This is MASH - From Fatty Liver to MASH
Reviewed by Dr. Peter Rawlek, MD and Dr. Scott Rollo, PhD
Historically, medicine viewed alcohol as the major cause of fatty liver disease and liver cirrhosis. Then came a modern disease called MASH, Metabolic Dysfunction Associated Steatohepatitis. If that is not a mouthful, I do not know what is.
MASH is largely a disease of modern lifestyles. It reflects the consequences of decades of increasing inactivity and the widespread availability of highly processed foods that deliver large amounts of energy into the body very quickly. So quickly, the body doesn’t know where to place it, and the body pushes the extra energy to storage.
Unlike alcohol-related liver disease, MASH refers to the metabolic form, and not the alcohol related form, of fatty liver disease. It develops when more energy enters the body than active tissues need, more energy than your muscles are using (here in lies the opportunity). The excess energy is converted to fat and stored. Some of that fat storage happens to end up inside liver cells. Not good!
At first, this condition is called fatty liver disease. In this stage, fat is accumulating inside the liver, but there may be little obvious damage. The encouraging news is that this stage is often reversible.
The problem begins when too much fat accumulates inside liver cells. Imagine trying to run a busy factory while gradually filling it with boxes. Eventually there is less room to do the work the factory was designed to do.
The same thing happens inside the liver. As fat builds up, liver cells become stressed. Their normal functions become less efficient. Harmful byproducts begin to accumulate. The body's immune system recognizes that something is wrong and responds with inflammation.
This inflammation is called hepatitis. When fatty liver progresses to fatty liver plus inflammation, the condition is called MASH.
If the inflammation continues for years, liver cells become injured and die. The body responds by laying down scar tissue in an attempt to repair the damage. Initially the scarring may be mild, but over time it can become extensive. This advanced scarring is called cirrhosis.
In some individuals, years of inflammation, cellular injury, and repeated repair increase the risk of liver cancer.
Today, being overweight, insulin resistance, type 2 diabetes, inactivity, and highly processed diets are all strongly associated with MASH. Alcohol can make the process worse and accelerate progression, but the underlying problem is often an ongoing mismatch between the amount of energy coming into the body and the amount being used.
The encouraging news is that the earliest stages are often reversible. When people reduce excess energy intake, improve food quality, become more physically active, and maintain healthier body weights, fat can leave the liver and inflammation can improve. In many cases, the liver is remarkably capable of healing when given the opportunity. See this link to the lifestyle changes that change outcomes.
My only marker: Remember it is insidious and the only early markers are: your lifestyle, how you eat and the waist line. My waitline tells all and tells me:
“Hey there, you need more exercise and less carbohydrates over the next few months. Just get on it!”
