3 Ways To Advocate for Yourself With NASH (MASH)

The relationship with your medical team is critical to your health. Our medical system can be tough to navigate. A shortage of healthcare workers and pressure on providers to see more patients in less time is making it even tougher. More than ever, advocating for your health is a MUST. Here are three areas you should advocate for yourself with NASH (also called MASH).

Screenings

NASH is linked to a number of other health conditions, due to its relationship with metabolic health. That means if you have NASH, you are at risk for type 2 diabetes and cardiovascular disease (such as heart attacks, chest pain, strokes, heart failure, etc.).^1,2 You may also struggle with your cholesterol and blood pressure levels.

Early and/or increased screenings for diabetes and kidney and heart disease are so important! That includes having your cholesterol, blood glucose, and blood pressure levels checked regularly.³ Additionally, NASH can be more difficult to manage if you also have other liver diseases, such as hepatitis. Screening for these and staying up to date on your vaccines is key to caring for your body.⁴

The takeaway: Attending your medical appointments for exams, lab work, and screenings, as well as asking what tests and labs are being done and why, is a key part of advocating for yourself.

Medications

Medication can be an incredibly helpful tool for managing many health conditions, including NASH. Most medications used in NASH are used off-label. That means they’re approved by the FDA to treat another health condition, but they’re also used to treat NASH because studies show they help target liver fat. This is important to understand for 2 reasons:

1. When you Google your medication (most of us do, don’t we?) it may worry you when it says it's a medication for another health condition. You may question your medical team, the medication, and so on. Again, almost all medications used for NASH are off-label. Talk your provider if you don’t understand your medication plan.
2. If you have another chronic disease, you may get the benefit of using one medication to treat both that condition and NASH/MASH. Ask your provider if there are medications that will help both NASH and other health conditions (ex. diabetes) and if any of these medications come in combination form (two medications in one injection or tablet).

Here’s a little insider’s scoop. Over 50% of people with NASH also have type 2 diabetes. A number of type 2 diabetes medications help target liver fat.⁴ Newer diabetes medications can lower the risk of heart disease and protect kidney health, both things you’d want as an added benefit to your NASH treatment.

Finally, be open with your provider and pharmacist about your use of alcohol and drugs, supplements and herbs, and over-the counter medications. Overuse of certain products can interfere with your medications and/or cause injury to your already struggling liver.⁵

The takeaway: Communication is key. Discuss with your provider which medications you’re prescribed and why. Find out what benefits to expect, side effects to report, how to take it, and any other potential options for treatment. You may even be able to see a clinical pharmacist for support in reviewing your medication plan.

Follow-up

For many people, NASH is silent. There are little to no symptoms. That means you could be feeling great, but your liver disease could be progressing. Often one of the best ways to find out what’s going on inside the body is routine bloodwork or imaging (like US or CT). You need to know what kind of monitoring your provider plans to do and how often. You also need to know what’s considered healthy and where your results are trending.

For example, let’s say you and your provider are monitoring your liver labs, such as AST and ALT. The questions you should be asking are: What’s considered a healthy range for AST and ALT? What are my current results? What were my results the last few times it was checked? (This is called trending. Are your labs showing little change, getting better, or getting worse? You need more than one result to see a trend). At what point would we change my treatment plan based on these tests?

In addition to knowing how your provider is going to be monitoring your liver health, it’s also important to know signs and symptoms of worsening liver disease. Ask your provider for specific directions on when you should call them. In general, signs of poor liver function include decreased appetite and/or nausea or vomiting, yellowing of the skin and eyes, fatigue, pale stools and/or dark urine, bloating or pressure in the belly, legs or ankles, and difficulty breathing. Some people also notice they bruise more easily.⁶

The takeaway: Take the time to understand how your provider plans to follow up on your liver health. This includes BOTH understanding how they will be monitoring your liver function and how that will inform what is used. Ask what signs and symptoms you should be looking for and reporting to your provider.