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NASH or Fatty Liver, a killer on the loose

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Nonalcoholic Steatohepatitis (NASH) or “fatty liver” disease; does this liver make me look fat?

 As time goes by and the “Standard American Diet” (SAD) plagues our bodies, we Americans’ have a “killer” disease on the loose. Most people don’t even know that this disease is lurking within them because in the early stages there are no symptoms. This “killer” disease is “fatty liver” disease or Nonalcoholic Steatohepatitis (NASH). By simple definition, NASH is liver inflammation and damage caused by a buildup of fat in the liver. If left untreated, or if the symptoms continue to get worse, the end result can be fibrosis, liver cancer, cirrhosis or other liver cell necrosis. This can result in the patient ending up with complete liver failure, needing a liver transplant, and even death. Being that your liver is a main organ in your body and you cannot live without it… this disease is not something that you want nor should it be taken lightly!

In brief, the importance of a healthy liver is crucial to your survival…here are a few examples of your liver’s functions:

  • Your liver breaks down and stores many of the nutrients absorbed from your intestines.
  • It makes some of the clotting factors to stop the bleeding from a cut or injury.
  • Your liver produces bile that goes into your intestines to help absorb nutrients from the food you eat.
  • Too many other precise functions to list…

But one of the MOST important functions is that it breaks down toxic wastes in the blood, which are then removed from the body, which is extremely important…

So a question… does this liver make me look fat OR am I making my liver fat?

According to the Centers for Disease Control, up to 20% of adults may have either fatty liver or NASH. In addition, more than 6 million children have this condition, being most common in Asian and Hispanic children. Recent evidence also indicates that NASH increases the risk of heart disease in children who are overweight or obese. To top it off, the statistics are even worse for the 15 million people in the U.S. who abuse or overuse alcohol. Almost all of them – 90%-100% – develop fatty livers and have Alcoholic Liver Disease (ALD), which is the precursor for cirrhosis (scar tissue that replaces the liver tissue, preventing the liver from functioning properly). ALD is another form of fatty liver disease but in this article we will be just discussing NASH.

In the early stages of “fatty liver”, the symptoms can be non-existent to mild. The most common symptoms would be fatigue or feeling tired all of the time, unexplained weight loss, general weakness, or an ache in the upper right part of your belly. Each one of these symptoms by themselves can be attributed to everyday life especially if we lead busy lives and do not eat healthy.  How one might attribute these symptoms to fatty liver is to recognize the basic causes of this disease. Although an exact cause is not known, being overweight or obese, having insulin resistance and type 2 diabetes, high cholesterol and triglycerides, or having metabolic syndrome all contribute to getting NASH. Some recent studies also point toward overgrowth of bacteria (caused by gut flora imbalances)in the intestines as a contributor. The most common age group in developing this disease is between 40 and 50 years old and having one or more of the above symptoms.  Do not let this list be an absolute list though. Even people who are “skinny-fat” meaning a normal weight person with high fat content to low muscle mass (doughy) and young children are being diagnosed more and more. This disease also can take many years to develop, so you might not immediately notice anything wrong until the symptoms are chronic and a more severe disease has set in. Fatty liver has been found to be the precursor for other severe liver diseases such as fibrosis, liver cancer and is always linked to cirrhosis. Because it is a precursor to other diseases; treating and reversing fatty liver should be a high priority when it is found.

Like some diseases, a patient can be treated successfully if fatty liver is found in the early stages.  Reducing your total cholesterol level, reaching a healthy weight (loosing 3 to 10% of your body weight can make a big difference), upping your muscle mass/reducing your fat ratio, control your blood sugar and diabetes, stopping or limiting alcohol consumption, exercise regularly and be careful of other medications that you take like OTCs– can all help treat and possibly even reverse fatty liver. Just like the rest of our body, the fat build up can be reduced if you make simple changes and healthier lifestyle choices. Obviously a diet full of fresh fruits and vegetables, lean protein, high in plant sourced fats (like nuts/avocados), low in animal sourced fats (excess fat on a steak) and good old-fashioned exercise is a good start.

So, how fat IS my liver and can I get tested for fatty liver?

Fatty liver is not always the first assumption when a patient exhibits the symptoms of NASH. How a patient can determine the extent of /diagnosis of fatty liver disease is to get tested through their local laboratory or clinic.  A simple blood test like an Alkaline Phosphatase Isoenzymes (ALP/ ALK PHOS) test can be performed or a fine needle aspiration liver biopsy.

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The ALP/ALK PHOS is one blood test used to help detect conditions that affect the liver. The damaged liver cells release increased amounts of ALP into the blood, thus this test can be the first test performed. This test is routine and can also be a part of a more extensive liver panel or a NASH Fibrosure. The ranges are commonly determined by either a method of calculation (measures the amounts of several chemicals in your serum) or Spectrophotometry (is a method to measure how much a chemical substance absorbs light by measuring the intensity of light as a beam of light passes through sample solution), which is ordered by a physician.  The ranges of reference would be determined by which method of testing is applied to the sample. This blood test only uses 2 (1) mL tube collections of serum-for both methods of testing listed above.

Another test would be a fine needle aspiration liver biopsy. This is more invasive to the patient than a simple blood test. A liver biopsy is performed by using a hepa-set needle apparatus. How it is performed: an incision is made in the abdominal area with a scalpel and a fine long needle is inserted into the incision between two of the right lower ribs. This needle then aspirates or extracts tissue from the patient’s liver. The tissue sample is then used as a single smear test with a 50% suspension of alcohol on a glass slide and it is observed under a microscope for fat content, scarring, inflammation, tumor cells or other abnormalities within the sample. A point of reference is that if the liver contains more than 5 to 10 % of its weight in fat, then NASH is suspected. Note: a healthy adult liver weighs about 3 pounds total.

Both of these tests can be accompanied by an ultrasound, computerized tomography (CT) scan or a magnetic resonance imaging (MRI) of the liver to get a visual of the diseased liver but the biopsy is the only way to confirm the diagnosis. Once a positive diagnosis is made, the patient and their physician can make a positive treatment plan to insure that this disease does not progress and develop into more severe diseases.

Although the information that you just read seems pretty grim, a diagnosis of fatty liver is not the end of the world. What it is: it is a wake up call to our habits and lifestyle choices that we make. Our bodies are strong by nature but if you abuse it, over time, it will break down and diseases can set in.  If one is showing abnormal symptoms then they should seek out answers by getting properly tested and examined by their physician… The best news out of this is that with some simple lifestyle changes as noted above, you can possibly reverse this disease… So a question… does this liver make me look fat? 

jarohoney copyright 2014

 

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