Inside the Dietary Changes That Help Manage MASH

Your liver is a vital organ in your body that’s responsible for important bodily functions, such as filtering your blood, creating bile, and metabolizing proteins, carbs and fats.

But an estimated 25% to 30% of the global population has some form of metabolic dysfunction-associated steatotic liver disease (MASLD), with many of these cases progressing to metabolic dysfunction-associated steatohepatitis (MASH). (Note: MASH originally was known as non-alcohol related steatohepatitis, or NASH.)

While a MASH diagnosis can be scary and overwhelming, gastroenterologist and transplant hepatologist Sobia Laique, MD, explains how certain dietary changes can slow or stop liver inflammation.

Diet changes that can help manage MASH

“Dietary changes can significantly slow the progression of MASH, and in some cases, stop or even reverse it, by reducing the amount of fat buildup in the liver and, subsequently, inflammation and fibrosis,” explains Dr. Laique.

So, what type of dietary changes should you make? Dr. Laique shares the following recommendations.

Follow a heart-healthy diet

“A diet that supports cardiovascular health is beneficial for people with MASH because you’re inherently at risk of developing cardiovascular disease, such as heart attacks, abnormal heart rhythms and heart failure,” stresses Dr. Laique.

Additionally, MASH is closely linked to conditions like obesity, Type 2 diabetes, high blood pressure and high cholesterol, all of which further elevate cardiovascular risk.

“A heart-healthy diet rich in vegetables, fruits, whole grains, legumes and seafood provides essential nutrients, antioxidants and fiber that support liver health and metabolic health,” states Dr. Laique.

“While lean meats can be included in moderation, processed meats and highly refined foods should be minimized, as they contribute to insulin resistance, oxidative stress and thus fat accumulation in the liver worsening MASH.”

Consider the Mediterranean diet

To take the idea of a heart-healthy diet one step further, Dr. Laique recommends following the Mediterranean diet.

“The Mediterranean diet is the optimal choice because it completely aligns with the dietary needs of people with MASH,” she notes.

The basic principles of the Mediterranean diet include eating the following foods:

• Whole grains and starches
• Fruits and vegetables
• Fish high in omega-3 fatty acids
• Plant-based proteins like legumes, nuts, egg whites and Greek yogurt
• Extra-virgin olive oil

“Extensive studies show that the Mediterranean diet may prevent not just MASH progression, but also lower your cardiovascular risk,” she adds.

Eat foods high in monounsaturated fat

“Fat” may seem like an ugly word, especially when you consider how excess fat can affect your liver. But it’s all about choosing the right kind of fat.

The goal is to replace saturated fats and trans fats found in foods like full-fat dairy, fried foods and red meat with monounsaturated fats like extra-virgin olive oil, avocados and nuts.

“Excessive saturated fat intake is what contributes to fat buildup within the liver and insulin resistance,” outlines Dr. Laique. “So, when you start replacing these saturated fats with monounsaturated fats, they improve your cholesterol metabolism in the body and improve MASH.”

Look for foods that have omega-3 fatty acids

If you follow a heart-healthy diet like the Mediterranean diet, you’ll notice food options that are high in omega-3 fatty acids, like salmon, mackerel, walnuts and flaxseed. The vital nutrient is important for heart, brain and eye health.

“Omega-3 fatty acids help reduce your liver’s triglyceride levels,” says Dr. Laique. “They also improve your body’s total cholesterol profile and decrease inflammation throughout your body — all of which are critical for MASH management.”

Drink coffee

Most of us reach for a cup of coffee each morning. And doing so can be beneficial to your liver health.

“Coffee consumption has been shown to provide hepatoprotective benefits in people with MASH,” shares Dr. Laique. “Studies suggest that regular coffee intake is associated with reduced hepatic fat accumulation, lower levels of liver inflammation and a decreased risk of liver fibrosis progression.”

Black coffee is best (and decaf works just as well). You need to consume at least two to three cups per day to reap the benefits. And black coffee means no added sugars, sweeteners or creamers (sorry!).

Try intermittent fasting

In addition to rethinking what you eat, you may want to look at when you eat.

Intermittent fasting may be beneficial for you if you are living with MASH by improving your metabolic health and reducing liver fat.

“Time-restricted feeding (such as 16:8 fasting) and alternate-day fasting can decrease hepatic triglyceride levels. Studies also show that it will improve insulin sensitivity and reduce your fasting insulin levels,” says Dr. Laique.

“We’ve also seen that intermittent fasting can decrease inflammation and oxidative stress.”

If you have diabetes or take glucose-lowering medications, Dr. Laique stresses the importance of talking to your doctor before trying intermittent fasting.

Foods to avoid

While what you eat is important, just as vital are the types of foods you should avoid:

• Ultra-processed foods: Fast food, fried foods and processed snacks
• Sugary beverages: Soda, fruit juices and energy drinks
• Alcohol: This can accelerate liver damage
• Red and processed meats: These can contribute to inflammation and metabolic issues

Bottom line?

The saying “You are what you eat” fits well when thinking about how to manage MASH. Making necessary dietary changes like focusing on heart-healthy foods and cutting out fast food and processed meats can go a long way to improving your liver health.

“Early intervention with the right lifestyle changes may reverse liver fat accumulation and improve liver health, potentially preventing progression,” encourages Dr. Laique. “Your healthcare provider is there to help you navigate these lifestyle changes and answer any questions you have along the way.”