Growing up in Mexico City, Evelyn Chavez had no idea that her grandmother died of liver failure. It wasn’t until years later, when her mother faced her own health scare, that she found out.
“About a year ago, my mother had turned completely yellow, and we were trying to figure out what was wrong with her. We were going over all our medical history together. That’s when I found out that my grandmother had passed away suddenly from cirrhosis of the liver,” she says.
Chavez had been worried about her own health after trying to lose weight without success for more than a year. Worried she might have the same disease as her mother and grandmother, Chavez called her doctor and asked to get a full workup. One test, the gamma-glutamyl transferase (GGT) lab test, came back very high. Sometimes, high GGT levels can mean liver damage. She soon went for a follow-up test, an ultrasound of her liver. The test showed that she has stage II metabolic dysfunction-associated steatohepatitis (MASH).
“I wish I knew about this disease sooner — that it was something genetic — because I think I would have approached my lifestyle in a different way,” she added.
MASH is a serious form of metabolic dysfunction-associated steatotic liver disease (MASLD). Often called fatty liver disease because it’s a condition where excess fat builds up in the liver, MASH is characterized by inflammation and scarring — called fibrosis — of the liver. When left untreated, it can worsen to cirrhosis, the same disease that Chavez’s grandmother died from. She, like many people with MASH, probably had no idea that she was ill with the disease since it often goes undiagnosed until it’s too late.
How Does Health Affect Your Family?
Chavez has always talked to her mother, taking care of her. Now, she says, her stress is doubled since she also has the disease. Indeed, having MASH can put a huge strain on a person and their family. MASH can cause long-term physical effects on the patient that can be uncomfortable and dangerous, says Monica Tincopa, MD, assistant professor of medicine, Transplant Hepatology at UC San Diego. These include:
- Pain, nausea, and fatigue
- Cirrhosis or scarring of the liver
- Liver failure, when the liver stops working completely
- Liver cancer
- Bleeding
Tincopa says that if you have a fatty liver disease like MASLD, you’re more likely to also have other serious, chronic diseases — including obesity, type 2 diabetes, high blood pressure, high blood sugar, and low HDL cholesterol — what doctors call “good” cholesterol. Three of these conditions are more linked to death than the others, according to a recent study. These include “high blood pressure, type 2 diabetes, and low HDL, which raise the risk of death by 40%, 25% and 15%, respectively.”
Physical symptoms and dangers aside, having to manage these diseases can stress out a family, adding to the emotional and psychological burden of everyone — not just the person who is sick. Studies show that having a parent with a chronic illness raises the risk of having dysfunction within a family. Children and teens are more likely to have social-emotional and behavioral problems if a parent is ill. Children may have mental illness or substance abuse problems. And unfortunately, the longer the parent is ill, the more the risks go up. Having a chronically ill parent makes language and cognitive difficulties more likely.
Is Your Family at Risk for Liver Disease, Too?
MASH is often seen in families where people share not only genes but also the same eating habits, lifestyles, and activities, Tincopa says.
“There are certain genes, particularly in Hispanic and Latino populations, that put people at a higher risk, but the other part of this is that people who live together tend to have the same nutritional patterns,” she says. “One person cooks, and they all get used to eating the same thing. For instance, a lot of ethnocentric foods tend to be foods that are high risk for fatty liver.”
Choices that you make as a family can affect everyone now and in the future. These include:
Diet and eating habits. As Tincopa says, if everyone is eating the same unhealthy food, the risk for obesity and fatty liver goes up. A diet high in processed foods with high fructose corn syrup, carbohydrates, fried foods, and red meat can trigger MASLD, setting into motion a lifetime of illness.
Where you live. If you live in a food desert where you don’t have access to whole, clean foods such as fruits and vegetables, it’s hard to eat healthy. That significantly raises your risk for MASLD. Likewise, food swamps, which are locations with too many fast food restaurants, can also lead to the disease.
