Suneth (age 45) came to my clinic last Wednesday in a state of confusion. Suneth is a bank manager who does not drink alcohol at all and does his job properly. However, during his annual medical check-up, his liver enzymes (AST/ALT) were very high, and an abdominal ultrasound scan showed that he had severe fatty liver.
"Dr. Priya, I've never drunk a single drop of alcohol in my life. How could my liver be full of fat and have liver disease? I can't even imagine this," Suneth asked in a frightened tone.
I calmly explained to Suneth. "Suneth, not only you, but many people in Sri Lanka think that liver disease occurs only if you drink alcohol. But even people who don't drink alcohol can develop fat in their liver. In medicine, we call this Non-alcoholic Fatty Liver Disease (NAFLD) . The most severe and inflammatory stage of it is called Non-alcoholic Steatohepatitis (NASH) . Today, let's talk about this in simple terms."
ðĻ Red Flags that require immediate medical attention
Although NASH may not cause any symptoms in the early stages, the following symptoms may appear when it progresses to severe liver failure. In such cases, immediate hospitalization is required:
- Yellowing of the skin and whites of the eyes (jaundice).
- Ascites is a condition in which the abdomen becomes swollen and distended due to abnormal fluid accumulation in the lower abdomen and pelvis.
- Vomiting red blood or passing black, tarry stools (a sign of internal bleeding).
- Frequent feeling of extreme drowsiness, inability to understand speech, or severe confusion (Hepatic Encephalopathy).
- Easy bruising or bleeding on the skin.
What is the difference between NAFLD and NASH?
Fatty liver disease in non-alcoholics can be divided into two main stages:
1. Simple Fatty Liver (NAFLD): In this condition, although fat is deposited in the liver, there is no damage or inflammation to the liver cells. This usually does not cause serious complications.
2. Non-alcoholic steatohepatitis (NASH): This is a very serious condition. In this condition, excess fat in the liver causes liver cells to become inflamed and destroyed. This causes a process called fibrosis, which causes scarring in the liver. If left untreated, this can lead to cirrhosis, a condition in which the liver becomes completely hardened and stops working.
Main causes and risk factors for NASH
Metabolic issues in the body cause unnecessary fat accumulation in the liver. The main factors that affect this are:
- Central Obesity: Excessive fat accumulation around the abdomen.
- Type 2 Diabetes: Inability to properly control blood sugar levels.
- Insulin Resistance: The inability of cells to use the hormone insulin properly.
- High blood fat: Increased levels of cholesterol and triglycerides.
- Bad eating habits: Frequent consumption of artificially sweetened drinks, fast food, and high-starch foods.
How to diagnose the disease
Doctors perform the following tests to check for the presence of NASH:
- Blood tests (Liver Function Tests - LFT): Measure liver enzyme levels (ALT, AST).
- Ultrasound Scan: Visually detects the presence of fat in the liver.
- FibroScan: A simple test to measure liver scarring (fibrosis) and stiffness.
- Liver Biopsy: A test that takes a small piece of the liver to most accurately confirm the disease.
Solutions to control NASH and protect the liver
Although specific medications specifically prescribed for NASH are limited, lifestyle changes can help reverse liver fat completely:
1. Lose weight (main solution):
By gradually losing between 7% and 10% of your current weight, you can almost completely eliminate fat and inflammation in the liver.
2. Healthy diet:
- Avoid foods containing fructose: The fructose sugar found in artificially sweetened drinks, soda, sweet biscuits, and canned fruit juices turns directly into fat in the liver.
- Get good fats: Include healthy fats in your diet, such as olive oil, nuts, and fish.
3. Daily exercise:
Exercising for at least 150 minutes a week (30 minutes a day, 5 days a week) such as walking or cycling increases insulin sensitivity in the liver and helps burn fat.
Do's & Don'ts
| âïļ Things to do (Do) | â Don'ts |
|---|---|
| If you have diabetes, high blood pressure, and cholesterol, control them with appropriate medications. | Do not take fake, unprescribed home remedies or pills that claim to dissolve liver fat (these can further damage the liver). |
| Lose weight gradually at a healthy pace of 0.5 - 1 kg per week. | Do not try to lose weight quickly by fasting suddenly (crash dieting). This will only increase liver fat and inflammation. |
| Check your liver function with a simple blood test at least once a year. | Do not take painkillers (especially high doses of paracetamol) frequently without medical advice. |
â Some other questions you may have (FAQ)
Why do people who don't drink alcohol also get fatty liver? âž
Excess carbohydrates and sugars (especially fructose) are converted into fat and stored by the body. When insulin resistance is present, these fatty deposits accumulate in the liver, leading to NAFLD/NASH, even in non-alcoholics.
Can Fatty Liver be completely cured? âž
Yes, in the early stages (simple fatty liver or early stage of NASH) before the liver develops cirrhosis, proper weight loss and diet control can completely dissolve the fat in the liver.
Can NASH cause liver cancer? âž
Yes, long-term neglect of NASH can lead to cirrhosis of the liver. Patients with cirrhosis are at a significantly increased risk of developing liver cancer (Hepatocellular Carcinoma).
Is it harmful to eat fruits containing fructose? âž
No, although natural fruits contain fructose, they are absorbed slowly by the body because they are rich in fiber and vitamins. It is not harmful. What is harmful are sweetened drinks and processed foods containing artificially added High-Fructose Corn Syrup (HFCS).
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