Fatty Liver details

June 13 was Global Fatty Liver Day. Here are some points on fatty liver that doctors won't generally tell you.

1️⃣ Fatty liver disease is now known as "Steatotic Liver Disease" to remove stigma and body shaming.

2️⃣ Fatty liver can be due to significant alcohol use or metabolic disease or both. Alcohol-related fatty liver reverses completely in 2-4 weeks with abstinence. You do not need drug treatments. Metabolic disease-related fatty liver disease reverses when associated metabolic disease is controlled (diabetes, obesity, hypothyroidism, high lipids, hypertension & heart disease). It requires treatment from metabolic disease point of view. Fatty liver due to both causes, called "MetALD" requires both abstinence and control of metabolic disease. An obese alcohol user has far worse outcome than non-obese alcohol user. But both have same high risk for many types of cancers.

3️⃣ Treating fatty liver based on only an ultrasound finding of fatty liver is wrong. Grades of fatty liver on ultrasound ➡️1, 2 and 3 are just patterns of fat deposition in liver. Grade 1 does not mean lower severity of disease and Grade 3 does not mean higher severity of disease.

4️⃣ If you find fatty liver on ultrasound, look for reasons for fatty liver. You do not treat the effect. You treat the cause. Obese? Lose weight. Diabetes? Control your glucose, maintain calorie deficit diet. Alcohol? Stop drinking. Many doctors will prescribe drugs for fatty liver solely based on ultrasound findings. They are looting you. A large majority of fatty liver patients require only lifestyle changes and no drugs.

5️⃣If you find fatty liver on ultrasound and there are associated risk factors or causes for the fatty liver, then assess the risk of you having or developing severe form of fatty liver. This is called steatohepatitis or NASH, now called MASH. This is the severe form of fatty liver that requires treatment. Do not jump to do a Fibroscan or Shearwave test to look for steatohepatitis. Listen...

6️⃣If you have fatty liver on ultrasound + risk factors (age >40 and metabolic diseases) for severe fatty liver, then screen yourself with the FIB-4 or NFS scores.
FIB-4 (use if 40-65y): hepatitisc.uw.edu/page/clinical-…
NFS (use if <40 or >65y): omnicalculator.com/health/nafld-f…
Remember, only use these scores if you have ultrasound fatty liver AND metabolic risk factors.

7️⃣ Now if the above scores are beyond cut off for significant or advanced (severe) fatty liver disease (also called significant fibrosis due to fat and inflammation) then go for Fibroscan or Shearwave (elastography) test to confirm presence of significant/advanced fibrosis in liver.

8️⃣ Those patients with significant or advanced fibrosis due to fat in the liver are the ones who require drugs for liver disease apart from drugs for metabolic disease and lifestyle changes.

9️⃣The currently approved drug for severe non-alcohol related fatty liver disease is Resmetirom (for those without cirrhosis). And the other recommended ones include vitamin E and pioglitazone. No other drugs are to be given and are not approved or recommended for non alcohol related fatty liver.

🔟 In India, a pharmaceutical company promoted drug called Saroglitazar is heavily prescribed by physicians, surgeons and specialists. This drug is NOT recommended by major Hepatology clinical societies for treatment of severe fatty liver disease. It is expensive and must be avoided. Many looter-doctors prescribe Saroglitazar even just based on ultrasound findings of fatty liver. Pharma promotion of this drug is out of control in India. But consumer/patients beware. It's use is only limited to diabetes patients with high triglycerides and not for severe forms of fatty liver.

1️⃣1️⃣Similarly other drugs like ursodeoxycholic acid, s-adenosyl methionine, combination of dietary supplements, n-acetyl cysteine, silymarin, vitamin C or herbal products are all waste of your money and sometimes more damaging to health. Avoid them and avoid doctors who prescribe them. more  

View all 6 comments Below 6 comments
There's no medicine for fatty liver. There's no medicine for modification of lifestyle There's no healthy cooking oil,despite overhyped olive oil which is used for salads in western countries, those people never use oil oil to fry potatoes because of its high boiling point, compared with our good old mustard oil or coconut oil or til oil or groundnut oil...all of them are extracted from seeds Desi ghee or clarified butter is a good fat,giving us good cholesterol, HDL and good cholesterol is not bad,rather There's no upper limit for good cholesterol level which is responsible for building up immunity, movement of joints and healing of wounds All supplements as vitamins or proteins work as add on factor of stressed liver Live with nature and eat healthy foods through nature Exercise according to your capacity Avoid outdoors because of heavy levels of pollution in Delhi and NCR and others as metro cities more  
Madam, looks a well written post on Fatty liver. Too many abbreviations for a non medical person to fully understand. more  
Causes of fatty liver in women are reproductive hormones, natural hormones and synthetic hormones, multiple pregnancies and abortions and easy availability of MTP pills without prescription Causes in men are alcohol, cigarettes and consumption of bad fats, ( applicable to men and women) Modification of lifestyle through proper diet and exercise according to capacity of affected person is helpful for reversal of some damage caused by fatty cells to delicate liver cells Intake of vitamin C through natural sources like lemons and citrus fruits helps BTW guava has more vitamin C among all fruits which too have this vitamin C Drink water directly and indirectly Avoid unhealthy fats,packaged foods Avoid supplements as vitamins or as proteins Liver cells have capacity of regeneration faster, than other cells, provided they're not loaded more than they can tolerate Regeneration and degeneration of cells is going on 24 hours..hair,nails grow..blood cells grow etc. Weight reduction helps Passage to heart is through liver Keep liver healthy and add on to the heart health more  
how to protect fatty liver patient who are Non Alcoholic more  
Avoid supplements as vitamins or proteins
Drink lots of water directly and indirectly
Vitamin C through fruits and vegetables and coconut water helps
Weight reduction helps
I've written details of reversal of fatty liver here
Liver health leads to heart health because of similarities to avoid certain things and to encourage certain modifications in lifestyle
Take care more  
Doctors specialized in this branch of medicine, please confirm the above findings so as to be doubly sure. more  
Language is technical but true
Ultrasound can be normal but fibroscan can show fatty liver changes
There's No Medicine for Fatty liver
Even vitamin C should be taken through plenty of natural sources which are likely to give others as vitamins and minerals, responsible for healthy body more  
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