Family living habits. If you spend more time on the couch than outside, you’re going to raise the risk of MASLD, according to research. The more time you spend playing video games or watching TV, the higher your risk. Poor sleep habits, which are modeled or encouraged — staying up late despite having to get up early in the morning — can also make you more likely to get MASLD.
Family values and beliefs. Tincopa says by the time she sees some patients, they have ignored symptoms for months or even years. Some of this may be due to traditions and culture, she says. “Some studies, when they’ve interviewed patients, have shown that overall health is impacted by things like belief in God and whether you believe that things like health are destined to be,” she says. “That impacts whether people choose to go to the doctor and how open they are to treatments, particularly new treatments. Some cultures simply believe, ‘Oh, I am in God’s hands.’”
How you deal with stress. Researchers know that stress is a major factor that can cause MASLD. Chronic stress and high levels of cortisol (a stress hormone) can play a role in how the disease develops. If you deal with stress in an unhealthy way, such as drinking or taking illegal drugs, you’re putting yourself at a higher risk.
How Can You Help Your Family Get Healthier?
There’s good evidence that making small changes can help you reverse your own disease. Sharing those changes with family members may keep them from developing MASH, too. The first thing you should do is talk to your doctor, Tincopa says. Your doctor will help you with a diet and exercise plan to get you moving in the right direction. Eating whole foods, keeping your weight at a healthy level, and exercising regularly can help you heal your liver.
Then, Tincopa suggests making time for family dinners and cooking together. While cooking, you can discuss why certain food choices are better than others. You’ll also want to share your health status with your family so they can be aware of their own risk.
“Studies have shown that if you have another family member who has a history of chronic liver disease, your likelihood of having clinically significant liver disease is also increased,” she says.
Going for walks and doing yardwork or housework can become fun family events that will also help you lose weight and improve overall health.
Changes everyone can make
Cut out soda and sugary drinks. High fructose sugar is converted into fat in the liver and can lead to inflammation. Swap out soda and juice for water or unsweetened tea or coffee. Limit sodas to special occasions.
Get some shuteye. Everyone should shoot for at least six hours of sleep each night, although eight hours is better. Research shows that people over 65 who sleep less than six hours a night have a 21% higher risk of MASLD than those who sleep between six and eight hours.
Focus on a Mediterranean diet. “We recommend a Mediterranean diet because it helps people avoid foods that are associated with a higher risk of fatty liver disease, and it promotes foods that have been shown to be helpful for liver health in general,” Tincopa says. Diets rich in these foods are linked to a reduced risk of MASLD and, for those who have the disease, lower mortality rates:
- Lean proteins, such as chicken or fish, such as salmon or tuna
- Plant-based proteins
- Green leafy vegetables
- Lots of vegetables
- Legumes such as beans and lentils
- Nuts
- Whole grains such as quinoa
- Healthy fats like olive oil or avocado oil
Getting moving. When you aim for at least 135 minutes of moderate exercise (just 19 minutes a day) and bring your family along, you’re not just helping yourself, you’re helping them, too. Look for fun activities, such as biking, hiking, or dancing. A Saturday morning dance party can get everyone moving and smiling. “Everyone has smartphones. Track your steps daily and compete against each other to get more exercise,” Tincopa suggests.
How Can You Help Your Family Make Changes?
Liver disease can be scary. You can help your family manage their anxiety about your condition or their risk of developing it. Make changes by having a weekly family meeting to talk and share information. This can also help lower stress. Everyone can air concerns calmly.
You can also make changes last by involving everyone in the planning and following your program, Tincopa says. Ask family members for exercise ideas or request them to help plan and cook healthy dinners. This fosters family bonds and a supportive living environment, which lowers stress.
Tools can help. Look for apps that gamify healthy habits, keeping everyone connected and working toward the same goals. Family Habits, MyFitnessPal, and Yuka are three examples.
