What You Will Learn
NASH (NonAlcoholic SteatoHepatitis) is a fatty liver disease. You are more likely to develop NASH if you are overweight or obese, not physically active, and eat a diet of highly-processed foods.
Weight loss is the recommended first-line treatment for NASH according to the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health.
If you are overweight or obese, gradual and sustained weight loss through proper nutrition and exercise may help reverse NASH.
A NASH diet is a healthy-eating plan. It is naturally rich in nutrients. It’s also low in fat, calories, and added sugar. Making healthy food and drink choices is key to managing NASH. Physical activity is also important.
Here are 5 steps you can follow as part of a NASH diet to reach or stay at a healthy weight.
5 Steps of a NASH Diet
Read on for more information about each of the steps of a NASH diet plan.
Note: Even if you are not overweight, a healthy and balanced diet plus exercise is recommended to treat or prevent NASH.
NASH Diet Goal: Gain from Weight Loss
Weight loss can help slow, stop, and even reverse the effects of NASH. For most people with NASH, losing weight can reduce:
- Fat in the liver
- Liver inflammation
- Liver fibrosis (scarring)
Research has shown that you should try to lose at least 3 to 5 percent of your body weight to reduce the fat in your liver. Ideally, you may need to lose up to 10 percent of your body weight to reduce the bigger issues with NASH—liver inflammation and liver fibrosis.
Take It Slow
Rapid weight loss through fasting—eating and drinking nothing except water—is not recommended. It can make NASH worse.
Doctors recommend gradually losing weight. Get started by setting a goal to lose 7 percent of your body weight or more over the course of 1 year.
NASH Diet Basics: Understanding Nutrition
A Look at Your Liver and Nutrition
Your liver is one of the largest and most important organs in your body. Your liver performs over 500 functions to keep you healthy, active, and alive.
The liver’s major roles are related to the metabolic processes of the body. These include:
- Breaks down or converts food
- Produces energy
- Makes toxins less harmful to your body
- Filters toxins from your bloodstream
Everything you eat and drink passes through your liver. Your liver changes food into stored energy and chemicals necessary for life. It breaks down fats, carbohydrates, and protein into substances your body can use. Your liver makes nutrients available so your body can use them to build cells, give you energy, and maintain normal body functions.
Research has shown that getting a healthy balance of fats, carbohydrates, protein, and fiber is the most effective way to reverse NASH.
The Four Pillars: Fat, Carbohydrate, Protein, and Fiber
Fat, carbohydrate, protein, and fiber are known as ‘macronutrients’ because we need them in large amounts in our diets. These nutrients are responsible for providing us with energy as well as having a number of other specific functions.
You need fat in your diet.
Fat helps with your body’s growth, development, and cell function.
Fat gives you energy, and helps your body absorb certain vitamins. Essential fatty acids help the body function, but they aren’t made by your body—you have to consume them.
Many foods naturally contain fats, including dairy products; meats, poultry, seafood, and eggs; and seeds, nuts, avocados, and coconuts.
There are 4 kinds of fats. Two are considered “bad” fats. Two are actually “good” fats. In general, bad fats include saturated and trans fats. Good fats are monounsaturated and polyunsaturated fats.
Bad Fat Breakdown
- Saturated fats are a type of fat found in food such as meat, poultry skin, butter, and some milk and dairy products. Eating too much saturated fat can increase your chance of developing heart disease and other health conditions.
- Trans fats is short for trans fatty acids. These dietary fats also increases your chance of developing heart disease. Trans fat is produced when liquid oils are turned into solids through a process called hydrogenation. They occur naturally in some foods, but are also artificially produced. Trans fats can be found in some processed foods like snacks.
Good Fat Guide
- Monounsaturated fats. These are a different type of dietary fat. Monounsaturated fats are healthy fats that can help lower your LDL (bad) cholesterol level. They are found in the greatest amounts in cooking oils (canola, olive, peanut, sunflower, and safflower oils). Monounsaturated fats can also be found in avocados, peanut butter, and most nuts.
- Polyunsaturated fats. Like monounsaturated fats, these are dietary fats. They are also considered healthy and can help lower your bad cholesterol level. Polyunsaturated fats include omega-3 and omega-6 fats. These are essential fatty acids that the body needs for brain function and cell growth. Polyunsaturated fats are found in the greatest amounts in sunflower, corn, soybean, and cottonseed oils. They are also found in fatty fish, walnuts, and some seeds.
As a general rule for your NASH diet, you should replace bad fats with good fats. If you eat a diet high in bad fats, your liver will have to work harder to break them down. A healthy NASH diet limits bad fat to put less stress on your liver.
