Bedtime Snacks and Cirrhosis

Snacking before sleep might be a guilty pleasure for most, but for those suffering from cirrhosis, the science shows that this indulgence can actually play an important role in managing energy levels - though not just any snack will do.

The liver, metabolism and nutrition.

The liver is the central organ in metabolism, its functions include detoxification and converting food into energy. Chronic liver disease sufferers see impairment in these functions, with one of the most prevalent complications being malnutrition. More specifically, reduced liver function leads to lower food intake and poor digestion and absorption – corresponding to a state of accelerated starvation.

As such, a healthy diet is crucial to managing symptoms and slowing progression of cirrhosis. Several studies over recent years have investigated the merits of a late evening snack (medical code for a bedtime snack) on cirrhosis sufferers, with the general consensus being that midnight snacking can have substantial benefits toward combating the negative effects of sleep-time fasting.

In each of the studies, the respiratory quotient – a measure of basal metabolic rate that compares carbon dioxide eliminated with oxygen consumed – was improved in patients who had a midnight snack. However, as up to 70 percent of cirrhosis sufferers also suffer glucose intolerance, the choice of snack is not an open field.

Which bedtime snacks to choose.

Several studies employed nutritional supplements with specific nutritional properties such as Ensure®. These drink products typically come as a powder that is dissolved in warm water, or as a premixed shake, and can be taken two to three times a day as a between meal snack. Two studies found that beyond improving respiratory quotient, a midnight snack of it could correct amino acid imbalances and may ultimately improve glucose intolerance.

The most recent findings come from a pilot study conducted last year, in which patients received Amazake® for their bedtime snack, a sweet traditional Japanese beverage made from fermented rice. In this small study four patients drank Amazake® before bed every night for 12 weeks, and saw improvement in a host of symptoms caused by overnight starvation: abdominal distension, fatigue, muscle cramps, vomiting, diarrhea, and sleep disorder. Although these results are very promising, the small size of the study means that further research is needed.

For those who prefer a midnight snack they can chew, a handful of studies have found similar respiratory quotient improvement from carbohydrate-based foods, such as rice balls. Studies typically administer around 200 calories per bedtime snack, or around 50 grams of carbohydrates. So that means a small serving of whole wheat or whole grain bread, rice, pasta, or a low sugar, salt-free cereal or nutrition bar. While a bag of potato chips may be tempting, the high sodium and fat levels mean they should be avoided completely.

Good nutrition is crucial for liver health.

Chronic liver disease and cirrhosis is the 12^th leading cause of death in the United States, but a healthy diet has been demonstrated to be effective in slowing the progression of associated liver damage. Part of such a diet should be a well-chosen bedtime snack.