The most effective treatment for serious NASH – Surgery

Ever since my Mom passed away suddenly after being diagnosed with late-stage NASH, I’ve been following the efforts of the medical community and many bio-pharma companies to develop effective treatments for the disease.  Mostly, I’ve followed the efforts to develop medicine that can slow or reverse the effects of NASH, as there is a lot of attention being paid to this and some recent successful trials.

I recently attended an event with a distinguished panel of liver experts and one of the discussion points that surprised me was how effective weight-loss surgery is at treating NASH.  I shouldn’t have been surprised, I suppose, because I already knew that losing a small amount of weight can lead to big improvements in NASH patients.  Surgery just seemed “extreme” to me, but in fact it is by far the most effective way to achieve sustained weight loss, and has even been called one of the most effective interventions in all of health care.

“Bariatric surgery is probably the most effective intervention we have in health care,” – Laurie K. Twells, Memorial University of Newfoundland.

One of the most challenging things for people attempting to reduce their weight permanently is keeping the weight off.  And the data that we have is incredibly daunting, suggesting that only FIVE PERCENT of people attempting permanent, long-term weight loss are successful over time.  And more and more research is confirming what doctors have known for a very long time; the struggles with weight loss are mostly biological and not a matter of will.  In other words, even the people fully committed to losing weight are facing an uphill battle with their own bodies natural inclination to maintain weight.


Some of the latest research is examining the effectiveness of weight-loss surgery with some surprising findings.  Researches have found that it may be the drastic change in the body’s microbiota, rather than simply the reduction in size of the stomach, that is responsible for the ability of the patients to loss weight quickly and effectively.  This suggests that future treatments for weight-loss could focus on changing the microbiota directly rather than far more invasive surgery.

There are unfortunately a lot of stigmas surrounding obesity, and specifically with weight-loss surgery.  People still see it as the “easy way out”, and associate it with laziness, competence, and responsibility for weight loss.  However, in the eyes of the medical community, it is viewed as the best available treatment for obesity, and could represent the best chance that patients with severe NASH have for avoiding permanent liver disease.

4 thoughts on “The most effective treatment for serious NASH – Surgery

  1. I recently had the occasion to go back several years and compare my weight changes to my liver enzymes bloodwork. While I know there are other variables at play, there was a seemingly direct correlation between my weight and the bloodwork outcomes. Unfortunately for me, I was on a weight roller coaster and I had lots or ups and downs to compare. If only I had know then what I know now. I’m a transplant recipient

  2. I’m 63 and was diagnosed with NAFLD/NASH/Cirrhosis late 2018.

    I grew up in a family where all of us were obese. My mother’s parents were Alcoholics, my mother chose sugar instead. Mom introduced me to OA, Overeaters Anonymous, using the same 12 Steps of AA. I was in my late 20’s. Before OA I’d already had 5 children and lost my gall bladder. I lost 100LBs, I even went to AA meetings when there were no OA meetings. Those in AA were stunned to learn I was the same as they, using sugar in dry form not liquid. After 5 years I took up sugar again and gained back all 100Ibs plus.

    When I reached 336 Lbs I had Royx-en-Y in 2004, I thought “it” would “cure” me. Unfortunately I had no idea how complex the physical, mind body relationship was. In the beginning it was easy, eventually I lost 155lbs. But 2 yrs later when faced with divorce after 32yrs I turned to sugar again. I was so upset when I took that first bite and it didn’t make me ill, I so wished sugar would have made me violently ill. I gained back 85lbs.

    I thought I was one of those healthy fat people, low blood sugar, low bad cholesterol, high good cholesterol, etc. I even had healthy babies with an avg 20lb weight gain and 6,2,2.5 and 4 hrs labor per. The 2.5 hr labor were twins, natural delivery and they were 7.1 and 7.6lbs. Never had gestational diabetes either.

    The only problem I thought I had was depression and had been on my fair share of physc drugs.

    Last yr I thought I’d broken a rib, after an X-ray then an ultrasound I was told I had an enlarged fatty liver and sent to a Gastric Dr. I was told no big deal, I had a fiberscan which came back as F4, cirrhosis! My endo showed no variiaces (sp?).

    Just before I thought I’d broken a rib my P.C. has sent neurologist because I’d been having memory issues, confusion, fog, sleep problems. I was diagnosed with dyskinesia due to some physc drugs I’d been on over the years. It causes my mouth to droop on one side of my mouth and some hand tremors. All test came back clear and they sent me to a neuropsychologist for 5 hrs of testing to see if any memory loss patterns could be found. In the end I was told the memory issues were not dementia related, but the test showed I had a “short” in my brain, things don’t process correctly.

    Once diagnosed with liver disease and researching it was easy for them to diagnose H.E. I’m on Lactulose now. I’ve only seen a nurse practitioner at my gastro to date, had to push hard to see the Hepatologist, but I’ll finally get to see him June 5th and hopefully learn more.

    So although surgery is good, it’s a much more complex issue and a good number of people like myself gain the weight back.

    1. Hi Cathy, thank you so much for being brave enough to share your story so candidly. Everything about the body/mind relationship is indeed extremely complex. I just wrote about how sugar is the catalyst for much of metabolic syndrome including NASH.

      Good luck and godspeed to you on your journey.

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