8 Lifestyle Changes To Help Manage MASH

If you’ve been diagnosed with metabolic dysfunction-associated steatohepatitis (MASH) (originally called non-alcohol-related steatohepatitis, or NASH), you know you need to make some adjustments or changes to your daily life.

But figuring out where to start and how to go about some of the recommendations (like following a heart-healthy diet, maintaining a healthy weight and avoiding alcohol) can be a daunting task.

Gastroenterologist and transplant hepatologist Sobia Laique, MD, shares some of the common MASH lifestyle do’s and don’ts.

MASH do’s and don’ts

So, why are lifestyle changes so vital to managing MASH?

“While there is no singular cure for liver health, a comprehensive approach — encompassing regular screenings, a balanced diet, consistent physical activity, weight management and, when appropriate, pharmacological interventions — can support and preserve liver function,” explains Dr. Laique.

“With timely and targeted strategies, it’s possible to prevent, and in some cases, reverse the progression of MASH.

Here’s what you should do and what you shouldn’t do.

Do: Reduce your cholesterol and blood sugar levels

Your doctor will discuss how to manage your cholesterol and blood sugar levels. Dietary changes such as following a heart-healthy diet can help.

Heart-healthy options include:

• Fish
• Fruit
• Vegetables
• Oats
• Legumes
• Whole grains
• Nuts and seeds

“This is important because high cholesterol and insulin resistance are essentially the key drivers of MASH progression,” shares Dr. Laique. “They’re responsible in not just causing the disease, but also the disease’s progression.”

Do: Exercise

It’s recommended that you get 150 to 300 minutes of moderate-intensity aerobic exercise per week (such as brisk walking or cycling) or 75 to 150 minutes of high-intensity exercise per week (like running or high-intensity interval training).

If you don’t currently exercise, this goal may seem unattainable. But Dr. Laique says it’s all about building toward those numbers.

“Hitting those numbers right off the bat for someone who’s been sedentary is not a plausible option,” she acknowledges. “So, we discuss the concept of exercise progression, which is when you slowly build up a regimen that is sustainable for you. A good rule of thumb is to increase your activity by about 10% per week for a safe and steady progression.”

Dr. Laique also stresses the importance of strength training, which she describes as “exercising different groups of muscles to increase muscle quality and function.” This can be done with free weights, resistance bands or weight machines. She even says you can leverage your own body weight by doing squats, lunges and planks.

“Strength training has a lot of inherent benefits for people with MASH,” reinforces Dr. Laique. “You should be trying to incorporate a strength training regimen at least twice a week.”

And you don’t have to go through this exercise journey alone. Dr. Laique says that she usually recommends people work with an exercise physiologist who can formulate an “exercise prescription” that considers any physical limitations and medical comorbidities (medical conditions that coexist alongside your primary diagnosis).

Do: Maintain a healthy weight

“For individuals with MASH, maintaining a healthy weight or achieving moderate weight loss is one of the most effective ways to reduce liver fat, inflammation and fibrosis progression,” states Dr. Laique. “Excess weight, particularly visceral fat (fat around the organs), contributes to insulin resistance, metabolic dysfunction and liver damage.”

In fact, Dr. Laique says studies show people who lose 5% of their body weight see reduced fat accumulation in their liver.

“When someone hits 7% to 10% weight loss, it starts cooling down inflammation within the liver, and then if it’s more than 10% weight loss, we start seeing not only a reduction in inflammation, but hopefully, over time, also a reversal of liver fibrosis or scarring,” she adds.

Dr. Laique emphasizes the importance of gradual weight loss — about one to two pounds per week — through a balanced diet and regular exercise, as this is the safest and most effective way to support your liver health.

Rapid weight loss or extreme dieting can actually harm your liver by increasing oxidative stress. Depending on your individual needs, your provider may also discuss options like weight loss medications or metabolic surgery as an additional way to help you achieve your health goals.

Do: Look at your relationship with food

In addition to changing the types of foods you eat, Dr. Laique says it’s vital to look at your relationship with food

“Someone with MASH should focus on their relationship with food because it plays a crucial role in long-term health and disease management,” she advises. “Instead of relying on restrictive diets, developing a positive and mindful approach to eating supports sustainable, nourishing habits without guilt or stress.”

This includes not just what to eat, but also how and why we eat.

“It’s important to understand your ‘food motivators.’ Do you struggle with portion control? Do you have binge eating pattern? Do you eat when you’re stressed,” notes Dr. Laique.

Mindful eating can help regulate hunger, prevent overeating, improve digestion and reduce cravings for unhealthy foods. Additionally, addressing emotional eating and stress-related food choices can help prevent reliance on sugary, processed or high-fat foods that worsen MASH.

Do: Focus on quality sleep

You’ve heard it before and you’ll probably hear it again: We all need a good night’s sleep.

So, it’s probably no surprise that sleep plays an important role in how you manage MASH.

“Adequate sleep is crucial to weight management because unregulated or disruptive sleep can change your eating behaviors or patterns throughout the day. You may default to foods with high sugar content because you’re looking for that quick energy boost,” explains Dr. Laique. “A lack of quality sleep also means you have less motivation to engage in physical activity.”

Dr. Laique also mentions that people with both MASH and obesity may also have sleep issues such as sleep apnea. Your healthcare provider may screen for any underlying sleep issues through a sleep study.

Don’t: Drink alcohol

If you have MASH, you shouldn’t consume alcohol at all, as it’s “adding fuel to the fire,” stresses Dr. Laique.

“Even moderate alcohol use (defined as two drinks or less per day for men and one drink or less per day for women) or mild alcohol intake can exacerbate liver inflammation, oxidative stress and increase progression to cirrhosis in individuals with MASH,” she warns. “There’s a reason why we associate alcohol with liver cirrhosis because it’s a known toxin to the liver. We recommend complete abstinence as the safest option.”

Don’t: Smoke

Smoking can make MASH worse in several ways:

• It increases oxidative stress, which can lead to more liver inflammation.
• It speeds up liver scarring (fibrosis), increasing the risk of serious liver damage.
• It worsens insulin resistance and metabolic issues, making it harder to manage the underlying causes of MASH.

“Quitting smoking can help protect your liver, improve your overall health and reduce disease progression,” says Dr. Laique.

Don’t: Use detox supplements

You may be tempted to turn to liver detox supplements. But Dr. Laique says many liver detox supplements that claim to cleanse or repair your liver can do more harm than good, especially for people with MASH.

In fact, a recent study shows turmeric, green tea, ashwagandha, Garcinia cambogia, red yeast rice and black cohosh are the most common supplements that can be toxic to your liver.

As with all supplements, it’s important to remember that liver detox supplements aren’t regulated by the U.S. Food and Drug Administration (FDA). This means some supplements may contain harmful additives, unlisted ingredients or contaminants that can worsen liver function and even cause acute liver failure.

“We have no scientific evidence or proven medical benefit that these supplements actually help treat or reverse MASH,” stresses Dr. Laique. “You should also be worried about potential liver toxicity.”

Bottom line?

The best way to manage your MASH diagnosis is through lifestyle changes. And just remember that these modifications will take time to incorporate into your life.

And your doctor (and/or team of healthcare providers such as a hepatologist, endocrinologist and registered dietitian) are there to help support you and hold you accountable.

“These changes aren’t something that’s going to happen overnight,” reiterates Dr. Laique. “This is something that requires continual work, and we’re here to help guide you, answer questions and be a support system.”