By ARIADNE WEINBERG, Featured Columnist
Nash syndrome sounds like something exotic, but it's actually way more common than it should be. In fact, there is a prevalence of 5% of Nash syndrome in the general population and up to 25-75% in patients with obesity and type II diabetes mellitus.
So what exactly is "Nash syndrome"? The great reveal. It is...non-alcoholic steatohepatitis, a form of liver disease. Nash syndrome is more common than alcoholic liver disease, and quite dangerous.
Nash syndrome may progress to cirrhosis and liver related death in 25% and 10% of the population, respectively, according to a 2002 study from A.J. McCoullough from the Robert Schwartz Center of Metabolism and Nutrition at MetroHealth Medical Center and Case Western Reserve University, in Cleveland, Ohio.
Non-alcoholic liver disease is most common in obese, middle-aged women with diabetes. However, the disease also occurs in children and men of an average weight with normal glucose and lipid metabolism.
The pathogenesis happens first with insulin resistance, which causes steatosis. Later, oxidative stress occurs, producing lipid peroxidation and the activation of inflammatory cytokines.
There are a few things you can do to avoid this progression, or keep it in check if it's already present. Read on to find out.
Get Some Exercise
Lifestyle changes can be one of the most important steps in oreventing liver disease, given the fact that pharmacological cures are still limited.
In 2016, D. Houghton from the Institute of Cellular Medicine in New Castle University in the United Kingdom performed a randomized controlled trial to study the effect of hepatic triglyceride content and the biomarkers of fibrosis in non-alcoholic steatohepatitis.
24 patients (average age 52, average body mass index 33) with sedentary lifestyles (less than 60 minutes per week of moderate to vigorous activity) and biopsy-proven non-alcoholic steatohepatitis were tested.
They were assigned to two groups: The first group of 12 exercised with cycling and resistance training. The second continued their life as usual. Both maintained their weight. The exercise group was supervised at an accredited Sports Center by a certified exercise specialist, and recorded three times per week on non-consecutive days.
After the 12 week experiment, results showed that hepatic triglyceride content was significantly reduced, as was visceral fat and plasma triglyceride levels.
Consider talking with your doctor about a good exercise plan to regulate or prevent non-alcoholic steatohepatitis.
2. Manage Your Diet, Cut Down on Salt
Eating a healthy, balanced diet, and keeping certain things out of your system, is key.
Y. Choi from the Sungkyunkwan University School of Medicine in Seoul, Republic of Korea studied data with the associations of intake of sodium (Na) and potassium (K) on ultrasound-diagnosed non-alcoholic steatohepatitis. In 2016, he performed a cross-sectional study with 100/177 participants (34.6% prevalence for men, 9.8% prevalence for women).
With potassium, there was no correlation to non-alcoholic steatohepatitis, but with sodium there was.
What the scientists found was that higher salt intake was associated with a greater prevalence in young and middle-aged asymptomatic adults of liver disease.
Scientists were also interested in looking at carbohydrate correlations.
It seems that, it's important to pay attention to your intake of carbohydrates.
In 2016, R. Tajima from the Ochanomizu University in Tokyo, Japan, examined cross sectional studies of 977 men and 1,467 women aged 40 to 69. Data was obtained using a validated self-administered diet history questionnaire.
It turned out that carbohydrate intake positively correlated with non-alcoholic steatohepatitis in women, but with men there was no such correlation.
So, if you're a middle-aged woman, try to replace some of those carbs with something else. Cut down.
3. Do Vitamin E Therapy to the Rescue?
Using Vitamin E for Nash syndrome is currently under investigation, either alone or in combination with other management methods.
Vitamin E has antioxidant potential that affects cell signal transduction and gene expression in vitro and in vivo.
The phosphorylation of vitamin E takes place in vivo, and results in a molecule provided with functions that are in part stronger and in part different from those of the non-phosphorylate compound.
According to a 2016 report from A. Azzi from Tufts University in Boston, this process slows down the progression of non-alcoholic steatohepatitis. It decreases inflammation and potentiates the immune response.
Vitamin E is pretty powerful. It has also been shown to help cardiovascular disease, cancer, cataracts, and neurodegenerative diseases.
A handful of almonds contains 7.3 mg of Vitamin E, about 27% of the minimum daily recommended amount. A cup of cooked spinach provides about 18% of what you need.
4. Add Omega-3 Fatty Acids
Omega-3 fatty acids are by now well-known and well-studied for their ability to lower your risk for cardiovascular disease and other health conditions.
In 2016, M.A. Noqueira and colleagues at the Sao Paolo University School of Medicine examined the effects of supplementation with omega-3 polyunsaturated fatty acids from flaxseed and fish on liver disease.
In their test, one group received three capsules daily, containing 0.315 grams of omega-3 polyunsaturated fatty acids, and the placebo group was given mineral oil. They later evaluated the liver biopsies histopathologically by the non-alcoholic steatohepatitis activity score.
The plasma levels of the omega-3 polyunsaturated fats were assessed as a marker of intake at the baseline and after six months of treatment.
The changes in plasma biochemical markers of lipid metabolism, inflammation, and liver function were also analyzed at the baseline and after three and six months of treatment.
It turned out that in non-alcoholic steatohepatitis patients, the supplementation of omega-3 polyunsaturated fatty acids from flaxseed and fish oils significantly impacted plasma lipid profiles and was associated with overall better liver histology.
So, if your liver is feeling weak, you know a few more things to buy on the way home.
Foods rich in omega 3 fatty acids are oily fish such as salmon, sardines and tuna.
5. Try Probiotics
There are many cases where non-alcoholic steatohepatitis and obesity go hand-in-hand. And microbiota actually differ between individuals who are obese and those who have a normal body mass index.
There is often increased intestinal permeability in non-alcoholic steatohepatitis, causing a higher risk of oxidative and inflammatory injury to the liver, from intestinal microbacteria.
With Nash syndrome, there is a danger of fatty acid injury and fatty deposition. Probiotics can help.
According to a 2015 report from A.A. Qamar at the Lahey Hospital and Medical Center in Burlington, Massachusetts, the role of probiotics is to prevent bacterial adhesion and translocation, and that it has been shown to improve some of the clinical markers in non-alcoholic steatohepatitis.
Even if you're not technically obese, depending on what state your liver is in, it could be a good option.
Consult your doctor to see if probiotics are applicable to your case.
6. Does Pentoxifylline Help?
This drug helps in reducing inflammatory response. By taking down inflammation, you also can reduce the possibility of progression of non-alcoholic steatohepatitis, avoiding tumour necrosis factor-alpha (TNF-α).
Pentoxifylline is a TNF-α antagonist that has been proved to be safe. It has been examined in several trials, two of which have analyzed histological response and shown improvement in steatosis, inflammation and ballooning, according to a 2012 report by Melanie D. Beaton from the University of Western Ontario.
7. Take Milk Thistle
Milk thistle has got this great active ingredient called "silymarin", which has demonstrated anti-inflammatory and anti-fibrotic properties.
There have been various experiments, but one, with the milk thistle product ETHIS 094 tested on animals, gives an idea of its benefits.
In 2014, P. Pais from the Euromed company in Barcelona tested 15 male mice induced with non-alcoholic hepatosteatosis. One group was given only the non-alcoholic hepatic steatosis induction, one group had it supplemented with milk thistle at 500 mg/kg, and the other had it supplemented with milk thistle at 1000 mg/kg.
In the high dose group, mean liver weight and liver-to-body ratio both went down, demonstrating an anti-steatotic effect.