Non-Alcoholic Steatohepatitis (NASH)

What is NASH?

Non-alcoholic steatohepatitis (NASH) is an advanced stage of non-alcoholic fatty liver disease. NASH occurs when fat builds-up, the liver becomes inflamed which leads to liver cell damage. If not treated, liver inflammation can lead to liver scarring — a complication typical with fibrosis and cirrhosis stages of liver disease.

How is NASH different from other stages of fatty liver disease?

Non-alcoholic steatohepatitis is considered an advanced but reversible stage of non-alcoholic fatty liver disease. This is how fatty liver diseases develops and progresses through the stages:

Simple fatty liver disease (steatosis) is the first stage of fatty liver disease characterized by the build-up of fat in the liver.

Non-alcoholic steatohepatitis (NASH) develops when the accumulated fat in the liver cells leads to liver inflammation. Unlike simple fatty liver disease (stage 1), non-alcoholic steatohepatitis is a much more serious condition. If left untreated, NASH can lead to life-threatening liver disease stages such as fibrosis and cirrhosis.

Fibrosis is a transitional stage to cirrhosis characterized by liver scarring increased by the accumulation of extracellular matrix proteins. Once diagnosed, fibrosis should be treated as soon as possible.

Cirrhosis develops when all healthy liver cells gradually become replaced by scarred tissues. The more scarred tissues form, the more liver function is impacted. Cirrhosis is an irreversible condition.

Causes of NASH

The likelihood of developing non-alcoholic steatohepatitis is largely linked to your eating habits. People who suffer from obesity, type 2 diabetes, and insulin resistance have a much greater risk of developing NASH. If you have a history of liver disease in your family, it is important to have your liver checked by a physician to ensure that you are not currently suffering from NASH or another stage of liver disease. To minimize your risk of non-alcoholic steatohepatitis, it is important to maintain a healthy diet and exercise regularly. Keeping your weight and BMI at a healthy level is generally a good way to ensure that you are not developing a wall of fat around your liver.

Early Signs & Symptoms of NASH

Non-alcoholic steatohepatitis is often referred to as a silent killer because most people are unaware that they have this form of fatty liver disease. Visit a physician if you feel tired or have an ache or pain near the upper right side of your abdomen. This is one of the most common “first signs” that you are suffering from NASH.

Other symptoms include:

• loss of appetite
• web-like clusters of blood vessels under your skin
• yellow skin and eyes
• weakness
• swelling of your legs
• fatigue
• nosebleeds
• itchy skin
• weight loss
• abdominal pain
• abdominal swelling
• breast enlargement in men
• confusion

Diagnosis of NASH

Getting regular checkups by your doctors is important because they may notice that your liver is slightly enlarged.

NASH can be diagnosed using various testing methods such as:

• A liver biopsy
• A liver function test
• An ultrasound scan
• A CT scan or MRI

If you have been diagnosed with NASH, it is critical to act as quickly as possible to avoid further liver damage. Take advantage of Amsety’s free resources: start with taking our Liver Health Score, trying our liver-healthy recipes, and subscribing to our weekly newsletter to stay updated on the latest liver news.

Find out more about liver disease symptoms on LiverDirectory >

Treatment of NASH

Currently, there are no FDA approved drugs to cure non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH). Some medicines can be used though to deal with the symptoms of the disease or even stop its progression.

The first step in treating non-alcoholic steatohepatitis is lifestyle and diet changes involving gradual weight loss and increased physical activity. NASH is a reversible condition. With the right lifestyle and diet changes implemented, a patient can stop or even divert the progression of NASH. Adopting liver-healthy lifestyle means:

• Get regular exercise
• Lose weight, if recommended by your doctor
• Limit or stop alcohol consumption
• Reduce your cholesterol level
• Follow a liver-healthy diet

You may be advised to see your doctor regularly to check your liver function and see any signs of progression.

Can NASH be reversed?

Non-alcoholic steatohepatitis can oftentimes be avoided by adopting healthy lifestyle habits. To minimize your chances of developing NASH, achieve your healthy weight level, follow a liver-healthy diet, and exercise regularly. Amsety has created the Liver Health Score to assess your own lifestyle habits. By taking your Liver Health Score you will be able to recognize which daily habits you need to change if your goal is to lead a liver-healthy lifestyle.

Discuss the following changes to your liver health diet with your physician:

• If obese, loosing 7 to 10% of body weight
• Increasing the intensity of your physical activity and workouts
• Reducing the fat in your diet
• Cutting out refined sugar
• Reducing salt in your diet
• Limiting or abstaining from alcohol consumption

Prevention of NASH

Similar to non-alcoholic fatty liver disease, maintaining a healthy lifestyle and diet is crucial for prevention of NASH:

• Maintain a healthy weight
• Exercise regularly
• Maintain or achieve a healthy body weight
• Eat a balanced and healthy diet. Typically, a healthy liver diet should be low in fat, sugar, salt, gluten, starch, and include enough protein, vitamins, and minerals.
• Exercise regularly

The Importance of a Liver-Healthy Diet

97% of liver health experts consider nutrition the most important factor for liver, according to a survey. A liver-healthy diet is essential for liver function and when absent, can lead to serious medical complications. A liver-healthy diet is a well-balanced diet and should:

• be low in fat
• be low in sugar
• be low in gluten
• be low in starch
• have an adequate amount of protein
• have an adequate amount of vitamins & minerals

Get our SUPER 16 Diet for Liver Health eBook to learn more about a liver-healthy diet >

Start your journey towards better liver health today by trying one of our delicious, liver-healthy liver-healthy recipes. Also, don’t forget to check your Liver Health Score regularly to keep track of your progress and identify the habits that are keeping you from meeting your liver-health goals.

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Sources:

Oseini AM, Sanyal AJ. Therapies in non-alcoholic steatohepatitis (NASH). Liver Int. 2017;37 Suppl 1(Suppl 1):97-103. doi:10.1111/liv.13302

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