Note: Remember, even if you make these substitutions, always keep your total fat intake within the recommended range.
Carbohydrates, or carbs, are your body’s main source of energy. Your body turns carbs onto glucose (blood sugar). Keep in mind, your body can have too much glucose. That extra glucose then gets converted into fat. This could lead to a buildup of excess fat in your liver. And, over time, NASH.
The fruit, vegetables, dairy, and grain food groups all contain carbohydrates. Sweeteners like sugar, honey, and syrup and foods with added sugars like candy, soft drinks, and cookies also contain carbohydrates.
There are two groups of carbohydrates: simple and complex.
- Simple carbohydrates include sugars, which are fast acting. That means they are digested and absorbed rapidly by your body. This causes a sharp rise and fall in blood glucose. You want to avoid too much of this type of carbohydrate if you have NASH.
- Many complex carbohydrates tend to have a low glycemic index (GI). GI is a relative ranking of carbohydrate in foods according to how they affect blood glucose levels. Lower GI is better for a fatty liver. Foods with a lower GI digest slower and their sugar doesn’t rush into your body. That can help increase insulin sensitivity and lower your blood cholesterol. These are good things if you have NASH. You should try to eat more complex carbohydrates from whole foods as part of your NASH diet. These foods tend to be higher in fiber and vitamins & minerals compared with processed foods. They can also be more filling. Options to consider include beans and lentils, quinoa, starchy vegetables, and whole grains.
Overall, experts recommend that you try to get most of your carbohydrates from fruits, vegetables, fat-free and low-fat dairy, and whole grains. You should avoid added sugars or refined grains as much as possible.
Many foods with carbohydrates also supply fiber. Fiber is a special type of carbohydrate that your body cannot digest. It is found in many foods that come from plants, including fruits, vegetables, nuts, seeds, beans, and whole grains.
Eating food with fiber can help prevent stomach or intestinal problems, such as constipation. It might also help lower cholesterol and glucose (blood sugar). Some tips to add fiber as part of a NASH diet:
- Eat cooked dry beans, peas, and lentils
- Leave skins on your fruit and vegetables (wash before eating)
- Choose whole fruit over fruit juice
- Eat whole grain breads and cereals that contain fiber
Proteins are often called the body’s building blocks. Your liver converts proteins from the foods you eat into proteins your body can use to:
- Build and repair tissues
- Fight infection
- Make energy
The protein foods group includes seafood, lean meat and poultry, eggs, beans and peas, soy products, and unsalted nuts and seeds. Protein is also found in the dairy group.
Protein from plant sources tends to be lower in saturated fat, contains no cholesterol, and provides fiber and other health-promoting nutrients. This is ideal for your NASH diet.
Note: A few words about red meat and NASH. Red meat is full of protein, but should be limited or avoided if you have NASH. Red meat is linked to liver damage in studies. It increases the chances of fatty buildup in your liver. It also may contribute to type 2 diabetes, high cholesterol, and related conditions.
NASH Diet Step 1: Eat a Healthy Diet
A bad diet sometimes can lead to liver problems. If your diet provides too many calories, you will gain weight. Being overweight is linked to the buildup of fat in the liver which can become NASH.
A good diet can actually help improve your liver health if you have NASH. A balanced diet can lead to better liver functioning and lowered risk of liver fibrosis and cirrhosis.
A NASH diet should include a wide variety of foods. Reducing calorie intake and eating high fiber, natural foods is a good starting point. Eating foods that contain complex carbohydrates, fiber, and protein can provide sustained energy and make you feel full.
Foods that reduce inflammation or help the body repair its cells are equally important. Some people choose to follow specific diet plans, such as a plant-based diet or the Mediterranean diet.
In general a NASH diet should include:
- Fruits and vegetables
- High-fiber, whole grain foods
- Very little added sugar, salt, trans fat, refined carbohydrates, and saturated fat
- Little or no alcohol
In addition to these basic principles, some specific foods may be especially helpful for people with NASH.
NASH Diet: Foods to Eat (with Examples)
- Leafy greens (like spinach and kale)
- Brown rice
- Whole-grain bread
“Oily” Fish That Are High in Omega-3 Fatty Acids
Foods With Monounsaturated Fats
- Olive oil
- Peanut oil
- Canola oils
Foods With Polyunsaturated Fats
- Corn oil
- Soybean oil
- Safflower oil
- Flaxseed oil
Bonus Foods to Include
In studies of people with fatty liver disease, those who drank coffee had less liver damage than those who drank little or no coffee. According to the American Liver Foundation, caffeinated coffee reduces the risk of liver fibrosis in NASH. Studies suggest you need to drink more than two cups per day to get this benefit.
