How Is Nonalcoholic Steatohepatitis (NASH) Treated?

As of 2022, there’s no Food and Drug Administration (FDA)-approved medication or other treatment for NASH or NAFLD. Some possible medications are currently being studied, including those that target glucose (sugar) and lipid (fat) metabolism to help reduce inflammation and fibrosis of the liver.

Until potential medications become available, the treatment for NASH and NAFLD instead consists of management strategies. For NASH, the focus is to reduce further liver injury and possibly reduce any underlying fat and inflammation on the liver.

It’s thought that NASH is more prevalent in adults who have other health conditions such as a higher body mass index and type 2 diabetes. While there’s not yet a medication available to treat NASH, managing such related comorbidities may help.

Reaching a moderate weight

Having overweight and obesity are both considered risk factors for developing NASH but losing weight may help you manage it. While a moderate weight is highly individual and can depend on other factors such as your height and genes, gradually losing weight may decrease the effects of NASH.

For example, losing 3% to 5% of your body weight can reduce excess fat in the liver. Also, losing 7% of your body weight may reduce inflammation in the liver.

Speak with a doctor about how you can get started with gradually losing weight. Some strategies may include:

• portion control
• reduced-calorie diet
• regular exercise

Controlling diabetes

Type 2 diabetes is another condition that’s common in adults with NASH. Managing your blood sugar and taking your recommended medications may help you manage both of these conditions.

Abstaining from alcohol

While NASH and NAFL are not caused by heavy alcohol consumption, abstaining from alcohol is recommended for anyone with liver disease. As one clinical review notes, drinking alcohol while having NASH may increase the risk of liver injury.

Lowering sugar intake

Diets that are high in sugary foods and beverages have also been linked to a higher risk of developing NAFLD. Cutting down on such processed foods may help you manage other comorbidities, such as diabetes and obesity.

Lowering total cholesterol

High cholesterol is another condition seen with NASH, though diet and exercise may help. The Centers for Disease Control and Prevention (CDC) reports that an “optimal” total cholesterol level is around 150 milligrams per deciliter (mg/dL). Also aim for a triglyceride level less than 150 mg/dL.

Regular exercise

Regular exercise is key to managing your weight and lowering the risk of chronic illnesses. While the general recommendation is at least 30 minutes per day, a doctor may encourage more than this amount.

Moderate exercises that increase your heart rate and make you sweat are best and may include fast walking, jogging, and swimming.

However, if you’re new to exercise, speak with a doctor first. They’ll likely recommend starting with lower intensity exercises first before you gradually work your way up to more moderate workouts.

Managing your blood pressure

High blood pressure is another risk factor for metabolic syndrome, which may be associated with NASH. In addition to regular exercise, you may be able to help manage your blood pressure with a healthy diet and a daily sodium intake lower less than 1,500 mg per day.

Both types of NAFLD may be diagnosed with a combination of a physical exam, imaging tests to look at liver fat and inflammation, and blood tests that measure potentially elevated liver enzymes.

One diagnostic tool that’s used in NASH and not NAFL is a liver biopsy. This involves taking a small sample of your liver to examine the tissue for signs of fibrosis or cirrhosis. The biopsy is sent to a lab for examination under a microscope to help make this determination.

When left untreated, the underlying inflammation and damage associated with NASH may lead to a type of scarring in the liver called fibrosis. According to a comprehensive clinical review that looked at NAFLD data between 1989 and 2015, about 41% of adults with NASH experience fibrosis progression.

This may further cause cirrhosis, or permanent scarring of the liver. Having cirrhosis also increases your risk of developing liver cancer or liver failure. A doctor may recommend a liver transplant to address these conditions.

Additionally, having NAFLD may increase your risk of developing:

• metabolic syndrome, which may also include high blood pressure and high cholesterol
• cardiovascular disease, which is also the most common cause of death in people with NASH
• type 2 diabetes

A diagnosis of NASH may raise many questions you may wish to discuss with a doctor. Below are a few common questions and answers to help you get started:

What is NASH?

NASH is a form of NAFLD that also causes inflammation in your liver. This inflammation can lead to permanent liver damage and possibly increase your risk of developing liver cancer.

Are there medications to treat NASH?

There currently aren’t any medications available to treat NASH, though there are possible drugs being investigated in clinical trials.

Instead, you may consider speaking with a doctor about ways to manage NASH through diet, exercise, and other lifestyle strategies. Also, be aware of claims surrounding supplements or vitamins as “cures” for NASH, as these may do more harm than good.

Is NASH reversible?

Left untreated, NASH may lead to permanent liver damage. However, the condition itself is reversible. In fact, significant improvements in your metabolic profile could potentially lead to normal liver function again in the future.

What should you eat if you have NASH?

Eating a diet that focuses on vegetables, fruits, and whole grains can help you manage NASH. One recommendation is the Mediterranean diet, which focuses more on plant-based foods that are naturally low in saturated fats rather than animal-based foods.

It’s also recommended that you focus on healthy (plant-based fats), such as olive oil, as these are lower in saturated fat.

NASH is a type of NAFLD that’s often associated with metabolic disorders. It’s characterized by excess fat accumulation, as well as inflammation that can potentially damage healthy liver tissues.

There’s currently no medication available to treat NASH, which makes diet, exercise, and other management strategies important in preventing and reversing damage to your liver. Speak with a doctor for more information about how you may manage specific comorbidities you might have with NASH.