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Diet and Nutrition With NASH

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By Editorial Team

4 min read

Reviewed by: HU Medical Review Board | Last reviewed: June 2024

Nonalcoholic steatohepatitis (NASH) is a liver condition that requires careful attention to diet and nutrition. Making changes to your diet – combined with regular exercise – is the primary way to manage NASH and reduce further liver damage. And if the disease is caught in the early stages, liver damage may even be reversed with a healthy diet and exercise.1,2

Consider the Mediterranean diet

The Mediterranean diet is a way of eating that focuses on whole, plant-based foods. It is inspired by what people who live in the Mediterranean region eat. Rich in antioxidants, vitamins, and minerals, the Mediterranean diet has been linked to:2,3

  • Decreased risk of heart disease
  • Reduced inflammation
  • Reduced LDL (bad) cholesterol
  • Weight loss

All these things can help improve liver health. This makes it an ideal diet for people living with NASH.2,3

The Mediterranean diet consists of:2,3

  • Fruits and vegetables
  • Healthy fats like avocado, olive oil, nuts, and seeds
  • Whole grains
  • Lean protein like chicken and fish
  • Limited red meat

Foods to eat

Whether you choose to eat a Mediterranean diet or not, those with NASH should focus on eating minimally processed, fresh foods.2

Colorful fruits and vegetables

Fruits and veggies are a staple of a NASH diet. They are packed with antioxidants and fiber. They help fight inflammation, make you feel full, and support good overall health.2,3

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The more naturally colorful your diet (food coloring does not count!), the better, as you receive a greater variety of antioxidants and micronutrients. Aim for a rainbow of produce colors from foods such as:2,3

  • Berries
  • Beets
  • Citrus fruits
  • Cruciferous vegetables like broccoli and cauliflower
  • Leafy greens like spinach and kale
  • Peppers
  • Tomatoes

Whole grains

Whole grains provide energy and fiber. Rather than refined grains like white bread and white pasta, opt for whole grains like:2,3

  • Brown rice
  • Oats
  • Whole wheat bread
  • Whole wheat pasta
  • Quinoa

Lean proteins

For those with advanced NASH (cirrhosis), doctors often recommend increasing protein intake. But eating the right protein is key. Rather than eating red meat, which is high in fat, incorporate these protein sources:2,3

  • Beans and legumes
  • Eggs
  • Fish
  • Skinless poultry
  • Tofu

Healthy fats

Fat is a staple of any diet. But there are good fats and bad fats. It is important to eat the right kinds if you have NASH. Saturated fats and trans fats promote high cholesterol, which is a comorbidity of NASH. So, avoid those and include healthy sources of fats such as:2,3

  • Avocado
  • Nuts and seeds
  • Olive oil

Low-fat dairy

Dairy products like milk, yogurt, and cheese are good sources of calcium and protein. But they can be high in fat, so choose low-fat or fat-free dairy alternatives, and eat them in moderation.2

Foods to avoid

People with NASH should also steer clear of certain foods that increase inflammation and fat buildup in the liver. If you have NASH, the following foods should be avoided.4,5

Processed foods

Processed foods – like fast food, junk food, and many packaged foods – are loaded with added sugar, unhealthy fats, and salt. These things contribute to liver inflammation and weight gain. It is best to cut out these foods from your diet.3,4

Saturated and trans fats

Saturated and trans fats are unhealthy fats that increase LDL cholesterol. High cholesterol and NASH are often related. Unchecked cholesterol levels can increase the pace of liver damage and can also lead to heart disease.5

Examples of foods that are high in saturated and trans fats include:2,5

  • Baked goods
  • Butter
  • Fatty meats
  • Fried foods

Excessive alcohol

Even though NASH is not caused by high alcohol consumption, alcohol can worsen liver disease and contribute to liver inflammation. It is better to limit alcohol if you have NASH. And if you have advanced NASH, experts recommend avoiding alcohol entirely.1,2

Be mindful of portion control

Portion control can help with weight loss goals and can therefore be helpful for those with NASH. Here are some portion control tips:1,6

  • Eat slowly and mindfully – Pay attention to when you feel hungry and full, and practice mindful eating to prevent overeating.
  • Don’t skip meals – Skipping meals can lead to overeating. It is best to eat regular, balanced meals throughout the day.
  • Use smaller plates and bowls – This may help you from overeating.
  • Eat without distractions – Eating without distractions allows you to fully focus on the sensory experience of eating, focusing on food's taste, texture, and smell. This helps you slow down and can cut down on overeating.

Meet with a dietitian or nutritionist

Your doctor may recommend you work with a dietitian or nutritionist to meet your diet and nutrition goals. These experts can help you make better food choices while taking into consideration your medical history, lifestyle, and food preferences.3

Additional help is available

If diet and exercise efforts alone do not lead to weight loss, other treatment options like medicines or weight loss surgery may be needed. These options can provide additional support in achieving weight loss, which is crucial for improving liver health and preventing further liver damage. Talk to your doctor about what is right for you.2

Treatment results and side effects can vary from person to person. This treatment information is not meant to replace professional medical advice. Talk to your doctor about what to expect before starting and while taking any treatment.