Supporting people with alcohol-related liver disease: the vital role of nutrition

Alcohol-related liver disease (ARLD) is one of the most well-known illnesses linked to long-term alcohol use. Cutting back on alcohol consumption, or stopping drinking altogether, is the best way to protect ourselves from alcohol-related liver problems. But good nutrition is also important for looking after our liver, and the right nutrition is an important treatment for people healing from or living with liver disease.

One of the jobs the liver does for us is to break down alcohol into less harmful chemicals. Liver cells process alcohol at a rate of about one unit per hour. If the liver has too much alcohol to break down, it will struggle to carry out its other functions and may become damaged. That damage occurs in three stages:

• Steatosis of the liver: A build-up of fat in the liver cells.
• Alcoholic hepatitis: Swelling of the liver.
• Alcoholic cirrhosis: Scarring of the liver.

The first two stages can be reversed by reducing alcohol intake, medical intervention and nutrition support; the third cannot be reversed but it can be halted by abstaining from alcohol.

A scarred liver is like a phone battery that won’t hold a charge. It struggles to carry out its crucial role of storing energy for the body, making even a short time without food – such as skipping a meal – much harder work. This is known as “accelerated starvation” and it means the body needs more fuel, and fast.

When the liver can’t get enough fuel or store essential nutrients (malnutrition), it starts breaking down muscle for energy – a process called “catabolism”.

This can lead to loss of muscle mass, and this can leave someone feeling frail and weak, making everyday tasks – like climbing stairs, or just standing up – a strain. We call this “sarcopenia” and “frailty”.

As well as cutting down on alcohol, good nutrition is one of our best tools for fighting alcohol-related liver problems: preventing malnutrition, muscle loss, and frailty.

Although many people are seeking to reduce their calorie intake, for people with alcohol-related liver disease, energy-dense foods are often the best option: like switching to full-fat milk instead of skimmed or semi-skimmed and eating regular meals with snacks in between. With the support of a dietitian, nutritional supplements can help too.

To work well, the body needs a good mix of nutrients. The following ones are particularly important for people with ARLD:

Protein: This helps repair the liver and can slow down and prevent muscle loss.

Where to find it: Lean meats (like chicken and fish), eggs, dairy products (milk, cheese and cream), pulses like chickpeas and lentils, and soy foods like tofu and tempeh. Studies show that protein can help people with ARLD recover faster and keep their muscles stronger.

Carbohydrates: These provide steady energy, so the body doesn’t have to break down muscle when someone’s not eating.

Where to find them: Starchy foods like potatoes, rice, and pasta, plus fruit. Carbohydrates provide a long-lasting energy source, keeping sugar levels stable and reducing the liver’s workload. Wholemeal options may also provide a longer-lasting energy supply and provide an additional source of fibre.

Vegetables: Aim for at least five portions a day to get all your vitamins and minerals.

Healthy Fats: You can get healthy fats from avocados, nuts, oils, and dairy products, and they help cells repair and lower inflammation.

We are launching our first training course, designed for people with alcohol-related liver disease and the people supporting them, led by Specialist Dietitian Bally Parekh. Click here to find out more and book your place.

Alcohol Change UK recently launched our Feeding Recovery Handbook, which looks at how poor nutrition and social isolation often go hand-in-hand with alcohol problems. It also offers a positive message about how connecting with others around food can promote wellbeing and build confidence.

Connect with Bally Parekh on Instagram and LinkedIn.