If you’re a teetotaler, like Susan Minch, you probably expect your liver to be in tip-top shape.
But several years ago, Minch’s “numbers” — measurements of her liver enzymes — started rising. Eventually, she was diagnosed with non-alcoholic steatohepatitis, a liver disease commonly called “NASH” that can turn into cirrhosis.
That discovery led to a sobering realization: Poor eating habits, plus chronic infection, can harm your liver, just as drinking too much alcohol does. It could even lead to a liver transplant.
As with heavy drinking, a combination of poor eating and infections can make a liver scarred, hardened, and unable to play its role in metabolism. The reason? Too much of the wrong foods causes excess fat buildup in the liver, known as fatty-liver disease. That leads to NASH, and then, for non-imbibers, non-alcoholic cirrhosis.
Fatty-liver disease may be harming about 30 million Americans, according to figures from the American Liver Foundation. And, according to the National Institutes of Health’s (NIH) estimates, up to 15.5 million may be affected by NASH — characterized by inflammation and damage to the liver. Today, NASH accounts for about 10 percent of newly diagnosed chronic liver disease, and is one of the major causes of cirrhosis in the United States, behind hepatitis C and alcohol.
And like hepatitis C, NASH is a so-called silent disease. Its symptoms — including fatigue, weight loss, and weakness — don’t show up until the disease is advanced.
Dr. Anne Roberts, chief of vascular/interventional radiology at the University of California, San Diego, uses liver biopsies to diagnose NASH; she says that, given what she’s seen, there will be a NASH epidemic in five to 10 years. She says the rapid rise of NASH among children is especially alarming.
Minch, 67, doesn’t want to be part of Roberts’ epidemic, but it’s unclear whether she can stop her disease from blooming into something more serious. Her husband has health issues, and she has other relatives who need help, too, so she’s primed for caregiver neglect.
“Watching my own health was never a top priority,” admits Minch, of Royal Oak. Unfortunately, she also has high blood pressure and type-2 diabetes.
Fortunately, Minch is seeing Dr. Mary Ann Huang, a liver specialist at Henry Ford Hospital. At Huang’s suggestion, Minch is eating better, helped in part by diet-changing recipes from diabetic cookbooks.
She’s also forming some new habits. For instance, she’s learned to carry a healthful snack to keep temptation at bay while away from home. Also, thanks to Huang, Minch is enrolled in research and is taking either a placebo or an anti-cholesterol drug that might help to treat NASH.
Kevin Pearson, 52, of Detroit, also enrolled in Huang’s research. He’s had fatty-liver disease more than 10 years, but never took it seriously until bad knees forced him to leave his postal-carrier job. He had one knee replacement and one hip replacement, was walking much less than when he was a mailman, and gained 60 pounds. Pearson had thought that his old job’s physical demands meant he could eat all the burgers and fries that came his way.
Now that he’s confronting NASH, he’s learning that what he eats matters, too. So he’s developed a taste for yogurt, artificial sweetener, and oatmeal.
Huang thinks there’s another component to NASH, too. Minch’s grandmother “never had a drop of alcohol,” but was diagnosed with cirrhosis when she was in her 50s. Pearson’s mother died of cirrhosis, but she did drink later in life.
“I think genetics is part of it,” Huang says.
Even though there’s no formal treatment for NASH, Huang and other doctors’ best advice is to lose weight, eat right, exercise, and get enough sleep (see related story on opening page). That’s because NASH appears so often in people who have some combination of too much weight, metabolic syndrome, diabetes, and high cholesterol.
In fact, Huang published a study in 2005 of 23 NASH patients treated with intense nutritional counseling: out of 15 who successfully completed intervention, nine improved, and six stayed the same. A more recent small study showed that NASH improved in people who lost 7 percent or more of their body weight.
Large research institutions are also looking at the disease. An NIH research consortium that includes Roberts’ UCSD has looked at treating NASH with weight loss, diabetes medications, and vitamin E, all of which showed some success, and omega-3 fish oil. Another NIH-funded researcher reported success using leptin to treat NASH in people who are deficient in this fat-metabolism hormone. But a big breakthrough is yet to come.
“There really hasn’t been anything new,” says Huang. “It’s very frustrating.”
However, researchers now suspect that abnormal fat metabolization may be the culprit. In July, the NIH gave a $1.7-million grant to Dr. Kezhong Zhang, a Wayne State University molecular medicine researcher, to further study a fat-controlling protein, whose function he and his department discovered. Zhang believes the protein, CREBH, is closely associated with fat building up in the liver, and with fatty liver’s progression to NASH.
He’s trying to figure out how that happens and learn how to control the protein, possibly leading to a medication to treat NASH.
The assistant professor doesn’t just think about molecules; he also focuses his research on stress and how it relates to disease. He throws poor sleep schedules and air pollution into the mix of NASH promoters. “I think air pollution is a big factor for metabolic diseases because of the body’s stress response,” he says.
Other WSU researchers working independently from Zhang may hasten his results. The National Science Foundation recently funded Drs. Yinlun Huang (no relation to Henry Ford’s Huang) and Howard Matthew for three years to develop a mathematical module that would predict liver metabolism of fats. Ultimately, it could guide Zhang and others to investigate what would most likely be helpful, saving time and money in the process, Matthew says.
“Our preliminary model is reasonably good at predicting a response,” he says. “Our predictions were close to what happened in a [petri] dish.”
Matthew, an expert in tissue engineering, is also working toward growing a fully functioning liver from liver and stem cells (see article at right).
In the meantime, even though Minch won’t know for a while if she took the research medication or a placebo, her newfound focus on her health has helped her to drop 37 pounds.