Starvation Hepatitis: Liver Inflammation Caused by Severe Malnutrition
By: Margherita Mascolo, MD
Monday, May 2, 2016
From the ACUTE team: To offer our readers a more comprehensive look into the various aspects of eating disorders and treatment, Medical Mondays will periodically be penned by team physicians at the ACUTE Center for Eating Disorder.
This week’s Medical Monday is written by Margherita Mascolo, MD, Interim Medical Director.
What do you mean starvation affects my liver?
The medical complications of severe malnutrition are often overlooked as we mistakenly think about this disease as a psychiatric illness and forget about the many medical complications that result from caloric restriction and starvation. I´d like to take this opportunity to discuss liver inflammation, or hepatitis, one very common and often misdiagnosed medical consequence of severe malnutrition.
As the body is being deprived of nutrition, it goes into what we call ‘hibernation mode’. One of the survival mechanisms it puts into place is the switch from a metabolism of cell growth (anabolic) to one of cell depletion (catabolic), or the breaking down of cells for nutrients. In other words, when you´re not taking in sufficient food to give the body enough fuel to carry on its basic processes such as brain function, breathing, and blood circulation, it looks for alternative fuel sources. It initially takes this fuel from fat cells, muscle cells, and bones leading to loss of fat, muscle mass, and bone density (osteoporosis). As the starved state continues, the body eventually begins breaking down organs and tissues in an effort to survive. One of the organs affected is the liver. The liver has many functions ranging from detoxifying the blood to storing glucose (sugar) to making factors that keep our blood from being too thin. When the starved state is prolonged, the body begins breaking down liver cells for nutrients and thus leads to a state of liver inflammation as its cells are dying.
Signs of starvation hepatitis are very vague and can include confusion, fatigue, abdominal pain (especially in the upper abdomen), yellowing of the eyes, and darkening of the urine. However, please keep in mind that hepatitis in the starved state is most commonly silent, or asymptomatic, meaning there are no warning signs and it is only diagnosed based on blood work. When physicians are inexperienced in caring for patients with eating disorders, they are often puzzled by such changes to liver function and may order more testing to rule out other possibilities of liver disease such as viral testing (ex: hepatitis C) or an autoimmune work up to exclude antibodies attacking the liver and causing this inflammation.
The treatment for starvation hepatitis is nutrition. The body needs to receive enough calories to provide fuel for all its processes so it can stop breaking down its own cells for nutrients. Sounds really simple, right? Wrong! If you´re battling an eating disorder and your malnutrition is so severe that your liver is breaking itself down for nutrients, it´s the hardest thing in the world to accept and follow through. It is also a sign that you need help from professionals that are experts in the treatment of eating disorders and can support you through this. The encouraging news is that with the proper nutrition and close medical care, the body halts this process of liver break down and the inflammation completely resolves. This takes time, proper nutrition, and medical care.
Wishing you health,
Dr. Margherita Mascolo