What is a NASH?
When fat gets accumulated in your liver whether you have a regular intake of alcohol or not you might be prone to Non-alcoholic fatty liver disease. It is still unknown what the cause of NAFLD or Steatohepatitis is However, risk factors include obesity, gastric bypass surgery, high cholesterol, and type 2 diabetes.
In the Nonalcoholic fatty liver disease condition, fat builds up in your liver. NASH (Nonalcoholic Steatohepatitis) is the next stagewhen NAFLD becomes severe. IN this condition, the excess fat in your liver causes cell damage and inflammation.
Non-Alcoholic Steatohepatitis Guide
Skim through this NASH guide that covers every important aspect of this disease, its causes, symptoms and Treatments.
1. Causes of NASH
The symptoms of NASH are only visible until your liver gets damaged beyond repair. However, understanding the risk factors for NASH can help at-risk patients get the right diagnosis.
Usually, Non-alcoholic Steatohepatitis (NASH) is silent diseases with few or no symptoms. As a result, you might be unable to notice any symptoms even if the NASH becomes severe and develops to the next stage cirrhosis. The reason for some people developing NASH from NAFLD and others do not is still unknown. Research suggests genes make the difference between you and the other person.
People with NAFLD are more likely to have NASH if they have one or more of the following conditions:
• obesity, especially with a large waist size
• high blood pressure
• high levels of triglycerides or abnormal levels of cholesterol in their blood
• type 2 diabetes
• metabolic syndrome
Less common causes of NAFLD and NASH include:
• disorders that cause your body to use or store fat improperly
• rapid weight loss
• certain infections, such as hepatitis C
• certain medicines, such as
– highly active antiretroviral therapy
– synthetic estrogen
– valproic acid
• exposure to some toxins
• Gallbladder removal may also provoke NAFLD
2. Signs and Symptoms of NASH
The symptoms are often silent or non-specific to NASH, making it difficult to diagnose. As a result, NASH patients remain unaware of their condition until the late stages of the disease.
NASH is the liver manifestation of a metabolic disorder, which is the most severe form of non-alcoholic fatty liver disease (NAFLD).
3. NASH Diagnosis
In some cases, alcohol may not play a part in the build-up of fat on the liver, in which case it is known as nonalcoholic fatty liver disease. This condition can also lead to liver inflammation, scarring, and in worst cases, Non-alcoholic Steatohepatitis cirrhosis.
These are the things that your doctor will ask you.
• Your history of obesity
• Insulin resistance
• High levels of triglycerides or abnormal levels of cholesterol in your blood
• Metabolic syndrome
• Type 2 diabetes
• Your doctor will ask about diet and lifestyle factors that may make you more likely to develop NAFLD and NASH, such as a lack of physical activity, eating a diet high in sugar and starch, or drinking sugary beverages.
• Medical tests are unable to show the cause of fat in livers. To find out whether the fat in your liver formed from drinking alcohol, you will have to tell the doctor about your alcohol consumption.
• Your doctor will ask about diet and lifestyle factors such as a lack of physical activity, eating a diet high in sugar and starch, or drinking sugary beverages.
4. NASH Treatment
It is best to visit a doctor before taking any steps.
– Vitamins and other dietary supplements
– Overweight is one of the main issues that cause this condition, but you can reduce weight or burn fat with the help of food choices, exercises, and diets. Losing only 3% to 5% of your body prevents many risks and if you can reduce 10% of fat, then it will eliminate the inflammation.
According to the doctors, losing 7% of fat yearly is very helpful and recommended. But Rapid weight loss through fasting can make NAFLD worse.
One of the best treatments that improved health and treated NASH for a lot of people is the pioglitazone or vitamin E. But this treatment method is not for those who have cirrhosis or diabetes.
When NASH becomes serious and goes on to the next stage of cirrhosis, you can treat the condition with different treatment options like operation, medication, ayurvedic medicines, etc with early detection. But once it is ignored, it eventually stops the functions of the kidney leading to liver failure, which has one treatment: a liver transplant.
Although it seems a bit unfair, even if you don’t consume alcohol, you might experience the same symptoms as alcoholic fatty liver disease. This type of fatty liver may be brought on due to obesity, high-fat content in the blood, and diabetes. Other fatty liver causes include Hepatitis, Cancer, immunity disorders, poison, or prescription drug overdose.
Early signs of nonalcoholic fatty liver disease include irregular sleep cycles and low energy levels. You might feel tired easily and feel like lying down often, and your eyes may develop a yellowish tint. You may notice skin conditions such as itching, acne, psoriasis, and eczema.
