Lifestyle changes and medications can stop MASH from getting worse and, in some cases, heal liver damage that has already happened.
“These interventions are fairly effective in stabilizing the progression of MASH and even possibly reversing the inflammation associated with MASH,” Dr. Karagozian says.
Lifestyle Changes
Lifestyle changes are the cornerstone of managing and potentially reversing MASH, whether a person is on medications or not.
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Healthy Diet and Exercise
A healthy eating pattern and regular physical activity can help you reach a healthier weight, and that combo has been shown to directly reduce liver inflammation, fat buildup, and fibrosis.
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You can reduce the amount of fat in your liver by losing 5 percent of your body weight, and you can heal existing scarring and potentially reverse MASH by losing 10 percent or more.
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For a 150-pound person, a 10-percent loss is 15 pounds.There’s no one-size-fits-all diet for managing MASH. Instead, focus on an eating pattern that’s rich in fruits, vegetables, whole grains, lean proteins, and healthy fats and light on added sugars, red meat, and full-fat dairy.
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Weight loss also hinges on taking in fewer calories than you burn, so aim to trim between 500 and 1,000 calories per day.
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Resist the urge to crash diet. Slow, steady weight loss is better for your liver, plus, it’ll give you a chance to develop habits that you can use for life.
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If you’re struggling to lose weight through diet and exercise alone, weight loss surgery or medications can help.
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As for exercise? Pick a heart-pumping activity you enjoy, and try to get at least 150 minutes per week (brisk walking, bicycling, dancing, or swimming are all good choices). If the activity is vigorous (like running), you can get by with 75 minutes per week. Add in resistance exercises twice a week to support your lean muscle mass. Check in with your doctor if you’re new to exercise to find the right workout plan for you.
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Alcohol Intake
There’s no safe amount of drinking when you have MASH. Even a moderate amount of alcohol can worsen inflammation and fat buildup in the liver, making it harder for your liver to heal.
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Your best best? Steer clear.
Medications
Depending on how severe your MASH is, your doctor may also recommend medications to help reduce inflammation and scarring in your liver.
“Most clinical trials [for these medications] include patients with stage 2 and stage 3 fibrosis and show reversal of steatohepatitis and fibrosis in some patients,” Barritt says.
These medications include:
- Resmetirom (Rezdiffra) This oral medication directly reduces the amount of fat and inflammation in the liver, which can reverse damage. It works by binding to thyroid hormone receptor beta in the liver, which regulates the liver’s fat metabolism and inflammation.
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In clinical trials, up to 28 percent of patients who took resmetirom had less liver scarring within one year.[11]
- Semaglutide (Wegovy) Semaglutide is an injectable GLP-1 agonist medication that’s often prescribed to treat diabetes and obesity. Now it’s also approved to treat MASH. The mechanisms that support weight loss and blood sugar control are also thought to help reduce inflammation in the liver and improve scarring.
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Managing your blood pressure, cholesterol, and blood sugar levels can help reduce your risk for MASH complications like heart disease and type 2 diabetes. If you’re having trouble making progress with lifestyle changes alone, your doctor might prescribe additional medications, such as:
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