NASH diet and lifestyle
Going up against NASH (non‑alcoholic steatohepatitis) can be a challenge—but it’s one you may be able to overcome with changes to your diet and lifestyle. The information below can help you get started making positive changes today. But it’s important to talk with your doctor or liver specialist about what’s best for you. If you’re not yet working with a liver specialist, find one here.
Weight loss is key
As you may know, someone doesn’t have to be overweight to be affected by NASH. But lowering your body weight is a proven way to slow, stop, or even reverse the progression of fibrosis (liver scarring) due to NASH. Research has shown that reducing your body weight by
- 3-5% could lower the amount of fat in your liver
- 7-10% could improve all features of NASH—including liver inflammation and fibrosis
Weight loss can be difficult, but it’s a little easier when you have a good reason to keep you focused.
Building your NASH‑friendly diet
The liver’s role in nutrition
Understanding weight loss to improve NASH starts with understanding your liver. Your liver is a key piece of your digestive system—the part of your body responsible for processing what you eat and drink. Your liver breaks down fats, carbohydrates, and protein into substances your body can use. Studies suggest that getting a healthy balance of each of these—plus fiber, which your liver doesn’t break down—is the way to take on NASH.
Core components of nutrition:
fats, carbohydrates, fiber, and protein
Not all fats are bad! Fats are a major source of energy and help you absorb nutrients your body may need.
Fat is a necessary component of your individual cells and is a vital part of blood clotting and muscle movement. So it’s important to get some amount of fat into your diet.
There are good fats and bad fats. In general, good fats are unsaturated fats, and bad fats include saturated and trans fats.
- Unsaturated fats have many benefits, including easing inflammation. Unsaturated fats often come from plant‑based sources like olives, nuts, and avocados, but can also come from fish.
- Saturated and trans fats are found mainly in red meat, dairy products, fast food, and desserts. Keep in mind that cutting back on saturated and trans fats will not make a difference to your liver health if replaced with processed carbohydrates (like sugary cereals, white rice, or pastries).
Your liver breaks down the fat you eat by producing a liquid called bile. If you eat a diet high in bad fats, your liver will have to work overtime trying to produce enough bile to break down all of those fat molecules.
A NASH‑friendly diet avoids bad fats to lighten your liver’s workload.
Carbohydrates (carbs) have gotten a bad rap lately, with many people avoiding them altogether. But, like with fats, it’s not quite as simple as that.
Your body processes carbs into glucose (a type of sugar). When your body has too much glucose, it gets converted into fat. So eating too much of something that may seem harmless and “low-fat”—like white bread—could contribute to a buildup of fat in your liver.
Like fats, there are some forms of carbs you should try to eat over others. Carbs break down into 2 types: complex and simple.
- Complex carbohydrates pack more nutrients, are often higher in fiber than other carbs, and digest more slowly. This means they provide more long-term energy. Complex carbs are a big part of a NASH‑friendly diet and can be found in foods like lentils, quinoa, beans, whole grains, and whole wheat.
- Simple carbohydrates break down quickly. This means energy from simple carbs is absorbed fast, raising blood glucose levels and often giving you a burst of energy. You can find simple carbs naturally in foods like fruits and milk, but you can also find them in processed foods like sugar, candy, and sweeteners.
- Processed foods—sometimes called refined foods—have had their carbohydrates stripped of all nutrients—though sometimes nutrients are added back in artificially. Processed foods should be eaten sparingly, if at all, in a NASH‑friendly diet. They can be found in foods like white bread, pasta, and sugar‑sweetened beverages.
If you’re living with NASH, focus on fiber! Fiber can reduce inflammation and help you absorb nutrients and vitamins.
Fiber is a special type of carbohydrate that our bodies can’t digest. This is actually a good thing: because your body doesn’t break it down, fiber helps keep things moving through your digestive system. As an added benefit, fiber can lower levels of glucose (sugar) and blood cholesterol.
Fiber is found in vegetables, fruits, whole grains, and beans. Some great sources of high fiber include raspberries, pears, broccoli, whole wheat pastas, barley, bran, peas, black beans, and lentils.
You may know proteins as the building blocks of muscle. But they do so much more!
Proteins perform countless processes in our bodies, and they also help make up our bones, skin, and blood. Your liver converts proteins from the foods you eat into proteins your body can use. Like with fats and carbohydrates, some sources of protein are better than others. A diet high in red meat increases the likelihood for fatty buildup in your liver, type 2 diabetes, high cholesterol, and related conditions.
