Dr. Wy, why does my doctor say I have hepatitis from too much fat? I eat a low fat diet!

Ask Dr. Wy…

Richard Wyderski, MD, FACP

Dr. Wy, why does my doctor say I have hepatitis from too much fat? I eat a low fat diet!

I suspect your doctor noticed that one or more of your liver blood tests was abnormal, and that led to a liver ultrasound demonstrating too much fat in the liver, a condition called Metabolic Associated SteatoHepatitis, or MASH for short. It’s most common in obese people, but prediabetes, diabetes, high blood pressure and high cholesterol are also risk factors. By definition it develops in people who drink little or no alcohol. In the US, about 1 in 3 people have it or a similar condition called MAFLD (Metabolic Associated Fatty Liver Disease) where the liver blood tests are still normal. It also isn’t directly caused by dietary fat.

The danger of not treating it is that it can lead to permanent scarring of the liver, a condition called cirrhosis. Cirrhosis can lead to liver failure requiring a liver transplant and is a strong risk factor for liver cancer. That’s why people at risk for it should be screened and get treated before complications develop. By the time MASH causes symptoms, the liver damage may be permanent.

The good news is that early treatment effectively prevents complications, Weight loss through diet and exercise with or without the weight loss drugs semaglutide or tirzepatide can normalize the liver cells and even reverse early fibrosis, a precursor to cirrhosis. If that fails, another option is a new medication called resmetirom that’s currently indicated when stage 2-3 fibrosis is present.

If you’re at risk for MASH or MAFLD, please talk to your doctor about getting screened. We all need healthy livers!

 

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