Garlic is a staple in many diets. It may provide benefits for people with NASH. A study showed that garlic powder supplements may help reduce body weight and fat in those with fatty liver disease.
Green tea provides several antioxidants, such as catechin, which may help improve NASH. Studies suggest that green tea may help lower levels of fat in the blood and throughout the body.
Soy or Whey Protein
Soy protein contains antioxidants called isoflavones that help improve insulin sensitivity and reduce the levels of fat in the body. Research suggests that both soy and whey protein reduce fat buildup in the liver.
NASH Diet: Foods to Avoid (with Examples)
Adding healthy foods to your diet is one way to manage NASH. However, it is just as important for you to avoid or limit your intake of certain other foods. These include the following.
Foods High in Saturated Fats
- Red meat and other higher-fat meats
- Poultry skin
- Milk and dairy products (except fat-free versions)
- Foods made with butter, lard, or shortening; some oils (coconut, palm, and palm kernel)
Foods Made With Trans Fats
- Any foods with hydrogenated or partially hydrogenated oil on the Food Label
- Crackers and snack foods
- Commercially baked products (such as cookies and cakes)
- Fried foods (like doughnuts and French fries)
- Sweetened soft drinks
- Sports drinks
- Sweetened tea
Note: These drinks contain large amounts of simple sugars, especially fructose. This is a class of carbohydrates with a sweet taste. One study found that people with fatty liver disease who consumed fructose each day had more advanced cases of the disease than those who consumed fructose less often.
“White” Foods (Refined Grains)
- White bread
- White rice
- White pasta
Note: These are high-glycemic index foods that affect your blood sugar more than low glycemic foods.
Note: Too much alcohol can damage your liver. Heavy alcohol use is defined as:
- Men—more than 4 drinks per day; or more than 14 drinks per week
- Women—more than 3 drinks per day; or more than 7 drinks per week
Bonus: Herbs to avoid in a NASH Diet
Some herbs are known to be dangerous and bad for your liver. You may want to avoid the herbs listed here as part of your NASH diet.
- Atractylis gummifera
- Bush tea
- Callilepis laureola
- Chaparral leaf (creosote bush, greasewood) Comfrey (Symphytum officinale)
- Gordolobo yerba tea
- Green tea extract
- Kombucha mushroom (tea)
- Ma-Huang (Ephedra sinica)
- Margosa oil
- Pennyroyal (squaw mint oil)
- Tansy Ragwort (variation of Ragwort)
- Senecio aureus
- Valerian root
Mediterranean Diet as a NASH Diet Option
Many healthy diets can help you lose weight, but some may have extra benefits for the liver. Research shows that following a Mediterranean diet may help promote weight loss and liver health. It has been proven to reduce the risk of heart disease, heart attack, and stroke. It may also lead to more stable blood sugar, lower cholesterol and triglycerides, and a lower risk for other health problems linked to NASH.
The Mediterranean diet is a way of eating that is similar to the cuisine of countries along the Mediterranean Sea. There are many versions of the Mediterranean diet, but in general you eat mostly plant-based foods:
- Whole grains
- Olive oil
Meals are planned around these foods. The diet also includes moderate amounts of lean poultry, fish, seafood, dairy and eggs. You should avoid fried foods, sweets, red meats and white flour products.
The Mediterranean-style diet has fewer meats and carbohydrates than a typical American diet. It also has more plant-based foods and monounsaturated (good) fat.
Learn more about the Mediterranean diet and NASH.
NASH Diet Step 2: Limit Portion Sizes
Smaller portions can make a big difference to your weight.
A NASH diet is not just about the foods you eat. It’s also about how much food you eat. Controlling food portions can help you manage and maintain your weight. That’s really important if you have NASH.
A “portion” is the amount of food you choose to eat at any one time – which may be more or less than a serving. A “serving” is the amount of food recommended to eat.
You may find that your portion sizes are leading you to eat more calories than you realize. Research shows that people unintentionally consume more calories when faced with larger portions. This can mean excessive calorie intake, especially when eating high-calorie foods.
Too many calories can affect your weight and health. Along with choosing a healthy variety of foods and reducing the total calories you take in through eating and drinking, pay attention to the size of your portions. Staying with healthy foods and drinks and managing your portions may help you eat just enough for you.
