Can You Reverse MASH?

Written by Clarissa Brincat
Medically Reviewed by Jabeen Begum, MD on October 03, 2025
7 min read

Metabolic dysfunction-associated steatohepatitis (MASH) is a type of fatty liver disease. It happens when too much fat builds up in your liver and causes inflammation and scarring (fibrosis). Left untreated, it can lead to liver failure. But you can turn it around if you act on it early.

“Making healthy lifestyle changes, such as losing weight, and in some cases taking certain medicines, can help the liver heal and increase the chances of recovery,” says Na Li, MD, a gastroenterologist and hepatologist at The Ohio State University Wexner Medical Center in Westerville, Ohio. 

These lifestyle changes can cut down fat in the liver, lower inflammation, and help prevent long-term liver damage.

Liver disease develops in stages. Your chances of reversing liver damage depend on how advanced your condition is.

“Early-stage liver disease can be slowed, stopped, or even reversed with lifestyle changes,” says Guy Neff, MD, founder and CEO of Covenant Metabolic Specialists.

Even with moderate or advanced scarring (MASH stage II and III), your liver can still repair some of the damage — and you can stop it from getting worse.

Once scarring becomes very severe (cirrhosis), your liver can still work and heal in small ways. But it’s much harder to reverse the damage, and at this stage, the only cure is a liver transplant. This is why acting early is so important.

If you have MASH with moderate liver scarring (stage II or III fibrosis), the right treatment — including a consistently healthy diet and regular exercise — can make a big difference. 

In the best-case scenario, "The inflammation and scarring may improve, and in some cases, MASH and the scarring can even go away completely,” Li says.

Typically, fat and inflammation usually improve first, and scarring gradually gets better over time — often taking a year or more, she explains.

MASH is often driven by lifestyle factors, so tweaking your diet and moving your body more can help you reverse liver damage. 

“These are the most important long-term steps,” says Li.

What is a good diet for MASH?

“Many patients see success following a Mediterranean-style diet,” says Neff. This diet focuses on whole, unprocessed foods that are naturally high in fiber, while limiting processed foods, sugary drinks, and refined carbohydrates.

Here is how you can bring your diet in line with this style of eating:

  • Eat plenty of fruits, vegetables, whole grains, legumes, nuts, and seeds.
  • Enjoy fish and seafood at least a couple of times a week, and poultry, eggs, cheese, and yogurt in moderation.
  • Save red meat and sweets for special occasions.
  • Use healthy fats such as olive oil. Research has shown that an olive oil-rich diet can help protect the liver from fat buildup and improve insulin sensitivity.
  • Limit added sugar to about 24 grams (six teaspoons) a day if you’re a woman, or 36 grams (9 teaspoons) a day if you’re a man. And check labels — sugars often hide in foods such as yogurt, granola bars, cereals, protein shakes, ketchup, and salad dressing.

It’s also important to make dietary changes you can sustain:

  • Avoid “crash” or “fad” diets that promise quick fixes, include only limited foods, or rely on “magic”, “fat-burning” foods. These diets can actually worsen your liver health.
  • Aim for slow, steady weight loss — no more than one to two pounds per week — through a healthy diet suggested by your doctor.

If you like coffee, it’s fine to keep enjoying it — it may actually help protect your liver. Research shows that people with fatty liver disease not caused by alcohol who drink coffee tend to have less liver damage than people who drink little or no coffee. When people drink more than two cups of caffeinated coffee a day, the caffeine seems to lower the risk of liver scarring.

Physical activity

The second step to healing your liver is to get active, says Neff. You should aim for a minimum of 150 minutes (two and a half hours) of moderate exercise per week. This can include things like brisk walking, cycling, or swimming. If you’re not able to do this, start with as little as 10 minutes per day and work up gradually until you reach the minimum, then go beyond it if you can.

In one study, people with MASH who followed a healthy eating plan and structured exercise program for 10 months lost more weight than those who got standard care. Their bodies also became more sensitive to insulin — meaning they processed sugar more effectively, which lowered stress on the liver.

