Metabolic-associated steatohepatitis (MASH) happens when excess fat in the liver causes inflammation and scarring, or fibrosis. The condition is serious, and when left untreated it can lead to permanent liver damage. But in many cases MASH can be reversed if the condition is caught early enough. “MASH is reversible,” says Sidney Barritt IV, MD , director of hepatology at UNC School of Medicine in Chapel Hill, North Carolina. “The keys are stopping the cascade of fat, inflammation, and scar tissue [in the liver]. As liver disease severity advances, MASH may become more difficult to reverse.”
The Liver Can Heal Itself From MASH Liver Regeneration MASH damages the liver through the buildup of fat in the body’s liver cells, called hepatocytes. This buildup causes inflammation in the liver, which can cause hepatocytes to become damaged. That damage can lead to the development of scar tissue, or fibrosis. If the damage continues, the fibrosis can advance to cirrhosis , which is severe and often permanent scarring that makes it harder for the liver to function properly. Untreated cirrhosis can lead to liver failure.e60dc2a1-f33c-4a05-9b50-8e3e8e597629011542d0-1790-4735-8d21-29a95b39dea5 But it is possible for the liver to recover by generating healthy new cells, as long as it hasn’t already sustained too much damage. “The question of MASH being reversible is essentially dependent on where the condition lies in the spectrum of liver damage,” says Raffi Karagozian, MD , a hepatologist at Tufts Medical Center in Boston. In order for the liver to generate healthy new cells, the factors causing the damage (like new fat buildup and inflammation) need to be addressed with lifestyle changes and medication. Over time, as more healthy cells and and healthy liver tissue accumulate, the amount of scarring stops getting worse or begins to heal.e60dc2a1-f33c-4a05-9b50-8e3e8e597629011542d0-1790-4735-8d21-29a95b39dea5e60dc2a1-f33c-4a05-9b50-8e3e8e597629ca63bb86-86df-4432-b02e-a2e64337f481
The Stages of MASH MASH Stages The stage of MASH is a big factor in whether or not it’s reversible. There are four stages, which range from mild to severe, says Dr. Barritt. These include:e60dc2a1-f33c-4a05-9b50-8e3e8e59762958520dc1-31f0-4b08-9b74-b9c863703a49 Stage 1 Very little or no fibrosis and normal liver function. Stage 1 MASH can likely be reversed. Stage 2 Some scarring, but still normal or mostly normal liver function. This scarring can mostly be repaired. Stage 3 Significant scarring that may start to impact a person’s liver function. Some stage 3 damage can be repaired. It’s also still possible to keep MASH from getting worse. Stage 4 Advanced scarring that has changed the shape of the liver and is impacting liver function. Some stage 4 damage may still be repaired, however, unmanaged stage 4 MASH can lead to liver failure. A person’s MASH stage is determined by the amount of inflammation and fibrosis in the liver, Barritt explains. Your doctor may use some of the following tests to check for inflammation and fibrosis:e60dc2a1-f33c-4a05-9b50-8e3e8e5976295f6fd8b6-5e99-4565-bdac-141a5e8992db Blood Tests These can include a complete blood count as well as tests that check liver function and enzymes, iron levels , chronic viral hepatitis, fasting blood sugar, hemoglobin A1C , and cholesterol. Imaging Tests These tests may include abdominal ultrasound, MRI or CT scan , transient elastography, or magnetic resonance elastography. Liver Biopsy
Treatments That May Reverse MASH Treatments Lifestyle changes and medications can stop MASH from getting worse and, in some cases, heal liver damage that has already happened. “These interventions are fairly effective in stabilizing the progression of MASH and even possibly reversing the inflammation associated with MASH,” Dr. Karagozian says. Lifestyle Changes Lifestyle changes are the cornerstone of managing and potentially reversing MASH, whether a person is on medications or not.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e41034ca-eea9-41c3-922c-78911721b92d Healthy Diet and Exercise A healthy eating pattern and regular physical activity can help you reach a healthier weight, and that combo has been shown to directly reduce liver inflammation, fat buildup, and fibrosis.e60dc2a1-f33c-4a05-9b50-8e3e8e597629db6c1b2e-219e-4531-ac31-1a0e0d75090c You can reduce the amount of fat in your liver by losing 5 percent of your body weight, and you can heal existing scarring and potentially reverse MASH by losing 10 percent or more.e60dc2a1-f33c-4a05-9b50-8e3e8e597629883825aa-cf03-480d-9f06-1a6a4347d5b9 For a 150-pound person, a 10-percent loss is 15 pounds. There’s no one-size-fits-all diet for managing MASH. Instead, focus on an eating pattern that’s rich in fruits, vegetables, whole grains, lean proteins, and healthy fats and light on added sugars , red meat, and full-fat dairy.e60dc2a1-f33c-4a05-9b50-8e3e8e597629933b7141-b8a2-4403-8e18-a0efac36b046 Weight loss also hinges on taking in fewer calories than you burn, so aim to trim between 500 and 1,000 calories per day.