While you were asleep: Nighttime may affect your liver more than you think

A few years ago, I bought myself a fitness watch. As I worked to rebuild my health after being diagnosed with metabolic dysfunction-associated steatohepatitis (MASH), I thought it would help me track my steps, estimate calories burned, and time my workouts. It also came with a feature I didn’t expect to love as much as I do: a sleep monitor.

If you’re like me, sleep ranks high on your list of favorite activities you don’t get enough of. I enjoy powering down each night with a book or a video. My brain needs something to latch on to before it finally settles down. I’ve wrestled with bouts of insomnia for years, particularly in early spring. Aging seemed to improve things for a while, but stress and relentless bad news have recently pushed my bedtime later and later.

I know better. Sleep is not optional when you’re protecting your liver. Getting close to eight hours a night matters, especially because nighttime can be one of the hardest stretches for liver function.

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Recognizing the symptoms

I learned this lesson the hard way during a lengthy hospital stay several years ago. My morning blood draws revealed a troubling pattern: I’d wake up with low blood sugar almost every day. The phlebotomist arrived at 5:30 a.m. to monitor my ever-changing liver enzymes, and the results kept raising eyebrows. When one of my doctors explained that I was hypoglycemic, I immediately worried about diabetes. Instead, they reassured me that my liver was struggling to maintain normal glucose levels overnight.

Their advice was surprisingly simple: I could support my liver by adding carbohydrates to my nighttime routine. So every evening, I ordered strawberries to be delivered to my room. They were delicious, comforting, and effective.

Many people with liver disease recognize these symptoms even if they don’t have a name for them. You might wake up ravenously hungry, nauseated, sweaty, or mentally foggy. Some people feel shaky, irritable, or notice heart palpitations. As liver patients, our bodies struggle to release glycogen, the stored form of glucose that fuels the brain and muscles overnight. When that system falters, mornings can feel frightening. Blood sugar instability is no small thing.

Research increasingly supports these lived experiences. A recent study from the University of Oxford found that people with MASH experienced lower blood sugar levels overnight while fat accumulation in the liver increased. Thomas Marjot, the lead author of the study, explained that key metabolic pathways worsened at night in the patients studied. The body became less responsive to insulin, the liver produced more fat, and muscle and abdominal fat tissue couldn’t perform their metabolic jobs efficiently. He also noted that heavy evening meals tend to worsen the problem.

So what helps? Most nutrition experts recommend spreading calories more evenly throughout the day. Small, frequent meals that balance protein, fiber, fat, and carbohydrates can stabilize blood sugar levels overnight. This approach works better than eating lightly during the day and consuming a large dinner late at night.

I like to build what I call “mighty meals,” which are snack-sized combinations that are satisfying without being overwhelming. Some of my favorites include cheddar cheese cubes with apple slices, almonds with raisins, and a half turkey-and-cheese sandwich with lettuce and tomato. Red grapes paired with Muenster cheese are another go-to. In the summer, watermelon or cantaloupe works beautifully alongside grilled meats and vegetables. These simple pairings taste good and help protect my liver at the same time.

If your mornings are consistently rough and include symptoms of hypoglycemia, it is time to call your doctor. Explain what you are experiencing. Ask whether regular blood sugar testing makes sense for you, even if you do not have diabetes. Understanding how your body chemistry interacts with sleep, food, and stress is essential.

You likely have many years ahead of you, so don’t shortchange your liver. Timing matters, even while you sleep.

Note: Liver Disease News is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Liver Disease News or its parent company, Bionews, and are intended to spark discussion about issues pertaining to liver disease.