Fatty Liver and Cirrhosis
Fatty Liver – This One’s Personal
This is a disease that upsets me deeply, as it is the one which took my Mom. Until the time of her diagnosis, the only thing I “knew” about cirrhosis was that it was a disease which only affected alcoholics and drug abusers. I was so wrong.
There are, in fact, several paths to liver disease, which I will cover in a separate post. In my Mom’s case, her cirrhosis developed as a progression from NASH or Nonalcoholic steatohepatitis. It is also called NAFL (non alcoholic fatty liver), or simply Fatty Liver.
NASH is a common, often “silent” liver disease. It resembles alcoholic liver disease, but occurs in people who drink little or no alcohol. The major feature in NASH is fat in the liver, along with inflammation and damage. Most people with NASH feel well and are not aware that they have a liver problem.
Nevertheless, NASH can be severe and can lead to cirrhosis, in which the liver is permanently damaged and scarred and no longer able to work properly.
Although having fat in the liver is not normal, by itself it probably causes little harm or permanent damage. If fat is suspected based on blood test results or scans of the liver, this problem is called nonalcoholic fatty liver disease (NAFLD). If a liver biopsy is performed in this case, it will show that some people have NASH while others have simple fatty liver.
NASH is usually a silent disease with few or no symptoms. Patients generally feel well in the early stages and only begin to have symptoms—such as fatigue, weight loss, and weakness—once the disease is more advanced or cirrhosis develops.
The progression of NASH can take years, even decades. The process can stop and, in some cases, reverse on its own without specific therapy. Or NASH can slowly worsen, causing scarring or “fibrosis” to appear and accumulate in the liver.
As fibrosis worsens, cirrhosis develops; the liver becomes seriously scarred, hardened, and unable to function normally.
Not every person with NASH develops cirrhosis, but once serious scarring or cirrhosis is present, few treatments can halt the progression. A person with cirrhosis experiences fluid retention, muscle wasting, bleeding from the intestines, and liver failure.
Liver transplantation is the only treatment for advanced cirrhosis with liver failure, and transplantation is increasingly performed in people with NASH.
Although NASH has become more common, its underlying cause is still not clear. It most often occurs in persons who are middle-aged and overweight or obese.
Many patients with NASH have elevated blood lipids, such as cholesterol and triglycerides, and many have diabetes or pre-diabetes, but not every obese person or every patient with diabetes has NASH.
Furthermore, some patients with NASH are not obese, do not have diabetes, and have normal blood cholesterol and lipids. NASH can occur without any apparent risk factor and can even occur in children. Thus, NASH is not simply obesity that affects the liver.
My Mom was 73, and had most of the risk factors for NASH, including age, obesity, sedentary lifestyle, insulin resistance and high triglycerides. Doctors see NASH often, and usually call it “Fatty Liver.”
Perhaps because it is fairly commonplace, it seems that most physicians don’t adequately impress on the patient the need to make the necessary lifestyle changes to reverse the condition before it potentially progresses to non-reversible cirrhosis of the liver.
Fatty Liver can be potentially reversed by weight reduction (if overweight), activity and healthy diet, and avoiding alcohol and unnecessary medications. Most importantly, a major attempt should be made to lower body weight into the healthy range. Weight loss can improve liver tests in patients with NASH and may reverse the disease.
These are standard recommendations, but they can absolutely make a difference. They are also helpful for other conditions, such as heart disease, diabetes, and high cholesterol.
People with NASH often have other medical conditions, such as diabetes, high blood pressure, or elevated cholesterol. These conditions should be treated with medication and adequately controlled; having NASH or elevated liver enzymes should not lead people to avoid treating these other conditions.
Experimental approaches under evaluation in patients with NASH include antioxidants, such as vitamin E, selenium, and betaine. These medications act by reducing the oxidative stress that appears to increase inside the liver in patients with NASH. Whether these substances actually help treat the disease is not known, but the results of clinical trials should become available in the next few years.
Over time, more research will help physicians to better understand the liver injury found in this disease. When the pathways that lead to the injury are fully known, safe and effective means can be developed and used along with lifestyle changes to reverse these pathways and help patients with NASH. Recent breakthroughs in mapping the human genome and uncovering the individual steps by which insulin and other hormones regulate blood glucose and fat could provide the necessary clues.
My Mom was told that she had fatty liver by her doctor many years ago, but that information was accompanied by only the advice to lose some weight. It haunts me to think that the disease could have been reversed if she had been warned of the potentially fatal consequences of ignoring it. I wish somebody had frightened her into changing her lifestyle when it could have made a difference in her future outcome.
It is a sad thought, indeed, that I lost my Mom to a lifestyle disease which could have been prevented or reversed.
Please share your thoughts or experience with liver issues in the comment section below.
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