Your liver is responsible for many body functions, including for recycling iron. Cirrhosis (a late stage of liver fibrosis) can significantly impair the liver function, causing a number consequences – and one of them is anemia, a disorder of the blood in which the amounts of red blood cells are not enough (lower than normal) to carry oxygen normally. In fact, anemia is common in people with cirrhosis.
Why and how does cirrhosis cause anemia? The disease makes it harder for the blood to flow through the liver. This causes portal hypertension, a condition in which the pressure in the blood vessel that carries blood from spleen and intestines to the liver increases higher than normal.
If left untreated, portal hypertension increases the risk of bleeding. It drives more blood to go to smaller blood vessels, making them increase in size and vulnerable to rupture (bleed).
If your anemia is associated with cirrhosis, treating factors or conditions that cause the disease is a must. Unfortunately, treatment is not always easy since the disease can be attributed by numerous different causes.
However, a combination of appropriate medications and lifestyle changes should help slow the progression of abnormal scar tissues in the liver — so should help improve anemia or other complications caused by cirrhosis! Even if started early, the outcome of the disease might improve significantly.
Stop drinking alcohol
Frequent, excessive use of alcohol is the leading cause of cirrhosis in many countries, including in the United States. Over time it drives your liver to swell and provoke inflammation. The amount of alcohol that factors into cirrhosis varies from person to person, because its effect on the liver is also different for each individual – depending on gender, age, medical conditions, medication use, etc.
The liver is usually able to tolerate small amount of drinks. But if you drink more than what you liver can process, this will damage healthy liver cells and provoke permanent scarring. Alcohol is also a diuretic, making dehydration more likely. And if there is insufficient water in the body, the liver works harder since it needs water to work effectively.
Cirrhosis is the liver scarring in which the healthy liver tissues are damaged and replaced by abnormal, hard scar tissues. If you continue drinking alcohol with the disease, this will speed up your liver damage.
If it’s very difficult to avoid alcohol completely, ask your doctor whether it’s still OK to drink in moderation.
Maintain a healthy weight
Being obese is another common cause of cirrhosis. More weight you gain can cause excess accumulation of fats in parts or organs of the body, including the liver. This puts you at high risk of non-alcoholic fatty liver disease.
If you’re being obese or have non-alcoholic fatty liver disease, it’s important to burn your excess fats and maintain your blood sugar levels so you can improve your liver function. To keep safe, lose weight gradually! Just keep the balance between ‘calories-in’ and ‘calories-out’! Also, make sure to maintain the balance of your dairy protein intake.
Interestingly, underweight is also quite common in people with cirrhosis. Once the disease becomes advanced, it could be harder to eat well. Discomforts and symptoms caused by the disease may affect your appetite. Even the disease may also cause malnutrition (see more here)!
Chronic hepatitis B and C can also hurt the liver, making liver inflammation and cirrhosis more likely. The good news, there are vaccines for hepatitis B, so make sure you get the shot to prevent the infection (particularly true if you need to go to a region /area where hepatitis is common).
Unluckily, the story is different for hepatitis C — currently, vaccine is not yet available. Also, there are usually also no early symptoms of the infection. Many times it’s diagnosed during a blood test for another condition. Here are a few steps to reduce the risk of having the infection.
- Eliminate any direct contact with blood or blood products!
- Don’t share needless with others!
- Sometimes small amounts of blood are probably enough to spread the infection. Avoid sharing personal care items, such as nail clipper, razors, and toothbrushes!
- Avoid practicing unsafe intercourse!
- Be careful about body tattooing or piercing. Make sure to only choose one that has appropriate sanitary procedures in which all steps (including tools) are clean and hygienic!
If you have hepatitis, treatment is necessary especially if the condition becomes chronic. Treatments include anti-viral medications and other appropriate steps to prevent liver damage.
It’s also important to eliminate or treat any other factors /conditions that contribute to cause liver damage. These include:
- Other infections that damage the liver, such as schistosomiasis.
- Problems of bile ducts (e.g. primary sclerosing cholangitis and biliary atresia).
- Excessive, unnecessary use of particular medications that make the liver work harder – methotrexate, for example.
