronic liver diseases are associated with malnutrition. One of the most common of these is cirrhosis.
Cirrhosis refers to the replacement of damaged liver cells by fibrous scar tissue which disrupts the liver’s important functions. Cirrhosis can occur as a result of excessive alcohol intake (most common), viral hepatitis, obstruction of the bile ducts, and exposure to certain drugs or toxic substances.
Chronic liver disease is often associated with muscle and body fat loss. This may be difficult to detect because of fluid retention. For example, you may be losing muscle, but if you are retaining fluid, you may stay the same weight. If not corrected, muscle and body fat loss can result in a variety of health complications.
Damage to your liver may result from drinking alcohol, hepatitis viruses, poor diet and toxins (from substances such as paracetamol, tobacco and marijuana), as well as genetic defects and autoimmune disorders. Once damaged, your liver requires extra care and can be assisted by limiting alcohol consumption and following a nutrition management program. Malnutrition is prevalent in liver cirrhosis due to the presence of ascites, nausea, vomiting, insufficient food intake, malabsorption and metabolic disorders, poor dietary intake, malabsorption, increased intestinal protein losses, low protein synthesis, and hyper metabolism.
Keeping your diet low in fat and well balanced will reduce your liver’s processing work.
Malnutrition
Weight loss and low vitamin or mineral levels are signs of malnutrition, and can be due to:
- poor digestion of food
- nausea and vomiting
- lack of appetite
- needing more nutrients.
Your dietitian can advise you on ways to eat enough high protein and energy foods to manage your weight and nutrition needs. They can also advise if you might need vitamin and mineral supplements, or special nutrition drinks designed to boost your protein, vitamin and mineral levels.
Tips to help you eat more include:
- have small frequent meals and snacks and avoid filling your stomach with water before meals
- nourishing drinks based on juice or milk can help to add energy, vitamins and minerals
- if tired and nauseous, try having cold meals more often, or use meal preparation and delivery services so that you can avoid cooking smells
- snack on small amounts of your favourite foods between meals, rather than trying to eat larger meal serves when you aren’t hungry.
Swelling and fluid retention (ascites)
Swelling and fluid retention are often improved by having a low salt diet. Your dietitian can advise you on which foods are high in salt, how to read labels for salt – also known as sodium chloride, and ways to replace salt in your cooking. More information is also available on Better Health Channel.
Some people also need to limit their fluid intake. Your doctor and dietitian can advise you how much to drink, and how to manage your thirst and avoid constipation while drinking less.
Weak bones (osteoporosis)
If your body isn’t getting enough vitamin D and calcium, it can weaken your bones and make them fragile. Osteoporosis is more common in liver disease. Your dietitian can assess if you are having enough in your diet and suggest what supplements may be of benefit.
Excess bleeding
If you are bleeding a lot you might be low in B12, folate or iron. You may need to increase your intake, based on your test results. Your health professionals may also suggest you will benefit from increasing your vitamin K intake to improve your blood clotting.
Diarrhoea and poor digestion of fatty foods (steatorrhea)
If you are unable to digest much fat, you might be suffering from heartburn or greasy diarrhoea. Your dietitian can advise you on how much fat to eat, what foods you may tolerate, and whether you may need a supplement of fat soluble vitamins (A, D, E and K).
Confusion due to a build-up of toxins in the brain (encephalopathy)
To prevent and control encephalopathy you will need to open your bowels more frequently, often by taking a laxative and an antibiotic prescribed by your doctor. To keep your bowels regular you might benefit from more fibre, probiotics, and drinking more water. To avoid the fast build-up of toxins your dietitian can advise on having enough energy and protein, timing of meals, using more vegetarian protein foods, getting enough zinc, and using special nutrition supplements designed for managing encephalopathy.
Finding an accredited practising dietitian
Many private dietitians will accept a ‘Chronic Disease Management Plan’ referral from your GP, which will provide Medicare funding for part or all of the cost.
Try the Dietitians Association of Australia website to find a private dietitian.
Your doctor might also refer you to see a low cost public dietitian, working from your local hospital or community health centre: check here.
Reference List:
(1) Natap.org. (2016). CIRRHOSIS: advanced liver disease. [online] Available at: http://www.natap.org/2002/Oct/103002_2.htm [Accessed 15 April 2020].