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Eating, Diet, & Nutrition for NAFLD & NASH

How can my diet help prevent or treat NAFLD?

If you don’t have nonalcoholic fatty liver disease (NAFLD)—nonalcoholic fatty liver (NAFL) or nonalcoholic steatohepatitis (NASH)—you may be able to prevent these conditions by eating a healthy diet, limiting your portion sizes, and maintaining a healthy weight.

If you have NAFLD, your doctor may recommend gradually losing weight if you are overweight or have obesity.

Your doctor may suggest changes to your diet such as

  • limiting your intake of fats, which are high in calories and increase your chance of developing obesity.
  • replacing saturated fats and trans fats in your diet with unsaturated fats, especially omega-3 fatty acids, which may reduce your chance of heart disease if you have NAFLD.
  • eating more low-glycemic index foods—such as most fruits, vegetables, and whole grains. These foods affect your blood glucose less than high-glycemic index foods, such as white bread, white rice, and potatoes.
  • avoiding foods and drinks that contain large amounts of simple sugars, especially fructose. Fructose is found in sweetened soft drinks, sports drinks, sweetened tea, and juices. Table sugar, called sucrose, is rapidly changed to glucose and fructose during digestion and is therefore a major source of fructose.

If you have NAFLD, you should minimize alcohol use, which can further damage your liver.

Last Reviewed April 2021

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. The NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by the NIDDK is carefully reviewed by NIDDK scientists and other experts.

Sours: https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/eating-diet-nutrition

NASH Patients: Add These Foods to Your Diet

The second most common reason for liver transplant is a condition called nonalcoholic fatty liver disease, also known as nonalcoholic steatohepatitis (NASH).  NASH takes place when fat accumulates in the liver of people who drink little or no alcohol. At its most severe, NASH can progress to cirrhosis and liver failure.

2016-11-04-almond crusted chicken

If you have NASH, losing weight and becoming more active are currently the primary treatments for a fatty liver. If your condition has progressed to liver failure and you need a transplant, your physician may recommend weight loss prior to receiving a transplant so you’re healthy enough for surgery.

What you can do

With weight loss, making healthy, long-term changes is key to success. We recommend a modified Mediterranean diet because studies have shown it can help reduce the amount of fat stored in the liver for people with NASH. Even modest reductions in weight (5-10% of total body weight) can help decrease the amount of fat deposited in the liver. Set reasonable goals for yourself as you begin your weight loss journey; a weight loss of 1-2 pounds per week is ideal.

The Mediterranean diet focuses on delicious fruits, vegetables, whole grains, and heart-healthy protein each day. Set yourself up for success by adding these foods to your diet each day:

  • Vegetables: Eat at least three servings of vegetables daily. Try eating vegetables that are in season for extra flavor and nourishment. Sneak vegetables into foods you love, like with this recipe for garlic cauliflower potato mash.
  • Fruit: Eat at least two servings of fruit each day. Serve it on a skewer with a low fat yogurt-based dip for a delicious snack.
  • Protein: Choose a good source of protein, like fish, shellfish, legumes or beans, white meat, lean red meat or eggs, with every meal. Try this almond crusted chicken for a filling and flavorful entrée.
  • Grains: Choose whole grains such as 100% whole-grain or whole wheat bread, 100% whole grain cereals, brown or wild rice. Experiment with grains such as quinoa, barley, bulgar, farro and whole-grain pastas. Give these protein-packed quinoa cakes as an appetizer or side dish.
  • Dairy and Dairy Alternatives: Choose up to 3 servings of dairy or dairy alternatives daily. Choose low fat or fat free milk, yogurt and cheese. Pass on sugar-sweetened dairy products such as yogurt or flavored milks or sweetened milk alternatives. This strawberry banana milkshake uses soy milk and fresh fruit to satisfy your sweet tooth.
  • Healthy fats: Eat healthy fats daily, like walnuts, hazelnuts and almonds. Be sure to count your calories for added fats and nuts into your daily allotment. Use “extra-virgin” or virgin olive oil in place of other fats such as vegetable oil or butter in low temperature cooking.  Here’s a savory and superfood-packed recipe using walnuts to add healthy fat and a tasty crunch.

If you have NASH, how have you changed your diet? What are your go-to healthy recipes?

