Have you ever heard of a disease in which fat accumulates in the liver? Sometimes, this condition can become serious without any major symptoms. Today, we are going to talk about one such disease that can silently affect our liver. This is called MASH (Metabolic Dysfunction-Associated Steatohepatitis).
What exactly is MASH (Metabolic Dysfunction-Associated Steatohepatitis)?
Simply put, MASH is a condition where your liver has too much fat, causing inflammation , a condition similar to an injury. Think of it this way: when you have an injury, the area becomes red, swollen, and hot, and the same thing happens inside the liver. The name for this condition is NASH (non-alcoholic steatohepatitis).
This condition, called MASH, is part of a broader group of liver diseases called MASLD (Metabolic Dysfunction-Associated Steatotic Liver Disease). This is caused by the accumulation of fat in the liver for reasons other than alcohol use.
The most important thing is that if this is not treated properly, over time it can lead to conditions like cirrhosis, which causes the liver to become hard and scarred, or even dangerous diseases like liver cancer. Therefore, it is very important to be aware of this.
What are the most common causes of MASH? Who is at risk?
The main cause of MASH is excessive fat accumulation in the liver, which damages the liver and causes inflammation. This condition can occur when there are problems with the metabolism of sugar and fat in our body. Let's take a look at the main causes and risk factors that affect this:
- Obesity or overweight: This is a major factor.
- Type 2 diabetes: People with diabetes are at increased risk of developing MASH.
- High cholesterol: Increased levels of bad cholesterol in the blood.
- High triglycerides: This is also a type of fat in the blood. An increase in these is also not good.
- High blood pressure: We call it pressure.
- Insulin resistance: When the body's cells do not respond properly to insulin. This is a condition that precedes diabetes.
Remember, sometimes even if you are a normal weight, if you have high cholesterol, high blood pressure, or conditions like diabetes, you may be at some risk of developing MASH. Therefore, if you have any of these risk factors, it is wise to see your doctor and get checked for MASH.
What are the symptoms of MASH? How do you recognize it?
Here's the problem. MASH often doesn't show any obvious symptoms in the early stages. The disease develops slowly over many years. Some symptoms only appear after the liver has been severely damaged. When symptoms do appear, they can include:
- Fatigue: Feeling tired even without doing anything.
- Discomfort or pain in your upper right belly: Right where the liver is.
- Unexplained weight loss.
- Muscle weakness or muscle loss.
- Swollen belly or legs.
- When the condition is severe, yellowing of the eyes and skin (jaundice): This is what we sometimes call jaundice.
Since there are no symptoms in the early stages, it is very important to have regular checkups, especially if you have risk factors such as obesity, diabetes, or high cholesterol. This is when you can identify this condition early.
What other complications can occur due to MASH?
If MASH is not treated properly, it can lead to serious, sometimes life-threatening complications. Here's what they are:
- Liver fibrosis: This is scarring of the liver. Over time, this scarring builds up, leading to cirrhosis.
- Cirrhosis: This is a condition where the liver becomes severely scarred and its function is impaired. This is often a permanent condition, meaning it is difficult to reverse.
- Liver failure: The liver stops working properly. This can happen suddenly. If this happens, you may need immediate medical attention or a liver transplant.
- Hepatocellular carcinoma: MASH increases the risk of developing this common type of liver cancer.
- Heart disease: People with MASH are at increased risk of developing heart-related diseases such as heart attack and stroke.
Just think, it all starts with a little bit of fat in the liver. That's why we say, don't ignore even the smallest thing.
How do doctors diagnose MASH disease?
Because MASH does not initially cause symptoms, there are several steps you need to take to diagnose it. A doctor will first do a physical exam. They will then ask you about other medical conditions that may increase your risk of developing MASH (e.g., diabetes, cholesterol). In addition, they may do the following tests:
Blood tests
Your doctor will order blood tests to check for liver damage or inflammation. These may include:
- CBC (Complete Blood Count): Complete blood cell count.
- BMP (Basic Metabolic Panel): Basic metabolic process test.
- Lipid panel: Check fat levels like cholesterol and triglycerides.
- Hemoglobin A1C: A test to assess diabetes control.
Imaging tests
These tests can take pictures (images) of the inside of your liver. Your doctor will look at these pictures to check for any changes in your liver that are related to MASH status. Tests like these may be done:
- CT scan (CT scan - Computed Tomography scan)
- Ultrasound scan
- FibroScan®: This is a special type of ultrasound that measures the stiffness of the liver. This can give an idea of liver fibrosis.
