Dr. Hanif warmly welcomes you! Thanks for consulting at my virtual clinic HCM. I have carefully worked through your case, and can well realize your health worries. Being your physician, I want to assure, I will take care all of your medical concerns. Nonalcoholic Steatohepatitis i.e. NASH patients may get benefits from: *Avoidance of unnecessary medications as they damage the liver more and more. Almost every medicine has to get through the liver for metabolism and excretion. *Do carry on with physical activity as you are already doing well. Physical activity reduces weight and Insulin receptor insensitivity gets better that may be a contributing factor for NASH in you. Anti-diabetic medications also help in this regard. *Reduce your weight and keep it in limits for your age and height. *keep taking a balanced healthy diet. Vitamin E is an antioxidant and is great for lowering the oxidant stress on liver in patients suffering from NASH. Almonds, hazelnuts, spinach, turnip greens and kale are some of the vit. E rich foods. Your liver gets better, your Liver enzymes will get into the normal limits too. Right now these are still high but much less than those in the start of the disease. It definitely means that you are doing good with the treatment options. Serum proteins you have are also in normal range for total serum proteins. It means directly that liver is functioning normal for making proteins. For GERD you may take Omeprazole and if there was some anatomical abnormality on endoscopy, the treatment goes accordingly. For constipation observe the following plan of action please:- *Take 4-5Litres of water daily. *Lactulose syrup at night. It is a bulk forming laxative & will be beneficial for you. *Citrucel dietary fiber supplement with water. *keep a good physical activity. It is as necessary as taking good diet. It will move your intestines, will pass on the gas and will improve digestion. *Vegetables, salads and fruits and avoid red meat refined grains, processed meat and fast fried junk foods. *Coconut water is full of dietary fiber and also provides a good amount of fluids. Take 250ml every other day. *If you feel nothing is working, take Glycerine Suppositories to help for defecation. Hope I answered all of your questions. Please don t forget to add your precious positive feedback to help me able to assist you better in future too. Have a wonderful time ahead. Keep in touch for a follow-up too to let me know if you have any doubts & need further assistance. I am available 24/7 for your help. Have a blessed time ahead. Regards! DR. MUHAMMAD HANIF USA