The Insulin Resistance and NASH Connection (And What You Can Do About It)

A type 2 diabetes (T2D) diagnosis is the most common time people learn about insulin resistance. However, insulin resistance is also linked to many other health conditions, including nonalcoholic steatohepatitis (NASH). Read on to learn more about what insulin resistance is and what it means for someone living with NASH.¹

What is insulin resistance?

Let’s start with insulin. Insulin is a hormone our body makes to help us process our food for energy. Insulin is often described as a key that opens doors to your body’s cells so that glucose (sugar) can enter. Your body’s cells need glucose to work.^2,3

In fact, if your body didn’t make insulin, your cells wouldn’t be able to get the glucose they need to function and you would die. Insulin resistance happens when your body’s cells don’t respond well to insulin.^2,3

How do you develop insulin resistance?

Insulin resistance is linked to metabolic syndrome. Metabolic syndrome is a group of conditions that can cause health issues such as high blood pressure, high cholesterol, diabetes, and more. This happens more often to people who live in a bigger body, especially those who carry most of their weight around their belly.^2,3

Your risk for metabolic syndrome also increases with things like:^2,3

• Older age
• Not exercising
• Not sleeping well
• Eating unhealthy foods
• Smoking or drinking alcohol
• Certain medical conditions

Metabolic syndrome is diagnosed if you have 3 or more of the following:²

• Fasting blood glucose above 100 mg/dl (sometimes called pre-diabetes or diabetes)
• Blood pressure over 135/85
• Triglycerides above 150 mg/dl
• HDL below 40 mg/dl for men or 50 for women
• Large abdominal size

Insulin resistance and NASH

Lots of research shows that insulin resistance and metabolic syndrome are connected to liver conditions. These conditions can include non-alcoholic fatty liver disease (NFALD) and NASH.⁴

In fact, NASH has been renamed MASH, or metabolic dysfunction steatohepatitis, for that reason. In one study, the more fat and fibrosis in someone had in their liver, the higher their insulin resistance. The other metabolic syndrome factors, like cholesterol levels and body size—even inflammation—were also worse as well. That means metabolic syndrome can worsen as you shift from NAFLD to NASH/MASH.³

Managing insulin resistance is an important part of managing NASH/MASH and lowering the risk of other insulin resistance conditions like T2D.¹

Ways to reduce insulin resistance

Weight loss is often recommended for people with NASH. Some ways to reduce insulin resistance below are also part of someone’s weight loss plan.

However, for many people, weight loss isn’t that easy to do, let alone maintain. Remember that healthy habits can decrease insulin resistance and help combat metabolic syndrome for people of all body shapes and sizes. Consider ways you can gauge success in building your new health habits besides weight.

For example, the number of fruits and veggies you’re eating, how often you’re active, the number of hours you sleep each night, etc. Let’s explore ways you can decrease insulin resistance.

1. Exercise

Study after study show your body can become more sensitive to insulin with exercise. Being active for 30 minutes a day most days of the week is the general recommendation for US adults. Exercise should include:^5,6

• Resistance training (lifting weights, resistance bands)
• Cardio (get that heart rate up!)
• Balance and flexibility (yoga, tai chi, etc.)

Always talk to your provider about getting active – some people do have limitations on the types of activity they can do safely.

2. Healthy eating

Eating patterns can have an impact on our health. For example, high amounts of saturated fat (like beef, pork, butter, heavy cream, etc.) have been linked to higher insulin resistance.⁷ Eating whole grains, fruits and vegetables, nuts and seeds, and lean proteins/healthier fats is recommended for US adults.^6,7

Remember little changes can make a BIG difference – add a fruit or veggie to each meal, or make a trail mix with nuts, seeds and dry fruit for a snack. Explore new foods and new recipes. Ask your insurance if they cover visits with a registered dietitian for support and training on healthy eating.

3. Sleep

One of the most overlooked aspects of health is sleep. Many studies connect lack of sleep with higher amounts of insulin resistance. Work schedules, stress, medical conditions (like sleep apnea), and general poor sleep habits can all play a role. Don’t overlook this very important part of your health. Talk with your doctor and therapist if your struggle in this area.⁸

There are so many other self-care habits to consider beyond these three. Things like avoiding nicotine, reducing stress, and staying connected socially all have an impact on health and insulin resistance, metabolic syndrome, and NASH/MASH. When building a new view of health consider all aspects of your mental, physical, and emotional well-being. You can do this!