Weight loss

Studies show that weight loss lowers fat and inflammation in your liver and can even improve scarring. The more weight you lose, the more your liver improves:

  • Losing about 5% of your body weight can start to cut down liver fat.
  • About 7%-10% weight loss improves liver inflammation.
  • More than 10% weight loss can even improve scarring.

Avoiding alcohol

Research shows that drinking alcohol, even in small amounts, can raise your risk of inflammation, scarring, more serious liver problems, and liver cancer. This is why some guidelines recommend avoiding alcohol entirely if you have MASH.

Limiting over-the-counter (OTC) medicines

Many OTC medicines can harm your liver. Always tell your health care team about everything you take, including any nonprescription medications, dietary supplements, vitamins, and herbs, so they can help keep your liver safe.

Vitamin E

Vitamin E is an antioxidant, which means it can help reduce the damage caused by inflammation. Some research shows that taking the natural form of vitamin E — the kind found in food — may help people with liver damage from MASH by lowering fat and inflammation in the liver. However, it can have side effects and it’s not right for everyone, so it’s important to talk with your doctor before starting it to see if it could be helpful for you.

Along with a healthy diet and regular exercise, Li says, your doctor may recommend one of two FDA-approved medicines to treat MASH:

  • Resmetirom (Rezdiffra): This drug can slow down or even reverse liver scarring in people with MASH stage II or III.
  • Semaglutide (Wegovy) promotes weight loss and potentially other effects (which are not fully understood) that may improve liver inflammation and scarring.

How quickly the liver improves varies among people and depends on several factors, says Neff. These include:

Consistency of lifestyle changes. A sustained healthy diet and regular exercise make a big difference to long-term liver health.

“If a patient stays committed long-term to daily exercise and weight management, MASH can ultimately be reversed,” says Neff.

Medications. Using certain medicines can speed up liver improvement, says Li.

Stage of disease. Earlier stages tend to reverse more quickly than advanced scarring.

Other health conditions. If you have other medical conditions like diabetes, high cholesterol, or high blood pressure, treating those may also improve fatty liver.

Age. As you get older, your liver repairs itself more slowly.

Your genes. Research suggests that genes play a role in the development and progression of MASH. They can also influence how effective lifestyle modifications are at treating the condition.

To see whether your liver health is staying the same, improving, or getting worse, it’s important to have regular follow-ups with your doctor.

Because liver scarring usually happens slowly, often taking five to seven years to move from one stage to the next, doctors typically recommend a checkup once a year.

“For people with MASH and stage II or III fibrosis, we check the liver each year with simple, noninvasive tests like elastography [a painless scan that uses ultrasound or MRI to measure how stiff the liver is] and blood tests to see if the disease is changing,” says Li.

One of the best ways to stay informed about new developments in MASH care is to work closely with a liver specialist, says Neff. “These providers work with patients to recommend certain medications or even recommend participation in upcoming clinical trials.”

Many universities, like Ohio State, are involved in clinical trials for new MASH therapies and share updates on their websites, says Li.

 

Researchers are studying several promising treatments for MASH. Some examples include:

Fibroblast growth factor 21 (FGF21) analogs. The medications efruxifermin and pegozafermin have shown potential for treating MASH in clinical trials.

mRNA-based therapies. These experimental medicines use the same technology as some COVID-19 vaccines. They’ve reduced fat, inflammation, and scarring in animal studies.

Your liver is your body’s powerhouse, says Neff, and maintaining its health is essential for a balanced, healthy life. If you’re living with stage II or III MASH, you can slow, stop, or even reverse the disease with the right steps. Experts agree that a healthy diet, regular physical activity, and the right medical care can make a real difference.

“Patients with stage II or III MASH are still at a point where they can make a change to avoid progression and ultimately reverse liver disease,” says Neff. 

Li points out, “The liver is a strong organ and doesn’t give up easily, even when it’s been injured — but we also need to do our part to take good care of it.”