Signs of this disease may include fatigue, jaundice, nausea, vomiting, discomfort felt in the right upper abdomen, and weight loss.
At this stage, your doctor might recommend a liver function test that might reveal elevated liver enzyme levels. Fluid may accumulate in your abdomen and your liver might break down completely if you do not seek immediate fatty liver treatment.
Non-alcoholic Steatohepatitis cirrhosis is another fatty liver condition that cannot be reversed. If you stop drinking, it will prevent more damage to your liver and may improve some symptoms. The liver is severely scarred at this stage and the patient requires urgent medical treatment and support.
If you have elevated levels of liver enzymes, that would call for imaging tests such as MRI scans, CT scans, and ultrasound tests. This way, the doctor can find out the cause of liver inflammation. Another technique commonly used in liver biopsy, where a piece of your liver tissue is extracted and tested in the laboratory. This test can detect whether your liver is scarred or not.
For non-alcoholic fatty liver disease, the most important part is to quit drinking alcohol. You might be able to reverse your condition if you quit drinking, provided your liver has not reached the cirrhosis stage. Some people require some help when it comes to quitting alcohol, and for them, there are alcohol recovery programs and therapists who can help.
You can also take the help of medicines to quit alcohol, which reduces the craving or creates an unpleasant sensation whenever you start drinking. Both types of fatty liver diseases, however, can cause cirrhosis, which can be treated with operations, fatty liver disease supplements, and medicines.
In severe cases, cirrhosis may lead to liver failure, in which liver transplant may be the only option available.
There are still no approved therapies indicated for NASH patients. But that’s about to change.
Regulatory authorities and the scientific community have accelerated clinical trials and approval procedures for NASH, intending to provide patients with NASH access to approved therapy as soon as possible.
Today, diet, lifestyle modification, and exercise remain the top priorities and recommendations for patients. The ultimate goal is to achieve and sustain a weight loss of 7% to 10% of body weight, as this has been shown to improve most histopathological features of NASH.
5. Home Remedies and Lifestyle changes
There are several alternative medicines, medical practices, herbal remedies that claim to reverse the condition but you should consult with your doctor before trying these out, as some of them can do you more harm than good.
If you introduce some lifestyle changes and follow a diet for reducing fatty liver, you can successfully reverse the condition. Your biggest step towards betterment is to follow the routine prescribed by your doctor.
6. Non-Alcoholic Steatohepatitis Diet
If you’re prescribed NASH Diet, your doctor may recommend nutrition that leads to gradual weight loss if you are obese. Try to avoid foods that contain high fat or calories to treat the condition faster and reduce the risk of obese.
You can prevent having any heart disease from NAFLD condition by consuming saturated fats, omega 3 fatty acid, and polyunsaturated fats. Your doctor will suggest to you:
• Eat more fruits, vegetables, and whole grains. These low-glycemic foods don’t affect your Blood glucose.
• Avoid sweets, soft drinks, sports drinks, sweetened tea, and juices because they contain fructose.
There are some medicines available that help to prevent NASH from developing to other aggressive and severe stages.
NASH can lead to some of the severe conditions like liver failure, cirrhosis, and liver cancer. Due to the obesity spread, mostly the countries in western shore, NAFLD keeps increasing worldwide which is estimated to be 24%.
Currently, the only effective way is weight loss with the help of diet, treatment, and other methods. Thus, developing medicine for NASH is very crucial and necessary.
Traditional Herbal Medicines (THM) on the other hand is a very good source that can be used to develop drugs to treat the condition. It has been used for many years now but there is no solid evidence by RCTs that can back up the effects. According to reports, more than 20% to 30% of NASH patients uses THM along with many other countries in Asia.
To prevent NASH, you can do the following:
• Maintaining a healthy weight
• Eat a healthy diet
• Limit alcohol intake
• Exercise regularly
• Use medicines and supplements exactly as prescribed
• Get regular, good quality sleep.
Through lifestyle changes, you can reverse the effects of this debilitating condition. You should consult a doctor immediately if you notice any of the symptoms, to prevent complications from occurring.
A liver transplant is an operation that involves the replacement of a patient's diseased liver with either a whole or partial healthy liver from a donor.
Dr. Bipin Vibhute
Liver & Multiorgan Transplant Surgeon
Dr. Aniruddha Bhosale
Consultant Liver & GI surgery
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Consultant Liver & GI surgery
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Asst Consultant Liver & Multiorgan Transplant
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Consultant Liver Transplantation Anaesthesia & Critical Care
M/S. Malvika Karkare
Sr. Transplant Dietition
A liver transplant is an operation that replaces a patient’s diseased liver with a whole or partial healthy operation that replaces.
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