British Liver Trust

NASH and Total Confusion! :o)

Hi Everyone,

I am totally confused about my NASH diagnosis of 8 months ago. My doctor is even saying that she may not have diagnosed me correctly, as no biopsy was done.

I will try to make this short and to the point. Over the past several years, I gained quite a bit of weight. Much was due to depression and a sedentary lifestyle. I also wasn't eating a healthy diet and was not exercising. In February of 2014, I fell down from the top of our hardwood stairs and landed on my head at the bottom. I remember nothing of the accident, the ambulance ride, hours in the ER with tons of blood drawn, x-rays and CTs. During this visit to the ER, I was given a copy of all of my blood test results. My liver enzymes were slightly higher than they should have been.....about 30 points higher on both my AST and my ALT. About three weeks later, I went to my internist and we followed up on the enzymes. By this time, my AST and ALT were even higher...but in the low 100s. She immediately tested me for Hepatitis, HIV, etc... and everything came back negative. Next, I had a liver ultrasound which came back with results that terrified me. Moderate to severe fatty infiltration of the liver, with no other remarkable findings.

My doctor said that the combination of elevated ALT and AST along with the fat in my liver meant that I had NASH. I did NOT have a biopsy. I freaked out and immediately started a very healthy, liver friendly diet and started exercising every day. Within 4 months, my enzymes were back to normal and have remained that way.

Here's where things get weird. We discovered that a medication that I started taking for my anxiety, about 2 1/2 weeks before my fall, actually caused me to be clumsy, and thus, my plunge down the stairs. My psychiatrist was horrified and read the drug monograph. It is indeed known to cause elevated ALT and AST. So now....the delimma. Have my AST and ALT levels gone down so rapidly because I stopped the respective medication at the end of March or have they gone down because of my new dietary and exercise routines? I eat very well and have lost 60 pounds. I have not had a follow up liver scan, as my doctor said that it's too early.

My question? Do liver enzymes elevated by NASH appear and elevate very quickly and then go back down within a few months with lifestyle changes? I was under the impression that it took longer than that. So, I am totally confused as to weather I have NASH at all, but GI won't do biopsy because she said treatment for NAFLD and FLD were the same and that the biopsy could be dangerous. My internist has now said that she doesn't think I have NASH, as did my GI, my OBGYN and my own father who is a physician. What symptoms would I be having if I have NASH other than elevated enzymes? I am so confused.

Can someone who knows more about this than I do, please help me? Thank you all...I really appreciate your input!


10 Replies

The ultrasound showed a fatty liver, well done for sorting it out! Im not sure if the medication could cause the fatty liver,but does it matter? You have got rid of both and your liver should be alot more healthy, just keep doing what your doing? I think most doctors would give it 6 months before another scan, but it really depends how much fat was there, some can get rid of it in a month or 2.

1 like

Hi Ralph....thank you so much for your response. Although my enzymes are back to normal, I haven't had a repeat liver ultrasound yet. I think my doctor wants to wait until the beginning of 2015 when I am scheduled to have my blood work analyzed again to discuss the follow-up liver scan/ultrasound. Thus, I have no idea if/how much fat is still in my liver. I guess I am really curious that if this is NASH, at this point, can I reverse it with continued healthy lifestyle practices? Did I confess to you that I have been craving....and giving in to that craving.....cookies at night for the past 2 weeks? I hope that hasn't caused significant damage! I have broken the habit tonight and have had no cookies.....even though I WANT some!!! :o) I'm just so paranoid of the unknown. And yes, I plan on continuing my exercise routine (walk 5 miles a day) and my healthy eating, MINUS the cookies! Luckily, I love fruits, vegies, nuts, fish and other liver-healthy foods. Argh....I just wish I could get a definitive diagnosis and know if I'm going to live a long and healthy life. Thanks again for your positive response! I hope you have a wonderful evening! Robin


try leave the cookies for now, I would also do a bit more than walking, sweat it out of you. Liver issues give alot of stress and anxiety once you start on google.


You are SO right about googling and the stress and anxiety caused by confusing and conflicting information! What other exercises/activities would you suggest for me to sweat that fat out of my liver? I am willing to try anything! I've actually gotten addicted to my 1 1/2 hour walks. I put on my Contemporary Christian music and it really gets me walking. I'm not sure where you live, but I live in a hilly area of the US. I also live in the south, so it's still pretty hot here, thus, LOTS of hills and sweating! As I said, I would love to hear your suggestions! Thanks so much for your help! And NO cookies tonight!!! :o) (Or the night after that, the night after that, etc.....) Hahahaha.....what is it about cookie cravings?????


Personally I cycle, you can burn loads off. I live in a hilly area too. Yes google scared the crap out of me, i had a heavy beer weekend 3months ago and felt like crap, i havent drunk since and went to the doctor and had blood test and ultrasounds, all clear, but im still a little worried.


Congratulations on three months sober! Although my doctor has told me that my elevated ALT and AST enzymes have absolutely nothing to do with alcohol ingestion, I am a recovering alcoholic working on my 8th year of sobriety. It's been one of the greatest things I've ever done for myself and my loved ones. I'm not in any way insinuating that you are an alcoholic, but it sounds like staying away from alcohol has been a positive step for you. I think you might be a long lost relative of mine. We are both hypochondriacs and addicted to googling our illnesses and freaking ourselves out! We both like reassurance and don't always trust our doctors, so we continue to go to numerous doctors, ask a zillion questions, not trust anything we are told by second, third and forth doctors and then go back to the crazy internet again! Can you say nuts? I can!!!! Just don't say COOKIES!!!!!!!!!!!!!!! Have a great night! Robin


I think there are many types of Alcoholic. I think i was, i used to drink pretty heavy twice a week and would work looking forward to my night out on the beer, I consider that alcoholic because it did have a hold over my life for 2 nights. Giving it up has been easy once I realised that it can harm you and I just dont need it. I was usually pretty cavalier about my health but this really got my attention and I have been scared beyond reason at times. Yep I think my doctors are getting annoyed with me, they are starting to offer psychological help. Well it was google that gave me the kick I needed, but sometimes it can be just very very scary.


Hi. You have done well to get your liver enzymes and your weight down. One word of caution though, for a lot of blood tests the American's use different systems to what we use in the UK, so comparisons to UK results are difficult, The important thing is that your liver enzymes are now down. I think the only thing proven in your case is that you have a fatty liver - Look at some of the literature on the British Liver Trust. I am sure there are other reliable sources for information, but I can really recommend the B L T ones -remember a lot of what you read on the internet is potentially rubbish and scares people! Any exercise is good - cycling, swimming, walking, etc - the aim being to get your weight to a healthy level and keep it there. You are doing well at present. I do not know what tests you can have in the US on your medical insurance - but a fibroscan might be useful. Keep up the exercise, avoid alcohol, and enjoy yourself rather than getting hung up with all the Googling. Good Luck.


My liver died from NASH. The only way it can be truly identified is with a liver biopsy. NASH causes a liver to become totally cirrhosis after many years. The cirrhosis causes the liver to become fatty because it does a bad job of pulling the fat out of your system. In my case it took about 30 years before the beast appeared. I had just turned 65 when I found out. Cirrhosis can not be reversed. It is dead tissue.


Wow, caseyliver....I am so sorry to hear this news. Did you find out that you had NASH 30 years ago and it's just now turned into cirrhosis? I understand that NASH can be reversed with diet and exercise. Any other ideas from your experience that I can do to prevent progression of NASH? I will keep you in my prayers. You remind me of how serious NASH can be. Robin


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