- Hemochromatosis (a condition that causes excess buildup of iron in the body).
- Any other conditions that may worsen the liver damage. These include cystic fibrosis, problems of sugar metabolism (like diabetes and galactosemia), autoimmune hepatitis, and Wilson’s disease (excess accumulation of copper in the liver).
Depending on your situation (e.g. the severity of your liver damage), sometimes a few changes in diet may help. Increasing nutrients your body needs — especially for particular nutrients that are lower than normal and have to do with your anemia — should help restore the deficiencies.
Eating right is also important to improve the overall health of your liver. For more guidance about diet with liver disease, read this article!
In case when you have iron deficiency anemia, here are some iron-rich foods to help rebalance the amounts of iron in the body:
- Nosh on beans! They are not only loaded with high iron properties, but also rich in protein and fiber.
- Spinach and other dark green leafy vegetables.
- Healthy, dried fruits (e.g. apricots and raisins).
- Pure, dark chocolate. While milk chocolates contain some bad ingredients (high in sugar or artificial sweeteners), dark chocolate is healthier choice since it’s quite high in iron and other essential minerals.
- These healthy legumes have high supply of healthful nutrients (including iron, fiber, protein, folate, and manganese). Bonus, they are affordable (economical source of iron) and easy to prepare.
How about iron-rich, animal based foods? In general, the body is relatively easier to absorb iron from meat or animal-based foods (e.g. poultry and seafood). But cirrhosis may make you to restrict animal-fatty foods (particularly if you have non-alcoholic fatty liver disease). If you choose to restrict /avoid meat, you may have to include more iron-rich plant based foods in your diet!
In addition, make sure that you don’t have vitamin C deficiency. Without enough vitamin C, your body doesn’t absorb your dietary iron effectively. Foods high in vitamin C include fruits (e.g. oranges, kiwi, and strawberries), broccoli, and kale.
Vitamin B12 deficiency
Vitamin B12 plays a role to help make red blood cells. That’s why not having enough this vitamin can also cause anemia. In cirrhosis, this kind of anemia is less common than iron deficiency anemia. Also, it’s rarely associated with what you eat. Instead, it’s more likely to occur if you have one or some of the following conditions:
- Problems affecting the way of the body to digest foods (e.g. Crohn’s disease, celiac disease, and overgrowth bacteria problem in the intestine).
- After stomach surgery, especially when it has removed certain part of the stomach that has a role to digest foods or absorb nutrients.
- Pernicious anemia — a disorder in which the body mistakenly damages its own healthy stomach cells that help absorb vitamin B12.
But if your diet has a role to cause the problem, some rich-vitamin B12 foods include; skinless chicken breast, fat-free plain yogurt, spinach, almonds, and mushrooms.
What to avoid?
There are also some ‘bad’ things in diet that may worsen anemia. Below are a few examples:
- Anything labeled with ‘refined, sweeteners’.
- Highly processed grains.
- Soda and high-caffeinated drinks.
- High-fat, dairy products.
Excessive consumption of those foods may make you stressed. And it’s well established that stress is bad for many health conditions, including for anemia and cirrhosis.
If necessary, consider participating relaxation therapies (e.g. yoga and meditation) to help make your stress ease up.
If the problem doesn’t respond to lifestyle measures, medical intervention is required. At first, doctors will usually prescribe oral supplements.
For instance, oral iron (about 3-10 mg of iron per day) may help keep the elemental iron stable in the body. This option is quite convenient, because the side effects are usually mild, such as abdominal bloating, constipation, and epigastric discomforts!
But sometimes the patient doesn’t respond to or intolerant of oral iron supplements. In such case, parenteral administration (infusion) may help. It can normalize the deficiencies more quickly.
Blood transfusion may be required if parenteral administration fails to work. This must be done carefully since iron overload could be counterproductive. Another option is a liver transplant, which is usually the last option for cirrhosis and other advanced liver diseases.
Overall, each option has potential risks, but its benefits should outweigh the risks!
Since cirrhosis could turn into serious (fatal), it’s recommended to always work with your healthcare provider to cope with any symptoms or complications caused by the disease!