Gastroenterology practitioner Saurabh Sethi, MD, answers questions about how diet can help with nonalcoholic steatohepatitis (NASH), a more severe form of nonalcoholic fatty liver disease.

Nonalcoholic steatohepatitis (NASH) is now known as metabolic dysfunction-associated steatohepatitis (MASH). This new term is more accurate and helps reduce the stigma associated with its older name.

According to the American Association for the Study of Liver Diseases (AASLD), the name change took effect in June 2023 and was agreed upon by a group of multinational liver societies and organizations.

Yes, diet plays a key role in managing metabolic dysfunction-associated steatohepatitis (MASH), a more serious form of fatty liver disease where the liver becomes inflamed and damaged. Unlike a simple fatty liver, which often doesn’t cause symptoms, MASH can lead to more severe issues like cirrhosis or even liver cancer if it’s not addressed.

Making healthier food choices is essential for managing this condition. A balanced diet can help reduce the amount of fat in the liver, lower inflammation, and prevent further liver scarring. By focusing on nutrient-rich foods and cutting back on less nutritious and overly processed ones, you can make a real difference in your liver health.

While diet alone might not cure MASH, it can significantly slow its progression and, in some cases, even reverse the damage. When combined with other lifestyle changes like staying active and managing your weight, these dietary adjustments can help you better control MASH and reduce the risk of serious complications.

Foods to Eat

Incorporate plenty of vegetables, fruits, whole grains, lean proteins, and healthy fats from sources like nuts, seeds, and fatty fish. The Mediterranean diet is often recommended for MASH because it emphasizes these liver-friendly foods. Including fiber-rich options like oats, legumes, and nonstarchy vegetables can also help reduce liver fat and improve overall health.

Foods to Avoid

Try to avoid foods high in sugar and refined carbs, as these can lead to more fat buildup in the liver. Sugary drinks, processed foods, and alcohol, in particular, can worsen liver inflammation and damage.

Beyond selecting the right foods, managing MASH can also benefit from specific dietary adjustments. One helpful approach is intermittent fasting, which is when you only eat during certain hours (e.g., 8 a.m. to 4 p.m.). This practice has been shown to improve metabolic markers and reduce liver fat. It can also help regulate insulin sensitivity and manage calorie intake.

Additionally, try to have dinner that is not too close to bedtime and focus on lighter meals to avoid excess fat accumulation. Minimizing late-night snacks and meals can further help reduce weight gain and enhance insulin sensitivity.

Yes, it’s possible to reverse MASH with the right dietary changes, especially if they lead to sustained weight loss. Reducing liver fat and inflammation through a healthy diet can improve liver function over time.

However, the extent of improvement varies from person to person, so it’s important to stay committed to these changes.

Regular physical activity, maintaining a moderate weight, and avoiding alcohol are key lifestyle changes that can help you manage MASH. These habits work together to reduce liver fat, lower inflammation, and improve overall liver health, making them all essential to your MASH management plan.

Dr. Saurabh Sethi is an ABMS board certified internal medicine physician specializing in gastroenterology, hepatology, and advanced interventional endoscopy. He is currently a gastroenterology practitioner in the San Francisco Bay Area.