Here are some tips to help control your portion sizes:
1. Read nutrition labels carefully for serving size information. You might think a package contains a single serving, but it might really include more. It’s important to understand how much food is in one serving if you are trying to control portions.
2. Eat your meals on a smaller plate. A smaller plate means a smaller portion. Downsizing your plate can reduce the number of calories you eat and allow you to feel satisfied at the same time.
3. Wait for seconds. Finished your plate but think you’re still hungry? Wait 10 minutes before going back for another plate. You might not want them after all. If you do go back for seconds, add veggies or fruit to balance what you’ve already eaten.
4. Break down big boxes. If you buy larger bags or boxes of foods, especially snacks, divide the items into single-serve, ready-to-go bags.
5. Rethink restaurants. When eating at a restaurant, try these healthy eating tricks:
—Share your meal
—Order a half-portion
—Order an appetizer as a main meal
—Ask for a take-home container as soon as your meal is served. Then put half the meal in the take-home container
Choosing smaller portions can be an important step in creating healthy eating patterns and maintaining overall health and well-being.
NASH Diet Step 3: Cut Calories
If you take in more calories than you use, you will gain weight. It’s a simple, yet powerful idea.
A recent study shows that cutting calories can improve your fatty liver quickly. It can also help with related health issues like high cholesterol and insulin resistance.
You can cut calories by eating foods high in fiber, making better drink choices, avoiding portion size pitfalls, and adding more fruits and vegetables to your eating plan.
Research shows that people get full by the amount of food they eat, not the number of calories they take in. You can cut calories in your favorite foods by lowering the amount of fat and or increasing the amount of fiber-rich ingredients, such as vegetables or fruit. Eating fewer calories doesn’t necessarily mean eating less food.
Note: The number of calories in a specific amount or weight of food is called “calorie density” or “energy density.” Low-calorie-dense foods are ones that don’t have a lot of calories in each bite. Foods that have a lot of water or fiber and little fat are usually low in calorie density. They will help you feel full without unnecessary calories.
Learn more about losing weight by cutting calories.
NASH Diet Step 4: Plan Meals
Meal planning is key to managing your weight. You eat in a variety of places. At home. At work. On the go. Since high-calorie foods are everywhere, it’s important to take the time to plan ahead to make sure you have healthy options available.
Planning healthy meals ahead of time can help you stick to a healthy-eating style. If you’re new to meal planning, start small and work up to more.
Map out meals. Outline meals you plan to eat for the week and use it as a guide.
Strike a balance. Cover all food groups in your meals. For example, if you have dairy, grains, and protein at breakfast, include fruit and veggies at lunch.
Mix up your proteins. Choose a variety of protein foods throughout the week. If you have seafood on Monday, try lean meat on another day.
Make a list. Write a grocery list. Start with ingredients for meals you want to make. Check off any things that you already have in your house.
Embrace leftovers. Make enough of a meal to eat multiple times during the week. Eating leftovers can help save you time and money.
Read this article to learn more about healthy eating through meal planning.
NASH Diet Step 5: Exercise
Being more physically active is an important step you can take to improve your health and quality of life. Regular exercise may help prevent or delay many health problems associated with your fatty liver. Physical activity can help decrease fat in your liver—and waistline. Being active may also help you look and feel better, both now and in the future.
Research has shown that taking part in endurance exercise or resistance training several times a week can significantly reduce the amount of fat stored in liver cells. This happens whether or not you lose weight.
According to a large study, how much you exercise is more important than the type of exercise you do. Since working out regularly is important for reducing liver fat, you should choose something you enjoy.
If you aren’t used to exercising start small and increase as you can. The American Heart Association recommends you set a goal of at least 30 minutes of exercise 5 days per week.
Tips to Becoming More Physically Active
- Take the stairs instead of the elevator
- Park further away at the grocery store
- Stretch every morning
- Keep an exercise journal to track your progress
Regular exercise is important for everyone. However, it provides extra benefits for people with NASH. Maintaining a healthy body weight with a healthy diet and exercise may help you manage and reduce your symptoms.
Note: Always check with your provider before beginning an exercise routine.
Learn more about how to get and stay more physically active.
All content based on trusted sources. Click the links for references to support the information presented in this article.
What You Should Remember
- Weight loss can help slow, stop, and even reverse the effects of NASH
- If you are overweight or obese, gradual and sustained weight loss through proper nutrition and exercise may help reverse NASH
- A good diet can actually help improve your liver health if you have NASH
- Cutting calories can improve your fatty liver quickly
- Meal planning is key to managing your weight
- Regular exercise may help prevent or delay many health problems associated with your fatty liver