HELPFUL LINKS

Sours: https://connect.mayoclinic.org/blog/transplant/newsfeed-post/nash-patients-add-these-foods-to-your-diet/
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With the lack of pharmaceutical solutions for nonalcoholic fatty liver disease, lifestyle is the primary factor in avoiding, reversing and alleviating the affects of the disease. “Lose weight” is generally the first words a patient hears upon being diagnosed with a fatty liver. But they aren’t usually told how. We continually hear this from newly diagnosed patients.

This section of the website is intended to help answer the “how” question. While the answer may differ from patient to patient, there is a lot of general information that we can pass along that will hopefully be helpful.
This section of the website is not intended to be a “nutrition encyclopedia”, but just to pass along some basics. Good nutrition advice is not a “one size fits all”. We hope this is information useful but encourage you to speak with a professional if you want targeted assistance.

Many thanks to our good friends at Case Specific Nutrition (CSN) for being a great source of information.

Lifestyle Prescription


1. Weight loss

  • 5% weight loss improves steatosis
  • 10% weight loss improves steatohepatitis
  • Weight loss is tough; a recent study showed that only 10% of people trying to lose weight through lifestyle intervention lose 10% of their weight; 12% lose 5-7%

2. Diet modification

  • Reduce intake of processed, low fiber, high sugar foods
  • Increase intake of high fiber, nutrient dense foods

3. Include more physical activity

Losing Weight

  • Weight Loss is More Than Just Counting Calories; it requires a multifaceted approach
    Diet, exercise, stress management, sleep
  • More complicated than calories in, calories out
    Where are the calories coming from?
  • Focus on small, sustainable lifestyle changes
    Consistent habits drive progress
  • Plan your meals whenever possible
  • Avoid pass/fail mindset
  • Think quality 80-90% of the time; no one is perfect

Eliminate Liver Stressors

  • Eliminate or reduce alcohol
    • Try alcohol free mixed drinks like Perrier and a splash of cranberry
    • Stick to alcoholic drinks you sip slowly, like wine
  • Eliminate hydrogenated oils, including pressed oils
  • Eliminate high fructose corn syrup (HFCS)
  • Reduce saturated fats
  • Reduce sodium – 1,500 and 2300 mg per day
  • Reduce added sugars
  • Reduce processed grains (white flour, baked products, snacks, convenience foods)

Include Liver Helpers

  • Monounsaturated fats (MUFAs) like nuts, seeds, avocado and olive oil
  • Omega-3 Fatty Acids such as fish, nuts and seeds
  • Fruits and vegetables
    • All are good but limit fruits to 3 cups per day
    • Watermelon, cantaloupe, pineapple and grapes are all good but limit to 1 cup per sitting
  • Whole grains and complex carbohydrates (potatoes, sweet potatoes, brown rice, quinoa, oats, etc.)
  • Lean proteins (tuna, fish, shellfish, chicken, turkey)
    • If vegetarian focus on beans, tofu, lentils, seitan
  • Antioxidant rich foods which include mostly fruits, vegetables, nuts and seeds)

Getting the Calories Right: Quality Not Just Quantity

Don’t lose weight too quickly; the goal should be to lose 10% of your body weight over six months. That can be done by consuming about 500 calories per day less than the number of calories needed to maintain your weight. The number of calories necessary to maintain your weight can be calculated at www.calculator.net.

Calories come from a combination of fats, carbohydrates and proteins, ideally with the following composition:

  • Fat 30%
    • No more than 10% should come from saturated fatty acids
  • Carbohydrates 40%
    • More than 54% is a risk for increased liver inflammation
    • Less than 100 grams per day is not great for the brain, unless monitored on a specialty diet
  • Protein 30%

Stay away from fad diets. Ketogenic diets are popular right now but there are widely disparate views on their affect on NAFLD. Recent studies have shown evidence that Keto may be useful in maintaining good liver health. One issue with Keto is the difficulty in sticking to it as it often difficult to avoid carbs. The Keto diet does benefit those managing certain hormonal issues (including PCDS, diabetes, high leptin and high insulin levels). CSN thinks the Mediterranean diet is greatly superior.

