What you need to know about fatty liver disease! 🧠

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."

🚨 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.

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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.