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Though it can be overwhelming to learn you have steatotic liver disease (SLD) — or that you may be at risk of developing the condition — many liver issues can be managed through lifestyle changes and with the support of your healthcare team.
Steatotic liver disease is an umbrella term that describes a range of liver conditions caused by too much fat buildup in the liver. Metabolic dysfunction-associated steatotic liver disease (MASLD) is a form of steatotic liver disease that is not caused by alcohol consumption and often occurs in people who drink little to no alcohol.
Metabolic dysfunction-associated steatohepatitis (MASH) is an aggressive form of MASLD characterized by liver inflammation and, in some cases, liver scarring (fibrosis) and swelling, in addition to excess fat in the liver. As MASH progresses, more and more scarring builds up, damaging the liver and compromising its function. This advanced scarring is known as cirrhosis and can cause a number of complications, including liver failure and liver cancer.
There are a number of factors — some of which you can control and others you can’t — that may make you more prone to develop MASLD or MASH. These include genetics, sex, race and ethnicity, and age. However, research indicates that weight is the biggest risk factor. Some studies estimate that as many as two-thirds of all adults with obesity and half of all children with obesity may have MASLD — and an estimated 20% of those people may have MASH, the more advanced stage of MASLD.
But the good news is that both MASLD and MASH are treatable, reversible diseases, according to Blanca C. Lizaola-Mayo, M.D., medical director at Mayo Clinic’s Liver Transplant Center.
“The liver is incredibly resilient,” Dr. Lizaola-Mayo says. “Even if the liver is inflamed, the liver is one of the only organs in the body that can regenerate itself, expel fat, and regenerate — as long as improvements are made before cirrhosis sets in.”
Learn more about the do’s and don’ts that can help you manage MASH and protect your liver health.
Lifestyle do’s for a healthy liver
There is no magic cure-all when it comes to liver health. But a holistic approach to your well-being — including having regular screenings, eating a healthy diet, getting regular movement, managing weight and in some cases taking medications— can help support and maintain your liver health. Remember, with the right interventions, it is possible to prevent and reverse MASLD and MASH.
As always, have an open, realistic conversation with your healthcare team to determine the best course of action for you, which may include:
- Managing weight. For most people, weight loss is the primary treatment for MASLD and MASH. For people who have obesity or are overweight, weight loss has been shown to improve liver biochemical test results, insulin levels and liver histology as well as quality of life. Typically, weight management begins with healthy changes to diet and increased exercise, but for some people, bariatric surgery, weight-loss medications or other interventions may be recommended.
- Managing heart health. Since MASLD is associated with cardiovascular disease, it’s important to take care of both your liver and your heart, says Dr. Lizaola-Mayo. “Pay attention to managing your risk factors for metabolic and cardiovascular conditions, like diabetes and prediabetes, sleep apnea, high blood pressure, and undesirable cholesterol levels,” she says.
- Getting vaccinated. Hepatitis A and hepatitis B are conditions that can compromise liver health and increase the risk of liver failure in people with MASLD or MASH. In addition to hepatitis A and B vaccinations, additional vaccines are available for people with chronic liver disease.
- Drinking coffee. Black caffeinated coffee has shown to be beneficial for the liver and it is associated with a slower progression of fibrosis, according to Dr. Lizaola-Mayo. “The more, the better,” she says. “Three cups a day keeps the hepatologist away.”
Though these changes may seem small, Dr. Lizaola-Mayo says they can make a big difference for your liver and overall health. “It’s pretty amazing seeing patients in the clinic and noting how lifestyle changes and weight loss have reversed their fibrosis and improved their quality of life.”
Lifestyle don’ts for a healthy liver
In addition to incorporating healthy habits for your liver, you can also do avoid a few key things, according to Dr. Lizaola-Mayo:
- Alcohol. Perhaps unsurprisingly, alcohol can worsen fatty liver disease. According to Dr. Lizaola-Mayo, moderate to heavy alcohol use is associated with more-rapid liver scarring and the development of cirrhosis. At the moment, it’s unclear whether light alcohol consumption has the same progressive effect — but experts agree abstinence is the safest choice. “Avoiding alcohol is especially important for people who have had bariatric surgery, such as gastric bypass or gastric sleeve. Since stomach space is restricted after surgery, even small amounts of alcohol affect the body and liver much more,” Dr. Lizaola-Mayo says.
- Fructose. Though fructose is a naturally occurring sugar in whole foods like fruit, it can be processed into high-fructose corn syrup — a supersweet additive found in many processed foods, candies, beverages and commercial baked goods. Research has found that excess fructose consumption can deteriorate the intestinal barrier and worsen MASH.
- “Detox” supplements. Though it can be tempting to try a supplement that promises to detox or cleanse the liver, be wary of these products. Some plants associated with liver health, such as milk thistle, can be safe to consume for some people, but research is mixed on their effectiveness. “I normally do not recommend any type of supplement. In fact, there are many supplements that claim to help the liver, but actually they can harm it,” Dr. Lizaola-Mayo cautions. To put it simply, Dr. Lizaola-Mayo says the only thing that really cleanses the liver is the liver itself.
Remember, you don’t have to overhaul your entire lifestyle overnight — the key is working with your healthcare team to identify sustainable habits and interventions that can support your liver health and properly address a MASH diagnosis.
Mayo Clinic does not endorse companies or products. Advertising revenue supports our not-for-profit mission.
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