Diet Comparison

Calorie SourceCSN RecommendedMediterranean DietKetogenic Diet
Fats30%35%80%
Carbohydrates40%45%5%
Protein30%20%15%
  • Focus on real food
  • Real food provides real change
  • Are blueberries, sweet potatoes and oats the problem?
    • No, so why avoid them with keto?

Calorie Source Examples

Here are some examples of calorie distribution at various weight. The amount of calories shown allows the loss of one pound per week. This assumes a 50-year old person with the male being 5’10” and the female 5’6”.

Source% of Cal.Males (pounds)Females (pounds)
150175200225120140160180
Calories17661932209822641473160617391872
Fats (grams)30%5964707549545862
Carbs (grams)40%177193210226147161174187
Protein (grams)30%132145157170110120130140

Conversion Factors – Calories to Grams

  • Carbs and Proteins – 4 calories per gram
  • Fats – 9 calories per gram

Dietary Supplements

  • Be careful, they are not well regulated and many claims are under researched
  • USPS (United States Pharmacopeia) and GMP (Good Manufacturing Practices) certifications help confirm quality
  • Food is 99% of the picture; supplements are just that – – minor helpers
  • Supplements to consider
    • Omega 3 Fish Oil – 1000 MG
      • Raises Omega – 3 levels but not greatly
    • Milk Thistle (silymarin) – 300 MG
      • Strengthen the outer membranes of liver cells and reduce the number of toxins entering cells
    • Glutathione – 700 MG
    • NAC (N-Acety-Crystene) – 600 mg
      • Protects liver from toxins

Dietary Fats

Dietary fats are essential to give your body energy and to support cell growth. They also help protect your organs and help keep your body warm. Fats help your body absorb some nutrients and produce important hormones, too. The amount and type of dietary fat directly affects liver fat content.

Healthy Fats

  • 30-40% of total calories
  • Healthy fats include both Mono- and polyunsaturated fatty acids (MUFA, PUFA)
  • MUFAs
    • MUFAs reduce liver fat
    • Sources include olive oil, advocados, nuts, fatty fish
  • PUFAs
    • Consist of Omega-3 and Omega-6 fatty acids
    • See more detail below on Omega

Acids Unhealthy Fats

  • Saturated Fats
    • Correlated with increased liver fat
    • No more than 7% of total calories
    • Sources are animal products
  • Trans Fat
    • Linked to metabolic syndrome, increased inflammation, reduced HDL
    • <1% of total calories
    • Sources are partially hydrogenated oil and fried foods

Omega Fatty Acids

  • Both Omega-6 and Omega-3 fatty acids should be part of your diet but the RATIO between the two must be monitored.
    • Ideal is four O-6 to one O-3
    • Ratio for the average American is 16:1
    • Best way to reduce the ratio is to reduce O-6
  • Omega-3
    • Help reduce inflammation
    • Higher intake lowers serum triglycerides and inhibits conversion of excess carbohydrates into fatty acids
    • Sources: Fatty fish (salmon, mackerel, herring, sardines, anchovies), oysters, flax, chia, walnuts, sea vegetables, enriched eggs, grass-fed dairy and meat products
  • Omega-6
    • Tend to promote inflammation
    • An increased ratio (15:1) is associated with chronic inflammatory diseases like NAFLD, cardiovascular disease and obesity
    • Sources: Sunflower oil, corn oil, soybean oil, cottonseed oil, grapeseed oil, vegetable oil, processed foods, prepared food (e.g., baked goods), dressings/sauces
  • Fish Oil has an O-3 supplement has mixed reviews because it has minimal effect on the ratio
    • 1000 MG of fish oil is only 1 gram
    • Very little effect on the ratio

Carbohydrates

Carbohydrates are not one thing but are a combination of sugars, starchy carbohydrates and dietary fiber.

  • Starchy carbohydrates provide an important source of energy
  • Fiber is important for digestive health.
  • There is also evidence to show that the type of carbohydrate consumed can affect risk of certain diseases including heart disease.

Carbohydrates provide the body with glucose, which is converted to energy used to support bodily functions and physical activity. What’s most important is the type of carbohydrate you choose to eat because some sources are healthier than others.
Carbohydrates are of two types – – Whole (or complex) Carbohydrates and Refined (or simple) Carbohydrates.
Whole carbohydrates are preferred over refined carbohydrates. Whole carbohydrates provide vitamins, minerals and fiber. Refined carbohydrates are nutrition poor and calorie dense.

