I recently returned from the annual meeting of the AASLD.  This is the association of the real liver disease experts and the very top of the profession attend and speak about the current research.  If music is your thing, often, the little side notes are as interesting as the majesty of the main orchestra.

An unappreciated aspect of advancing liver disease is that the liver, as the real guardian and engine of the body, takes its job seriously.  Did you ever wonder what extremes the liver will go to in order to maintain your life?  Can you imagine that it will actually eat your muscles if necessary?

An example that is easy to visualize is what happens to prisoners of war who are not fed.  We have all seen pictures of skeletal people reduced to a shadow of themselves by starvation.  Imagine that process as an aspect of liver disease.  We are all familiar with the frailty that tends to come to the very old.  Frailty is actually a medical condition that is involved with a number of processes.  But what if you are not extremely old, how might that affect you?

If your liver is not operating properly one of the organ systems that can be affected is your digestion.  There is an intimate dance that takes place between the bowels and the liver.  When food is digested and nutrition moves into the cells of the bowel it very soon must pass through the liver where the biochemical magic takes place.  A lot of chemicals are involved and some important ones are amino acids.  These are the building blocks for a host of critical functions of the body.  So imagine what happens if your diet is deficient or your digestive system is compromised so that the liver is unable to get the amino acids it requires.

What to do?  Well, the liver, being resourceful sends hunters out to get what it needs.  Fortunately the muscles have useful materials so the liver takes what it needs and the muscles are reduced.  The liver effectively eats the muscles if necessary to maintain life.  Clearly that eventually leads to the same kind of frailty of extreme old age even in younger people.

So, can that apply to you if your liver isn't tip top?  Indeed it can.  Here is an example that might give you a mental image.  For someone with a compromised digestive system that is not operating at a normal speed, overnight is metabolically the same as a 3 day fast.  So every night your liver may go looking for some nutrients and harvest them from your muscles.  The medical term is sarcopenia, but it is essentially muscle wasting and fatigue is part of the process.

As a patient, what can you do?  As a practical matter diet is the main tool.  Taking some nourishment later in the evening, like a can of Ensure at 10 o'clock to break the fast cycle and soothe the liver's need for nutrients will help.  It will also help to add branched chain amino acids to your supplements.  This is what body builders use to grow big muscles but 4 grams a day is sufficient.  It doesn't take a lot.  They are called BCAA and are available online or at any store that sells supplements.  These are important because they are basically predigested and easily used by the liver.  I don't generally suggest supplementation but the mortality risk associated with frailty is serious and something that liver patients need to be aware of.