Nonalcoholic Steatohepatitis Treatment

Nonalcoholic Fatty Liver Disease and Nonalcoholic Steatohepatitis Treatment

The first line of treatment for NAFLD and NASH is weight loss, done through a combination of calorie reduction, exercise, and healthy eating. Weight loss can reduce fat and inflammation in the liver. The following lifestyle changes are important in managing your disease.

1. Lose weight

This is one of the best treatments for NAFLD and NASH, because it moderates the conditions that contribute to fatty liver disease. Losing just 3 to 5 percent of your body weight can reduce fat in your liver; losing 7 percent can decrease inflammation as well. If you are overweight or obese, doctors typically recommend you gradually lose 7 to 10 percent of your body weight over the course of one year. Rapid weight loss through fasting is not recommended, as it can make NAFLD worse.

The best way to lose weight is done by:

  • Reducing the number of calories you eat. Keeping track of the calories you consume every day and employing portion control can help.
  • Eating a healthy diet that’s rich in fruits and vegetables, whole grains and low in saturated fats. Limit animal-based foods, like red meat which is high in saturated fats, and eat more plant-based foods like beans, legumes, and nuts. Use good fats like olive oil. This is the basis for the Mediterranean diet – which isn’t a diet in the traditional sense, but a healthy way of eating inspired by the eating habits of people living in the Mediterranean area – and is often recommended by doctors as a way to reduce some of the risk factors associated with fatty liver disease. Visit the ALF Liver Disease Diets page to learn more about how nutrition can make a difference for you.
  • Limiting the amount of salt and sugar in your diet, particularly sugar-sweetened beverages, like soda, juices, sports drinks, and sweetened tea. High consumption of fructose, one of the main sweeteners in these beverages, increases your odds of developing obesity, type 2 diabetes, metabolic syndrome, and NAFLD. Watch the ALF Webinar on 10 Ways to Cut Back on Salt and Sugar.
  • Exercising more – exercise is important for many reasons; it can help with weight control, boost your immune system, and alleviate stress and depression. Try to be active at least 30 minutes most days of the week. Depending on how much weight you’re trying to lose, you may need to up that amount. Getting exercise doesn’t mean you have to go to a gym – walking, gardening, and even housework counts. However, if you don’t already exercise, get your doctor’s okay first and build slowly. The goal is to participate in exercise of a moderate intensity (examples include light jogging, biking, swimming or playing a sport that boosts your heart rate and results in sweating). For more valuable information about how you can get fit, visit ALF’s Health & Wellness blog.

While following a healthy diet and maintaining a normal body weight may not seem like a specific treatment, it’s essential to managing NAFLD and NASH.

If you’ve tried to lose weight in the past without success, talk to your healthcare provider about getting help. You may be a candidate for a medically-supervised weight loss program that employs medication along with diet and exercise. Alternatively, there are weight-loss (bariatric) surgical procedures and endoscopic therapies that work by either physically limiting the amount of food your stomach can hold, or reducing the amount of nutrients and calories your body absorbs. Talk to your doctor about which option may be best for you.

2. Control your diabetes

Closely monitor your blood sugar and take medications as prescribed.

3. Keep your cholesterol down

Limit your intake of saturated fats, which are found in meat, poultry skin, butter, shortening, milk and dairy products (except fat-free versions). Replace them with monounsaturated fats (olive, canola, and peanut oils) and polyunsaturated fats (corn, safflower, soybean oils, and many types of nuts). Particularly helpful in reducing heart disease are omega-3 fatty acids, a type of polyunsaturated fat found in oily fish such as salmon, flaxseed oil, and walnuts. Healthy eating combined with exercise – and taking cholesterol-lowering medications if prescribed by your doctor – will help keep your cholesterol and triglyceride levels where they need to be.

4. Protect your liver

Don’t do things that put extra stress on your liver.

  • Avoid drinking alcohol.
  • Take medications and over-the-counter drugs only as instructed.
  • Be cautious about taking dietary supplements. Certain vitamins and minerals – like vitamins A, iron, and niacin – can be harmful to your liver in higher doses than necessary or prescribed.
  • Check with your healthcare provider before trying any herbal remedies. Just because a product is called “natural,” does not mean it’s safe.
  • Get vaccinated for hepatitis A and hepatitis B. If you get hepatitis A or B, along with fatty liver, it’s more likely to lead to liver failure.

A multidisciplinary approach to treatment that involves nutritionists, endocrinologists, cardiologists, and other specialists as needed – in addition to your hepatologist – is essential to successfully manage the underlying metabolic conditions associated with fatty liver disease.

Are there medications to treat NAFLD and NASH?

In March 2024, the US Food and Drug Administration approved the use of resmetirom (Rezdiffra™) for people with NASH and stage 2 or 3 fibrosis (but not cirrhosis) along with eating a healthy diet and participating in regular exercise. This is the first drug approved for NASH in the United States and the approval was based on resolution of NASH and improvement in fibrosis in about a quarter of the patients treated in a large international trial (MAESTRO NASH, NCT03900429). This drug works by revving up the thyroid hormone pathway in the liver to increase the metabolism of liver fat. The most common side effects of treatment are nausea and diarrhea. Gallstones and gallbladder inflammation also developed in some patients in the trials. It can also interact with other medications such as statins, gemfibrozil (Lopid) and clopidogrel (Plavix), so be sure that your health care provider has a full list of your medications before prescribing Rezdiffra. A liver biopsy is not essential to start Rezdiffra because other tests that can show the accumulation of liver fibrosis such as Fibroscan or other measures of liver stiffness can provide the necessary information. Rezdiffra is not for people who do not have evidence of significant liver fibrosis.


In studies of people with NAFLD, those who drank coffee had less liver damage than those who drank little or no coffee. Caffeinated coffee reduces the risk of liver fibrosis in several liver diseases, including NAFLD. Studies suggest you need to drink more than two cups per day to gain this benefit, however, some people do not tolerate it well. But for those who currently do drink caffeinated coffee – enjoy!

Vitamin E

This vitamin, which is an antioxidant, theoretically works by reducing or neutralizing the damage caused by inflammation. Some evidence suggests vitamin E supplements may be helpful for people with liver damage due to NAFLD and NASH. Researchers in one study found that a daily dose of the natural form of vitamin E – the kind that comes from food sources and isn’t made in a laboratory – improved NASH in study participants overall by reducing fat and inflammation although not scarring. This medication is not for everyone and may have potential side effects as well. Discuss the potential benefits with your doctor.

*NAFLD is newly renamed metabolic dysfunction-associated steatotic liver disease or MASLD.

*NASH has been newly renamed metabolic dysfunction associated steatohepatitis or MASH.

*Fatty liver disease is newly renamed steatotic liver disease.

Last updated on May 24th, 2024 at 11:08 am

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