Proteins

Proteins play many critical roles in the body. Protein is made from 20+ basic building blocks called amino acids. Though all 20 of these are important for your health, only nine amino acids are classified as essential. Essential amino acids can’t be made by your body and must be obtained through your diet.

Proteins are characterized as either Complete or Incomplete.

  • A Complete Protein has all the essential amino acids and are typically found in animal products.
  • Incomplete proteins are found in most grains, nuts, seeds, nut butters, green peas and legumes (such as lentils, chick peas, black beans, pinto beans and navy beans).
  • Pairing Incomplete Proteins provides more amino acid coverage. For example, eating both grains and legumes will cover most amino acids.

Protein consumption has to be considered as part of a “protein bundle.” When we eat foods for protein, unhealthy “baggage” comes with it. Broiled sirloin steak, for example, provides lots of protein but also has saturated fats. Salmon is a much better choice because it carries less baggage.

Physical Activity and Exercise

  • Abdominal obesity is a major risk factor for NAFLD (more important than BMI)
  • Individuals who exercise have less visceral fat than those who are sedentary
  • Exercise increases insulin sensitivity and improves blood lipids independent of weight loss
  • Decreased hepatic steatosis, inflammation, and disease progression
  • Both intermittent and daily exercise are beneficial
  • Combined exercise (aerobic + resistance training) more effective than aerobic alone
  • Keep moving! It doesn’t have to be in a gym. Any activity helps liver function and decreases inflammation
  • Recommendations:
    • 150-300 minutes a week of moderate-intensity or 75-150 minutes a week of vigorous- intensity aerobic physical activity
    • Muscle-strengthening activities that involve all major muscle groups 2 or more days per week

SMART GOALS

  • Specific
  • Measurable
  • Achievable
  • Realistic
  • Timely

Example of a SMART goal: Lose 5 pounds in 30 days using a 300 calorie/day diet reduction and 30 minutes walking daily (burns 200 calories)

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Sours: https://www.nash-now.org/nutrition/

NASH Treatment


1. Lose weight
This is one of the best treatments for NAFLD and NASH, because it moderates the conditions that contribute to fatty liver disease. Losing just 3 to 5 percent of your body weight can reduce fat in your liver; losing 7 percent can decrease inflammation as well. If you are overweight or obese, doctors typically recommend you gradually lose 7 to 10 percent of your body weight over the course of one year. Rapid weight loss through fasting is not recommended, as it can make NAFLD worse.

The best way to lose weight is done by:

  • Reducing the number of calories you eat. Keeping track of the calories you consume every day and employing portion control can help.
  • Eating a healthy diet that’s rich in fruits and vegetables, whole grains and low in saturated fats. Limit animal-based foods, like red meat which is high in saturated fats, and eat more plant-based foods like beans, legumes, and nuts. Use good fats like olive oil. This is the basis for the Mediterranean diet – which isn’t a diet in the traditional sense, but a healthy way of eating inspired by the eating habits of people living in the Mediterranean area – and is often recommended by doctors as a way to reduce some of the risk factors associated with fatty liver disease. Visit the ALF Liver Disease Diets page to learn more about how nutrition can make a difference for you.
  • Limiting the amount of salt and sugar in your diet, particularly sugar-sweetened beverages, like soda, juices, sports drinks, and sweetened tea. High consumption of fructose, one of the main sweeteners in these beverages, increases your odds of developing obesity, type 2 diabetes, metabolic syndrome, and NAFLD. Watch the ALF Webinar on 10 Ways to Cut Back on Salt and Sugar.
  • Exercising more – exercise is important for many reasons; it can help with weight control, boost your immune system, and alleviate stress and depression. Try to be active at least 30 minutes most days of the week. Depending on how much weight you’re trying to lose, you may need to up that amount. Getting exercise doesn’t mean you have to go to a gym – walking, gardening, and even housework counts. However, if you don’t already exercise, get your doctor’s okay first and build slowly. The goal is to participate in exercise of a moderate intensity (examples include light jogging, biking, swimming or playing a sport that boosts your heart rate and results in sweating). For more valuable information about how you can get fit, visit ALF’s Health & Wellness blog.

