Rueben Ramirez

burner of poptarts; breaker of things

Bad news from my first Fibroscan

Published September 14, 2023

This is a longer post so TL;DR: my first Fibroscan yielded some scary results indicating I’m worse off than I or my doctors originally thought. I’m still making awesome progress to get into better shape though.

First, a little context…

Let’s start with some terminology

  • Non-alcoholic Fatty Liver Disease (NAFLD) has been renamed to Metabolic dysfunction-associated steatotic liver Disease (MASLD)
    • Higher than normal storage of fat in the liver commonly due to poor diet and a sedentary lifestyle. Typically diabetes, insulin resistance, obesity,
  • Nonalcoholic Steatohepatitis (NASH) has been renamed to Metabolic dysfunction-associated Steatohepatitis (MASH)
    • Advancement of MASLD inflammation in the liver (hepatitis) that causes fibrosis damage (scared tissue).

Before all of the processed food became the norm, fatty liver disease was most commonly caused by abuse of alcohol. (we’ve all heard of the old man with a bad liver because he has drank heavily for 50 years) Because so many of us consume processed foods and high volumes of sugar (fructose) regularly, MASLD and MASH are soon to take over as the leading cause for need of liver transplants in Western countries.

Do genetics have anything to do with this? It turns out that hispanic populations are genetically predisposed to fat liver disease. To a lesser extent, white populations are less so, and black populations the least.

Before zooming into all the technical details of the Fibroscan, I have to first acknowledge a few things: I may have been dealt a bad hand (yay genetics), but there’s a huge element of personal responsibility I need to own. I know I’ve been too heavy for far too long. I’ve had a few attempts at dropping the weight, but this has mostly resulted in yo-yo dieting at best. The Fibroscan results below show that what I’m up against is incredibly scary. Nothing is more effective for committing to health as much as the threat of it being taken away.

So let’s dig in.

What is a Fibroscan?

Fibroscan is a really awesome diagnostic tool that provides accurate reporting of liver fat levels and liver damage levels.

Before Fibroscans, the gold standard for determining this information has been liver biopsy. This would require a couple of local anesthetics, and then poking your liver with a HUGE needle to grab a chunk of tissue to observe under a microscope. This is still relied upon when other tests are inconclusive.

Steatosis scoring

This measures the amount of fat stored in the liver. The higher this score, the more fat contained in the liver.

CAP ScoreSteatosis gradePortion of your liver affected by fatty change
< 238 dB/mnormal range of fatn/a
238 to 260 dB/mS1Less than ⅓ (11% to 33%)
260 to 290 dB/mS2Between ⅓ and ⅔ (34% to 66%)
290 to 400 dB/mS3More than ⅔ (67%)


My steatosis score (CAP)

Today, I’m currently in the upper range of S2 grade. Even though I’ve made so much progress, this clearly indicates that I have a lot more progress to make to lower this number.

Fibrosis score for Non-alcoholic Fatty Liver Disease (NAFLD or NASH)

This measures the scarring (damage) of the liver. The higher this score the more damage accumulated in the liver.

Liver Stiffness ResultFibrosis ScoreYour Liver
2 to 7 kPaF0 to F1Is normal.
7.5 to 10 kPaF2Has moderate scarring.
10 to 14 kPaF3Has severe scarring.
14 kPa or higher (75 kPa = upper range maximum)F4Has cirrhosis.


My fibrosis score

Today, I’m currently at the beginning at the range of F4 fibrosis scoring. This was an incredibly surprising and, honestly, scary finding.


S2 grade for fat in the liver:

  • I have to drop this fat as quickly as possible. If not, the damage to my liver will continue to progress.
  • So far those efforts have been through stringent dieting and rigorous exercise.
  • I will be doubling my efforts to what some may consider extreme. I have a will to live, by any means.

F4 fibrosis liver damage:

  • The poor diet and generally sedentary lifestyle over the years has caused me to carry far too much weight for too long.
  • This scan result shows the fat in my liver has caused an advanced level of damage.

What now?

My hepatologist is now working with my insurance company to approve a liver biopsy. This procedure will help to confirm the results of this Fibroscan and provide additional information for appropriate treatment.

In the meantime, I’m continuing to add more exercise and general activity to my day. Even though my diet is improved significantly, there’s always room for growth. Every day I’m learning more about exercise, nutrition, and other aspects of my condition that I can tweak and otherwise work on.

So yep, this is pretty scary stuff. I do still truly believe that I have a fighting chance at recovery, though.