mburgs

Hi Dr. Callery,
Thanks so much for this site, there's so much information. I have been diagnosed with early stages of NASH, my PCP doesn't typically interact with that many morbidly obese patients so I just have a couple of questions:

I have already rectified my diet, but had an ALT level of 65, is this typical of obese patients or is this high regardless? I am not on any medication (just got meds for insulin resistance today).

In general, will my liver be able to repair itself on its own? Is there anything that will help i heal nutritionally speaking? I'm assuming this would qualify more as a comorbidity thus a 'positive' for surgery, is there any way this will hinder my chances of approval?


Thank you!
Megan

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Dr. Callery

NASH stands for non alcoholic steatohepatitis. When one gains weight fat accumulates in the liver. With time the fat can effectively cause inflammation of the liver tissue, ie. hepatitis. If the inflammation is severe enough it in turn can cause liver damage and scarring. The scarring is caused cirrhosis. As cirrhosis gets more severe it can lead to portal hypertension and liver failure. Some patients have had to go on to liver transplantation.

To make things more complicated, people can have a combination of problems that affect the liver. These commonly include viral infections and alcohol toxicity.

If one has simple fatty liver or has NASH, weight loss can reverse the liver abnormality. If cirrhosis has occurred, it is permanent. But progression of the cirrhosis can be halted or minimized by weight loss.

I can't comment on your personal lab test results. Best to ask your PCP or surgeon. NASH generally doesn't qualify as one of the major comorbidities that would prompt surgery for BMI 35 - 39. But there is no harm in using it in your problem list when your surgeon requests authorization for surgery.

Here are some pics to illustrate the progression of fatty liver to NASH to cirrhosis.

1. Near normal liver
2. Fatty liver
3. NASH
4. NASH Cirrhosis

Attached Thumbnails

       

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