While following a healthy diet and maintaining a normal body weight may not seem like a specific treatment, it’s essential to managing NAFLD and NASH.

If you’ve tried to lose weight in the past without success, talk to your healthcare provider about getting help. You may be a candidate for a medically-supervised weight loss program that employs medication along with diet and exercise. Alternatively, there are weight-loss (bariatric) surgical procedures and endoscopic therapies that work by either physically limiting the amount of food your stomach can hold, or reducing the amount of nutrients and calories your body absorbs. Talk to your doctor about which option may be best for you.

2. Control your diabetes
Closely monitor your blood sugar and take medications as prescribed.

3. Keep your cholesterol down
Limit your intake of saturated fats, which are found in meat, poultry skin, butter, shortening, milk and dairy products (except fat-free versions). Replace them with monounsaturated fats (olive, canola, and peanut oils) and polyunsaturated fats (corn, safflower, soybean oils, and many types of nuts). Particularly helpful in reducing heart disease are omega-3 fatty acids, a type of polyunsaturated fat found in oily fish such as salmon, flaxseed oil, and walnuts. Healthy eating combined with exercise – and taking cholesterol-lowering medications if prescribed by your doctor – will help keep your cholesterol and triglyceride levels where they need to be.

4. Protect your liver
Don’t do things that put extra stress on your liver.

  • Avoid drinking alcohol.
  • Take medications and over-the-counter drugs only as instructed.
  • Be cautious about taking dietary supplements. Certain vitamins and minerals – like vitamins A, iron, and niacin – can be harmful to your liver in higher doses than necessary or prescribed.
  • Check with your healthcare provider before trying any herbal remedies. Just because a product is called “natural,” does not mean it’s safe.
  • Get vaccinated for hepatitis A and hepatitis B. If you get hepatitis A or B, along with fatty liver, it’s more likely to lead to liver failure.

A multidisciplinary approach to treatment that involves nutritionists, endocrinologists, cardiologists, and other specialists as needed – in addition to your hepatologist – is essential to successfully manage the underlying metabolic conditions associated with fatty liver disease.

 


Are there medications to treat NAFLD and NASH?

Currently, there are no FDA-approved medications to treat nonalcoholic fatty liver disease, although a few are being studied with promising results. In the next few years, it’s expected that there will be several drugs available for treatment. In the meantime, there a few alternative treatments that could be helpful, although none have been proven to cure nonalcoholic fatty liver disease.

Coffee
In studies of people with NAFLD, those who drank coffee had less liver damage than those who drank little or no coffee. Caffeinated coffee reduces the risk of liver fibrosis in several liver diseases, including NAFLD. Studies suggest you need to drink more than two cups per day to gain this benefit, however, some people do not tolerate it well. But for those who currently do drink caffeinated coffee – enjoy!

 

Vitamin E
This vitamin, which is an antioxidant, theoretically works by reducing or neutralizing the damage caused by inflammation. Some evidence suggests vitamin E supplements may be helpful for people with liver damage due to NAFLD and NASH. Researchers in one study found that a daily dose of the natural form of vitamin E – the kind that comes from food sources and isn’t made in a laboratory – improved NASH in study participants overall by reducing fat and inflammation although not scarring. This medication is not for everyone and may have potential side effects as well. Discuss the potential benefits with your doctor.

Sours: https://liverfoundation.org/for-patients/about-the-liver/diseases-of-the-liver/nonalcoholic-steatohepatitis-information-center/nash-treatment/

Diet nash

Nonalcoholic Fatty Liver Disease

Fatty liver disease means that you have fat inside your liver that can, over time, affect liver function and cause liver injury. People who drink too much alcohol may also have fat in their liver, but that condition is different from fatty liver disease.

Types of fatty liver disease

Health care providers divide fatty liver disease into two types. If you just have fat but no damage to your liver, the disease is called nonalcoholic fatty liver disease (NAFLD). If you have fat in your liver plus signs of inflammation and liver cell damage, the disease is called nonalcoholic steatohepatitis (NASH).

About 10% to 20% of Americans have NAFLD. About 2% to 5% have NASH.

Symptoms

Fatty liver disease is sometimes called a silent liver disease. This is because it can happen without causing any symptoms. Most people with NAFLD live with fat in their liver without developing liver damage. A few people who have fat in their liver develop NASH.

