NASH: what is reversible?

[lecc]

Hello all,

I recently was diagnosed with nash and i ve been trying to learn as much as possible about the disease.

However, i ve came to the realization that the internet contains conflicting statements specially when it comes to the question "is nash reversible". I have found both yes and no answers and i suspect they might refer to different features of the disease.

So here are some simple questions for whose answers i d be very very grateful:

1) assuming a change in life style and and improvement in metabolic profile, is it possible to reduce (or even remove) the inflammation of the liver in a case of nash without fibrosis?

2) in case of a yes answer for the first question, is it also possible for a case of nash with fibrosis?

3) is it possible to reduce the fat content present in the liver? Or is it the fat content permanently there?

Many thanks in advance!

[Baracuda25]

Here are the answers based on my personal experience :

1) Yes. Basically you just remove the fat and the inflammation stops progressing and gets reversed proportionally to the amount of fat which gets removed from the liver.

2) Yes. Basically the same idea as with the case without fibrosis but with a little difference that fibrosis is a permanent thing and it won't go away however it might get "softer" and in some cases act as a healthy tissue.

3) Definitely yes, it's possible to reduce it and the whole treatment for NASH is based on the removal of the fat deposits in the liver.

I personally have(hopefully had) F2 fibrosis and had for almost 5 years mildly elevated livers enzymes which i managed to normalise after the diet and lifestyle intervention (in total lost 20kg of weight and i wasn't really overweighted) which means that inflammation is gone and i believe fat as well (at least it got reduced significantly, so that it doesn't cause severe inflammation). But i believe that the damage fat did to my liver is going to remain much longer and i'm not sure that it can be reversed at all, so the main idea is to keep it like this as long as possible, since the liver can still function properly even if it's damaged as long as there is enough healthy tissue.

All I stated above is fully based on my experience and for others might be different, but i believe that all of us can agree that lifestyle and diet interventions are the only weapons we have against NASH and if it helps to halt and compensate it then it's definitely worth to do even if it's not going to reverse it entirely (which is frustrating I know).

Good luck and don't give up!

[lecc in reply to Baracuda25]

Hi Baracuda,

this community is really great, you guys are really motivating me to keep fighting!

Did you have fibroscans before and after your life changes? I wonder how much the measurement of the fat content went back (so I can have a realistic goal to work on). Personally, I have S3 F0 (and currently normal liver enzymes)...

I have a tiny hope that with a lot of hard work i could bring S3 back to S2, but dont know whether this is a realistic assumption.

[Baracuda25 in reply to lecc]

Hi Lecc,

I didn't have any fibroscans before my lifestyle interventions, but i had a liver biopsy(twice) which is a "golden" standard for NASH diagnosis which by the way can be also "false negative" (my previous one two years ago didn't show any fatty liver neither fibrosis).

Also i didn't have any fibroscans after the lifestyle interventions, but i had regular blood tests every 3 months and they were getting better proportionally to the weight i was loosing which I believe is highly correlated with amount of fat which was leaving my liver.

You are in a much better situation than most of us who has a fibrosis and if you will work hard enough i believe you can bring your liver back into healthy state, but you have to understand that those lifestyle changes should stay forever with you because if you stop them everything will come back.

Keep going!

[Hidden in reply to Baracuda25]

Hello. Did either of your biopsies show fat or fibrosis. You mention the one showing neither so was curious if the other one. How high did you liver enzymes get before the modifications ?

[lecc in reply to Hidden]

Around twice higher than normal... but i did not get a biopsy.

[Baracuda25 in reply to Hidden]

Hello,

First biopsy showed no fibrosis and less than 5% of fat (at this time i already had mildly elevated ALT which was around 70 and AST was fine) and then in two years F2 fibrosis borderline NASH with 30% of fat. If i remember correctly the highest values i had were 147 ALT and 53 AST which was exactly before i started interventions.

I believe the first biopsy targeted the healthy part of the liver hence there were no signs of anything and then the second one went into the "right" place. Otherwise i can't explain how can it progress that fast from 0 fat and no fibrosis to 30% and F2.

[Hidden in reply to Baracuda25]

Ah and how long since the second biopsy? And since then the lifestyle modifications have shows the liver enzymes going down?

[Baracuda25 in reply to Hidden]

It's almost 8 months since the last biopsy and my latest values are 41 ALT and 25 AST (month ago) together with minus 20kg of weight (went from 94 kg to 74kg).

[Moonsta in reply to Baracuda25]

I agree. I lost 53 pounds and my liver has improved. The scarring can't be changed, but your liver will be healthier. My hardest thing is avoiding foods that contain sugar. It's in everything!

[Kdrc36]

With s3, that indicates you only have fatty liver, no fibrosis. I also had just fatty liver no fibrosis. My tests were 6 months apart and in that time I lost 30 lbs, started exercising, better diet. My test at 6 months showed zero fat left. Enzymes also back to normal. You can reverse fatty liver back to normal. It’s the fibrosis levels that are tougher to reverse. Keep working at it, you’ll get there.

