NASH: A Liver Disease

What is NASH

nashNonalcoholic Steatohepatitis, better known as NASH is not a new disease. It is a liver disease that replicates a disease that is found in someone who is a heavy drinker. That disease is ASH, Alcoholic Steatohepatitis. The consensus is that people with NASH were assumed to be Alcoholics.

According to the National Digestive Diseases Information Clearinghouse, (NDDIC) a silent liver disease, NASH affects 2 to 5 percent of the American population. Another 10 to 25 percent have a fatty liver. Although this is not normal, it probably causes little harm or permanent damage

Problems becoming more common in American’s are, NASH, obesity, which in the last ten years has tripled in children and doubled in adults, and NAFLD (Nonalcoholic Fatty Liver Disease). Also, diabetes and high blood cholesterol are up in numbers of American’s.

Elevations in liver tests done in blood work are the first sign that something may be wrong. Elevation in alanine aminotransferase (ALT) or/and aspartate arminotransferase (AST) is a sign to watch for. Along with x rays that show a liver with fat. But, the only true way to show a diagnosis of NASH is to have a liver biopsy.

The biopsy consists of a needle inserted thru the skin and a small piece of the liver is removed. This is put under a microscope. If it shows damage to the liver cells, inflammation and fat, then you most likely have NASH. They also look at the piece of liver to see if it shows scar tissue, how bad and if you have cirrhosis. NASH can cause cirrhosis and even death.

Symptoms

NASH has very few, if any, symptoms. In the early stages, people generally feel well. Once the disease has progressed, weakness, fatigue and weight loss can become a major problem. This process can take years, even decades. If this process stops, it can reverse itself. Or, it can worsen, with fibrosis taking over the liver and with that worsening, cirrhosis develops. With cirrhosis the liver hardens and unable to function. Then fluid retention, muscle wasting, intestinal bleeding and total liver failure develop. Liver transplants are the only treatments at this point, and has become an increasing treatment in people with NASH.

NASH is one of the major causes of cirrhosis in American, behind hepatitis C and ASH (Alcoholic Steatohepatitis).

Causes of NASH

The underlying cause of NASH is still unclear, it occurs mostly in people are middle-aged and obese, overweight. Many people with NASH have elevated blood lipids, which include cholesterol and triglycerides. And many have become diabetics. Not everyone is obese, diabetic and has normal blood work. NASH can strike without any apparent risk factor and even strikes children. You don’t have to be obese to have NASH.

The underlying reason for NASH is not known, but some of the factors possible are:

  1. insulin resistance
  2. (Cytokines)release of toxic inflammatory proteins by fat cells
  3. oxidative stress inside liver cells (deterioration of cells)

NASH currently doesn’t have any strict therapies in existence. Patients are highly recommended to follow the following:

  1. avoid alcohol
  2. a balanced and healthy diet
  3. if obese or overweight, reduce weight
  4. increase physical activity
  5. don’t take unnecessary medications

These do help, and also in other conditions, such as heart disease, diabetes and high cholesterol, which most people with advanced NASH, also have.

There are several experimental approaches being used to treat NASH. They include the following:

  • antioxidants such as vitamin E, selenium and betaine
  • antidiabetic medications

According to the National Digestive Diseases Information Clearinghouse (NDDIC)

Much more research is needed in the management of NASH to better understand the damaged liver in this disease. Once there is more understanding, there will be a way to treat this disease.

The National Institute of Diabetes and Digestive and Kidney Diseases funds the NASH Clinical Research Network, which comprises eight clinical centers located throughout the United States and a coordinating center at John Hopkins University. The NASH network researches the nature and underlying cause of NASH and conducts clinical studies on prevention and treatment.

The important things to remember about NASH are:

  • Nonalcoholic Steatohepatitis (NASH) is fat in the liver, with Inflammation and damage
  • NASH occurs in people who drink little or no alcohol and affects 2 To 5 percent of Americans, especially people who are middle aged And overweight or obese
  • NASH can occur in children
  • You can feel well with NASH and never know you have a liver Disease
  • NASH can lead to cirrhosis and liver failure
  • Fatigue can occur at any stage of NASH
  • Weight loss and weakness can happen once NASH is advanced
  • Or you have cirrhosis
  • High levels of liver enzymes in blood work or fatty liver by scan
  • NASH can be suspected
  • A needle biopsy of the liver is the only way to diagnosis NASH
  • Weight reduction, balanced diet, physical activity, avoid alcohol
  • Experimental therapies include antioxidants and antidiabetes