If you have NASH, you may have symptoms that could take years for them to develop. If liver damage from NASH leads to permanent scarring and hardening of your liver, this is called cirrhosis.  

Symptoms from NASH may include:

  • Severe tiredness

  • Weakness

  • Weight loss

  • Yellowing of the skin or eyes

  • Spiderlike blood vessels on the skin

  • Long-lasting itching

NASH that turns into cirrhosis could cause symptoms like fluid retention, internal bleeding, muscle wasting, and confusion. People with cirrhosis over time may develop liver failure and need a liver transplant.

Who's at risk

Health care providers don’t know the exact cause of fatty liver disease. But they think that obesity is the most common cause. Obesity in the U.S. has doubled in the last decade, and health care providers are seeing a steady rise in fatty liver disease. Although children and young adults can get fatty liver disease, it is most common in middle age. 

Risk factors include:

  • Being overweight

  • Having high blood fat levels, either triglycerides or LDL (“bad”) cholesterol

  • Having diabetes or prediabetes

  • Having high blood pressure

Diagnosis

Fatty liver disease can happen without causing any symptoms. It’s usually diagnosed when you have routine blood tests to check your liver. Your health care provider may suspect fatty liver disease with abnormal test results, especially if you are obese.

Imaging studies of your liver may show fat deposits. Some imaging tests, including special ultrasound and MRI scans can help diagnose the disease and spot scar tissue in the liver. But the only way to be certain that fatty liver disease is the only cause of liver damage is with a liver biopsy. A liver biopsy involves getting a tissue sample of your liver with a needle. The needle removes a small piece of liver tissue that can be looked at under a microscope. Here’s how your health care provider makes the diagnosis:

  • If you have fat but no inflammation or tissue damage, the diagnosis is NAFLD.

  • If you have fat, inflammation, and liver damage, the diagnosis is NASH.

  • If you have a type of scar tissue in your liver called fibrosis, you may be developing cirrhosis.

Treatment

If you have NAFLD without any other medical problems, you don’t need any special treatment. But making some lifestyle changes can control or reverse the fat buildup in your liver. These may include:

  • Losing weight

  • Lowering your cholesterol and triglycerides

  • Controlling your diabetes

  • Avoiding alcohol

If you have NASH, no medication is available to reverse the fat buildup in your liver. In some cases, the liver damage stops or even reverses itself. But in others, the disease continues to progress. If you have NASH, it’s important to control any conditions that may contribute to fatty liver disease. Treatments and lifestyle changes may include:

  • Losing weight

  • Medication to reduce cholesterol or triglycerides

  • Medication to reduce blood pressure

  • Medication to control diabetes

  • Limiting OTC drugs

  • Avoiding alcohol

  • Seeing a liver specialist

Some medications are being studied as possible treatments for NASH. These include antioxidants like vitamin E. Scientists are also studying some new diabetes medications for NASH that may be given even if you don't have diabetes. However, you should only take these medicines after consulting with a liver specialist.

Complications

The main complication of fatty liver disease is the progression of NASH to cirrhosis. Cirrhosis means permanent scarring and hardening of the liver.

When to call the health care provider

If you've been diagnosed with any fatty liver disease, let your health care provider know if you have any symptoms that mean the disease is getting worse. These include fatigue, loss of appetite, weight loss, weakness, fluid retention, or bleeding.

Living with fatty liver disease

If you are living with fatty liver disease, learn as much as you can about your condition and work closely with your medical team. Since many medications can harm your liver, always let all your health care providers know about any medications you are taking. These include OTC drugs, dietary supplements, and vitamins. Other ways to manage fatty liver disease include maintaining a healthy weight, eating a balanced diet, getting regular exercise, and continuing to avoid alcohol.

Sours: https://www.hopkinsmedicine.org/health/conditions-and-diseases/nonalcoholic-fatty-liver-disease
Nonalcoholic Steatohepatitis (NASH) - Dr. Julie Heimbach

Some strange beast and such a strange name. I haven't even read it. True.

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She looked about 22-24 years old. Having lit a cigarette, I also sat down next to him and began a small interrogation. After a while, the girl stopped whimpering and calmed down a bit.



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