[Maxi99 in reply to Kdrc36]

What kind of test did you have done to show there was no more liver fat? I am wondering what my options are to measure my progress down the road.

[Kdrc36 in reply to Maxi99]

Hi! I had an MRE (MRI with elasticity). The fiber scan didn’t work for me.

[lecc in reply to Kdrc36]

But did you know the S scale you had before making the lifestyle changes? With S3 I would be really happy to move back to S2, but I think reverting to S1 is out of the possibilities.

[Kdrc36 in reply to lecc]

I don’t know what the level was but had a ultrasound 5 years ago with no fat and they compared it to the first MRE. They said it was heavily fatty. My understanding is you can completely remove fat at all levels depending on why it’s accumulating. It’s the scarring that harder and takes longer and sometimes reduces by 1 level once you get to a certain level with changes to lifestyle. I think you’re getting the S levels confused with the F levels. Maybe nash2, Wayne, can verify that for me.

[lecc in reply to Kdrc36]

Understood. I m doing my best to live a liver friendly life. I ll keep fighting thanks for sharing your story, its quite inspiring!

[Kdrc36 in reply to lecc]

You’re doing all you can at this point. Report back. I’d love to hear how your story turns out.

[lecc in reply to Kdrc36]

I will, i am eager to share a success story in the future.

I panicked when i learned about nash and my fat liver. This community helps a lot. Thank all of you for that!

[Hidden in reply to Kdrc36]

Hi there. How high did you alt and ast get? Did the first test show a lot of fat?

[Kdrc36 in reply to Hidden]

Alt was 131, 12-78 normal. AST was 71, 15-37 normal. Alp was 129, 45-117 normal. Yes, first test showed heavily fatty. But enzymes don’t always equal what your level of damage is. They can be normal with damage.

[Kdrc36 in reply to Hidden]

I also had a fiber scan that didn’t work for me. Don’t know why, just gives me false readings. Said severe scarring into cirrhosis. MRE showed no fat no scarring.

[Hidden in reply to Kdrc36]

Wow! Mine ultrasound showed normal liver but fibroscan showed greater than 67% fat (not sure how to ultrasounds could miss that) with slight to minimal scarring on fibroscan. Did they find out what caused your elevated liver enzymes if no fat? Or you mean you had fat but the latest showed none abs you reversed it? Did your liver enzymes go back to normal one the fat went away?

[Kdrc36 in reply to Hidden]

Yes, I was diagnosed with fatty liver last September with elevated liver enzymes. An ultrasound and regular MRI verified fatty liver and was told that it looked heavily fatty. Obviously they can’t be super accurate with those tests on scarring or fat level. I was referred to a hepatologist, I then did a fiber scan that didn’t turn out. That test said mild fat and severe scarring, but hepatologist said it was a bad test for me. Then I had another ultrasound (done by a pulmonologist due to another issue) and it showed no fat. Then an MRE that showed no fat no scarring. Now, there was a 4 month gap between my first ultrasound and MRI showing fat to getting an appointment with the liver doctor. Somewhere in that time, enzymes and fat changed back to normal. So I’m saying, for me, it took about 6 months for my changes in lifestyle to have everything go back to normal. I have to check enzymes every 3 months and will repeat MRE annually. Hope this helps. Enzymes numbers and fat or scarring don’t always equal each other but my enzymes went back to normal when the fat was gone.

[Baracuda25 in reply to Kdrc36]

What is really interesting that all stories i read so far including mine were mentioning that liver enzymes came back to normal after 6 months since the lifestyle interventions. I'm wondering if it's just a random coincident or there is some sort of natural period during which liver is able to flush all the extra fat accumulated.

[Kdrc36 in reply to Baracuda25]

In all those stories, people have changed their diets, started exercising. I don’t think it’s a coincidence. When you start not adding additional fat and alcohol to your diet and you start exercising, which is working off fat, your liver has a chance to start clearing the fat it has accumulated thus your not damaging the liver and enzymes return to normal. I was eating horribly. Never ate fruits and vegetables. Was eating a lot of restaurant food and fast food. I was not active. I’ve always been a thin person but over the last few years put on 30 pounds. No doubt bad eating habits and no exercise was my problem. I’m not sure I answered your question. I think with liver disease, there’s a lot they still don’t understand. I also read in your earlier post here about your 2 different biopsies. Have you done any other tests? It’s true, your biopsy is only as good as the piece you take out. I’d be curious to see what an MRE would show. Per my hepatologist your still in a good place for reversing your situation. He thought I’d could possibly be an f2 due to another diagnosed issue I have but was happy to see nothing more was happening.

