Weight loss can treat liver disease
Dear Dr. Roach: I had right upper abdominal pain, and my doctor suspected gallbladder problems. The abdominal ultrasound reported “hepatic steatosis,” aka fatty liver disease. My labs were all normal, including an ALT test of 19.
My doctor did not seem concerned about this diagnosis and had little to offer. Could you please discuss nonalcoholic fatty liver disease? I’d be particularly interested in any dietary or supplemental recommendations.
Anon.
Answer: The word “fatty” carries a stigma, so the names have changed. Nonalcoholic fatty liver disease, now called steatotic liver disease, is a spectrum of illness — from the more-benign metabolic dysfunction-associated steatotic liver disease (MASLD) to metabolic dysfunction-associated steatohepatitis (MASH). The difference between the two is liver inflammation that may lead to liver fibrosis and even cirrhosis, which is the end stage of liver disease.
Treatment of MASLD, even in people without MASH, includes avoiding alcohol. It is clear that heavy alcohol use makes the disease progress, but even occasional use may also be harmful. So, it is best to avoid it. For most people, weight loss is the primary therapy.
The specific diet is less important than the actual weight loss, but I want to be clear here that crash or fad diets are not healthy and rarely lead to sustained weight loss. Working with a registered dietician can help ensure a good diet.
Supplements are not part of therapy for most people with MASLD. Vitamin E is used for some people who have MASH but don’t have diabetes; this decision requires careful consideration and consultation with an expert. Vitamin E has not been proven effective in people with diabetes, and it has been shown in one large trial to increase the risk for prostate cancer. So, it should not be used in a person at a very high risk for, or with a history of, prostate cancer.
Drug therapy to help a person lose weight can be considered in people who would benefit from weight loss but who have not been able to accomplish this with lifestyle changes alone.