Fatty Liver Disease: MASLD and MASH

Metabolic dysfunction-associated steatotic liver disease (MASLD) and Metabolic dysfunction-associated steatohepatitis (MASH) are conditions associated with extra fat tissue, or adipose, in your liver. This is important to know, as it is an opportunity to think about your overall health and changes you can make in order to improve your health.

Your liver can handle damage without you knowing. This complex organ helps keep the body in balance, or homeostasis. The major roles of the liver include helping break down and use the food we eat for energy, cleaning our blood of toxins and helping with hormone regulation.

Keeping your liver healthy is important to your body’s overall well-being. If your liver cannot function properly, you could be at risk for developing such health conditions as diabetes, chronic kidney disease, sleep apnea, high cholesterol and heart disease. You also could be much more susceptible to viruses. You have the power to make changes to improve your liver health, and we have tools to help.

There are several terms and abbreviations used to describe fat deposits in the liver.

The most common are:

Why Does It Matter?

Modifiable liver diseases are on the rise. Studies show that this type of liver disease takes seven years on average to progress. Factors that speed this up include:

• Alcohol;
• Diet, such as:
  • Excess simple sugars like fructose, glucose and sucrose;
  • Increased calories; and
  • Intake of saturated fat.
• Genetics;
• Inflammation; and
• Your microbiome (bacteria that lives in your gut.)

MASLD is a sign of metabolic problems including:

• Advanced liver disease;
• Blood glucose abnormalities;
• Chronic kidney disease;
• Increased risk of some cancers;
• Inflammation;
• Lipid dysregulation, insulin resistance.

These factors disrupt nutrient intake and energy regulation.

Potential Complications

If fatty tissue in the liver is not addressed, it can progress and, when combined with inflammation, can lead to cirrhosis of the liver. Cirrhosis is severe scarring, or fibrosis, that cannot be fixed, putting you at risk of liver cancer, gastrointestinal bleeding, severe fluid retention and changes of the mind, called encephalopathy.

Opportunities

Now that you know, you have options to change! You can help slow or even reverse this process, leading to better overall health.

Lifestyle Modification

Eating healthy food helps heal your liver. Eat meals that are high in lean protein, healthy fats, fruits and vegetables, as well as complex carbohydrates/whole grains and fermented foods. These foods can change your microbiome, liver state and overall health. See examples of these on the following page.

• The Mediterranean Diet offers recipes that are great for liver health. Look for online recipes, groups and cookbooks to create a variety of healthy meals.
• Healthy portion sizes are important, as well as cutting back on foods that are not good for you, including those with high sugars, such as fructose, glucose and sucrose and any foods that contain high-fructose corn syrup.
• Reduce foods high in simple carbohydrates or sugar, highly processed foods (like prepackaged meals full of emollients or preservatives), and foods that have a high glycemic index. The extra calories from these foods are stored in the form of fat tissue in your liver and other organs.
• Exercise: Evidence suggests increasing your heart rate for 150 minutes per week will improve your liver health; studies support that 200 minutes per week is more effective for weight loss.

Other Considerations

Alcohol Intake

Studies suggest limiting alcohol intake to one serving per day for women and two servings per day for men helps to avoid liver injury.

One serving of alcohol is one measured shot, one 12 oz beer or one 5 oz glass of wine.

If you have evidence of liver injury, limited use of any alcohol is suggested. If you have scarring classified as F2 fibrosis or more, it is suggested that you avoid alcohol altogether, as it creates inflammation that can lead to further scarring and cirrhosis. If you have been told that you have cirrhosis, you should avoid all alcohol.

Studies now link all regular alcohol intake to changes in microbiomes, increased risk of cancers and changes in brain health.

Common prescription medications that may have a lasting negative impact on the liver, but are not limited to: amiodarone, 5 FU, irinotecan, tamoxifen, methotrexate and corticosteroids. Supplements with potential liver complications include, though are not limited to, certain mushrooms, ashwagandha, turmeric/curcumin and black cohosh.

Supplements studied to help your liver (though should be reviewed with your clinician due to associated risks) include coffee (three cups of black coffee per day), vitamin E and milk thistle.

Prescription Medication

Cholesterol medications, or statins, are safe for those with MASLD and MASH, but not always for those with decompensated cirrhosis. Consult with gastro/ hepatology if this is the case. Beta blockers have similar considerations.

Additional Medical Interventions

You and your doctor may want to discuss other ways to address your liver health. These can include:

• Non-surgical procedures that change the stomach and digestion process enough to be a great tool for weight loss. These include Orbera®, ESG (endoscopic sleeve gastroplasty) and TORe (transoral outlet reduction after gastric bypass).
• Surgical weight loss programs, including gastric sleeve or gastric bypass surgery.
• Medications to assist with improving fatty liver tissue, or increasing likelihood of weight loss, such as: Rezdiffera®, semaglutide, CONTRAVE or metformin.

Reach out to your PCP or gastroenterology clinician with further questions.

Suggested Dietary Intake for MASH Patients

Lean Protein

• Beans, peas, lentils
• Nuts and seeds, such as walnuts, pumpkin seeds
• Lean meats such as chicken, turkey, salmon, tuna
• Dairy products such as milk, yogurt
• Soy products such as tofu

Vegetables

• Cruciferous vegetables: Broccoli, Brussels sprouts, cabbage, cauliflower and kale
• Leafy green vegetables: Spinach, collard greens, Swiss chard and asparagus
• Other vegetables: Artichokes, beets, carrots, eggplant, okra, peppers, potatoes (especially sweet potatoes) and tomatoes.

Healthy Fats

• Olive Oils
• Avocado
• Fish
• Walnuts
• Flaxseed oil

Fruits

• Blueberries
• Strawberries
• Pears
• Apples
• Banana
• Oranges

See more dietary suggestions and serving sizes in the document below.

Fatty Liver Disease: MASLD and MASH