[Baracuda25 in reply to Kdrc36]

All my story started 5 years ago when my liver enzymes started climbing slowly and since then i had plenty of MRI, ultrasounds, gastroscopies and colonoscopies. All of them were "normal" and my doctor at the beginning was telling me that "nothing to worry". Then at some point i had a toxic hepatitis because of medications which was pretty weird since i was taking ursodeoxycholic acid which was suppose to "help" the liver. Then i had my first biopsy which was "normal" except that there was a sign of inflammation which was resolving. Since then i was suffering constantly with all kinds of different issues (IBS, reflux, psoriasis, allergies) and in the end i was diagnosed with alpha 1 antitrypsin deficiency which was the reason why the second biopsy was performed and that's when NASH(they called it borderline NASH) was diagnosed.

My doctor also told me that the outcome looks good especially that my liver enzymes came back into normal ranges, so i still have a hope that at some point i will get healthy again.

[Kdrc36 in reply to Baracuda25]

Oh my gosh, I have alpha 1 too! I was diagnosed shortly after my routine blood work showed elevated liver enzymes. And that started months of doctors and tests. May I ask your age and alpha pheno type? I’m mz and they expected my liver to have some scarring because of the alpha. I’d still love to see something like an MRE with you just to confirm your level. All the other tests minus the biopsy will not show scarring and the biopsy will only show a tiny piece of the picture. I didn’t want a biopsy for that reason and the risks that go with it. Both docs, liver and pulmonologist are alpha 1 specialists and said alpha wasn’t the cause of my fatty liver but over time would have exasperated the damage.

[Baracuda25 in reply to Kdrc36]

I'm sorry to hear that you are "alpha" as well.

My type is mz (0.8 and the normal range is 0.9-2.0) as well and i'm 32.

My hepatologist and pulmonologist said the same that alpha1 is not the cause of my NASH, but it may do an extra stress on the liver which in combination with other factors can accelerate any kind of liver disease. Basically we were told more less the same thing.

Based on my experience I don't trust any other diagnostic tool except biopsy which i plan to redo in one year, so it's going to be 2 years since the intervention. However i might also ask to measure the stiffness of the liver after the year of the intervention since this one was more less inline with the biopsy results.

[Kdrc36 in reply to Baracuda25]

Understand! The MRE is different from an MRI and also considered a gold standard test and less invasive. But, I understand where you’re coming from. I had a fibro scan that scared me to death and was wrong. So, I’ll only do the MRE unless I absolutely have to. I’m alpha 1, MZ, serum 76, normal is 90-250. And I’m 55.

[sosteady in reply to Kdrc36]

Thank you (and Barracuda 25) for being here, I am sad for your illnesses but grateful for your clarity and information - your interactions with each other are fantastic and very helpful to the rest of us. all the best to you both, sosteady

[Kdrc36 in reply to sosteady]

Thank you so much. That was kind of you.

[confused71 in reply to Kdrc36]

Hi I have Alpha SZ and nash stage 2 liver disease I was told that my Nash wasnt caused by the Alpha but caused by my being overwieght and diet --- I have never drunk alcohol I was 73 when i had my biopsy and will be 76 in October

[Kdrc36 in reply to confused71]

Yep, just bad diet. Have you bettered (probably not a word 😊) your liver situation?

[confused71 in reply to Kdrc36]

I kept of the weight i lost for 2 years --my KPA went down from 9.8 to 7.1 in less than a year my LFT went from 128down to 26 which is well in the normal range ---I have put on 10 pounds in this latest lockdown so I am not sure where that leaves me hopefully when the summer kicks in I will want to eat more salads .I eat a mediteranean diet . I feelso much better and most importantly i havent progressed

[Kdrc36 in reply to confused71]

That’s great! I read a study that followed fatty liver people who gain some weight back, pretty much 10 lbs, and their fatty liver didn’t return. So you’re probably okay on the weight gain. Just don’t let it keep growing 😊. Not only did my liver blood work come down into normal but my cholesterol went down 100 to 200 from 300. Crazy what eating good and moving around does for your body.

[sosteady]

Hi lecc,The fat is deposited in the liver as a slow drip drip over years. Yes it is removable albeit the same slow steady determined way. The liver is the most recoverable organ in the body. The inflammation is aggravated by the stored fat.

All those are facts, now you must determine how much of your lifestyle are you willing to modify to improve your liver? It will not be fast but it is doable, stay the course and you will be impressed with yourself!

I sure have been amazed at my results. Plus you feel better! It’s a win-win.

all the best on your journey

[lecc in reply to sosteady]

I am willing to modify every single bit of my life to fight this thing! Life is awesome and i wanna be here for a long time! Thanks a lot for answering! You keep going also! Let us live long and healthy

[sosteady in reply to lecc]

Great attitude-this is a great site for ideas, inspiration and help. We are here for each other-be well

[confused71]

I am not managing to lose fat from liver but have halted progression --I think different people different results

[lecc in reply to confused71]

Hi,

can you share a bit more? How long has your situation remained stable? What were your fibroscan results and how does your blood work look like?

Thanks,