Flying Blind with NAFLD in the UK – My GPs seem oblivious to the latest understanding of NAFLD causes and treatments

[DBradley]

I have posted a couple of times on here discussing my own experiences WRT my liver fat, trying to figure out how serious it is, and knowing the best way forward. I have found improvement of surrogate markers of liver health (ALT, gGT, etc) through lifestyle change – mainly diet and exercise, so I have a way forward, to aim for some sort of future treatment/management strategy.

The reason I’m posting here now, is that I find myself feeling like a fly at a window, banging my head on the glass, and not getting anywhere WRT to my GPs, getting medical help, and trying to establish a formal diagnosis and liver health baseline.

I’m in the UK, and my GPs seem unable to really get there head around what is going on for me, or the potential seriousness of liver fat in general, opting for a don’t worry about it, and come back in a few years when it’s a lot worse approach, at which point they will be able to refer me to a hepatologist.

This is leaving me without any medical guidance, or expert help going forward. This means I’m in the driving seat rather than an expert, having to figure out the best way forwards. Trawling the vast medical literature regarding NAFLD, though useful for understanding, takes me no further forwards with respect to knowing where to go for a definitive way forwards.

So the point of my post is this:

Please could those of you with a good experience of being tested, and monitoring your own liver health, and understanding the more relevant modern testing technologies (e.g., Wayne #nash2), please would you mind outlining what in your opinion is the best cascade of analyses to perform to achieve a definitive baseline analysis, that will categorically quantify my liver health (I have ALT, AST, ALP, GGT, and blood lipid data, and 2 qualitative ultrasound reports at 2 years apart). E.g., is it best to push for a Liver Mutliscan to quantify my liver fat content? Is best to get a Fibroscan? Would it be better to a basic MRI?

In terms of monitoring my liver health as time goes by, do you think it’s sufficient to keep an eye on ALT and blood lipids, or would it be better to push for regular spectroscopic liver fat quantification?

[nash2 Partner]

Try Fib-4 to see if you are above the lower cutoff. If you are lower you should stop worrying. If you are above it get a Liver Multiscan to find out your liver fat and stiffness measurements then you can talk to the docs with specifics

[DBradley in reply to nash2]

Thanks.

Yes my fib-4 came back at 0.61. Which is very comforting, especially given your comment. I just wasn't sure how much I can trust the fib4 given it's 5% false negative.

Both ultrasounds show mild liver fat, they were 2 years apart and it was impossible from the report to tell if my NAFLD IS progressing. I'd imagine it will take years of dieting and low BMI to remove this fat.

I'm going to check my ALT and blood lipids, every 3 months or so for a while, to see if they remain stable as I transition to a long term sustainable lifestyle from this strict diet.

I seem to have a carbohydrate metabolism issue, as I have never been over the BMI threshold. Saying that I feel I had a level of visceral obesity before losing 14 pounds, and 2 inches from my waist circumference.

Do you think monitoring in this way is a sensible way forward given the technology available at present?

[nash2 Partner in reply to DBradley]

Fib-4 deals with the probability of fibrosis. Since your score is low, you should be comforted and stop worrying so much. Fatty liver is a condition that you can deal with through lifestyle and it is likely not causing irreversible damage but may if ignored for a few years. If you feel the need to know the actual amount of fat you need to have the Multiscan or an MRI-PDFF which will measure it directly but if your Fib-4 stays low and your AST/ALT ratio is less than 1 you are on fairly solid ground absent other symptoms.

[DBradley]

Thanks Wayne, your view on this subject is very helpful for perspective for me.