Try to get proteins from healthy sources, like lentils, pinto beans, split peas, kidney beans, peanuts, and products made from soy. Some nuts and seeds that are high in protein include almonds, walnuts, pistachios, sesame seeds, and chia seeds. Fish like salmon and tuna are also a healthy source of protein. If you’re really craving meat, you can eat poultry in smaller portions. Red meat should be limited to a few times per month.
Putting it all together
Now that you understand the parts of a healthy diet, how do you make one that helps you lose body weight and helps your liver? As you put your NASH-friendly diet together, try to focus on the same things that make up many popular and existing diets: vegetables, grains, healthy fats, and fibers.
Remember: Fat in your liver is not just due to fat. Eating too much of other foods—like processed carbs and sugars—can lead to a buildup of fat in your liver.
At the grocery store
When you’re shopping for your NASH‑friendly diet, try to buy unprocessed foods from each of the 4 core components (fats, carbohydrates, fiber, and protein). A good general rule is to stay around the edges of the store—that’s usually where all of the fresh stuff is. The center is often where more processed foods are kept.
Here are some NASH‑friendly foods to get you started:
leafy greens like spinach and kale, carrots, broccoli, collard greens, arugula
tomatoes, cucumbers, berries, apples, oranges, grapes, figs, melons, peaches
lentils, chickpeas, beans, almonds, peanuts
whole-grain bread, quinoa, oatmeal, brown rice
tuna, salmon, mackerel, herring, sardines, trout, pollock
lots and lots of olive oil, which can have anti‑inflammatory properties
Download a NASH‑friendly diet shopping list to take with you next time you go shopping.
Fewer restaurants, more control
Eating healthy is a lifestyle, made of a series of choices you may not be used to making. Cutting down on eating in restaurants can make it easier to follow your NASH‑friendly diet. Meal prepping and cooking can be difficult at first—here are some tips to make it a bit easier:
- Plan and prep your meals ahead of time
- Avoid too much canned or frozen produce—it lasts longer but can be high in sodium or sugar
- Canned or frozen fish can be cheaper, but sometimes your local grocery or market will do sales on fresh seafood
- Look for “plant-based recipes” on the Internet
- Try to pick foods that are “100%,” like 100% fruit juice or 100% whole grain
- Cook with the seasons! Your local farmer’s market should have fresh, affordable seasonal produce
Wondering what to make with all of this NASH‑friendly food?
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A NASH‑friendly diet doesn’t really take that much work—just a little practice. Download a NASH‑friendly food pyramid to put on your refrigerator or somewhere else you’ll see it every day. It can help remind you what makes sense for you to eat and drink—and remind you of why you’re doing it.
Making a difference with movement
Another way to reduce your body weight—and the amount of fat in your liver—is through exercise. And it doesn’t have to be an intense workout like lifting weights or running 5 miles! Moderate‑intensity exercise is your best bet for sustaining weight loss over time. It can be as simple as working more movement and activity into your daily routine. Be sure to check with your doctor first before starting any new exercise program.
Here are some ways you can get more movement and simple exercise every day:
Make housework a workout
Vacuum, scrub, rake…and enjoy the results.
Walk to work
Even if it’s just partway: get off a stop earlier on the train or bus, or park a bit farther away.
Walk a little faster
Find a speed that works for you—including alternating between a fast and slow pace.
Take the stairs
Use your legs instead of the elevator or escalator—even if it's just on the way down.
Get out and do some gardening
Just being outside more has been shown to be beneficial to your overall health.
The most important thing to realize about exercise is that every bit counts. A longer workout may not be reasonable for you based on your schedule or level of fitness. Do what you can when you can and know that you’re making a difference.
Staying positive and lowering stress
The last piece of a healthy diet and lifestyle may be the most important: making sure you’re taking good care of your mental health. This means staying focused, staying positive, and maintaining a low level of stress. In general, staying calm and focused can make it easier to accomplish goals—like sticking to your NASH‑friendly diet and avoiding “stress eating.” Stress is also a risk factor for high blood pressure, cardiovascular disease, and cancer. Here are some simple ways you may be able to keep your stress level down:
- Count to 10 before speaking or reacting
- When you’re feeling stressed, take several slow, deep breaths
- Go for a walk, no matter how short a distance
- Get plenty of sleep
- Break down big problems into smaller, more manageable parts
- Talk to your friends and loved ones—let them know how you’re feeling
- If you’re feeling stressed about NASH and your liver health, talk to your doctor or liver specialist