NASH: non- alcoholic steatohepatitis is a part of this spectrum of NAFLD that also has inflammation of the liver. It is the most common form of progressive liver disease. NAFLD should not be treated as completely benign as it can sometimes lead to NASH which can progress to cirrhosis. In a patient whose liver enzymes keep climbing I would treat aggressively.
NASH does set the stage for liver damage and the cellular features of alcoholic or non-alcoholic liver disease are identical.
Diagnosis is made when liver enzymes are high and the following are ruled out: negative for hepatitis, don’t take medication that can raise liver enzymes such as diltiazem, corticosteroids and tamoxifen, have not had extreme weight loss, no excessive alcohol exposure and have not been exposed to organic-solvents.
Fatty liver is also diagnosed on xrays and imaging studies. A liver biopsy is the most conclusive test. Most of the patients I am seeing are like Andrew, age 55, who is obese, with elevated blood sugars and has insulin resistance which is the most common cause of fatty liver. Andrew is pre-diabetic meaning that his blood sugars are close to seven mmol/L and his fasting insulin levels are also high but his hemoglobin A1C is below 7.0. His doctor has told him that he has a fatty liver based on his blood work and an ultrasound of the liver.
Andrew’s GGT was over 100 U/L, his ALT was 75 U/L and his AST was also in the above 70 U/L. I explained that an elevated GGT has been shown to relate to the liver’s inability to make adequate amounts of glutathione in the mitochondria of the cell. Glutathione is a powerful antioxidant that helps the liver process large number of toxins from inside and outside the body. I explained that magnesium, B vitamins, cysteine, glycine and glutamic acid are some of the building blocks of glutathione that would help improve his liver function and lower his liver enzymes.
Another test that is helpful to evaluate NASH is homocysteine, a protein in the blood that becomes elevated when the body is deficient in B2,