- Magnetic resonance elastography and proton density fat fraction (MRE-PDFF): This can accurately measure the amount of fat in the liver.
Liver biopsy
Sometimes, your doctor may need to take a small sample of tissue from your liver called a liver biopsy. A medical pathologist will examine the sample under a microscope to check for fat, inflammation, and scarring in the liver. A liver biopsy is the best way to accurately diagnose MASH.
In addition, your doctor may perform other tests to determine if your symptoms are caused by another liver disease.
What are the treatments for MASH?
Treatment for MASH focuses on improving your body's metabolic health and preventing further damage to your liver. Your treatment plan may include:
Lifestyle changes
To control MASH, it is important to adopt a healthy diet, be active, and lose weight. Your doctor may recommend lifestyle changes such as:
- Eat a healthy diet: A good diet plan that helps control MASH is the Mediterranean diet or a low-carb diet . Simply put, eat more vegetables, fruits, legumes, fibrous whole grains, good quality proteins (fish, chicken), and healthy fats (avocado, olive oil, nuts). You should reduce sweets, fatty foods, and fast foods as much as possible.
- Be active: Try to get at least 150 to 300 minutes of moderate-intensity aerobic exercise per week. Examples include brisk walking, running, cycling, and swimming.
- Avoid alcohol completely: Even a small amount of alcohol can put a strain on your liver, so it's essential to stay away from alcohol completely.
Medication
Your doctor may prescribe certain medications to help reduce symptoms, such as scarring, caused by MASH. For example:
- Resmetiron (Rezdiffra®): This medication may help reduce or reverse the scarring of the liver caused by MASH. It is the only medication approved by the U.S. Food and Drug Administration (FDA) to treat MASH in stages 2 and 3 of fibrosis.
- GLP-1 agonists: These drugs help reduce inflammation and fat in the liver. Examples include liraglutide (Victoza®, Saxenda®), semaglutide (Ozempic®, Wegovy®), and tirzepatide (Mounjaro®, Zepbound®). These are also often used to treat diabetes.
In addition, your doctor may prescribe other medications or supplements. For example, a diabetes medication called pioglitazone (Actoplus Met XR®) or a supplement like vitamin E may be recommended.
Researchers are currently conducting clinical trials to find new drugs for MASH. You can talk to your doctor about whether you would be eligible to participate in such a trial.
Weight loss surgery (Bariatric surgery)
If you are severely obese and have severe liver disease, weight loss surgery (bariatric surgery) is another treatment option. Gastric sleeve surgery (removal of part of the stomach) or gastric bypass surgery (reduction of the stomach) can provide the following benefits:
- Helps reduce body weight.
- The damage caused to the liver by MASH can be reduced to some extent, and perhaps even reversed.
- Significantly reduces the risk of developing cirrhosis, liver cancer, and needing a liver transplant.
Can MASH be completely cured?
MASH is not always curable. However, if the disease is diagnosed early and treatment is started early, it can sometimes be reversed or prevented from getting worse. This means that there is a good chance that further damage to the liver can be prevented.
How long can someone with MASH usually live?
Your life expectancy depends on how much damage has been done to your liver by MASH. If the disease is diagnosed and treated early, most people can live a normal life. However, as the disease progresses, the risk of early death from complications such as liver failure and liver cancer increases. However, treatment can slow the progression of the disease and improve quality of life. Starting treatment as early as possible is the best way to achieve the best results.
When should I see a doctor?
If you feel tired all the time, have pain or discomfort in the upper right part of your abdomen, or have symptoms like unexplained weight loss, it's important to see a doctor. These could be signs that something is wrong with your liver. Your doctor will run tests to see if it's MASH or another liver disease.
Remember, certain medical conditions, such as obesity and type 2 diabetes, increase your risk of developing MASH. If you have any of these conditions, your doctor will also regularly check your liver function.
Finally, the most important things you need to remember
When you receive a diagnosis of MASH (metabolic dysfunction-associated steatohepatitis), you may feel a great deal of shock and fear. If you have conditions like obesity, high blood pressure, or high cholesterol, you may wonder, "Am I responsible for this?"
But remember one thing. None of these conditions, including MASH, are your fault. Your medical team focuses on the present, not the past. They will explain to you what steps you can take to manage MASH. And they will be with you every step of the way. So don't be afraid.
The most important thing is to be aware of the symptoms, get proper medical tests if there are risk factors, and follow medical advice. Then we can save our liver from this silent enemy.
` MASH, fatty liver, cirrhosis, liver cancer, diabetes, obesity, cholesterol
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