Non Alcoholic Fatty Liver Disease

Hi. I have been having raised LFT for quite some time now. I am on Biological Drugs for skin condition call Psoriasis and also Type 2 Diabetic (16yrs), plus suffer with Aneamia.

2 weeks ago had a Fibroscan and have been told I have Fibrosis and graded at 10. Have an appointment to see a Liver Specialist - just wondered what treatment is there for Fibrosis.

Thanks in advance for replies.

8 Replies

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  • Unfortunately there is no actual treatment for fibrosis, however, if the cause of the fibrosis is tackled then there may be a chance of slowing it's progress or even reversing the fibrosis.

    In your case this will need to be some analysis of your other pre-existing conditions, the drug regimes involved and possibly some adjustment to lifestyle (especially dietary if perhaps you are overweight not that you necessary need to be even though you have NAFLD).

    Dietary advise for NAFLD (directly copied from the British Liver Trust website) states:-

    Non-alcohol related fatty liver disease (NAFLD)

    Non alcohol related liver disease is a term for a wide range of conditions in which there is a build-up of fat in the liver cells of people who do not drink alcohol excessively. Initially the fat deposits may not be associated with any symptoms, however, in some people this may progress to inflammation – non alcoholic steatohepatitis (NASH) which may in turn lead to scarring and cirrhosis.

    You are more likely to develop a fatty liver if you:

    are overweight or obese, particularly if you put on weight around your middle (apple shaped)

    have high blood cholesterol

    have diabetes

    have been diagnosed with insulin resistance (where your body does not respond to insulin as it should)7.

    If you have a fatty liver you may be advised to make changes to your diet and life-style including:

    cutting out or down on alcohol (remember, alcoholic drinks are often high in calories

    taking regular exercise, such as walking or swimming

    eating plenty of fruit and vegetables

    eating slow-release starchy foods, such as bread and potatoes

    avoiding refined sugars and saturated fats – as in chocolate, cakes and biscuits.

    if necessary, slowly reducing your weight to a healthy level for your build and age, and keeping it there.

    If you are diabetic, then it is important to work with your doctor to keep your blood sugar levels under good control. If your blood cholesterol is high or you are insulin resistant, you may be prescribed medication as well given dietary advice.

    I hope that helps.

    All the very best.

    Katie

  • Thank You Katie.

    An interesting read. I do not understand Why? I have NAFLD - I do not drink Alcohol, I'm a Vegetarian, take Insulin, my Cholesterol is 3.2, I am 12stone 10lbs for my height of 5ft 8mins tall. Have got to lose the 10lbs by May this year, always on the go as I am a Carer for my partner, don't eat between meals.

    GP says I am on 3 different tablets that could be related, but leave it until I see Liver Specialist he will advise what is to be done.

    I am bewildered???

  • Hi William.

    How long have you been on medication for the psoriasis and have you checked to see if it elevates liver enzymes over time?

    With the diabetes,have you progressed over a long period from controlling it initially with diet, then medication, and now insulin. Drugs like Metformin can affect the liver, best to discuss this with the liver specialist. Unfortunately diabetes does put you into the risk category for NAFLD which long term can cause fibrosis just like other causes of liver inflammation.

    I suspect this needs your diabetic team to communicate with your liver specialist to find the best solution for you.

  • Hi Bolly and Thanks for reply.

    I have been on medication for 10 years for the Psoriasis : ACITRETIN just over 5 yrs, Methotrexate 18mths, STELARA (Biological Drug) 18mths and now on HUMIRA (another Biological Drug) began in October 2014

    Diagnosed Type 2 Diabetic 16 yrs ago and taken Metformin for 15yrs and on Insulin for nearly 2years now. I think it is the BIOLOGICAL DRUGS because the elevated LFT began about 8 - 9 yrs ago. It was the Dermatologist who referred me for a Fibroscan because my liver function blood results were climbing.

    Thanks.

    William

  • I think you may be right about the drugs elevating the liver enzymes. There are some cases of the psoriasis drug causing elevated enzymes, though it's rare and can in some cases be resolved by coming off the drug.

    But that's the dilemma. You need the meds for your health problems to stay stable.

    Sounds like a frank discussion needed with your doctors about the risks of the meds long terms versus the benefits of them.

  • Thank You Very Much.

    You are a STAR.

  • Long term medications are generally not ideal what ever they are. There are countless stories of medications fixing one thing but, causing another years or decades later.

    Fibrosis is scarring of the Liver. Its usually measured in 5 categories :

    F0

    F1

    F2

    F3

    F4

    F0 is no scarring, which is what you want. F1 and F2 are mild scarring, this type of scarring should heal over time if the cause is removed.

    F3 is usually know as Progressive Fibrosis, this will continue to spread even if you remove the cause, it usually progresses to F4 also know as Cirrhosis.

    F4 the dreaded Cirrhosis, this will spread and lead to Liver failure and death.

    F3 and F4 can be slowed from spreading by making life style changes and avoiding chemical ridden environments. But they do progress generally.

    Diabetics seem to be prone to Liver problems, especially fatty liver, I suppose its not surprising considering its a metabolic issue and the Liver runs the show on that front.

    This grading of 10, is it 10kpa as in the Fibroscan scoring? If so that would mean you are getting into serious damage, if you have Fatty Liver disease. The Fibroscans numbers mean different levels of damage depending on the cause.

    here is a scoring card:

    upload.wikimedia.org/wikipe...

    Another thing to remember with the Fibroscan is that raised LFTs can cause it to give a reading higher than it should. The accepted level can be up to 2kpa of extra stiffness. So with your raised LFTs you could be 8 or 9kpa in reality.

    Obviously we are not doctors, each Liver issue is a different situation, but your tests to date do strongly suggest you need to act and fast.

    So what you need to do now is have a think and get ready for your appointment, its usually advised to take a friend or family member with you. Take a list of questions.

    what I would ask:

    1) Can you give me information on the best diet for my Liver issues

    2) Can we take a look at my medications to see if they are stressing my Liver, may I need alternatives?

    3) With changes to life style/medications put in place will I be able to have more Fibroscans to monitor for improvements?

    4) Can we confirm what the cause is? Do I have fatty liver disease or is it from something else?

    These are just a few thoughts off the top of my head, at this stage I would say you need to find the cause in order to have the best chance of halting/healing this.

    Good Luck.

  • Thank You Very Much Ralph2014

    An interesting and informative read.

    Regards, William.

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