What is NASH?

NASH is the acronym for nonalcoholic steatohepatitis.  It’s a type of advanced liver disease that is clinically indistinguishable from alcohol-induced liver damage, but whose causes are totally different.  Late stage NASH leads invariably to chronic cirrhosis and ultimately liver failure and death.  The most common cause of NASH is long-term obesity, and so the threat has grown in relation to the rising rates of obesity in western society.  Therefore NASH is quickly becoming an epidemic, with estimates of 15 to 30 million Americans living with the disease, the vast majority of whom are undiagnosed.  They are living with a ticking time bomb inside their bodies.

One of the most challenging things about NASH is that is usually asymptomatic until very late stages.  In earlier stages, the only common symptoms are fatigue and mild pain in the upper right abdomen (where the liver is located).  As you can imagine, these symptoms can also be easily mistaken for hundreds of other conditions, including just getting older.  As such it has been regarded as a silent killer disease.  As older generations have aged and lived with obesity over long time periods, the rate of NASH diagnosis’s has dramatically risen, with NASH now surpassing Hepatitis C as the leading cause for liver transplants in adults under age 50.  It is likewise on track to overtake Hep C in adults over 50 in the next few years.

There are also very few ways to diagnose the disease itself.  The preferred manner until very recently has been through invasive liver biopsy.  For obvious reasons, this isn’t a standard diagnostic test.  There are a number of blood tests that can be used to make preliminary diagnosis’s but they are also non-standard and not part of any normal checkup process.  One of my primary goals in promoting NASH awareness is to make such tests standard for anyone with sufficient risk factors, similar to the way that mammograms and prostate exams have become normal procedures.

There is currently no treatment for NASH.  While the liver is the only visceral organ with the ability to regenerate, once serious scarring develops it may become too damaged to repair itself.  That means that for suffers of severe NASH the only current treatment option is a transplant.  Complicating matters is the fact that generally unhealthy and obese patients are at high risk for transplant failure.  Therefore potential transplant patients must usually go through a healthy life change for a period of time to get to a manageable weight and overall health to be considered for transplant.  Given the rapid onset of late stage NASH symptoms and liver failure, this is precious time that they may not have.

Several biomedical companies are running large trials that are showing promising results for the treatment of NASH through medicine.  Given the enormous size of the potential population that will develop NASH, treatments for the disease are considered the largest untapped matter in medicine.  However, even with advanced treatments on the horizon, without more preventative early diagnosis procedures far too many will be faced with dire prospects.  The answer for doctors should be simple: if your patient has been obese for more than a few years or has other recognized risk factors then specialized blood tests to detect NAFLD/NASH should be administered.

7 thoughts on “What is NASH?

  1. Hi David,
    I came to your webstie after reading your reply to my post regarding NASH on the AFL website. Just wanted to say “Thank you” for doing this. I’m fairly new at this diagnosis & haven’t received much info on the “Do’s & Don’t’s” of NASH. I’m overwhelmed by the number of folks with this diagnosis whose illness has progressed simply because they didn’t know better or were never given the proper information to help stave the illness off and maintain better health. Really appreciate you reaching out to help others. Thank you again!

      1. David, Thank you for actively working on finding answers to this horrible disease. My sister was just diagnosed with NASH, She also still has her gallbladder. Her weight was approximately 145. She had previously lost about 80 lbs through the years. She has been having issues with diarrhea. She is diabetic, non insulin. One of her symptoms is her abdomen is full of fluid, like she’s about ready to have a baby, which she Isn’t since she is 64. They did draw off about 3 quarts of fluid which helped her to feel physically better but got no answers, other than there wasn’t any infection. She also had just had a stroke within the past 6 months which is also complicating the situation. She can’t stand or walk due to her balance being off. She has tried to use the walker, which helps UNTILL she loses her balance and falls over. She is on Coumadin due to have a mechanical mitral valve because she had rheumatic fever when she was little. Thanks for listening David and for your research. I am so happy to see this happening. I was diagnosed with calsyphilaxsis back in 2014. I researched about it and found it was a death sentence for those with kidney disease. Even some of the doctors didn’t know anything about it. It was so uncommon unless you were in the field of Nephrology. I had two biopsies done. One on each hip. I thank God for my husband because the biopsys led to ulcers that wouldn’t heal. I attended outpatient wound care for a year with the help of my husband who tended the wounds. They did heal because I didn’t have kidney disease then. I now have stage #3 and we are working on controlling that issue, I have diabetes but it is very well controlled with pills, no insulin. My A1C is almost normal and has been. I have lost about 120 lbs over the last two decades. My diabetes doctor just recently cut my medications in half and my body is tolerating this adjustment very well. Thanks for listening. I will research further on my kidney issue. God bless You

  2. Hello David, I attended the June 12 2019 webinar and heard you speak. I am end stage Nash, my daughter is 15 and has also been diagnosed with NASH. We are praying for miracles on all ends here. I am so thankful for all that you do in raising awareness.

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