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e41034ca-eea9-41c3-922c-78911721b92d Resist the urge to crash diet. Slow, steady weight loss is better for your liver, plus, it’ll give you a chance to develop habits that you can use for life.e60dc2a1-f33c-4a05-9b50-8e3e8e597629933b7141-b8a2-4403-8e18-a0efac36b046 If you’re struggling to lose weight through diet and exercise alone, weight loss surgery or medications can help.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298eafde9f-efaa-4d01-81c4-ccf49b2ca9f1 As for exercise? Pick a heart-pumping activity you enjoy, and try to get at least 150 minutes per week (brisk walking, bicycling, dancing, or swimming are all good choices). If the activity is vigorous (like running ), you can get by with 75 minutes per week. Add in resistance exercises twice a week to support your lean muscle mass. Check in with your doctor if you’re new to exercise to find the right workout plan for you.e60dc2a1-f33c-4a05-9b50-8e3e8e5976298eafde9f-efaa-4d01-81c4-ccf49b2ca9f1 Alcohol Intake There’s no safe amount of drinking when you have MASH. Even a moderate amount of alcohol can worsen inflammation and fat buildup in the liver, making it harder for your liver to heal.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e41034ca-eea9-41c3-922c-78911721b92d Your best best? Steer clear. Medications Depending on how severe your MASH is, your doctor may also recommend medications to help reduce inflammation and scarring in your liver. “Most clinical trials [for these medications] include patients with stage 2 and stage 3 fibrosis and show reversal of steatohepatitis and fibrosis in some patients,” Barritt says. These medications include: Resmetirom (Rezdiffra) This oral medication directly reduces the amount of fat and inflammation in the liver, which can reverse damage. It works by binding to thyroid hormone receptor beta in the liver, which regulates the liver’s fat metabolism and inflammation.e60dc2a1-f33c-4a05-9b50-8e3e8e597629b5f1623d-ba95-4fe1-b90a-74f4ebe5724b In clinical trials, up to 28 percent of patients who took resmetirom had less liver scarring within one year.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291f7f054d-34e4-48cb-8502-7d6ebc19ce5b Semaglutide (Wegovy) Semaglutide is an injectable GLP-1 agonist medication that’s often prescribed to treat diabetes and obesity. Now it’s also approved to treat MASH. The mechanisms that support weight loss and blood sugar control are also thought to help reduce inflammation in the liver and improve scarring.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294df40ff3-0edc-4143-8da9-69416e31e3f3 Managing your blood pressure , cholesterol, and blood sugar levels can help reduce your risk for MASH complications like heart disease and type 2 diabetes. If you’re having trouble making progress with lifestyle changes alone, your doctor might prescribe additional medications, such as:e60dc2a1-f33c-4a05-9b50-8e3e8e597629933b7141-b8a2-4403-8e18-a0efac36b046e60dc2a1-f33c-4a05-9b50-8e3e8e5976296ce93102-4232-4e00-8f93-088c368489d8 Statins Blood pressure medication Diabetes medication
Severe MASH and Cirrhosis Cirrhosis Stage 4 MASH is marked by cirrhosis, or severe liver scarring, that’s often permanent. However, getting on the right treatment plan can still help slow or prevent further liver damage.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cebffd6c-7195-440f-8f4f-12e44bad1561 “Even advanced MASH can improve if risk factors are successfully managed and treated,” says Karagozian. Without treatment, stage 4 MASH can lead to liver cirrhosis and potentially liver failure. At that point, a person’s liver is no longer able to function properly, and they may need a liver transplant.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296b19fe8c-0e29-45ed-9fcd-799ca2afb393
Early Detection Is Key Early Detection MASH doesn’t always cause noticeable symptoms in the beginning, so it can be harder to catch in its early stages. You can protect your health by asking your doctor if you have MASH risk factors and, if so, whether you should be screened for liver disease, says Barritt. Common risk factors include type 2 diabetes, high blood pressure, obesity, and sleep apnea .e60dc2a1-f33c-4a05-9b50-8e3e8e59762998774e1b-5df1-4907-957d-8e0914bbccfa
The Takeaway Metabolic-associated steatohepatitis (MASH) is a serious liver condition that can be reversed with early detection through lifestyle changes and medication. Key lifestyle interventions, such as gradual weight loss, a healthy diet, regular exercise, and forgoing alcohol, can stop the progression of MASH and, in some cases, reverse liver damage. Medications like resmetirom and semaglutide can reduce liver fat and inflammation, which both can permanently damage the liver. If you suspect you may have MASH, especially if you have risk factors like type 2 diabetes or obesity, see a doctor right away to help prevent the disease from progressing.
Resources We Trust Cleveland Clinic: Metabolic Dysfunction-Associated Steatopheptitis (MASH)Mayo Clinic: Mayo Clinic Explains Cirrhosis Fatty Liver Alliance: Non-Invasive Tests (NITS) for MASLD/MASHLiver Foundation: Can Liver Damage Be Reversed?British Liver Trust: Physical Activity and Exercise
