Reversing Silent Liver Disease: How to Manage MASLD Early On
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| Early detection and lifestyle changes, such as weight loss and a Mediterranean diet, can reverse MASLD in its early stages.(Image Aljazeera) |
Metabolic Associated Steatosis Liver Disease (MASLD) is a condition that can affect the liver for years without noticeable symptoms. This disease has gained increased attention due to its ability to develop unnoticed, causing severe liver damage before being detected. Early detection and management are essential, as MASLD can be reversed through lifestyle changes, yet many patients remain unaware of their condition until it's too late.
According to a report from The New York Times, MASLD impacts an estimated 40% of the global population. It can be reversed in its early stages, particularly with interventions such as weight loss. However, patients like Geraldine Frank, a 61-year-old woman who showed no symptoms until late in the disease progression, often miss early warning signs. Geraldine's son, David Frank, noticed her jaundice – a sign of liver failure – prompting a visit to the doctor. Unfortunately, by then, her liver was severely scarred by cirrhosis, a condition where the liver develops permanent fibrotic tissue.
Cirrhosis develops over years, often as a result of untreated MASLD. MASLD occurs when fat accumulates in the liver, which can eventually lead to inflammation and scarring. As Dr. Meena Bansal, the head of liver diseases at Mount Sinai Medical School in New York, explains, MASLD is "mostly asymptomatic until it reaches an advanced stage." By the time symptoms appear, such as jaundice or fluid accumulation in the abdomen, the liver is often already failing.
Individuals with MASLD typically have metabolic risk factors like obesity, high blood sugar, or high blood pressure. These factors contribute to excess fat storage in the liver, leading to the disease. One in four MASLD patients develops a more advanced form called Metabolic Associated Steatohepatitis (MASH), in which fat accumulation causes inflammation and damage to liver cells. About 20% of MASH patients progress to cirrhosis, which can eventually lead to liver failure and increase the risk of liver cancer.
People with type 2 diabetes or obesity, particularly those with excess abdominal fat, are at higher risk of developing MASLD. Insulin resistance and excessive calorie intake, especially from saturated fats and carbohydrates, are key contributors. As fat builds up, it releases chemicals that trigger inflammation, further damaging the liver cells. Latinos are at increased risk due to a higher prevalence of metabolic conditions and a genetic predisposition to fat accumulation in the liver, as noted by Dr. Arun Sanyal, director of the Stravitz-Sanyal Institute for Liver Disease and Metabolic Health at Virginia Commonwealth University.
The liver attempts to heal itself by producing collagen, which results in scarring, or fibrosis. If fat continues to accumulate and inflammation persists, the scarring worsens, eventually leading to cirrhosis. Doctors use a scoring system called FIB-4, based on routine lab tests, to identify patients at risk of advanced liver disease. However, as Dr. Sanyal points out, many patients do not undergo regular screenings, meaning MASLD often goes undiagnosed until cirrhosis has already developed.
By the time Geraldine Frank received her diagnosis, it was too late to reverse the damage. She passed away just five weeks later. This tragic outcome highlights the importance of early detection and lifestyle changes in managing MASLD. Weight loss and dietary adjustments can reverse MASLD in its early stages. If fat accumulation and inflammation are halted, the liver can recover.
Doctors recommend the Mediterranean diet, which focuses on whole grains, lean proteins, fruits, and vegetables, combined with at least 150 minutes of aerobic exercise per week. Resistance training is also encouraged to maintain muscle mass and boost metabolism. Bariatric surgery has been proven to reverse fibrosis, and new weight-loss medications like Ozempic offer hope for slowing liver disease progression. The U.S. Food and Drug Administration (FDA) recently approved resmetirom, a medication that targets inflammation and fibrosis in the liver, offering an option for treating patients with stage 2 or 3 fibrosis.
Lifestyle changes have made a significant difference for patients like Shawana James-Coles, a 54-year-old school district administrator from Pennsylvania. After being diagnosed with MASLD and stage 2-3 fibrosis in 2021, she worked with her doctor and a nutritionist to make gradual changes. These included practicing chair yoga before work and taking daily walks. She also monitored her carbohydrate and sugar intake, replacing sugary oatmeal with healthier alternatives like egg omelets. As a result, Shawana lost 50 pounds, and her fibrosis is now classified as stage 0-1. "Maintaining that will be critical," she says.
MASLD is a silent but serious condition that often goes unnoticed until it has caused significant liver damage. However, with early detection and lifestyle modifications such as weight loss, a healthy diet, and regular exercise, the progression of MASLD can be halted or even reversed. Raising awareness about the importance of liver health and regular screenings, particularly for high-risk individuals, can help prevent the devastating outcomes associated with late-stage liver disease. Effective treatments and new medications like resmetirom offer hope for the future, but personal commitment to lifestyle changes remains crucial in managing this growing global health challenge.
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