Managing Nonalcoholic Steatohepatitis (NASH) With Diet and Lifestyle

Nonalcoholic steatohepatitis (NASH) is directly linked to lifestyle habits. Both an unhealthy diet and a lack of exercise can increase the risk of NASH. But there is good news! These factors are also ones that you can control. A healthy diet and exercise can have a big impact on your liver health.¹

Making healthy lifestyle changes can greatly improve NASH. If the condition is caught early, you may even be able to reverse its effects. However, it can be challenging to overhaul your life with new habits. This is why it is so important to have support from others. They can help you make these habits a permanent part of your life.¹

Understanding the basics of NASH

NASH is a serious liver condition that results in inflammation and damage. It is caused by fat building up in the liver over time. NASH is the more advanced form of nonalcoholic fatty liver disease (NAFLD).

If it is left untreated, NASH can progress to liver scarring. This scarring is called fibrosis. It can lead to more severe problems, like cirrhosis (permanent scarring) and liver failure.

How does diet and nutrition impact NASH?

When it comes to managing NASH, a balanced and nutritious diet is vital. Research has found that obesity has increased the rates of fatty liver and NASH at alarming rates around the world. Obesity often results from eating a typical “Western” diet. Therefore, the link between an unhealthy diet and NASH is clear.^1-3

Foods to avoid and prioritize

If you have NASH, the first treatment approach is weight management. Foods that are high in fat, sugar, and salt can worsen liver damage. You should limit the following foods:^1-3

• Foods with high levels of saturated fats and trans fats (such as junk food and fast food)
• Foods with added sugars, particularly fructose (found in many juices, soft drinks, and sports drinks)
• Foods with too much salt
• Processed, packaged “convenience” foods

It is important to focus on nutrient- and antioxidant-rich foods. These support good liver health and help reduce inflammation. Try the following:^1-3

• Incorporate plenty of fruits, vegetables, whole grains, and lean proteins into your meals
• Limit red meat
• Opt for healthy fats found in nuts, seeds, avocados, fatty fish like salmon, and olive oil

Weight management

A Mediterranean diet is a great way of eating for people with NASH. Adopting this diet has been shown to reduce inflammation and help people lose weight. It also lowers cholesterol and improves heart health.^1-3

The amount you eat matters, too. Watch your portion sizes. If you have advanced NASH, try eating smaller, more frequent meals throughout the day.^1,2

Finally, consider working with a registered dietitian (RD). These are experts who can help you with weight management. They will make sure you are getting the nutrients your body needs.

How does exercise impact NASH?

Regular physical activity is another crucial part of managing NASH. Exercise helps you reach a healthy weight and stay there. It helps slow down the progression of NASH. It also:^1-4

• Improves how the body processes insulin (helping treat or prevent diabetes)
• Reduces fat in the liver
• Lowers inflammation throughout the body
• Builds muscle and improves flexibility
• Improves bone density, heart health, and blood flow
• Improves mood and relieves stress

Try to exercise for at least 30 minutes a day, most days of the week. Aim for moderate-intensity exercise like brisk walking, cycling, or swimming. Anything that gets your heart pumping qualifies.^1-4

If you are new to exercising, start slowly. As you get stronger, you can exercise harder and for longer. Find activities that you enjoy. If you are having fun, you are more likely to keep going.⁴

Alcohol and liver health

NASH is not caused by alcohol. However, alcohol can also cause fat to build up in the liver. This can make liver damage worse. Even small amounts of alcohol can increase the risk of scarring and other complications.¹

Experts recommend that anyone with NASH limit alcohol. Anyone with cirrhosis should avoid alcohol completely.¹

If you need to cut back, consider swapping alcoholic drinks for nonalcoholic ones. Just be careful. Many "mocktails" contain lots of added sugar. Talk to your doctor or a dietitian about how to cut back safely.¹

The importance of quality sleep

Getting enough sleep each night is essential for overall health. During sleep, our bodies repair tissue, regulate hormones, and make memories. Sleep also boosts our immune system.⁵

Poor sleep habits are linked to weight gain and difficulty processing sugar. Both of these can worsen NASH. According to research, not getting enough quality sleep can lead to:⁵

• Higher levels of the hormones that control hunger
• Increased craving for fatty, sweet, and salty foods
• Having less energy for exercise
• Weight gain

Aim for 7 to 9 hours of sleep each night. Establish a relaxing bedtime routine to help you unwind. Some light stretching, reading, or listening to calming music can help relax the body and mind. Avoid caffeine, large meals, and electronics right before bed.⁶

If you are struggling with sleep, talk to your doctor. They may recommend a sleep specialist.⁶

Managing stress

Chronic stress can take a toll on your physical and mental health. Find healthy ways to manage stress. To help calm your body and mind, explore these relaxation techniques:⁷

• Deep breathing exercises
• Meditation
• Yoga

Prioritize self-care

Living with or caring for someone with a chronic condition like NASH is challenging. It is often stressful. Prioritize self-care activities that bring you joy. This might include visiting loved ones, pursuing hobbies, or spending time in nature.⁷

Reach out to friends, family, or support groups for encouragement. If you are feeling overwhelmed, get support from a therapist or counselor. They can help you develop healthy ways to cope with and manage stress.⁷