Non Alcoholic Fatty Liver Disease : Reversing It


Imagine a silent epidemic, one that’s quietly affecting a staggering 32 percent of the global population. More pervasive than obesity and more widespread than diabetes, this stealthy health crisis is lurking unnoticed in one-third of people around the world.

This is not the common culprit here; this is about fatty liver disease. Surpassing even viral hepatitis and alcoholic liver disease, fatty liver has become the leading cause of liver cancer and chronic liver failure. Alarmingly, its insidious nature means it often escapes early detection, as standard screening tests frequently miss it.

I will go through a few effective strategies and solutions to identify, prevent, and manage fatty liver disease, empowering you to take charge of your health against this hidden menace.

Despite the scary introduction, there is hope on the horizon.

First there are current and upcoming drugs which have shown promise in reversing fatty liver disease.

Next, the liver, the factory of the human body has a remarkable defence against fatty liver disease.

Stick around to the end of this video.

Risk Factors for fatty liver disease

Well, the likelihood of developing NASH (Non-Alcoholic Steatohepatitis) is higher in certain groups:

  • Individuals aged 50 and above.
  • Those with specific genetic predispositions.
  • People who are obese.
  • Individuals with diabetes or elevated blood sugar levels.
  • Those displaying symptoms of metabolic syndrome, including high blood pressure, elevated triglycerides, and a larger waist circumference.

Nonalcoholic fatty liver disease, is a condition where too much fat accumulates in the liver of people who drink little or no alcohol. This condition is often linked to being overweight or obese and is increasingly prevalent worldwide, particularly in the Middle East and Western countries, paralleling the rise in obesity. It’s now the leading chronic liver disease globally, affecting about a quarter of the world’s population, including roughly 100 million Americans.

In some cases, NAFLD can progress to a more severe stage called nonalcoholic steatohepatitis, or NASH. NASH is a serious version of fatty liver disease where the liver becomes inflamed and damaged due to fat buildup, leading to complications like severe scarring (this is called cirrhosis) and even liver cancer, similar to what heavy alcohol use can cause.

Currently, there’s a push to rename nonalcoholic fatty liver disease to ‘metabolic dysfunction-associated steatotic liver disease’ (MASLD) and nonalcoholic steatohepatitis to ‘metabolic dysfunction-associated steatohepatitis’ (MASH) to better reflect the underlying causes of these conditions.

So why is this condition relevant?

Severe scarring of the liver, known as cirrhosis, is a major health issue related to NAFLD (Non-Alcoholic Fatty Liver Disease) and NASH (Non-Alcoholic Steatohepatitis). Cirrhosis develops due to liver damage, often resulting from the inflammation seen in NASH. When the liver tries to heal this inflammation, it forms scar tissue, a process called fibrosis. If the inflammation continues, the scarring expands, affecting more of the liver.

If the scarring isn’t addressed, it can lead to several serious conditions:

  1. Fluid accumulation in the abdomen, known as ascites.
  2. Swollen blood vessels in the esophagus, termed esophageal varices, which can burst and cause bleeding.
  3. Mental confusion, drowsiness, and unclear speech, a condition called hepatic encephalopathy.
  4. An enlarged spleen, or hypersplenism, leading to a reduced number of blood platelets.
  5. Liver cancer.
  6. Advanced liver failure, where the liver fails to function.

It’s estimated that about 24% of adults in the United States have NAFLD, with around 1.5% to 6.5% suffering from NASH.

So how is this diagnosed?

Fatty liver disease often doesn’t show symptoms, so it’s usually first identified by a healthcare provider. Signs like high liver enzyme levels in blood tests, which indicate liver injury, can be an initial clue.

Imaging techniques like ultrasound, CT scans, or MRIs can detect inflammation and scarring in the liver. A specialized ultrasound called FibroScan can be used to measure liver fat and scar tissue.

A liver biopsy, which involves taking a tissue sample from the liver is the definitive method to differentiate between various stages and types of fatty liver disease.

What is the Treatment for Fatty Liver Disease?

Before we get to it. Fun fact. Did you know the liver can often heal itself, so it’s possible to improve or even reverse fatty liver disease and some scarring. By following these next steps, you can reduce liver fat and inflammation, preventing further damage and potentially reversing early liver damage.

  1. Avoiding alcohol, even if your liver disease isn’t caused by alcohol.
  2. Losing weight by exercising, changing your diet with a nutritionist’s guidance, and possibly using medications like GLP1 agonists like wegovy and ozempic. In some cases, weight loss surgery might be an option.
  3. Taking medication to manage diabetes, cholesterol, and high triglycerides. Sometimes, vitamin E and certain diabetes medications like pioglitazone might be necessary.
  4. Getting vaccinated for hepatitis A and B, as these can be more harmful if you have liver disease.
  5. Adjusting your current medications if they contribute to fat buildup in your liver.

Preventing Fatty Liver Disease

  • Exercise regularly.
  • Limit alcohol intake.
  • Maintain a healthy weight.
  • Follow medication plans if you have diabetes or metabolic syndrome.

Current Research About Fatty Liver Disease

There are several promising developments in the treatment of fatty liver disease, particularly for non-alcoholic steatohepatitis (NASH) and non-alcoholic fatty liver disease (NAFLD).

  1. Researchers at the University of California San Diego School of Medicine conducted a study on pegozafermin, a drug that mimics the hormone fibroblast growth factor 21 (FGF21), which is naturally produced in the liver. This hormone regulates energy usage and lipid metabolism in the liver. The clinical trial found that pegozafermin improved liver fibrosis and inflammation in NASH patients. The 24-week trial involved 222 participants, and those who received a higher dose of the drug showed significant improvement in liver fibrosis compared to those who received a placebo. The next step for this research is a larger, multi-center, international trial to better assess the drug’s safety.

  • The US Food and Drug Administration (FDA) advisors were set to discuss the approval of Ocaliva (brand name for obeticholic acid) for the treatment of NASH. This discussion was based on weighing the antifibrotic benefits of Ocaliva against its toxicity risks. A regulatory decision on Ocaliva, as well as another drug called resmetirom have been delayed so far.

  • Another study, known as the SAMARA Study, is investigating semaglutide, an FDA-approved medication commonly used for type 2 diabetes and obesity, as a potential treatment for liver scarring caused by NAFLD. Semaglutide belongs to a class of medications known as GLP-1 receptor agonists, which mimic a hormone released in the gut in response to eating. This randomized trial will include 120 participants with type 2 diabetes and obesity, who will administer the drug or a placebo through weekly injections. The trial is distinctive for using non-invasive methods for screening patients in primary care settings, which could improve the detection and care for NAFLD patients. The next steps after this trial will be a larger, multicenter, international trial.

These ongoing studies and potential approvals indicate a growing focus on finding effective treatments for fatty liver diseases, which currently lack FDA-approved therapies.

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About the Author MyEndoConsult

The MyEndoconsult Team. A group of physicians dedicated to endocrinology and internal medicine education.

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