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NASH: A liver disorder not caused by alcohol

September 28, 2011
By Mary Lou Williams, M. Ed. , Fort Myers Beach Bulletin, Fort Myers Beach Observer

The association between fat accumulation in the liver and alcohol has been recognized for centuries. However, when fatty liver occurs in the absence of alcohol, the condition is called nonalcoholic fatty liver. It is the human equivalent of foie gras, the same condition produced in geese by force-feeding them more calories than they can use.

This disorder is not new, but its discovery is of relatively recent origin. The medical term for fatty liver is steatosis. When inflammation occurs with fatty liver, the condition is called steatohepatitis. In 1980 the term nonalcoholic steatohepatitis, or NASH, was coined to describe a condition of fatty liver inflammation occurring in people who drink little or no alcohol. NASH is not associated with other causes of liver disease, such as hepatitis B and C viruses or autoimmune disorders. Like alcoholic hepatitis, NASH can progress to cirrhosis.

A possible cause

The underlying cause of NASH has not been conclusively established. However, some researchers think that sugar may play a role. Excess glucose (sugar in the blood) is converted into fat and stored in the liver in the form of triglycerides. In one study, rats fed a diet high in sugar developed fatty livers in proportion to the amount of sugar they were fed. Another study was done in humans with abnormal liver tests potentially due to fatty liver and associated with a high sugar diet. Dietary sugar restriction resulted in normalization of liver function tests.

Further supporting the role of sugar as a factor in the cause of fatty liver and NASH are the primary risk factors for these liver disorders: obesity, type 2 diabetes, and elevated blood levels of triglycerides and cholesterol. All of these risk factors are associated with high sugar intake, including elevated triglyceride and cholesterol levels: sugar raises triglyceride levels, which in turn raise cholesterol levels. Other risk factors for fatty liver and NASH are rapid weight loss, starvation, weight-reduction surgery, and medications such as steroids (like prednisone), estrogen, amiodarone ( a heart drug), methotrexate (used in chemotherapy and for arthritis), and NSAIDs (ibuprofen, naproxen, ketoprofen, aspirin, etc.).

Symptoms and treatment

Symptoms of fatty liver or NASH are often unspecific, such as fatigue, weakness, or lack of energy. But sometimes upper abdominal pain or discomfort over the area of the liver and a feeling of fullness or bloating in that area may also occur. This may be due to the stretching of the liver with fat. A liver biopsy is needed to confirm a diagnosis of NASH. As with all liver diseases, avoidance of alcohol is essential regardless of the cause. Reduction of sugar intake is also essential and can be part of lifestyle changes to reverse or control overweight, type 2 diabetes, and high triglyceride and cholesterol levels.

A natural remedy that can supplement lifestyle changes is polyunsaturated phosphatidylcholine. It has been shown to protect against fatty liver and various other types of experimental liver damage in animals. It is approved for chronic liver diseases in many European countries, and it is listed in the PDR (Physicians' Desk Reference) for supplements in the United States. It is not indicated for people with clinical depression as high dosage has been shown to worsen depression in some cases.

Mary Lou Williams, M. Ed., is a lecturer and writer in the field of nutrition. She welcomes inquiries. She can be reached at 267-6480.



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