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NASH Studies Unit -Take Care of Your Liver

General advice for people with NAFLD and NASH
What to do

Lifestyle Modification

“Lifestyle” means that changes you make are things that you can live with for the rest of your life (and if you do, your life will likely be longer!).
Avoid drastic crash diets or overly ambitious exercise programs. Just make small changes—they add up to big differences over the years.
Vary what you do depending on the weather, your level of energy, your mood, and the company you keep.

Exercise

Take stairs instead of elevators. Start with one flight up, two flights down.
Walk to do errands.

Weather is nice? Park in the easy to find spots further out in the parking lot.
In general, the more often you do activities that make you sweaty and out of breath, the better off you are. (Reminder: check with your doctor first.)
Talk to your primary physician before beginning any exercise program.
Don’t stay at work for such long hours that you don’t have time take care of yourself.

Healthy Eating

Avoid fast food: fat content is usually too much and portion sizes are commonly too large.
Fat you eat does not go straight to the liver, but it is a major source of calories.
Excess carbohydrates (sugar, starch) are converted to fat in the liver and cause fatty liver. Soft drinks are a major source of excess sugar in the diet.
Weight loss is good, but exercising your muscles may be more important. Both weight loss and exercise are the best.
Avoid fasting. Fasting makes your liver work extra hard.
People who are the most successful at maintaining weight loss are those who eat breakfast and exercise regularly.

Hepatitis A vaccination

Your chances of severe liver disease or death caused by hepatitis A are increased if you already have a liver problem.
Hepatitis A is transmitted by food handled by someone with this viral infection.
The vaccine works great. Get two shots six months apart and never worry about hepatitis A again.
Get the vaccination from your primary physician or your local county health department.
You might also consider hepatitis B vaccine if you are at risk (e.g., unprotected sex, IV drug use, regular contact with hepatitis B carrier).


What to avoid

Limit or avoid alcohol: drink no more than one beer or glass of wine or mixed drink per week.
There are no particular foods that are bad for the liver. Some foods are bad in the sense that they are high in calories, so that when eaten in excess they become bad for the liver. Many fast food items are bad for the liver because the serving sizes are excessive.
Ask your doctor about herbal or natural remedies. Some can damage the liver.


Common concerns

What about Tylenol (acetaminophen)?

Take no more than 2000 mg per day for occasional use (6 regular tablets or 4 extra strength tablets). Liver damage from this dose has never been reported, even in people with liver disease.
If you use Tylenol/acetaminophen regularly, you should limit your use to 1500 mg (5 regular or 3 extra strength tablets daily).
Be sure to count acetaminophen in other medications that you take (for example, Vicodin, Percocet).

What about cholesterol lowering medications such as Mevacor, Lipitor, Zocor, and Pravachol?

Despite what the TV ads say, these medications seem to be okay if you have fatty liver disease.
Liver enzymes should be checked before starting, 3-6 months later and then every 6-12 months when taking one of these medications. This is about how often we check with fatty liver disease anyway.
If liver enzymes go up after starting one of these medications, it is not clear that this is particularly bad for the liver. This is different than with some other drugs when rising liver enzymes means the drug should be stopped right away.

Are any other medications harmful?

Excess iron can damage the liver. You should only take iron supplements if you know you are iron-deficient.
High dose vitamin A supplements can cause liver damage and should be avoided.
Just about any medication has been reported to cause rare liver damage.
If you develop any new symptoms of any kind after starting a new medication, report this to your doctor right away.

What about herbal remedies? Are any harmful or helpful?

Many herbal remedies contain active ingredients. How much is usually uncertain and variable. Some herbal remedies clearly cause liver damage (e.g., Kava kava) and some are worrisome on theoretical grounds (e.g., St. John’s Wort).
Milk thistle has not been shown to be harmful. Whether it is helpful or not is not clear. It is certainly not cheap.

The “H” in NASH stands for hepatitis. Does this mean that NASH is contagious?

No, NASH is not contagious. “Hepatitis” simply means inflammation in the liver. Although some people have liver inflammation (hepatitis) because of infections by viruses such as hepatitis B and hepatitis C, NASH is not caused by an infection of the liver and is not contagious.

The opinions expressed here are those of Dr. Tetri. If you have any concerns or questions, be sure to ask Dr. Tetri or your primary physician. It is especially important to talk with your doctors before beginning any program of strenuous exercise.

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