What Is Metabolic Dysfunction-Associated Steatohepatitis?
Metabolic dysfunction-associated steatohepatitis, or MASH, is a form of liver disease. MASH occurs when fat accumulates in liver cells. Plenty of people have fat in their liver cells, which is a common condition called metabolic dysfunction-associated steatotic liver disease (MASLD). Many people with MASLD never know it because the condition may not cause problems. However, you can develop MASH if large amounts of fat collect in your liver. MASH can cause serious health problems, such as inflammation and scarring in the liver. If left untreated, MASH can cause liver failure.
You may be aware that drinking too much alcohol can cause liver disease. MASH causes similar problems in the liver, but it isn’t related to heavy drinking. Doctors aren’t sure what causes MASH, but you may be more likely to develop the condition if you:
- Have obesity
- Have type 2 diabetes
- Have high levels of cholesterol or blood fats called triglycerides
- Have metabolic syndrome, which is a collection of conditions that often occur together, including high blood pressure and blood sugar, a big waistline, and elevated cholesterol and triglycerides
MASH symptoms
MASH doesn’t necessarily cause symptoms in early stages. However, as MASH advances, some common symptoms include:
- Fatigue
- Weakness
- An ache on the right side of your belly
- Unintentional weight loss
Here’s a closer look at these and other symptoms MASH may cause.
Liver Disease and Fatigue
If you have MASH, chances are fatigue is the symptom that has the biggest effect on your life. About 50% to 80% of people with MASH and other forms of chronic liver disease say they struggle with fatigue. People who experience severe fatigue from MASH say it has a major impact on their quality of life. (Many people with MASH who struggle with feeling exhausted all the time say they’re bothered by chronic itching, too.)
Doctors aren’t sure why MASH and other types of chronic liver disease cause fatigue, but they have some theories. Some point out that many people with liver disease also have obstructive sleep apnea, which can keep you from getting a good night’s rest and leave you feeling tired the next day. Others believe that inflammation in the liver sends signals to the brain that promote fatigue. Still others suspect that if your liver isn’t working right, it may change your blood chemistry in a way that makes you feel exhausted all the time.
Liver disease fatigue treatment
Many doctors agree that exercise and weight loss are the best treatments for fatigue related to MASH and other forms of chronic liver disease. Both will contribute to burning fat in your liver, reducing inflammation, and creating other changes that can help reduce fatigue. If you lack energy and feel like fatigue is interfering with your life, talk to your doctor. If you need to shed some pounds, they can help you develop a meal plan to help you lose weight. You may also be able to get a type of medication known as a GLP-1inhibitor such as liraglutide (Saxenda, Victoza) or semaglutide (Ozempic, Wegovy), which promote weight loss. (These drugs are being studied as treatments for MASH.)
Abdominal Pain and MASH
Abdominal pain is another common symptom you may experience from MASH. This discomfort usually occurs in the upper right quarter of your abdomen, which is where your liver is located. Doctors aren’t sure why metabolic dysfunction-associated steatohepatitis causes pain, but some point out that the liver is surrounded by a capsule made of thin tissue. This tissue has pain receptors. As damage to the liver progresses, it becomes swollen, triggering pain signals to the brain.
Liver pain treatment
If you have pain related to MASH or another form of liver disease, talk to your doctor about the best way to relieve it. They will likely tell you to avoid certain over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen, which can harm your liver, particularly if you have chronic liver disease. Contrary to common belief, you can take acetaminophen, though it’s critically important to stick to the recommended dose for people with liver disease, which is a maximum of 2,000 milligrams a day. In your daily total, be sure to include acetaminophen that may be an ingredient in other medications you take, such as over-the-counter cold and flu remedies.
Weakness From MASH
Having MASH may not only leave you feeling exhausted all the time, but you might also lack your usual strength to perform daily tasks. You may also notice that your muscles have shrunk somewhat. Scientists believe that the inflammation generated by chronic liver disease causes muscle to break down, resulting in weakness, a problem known as sarcopenia. In turn, sarcopenia seems to make liver disease worse. A poor diet and lack of exercise can contribute to muscle weakness related to MASH, too.
Muscle weakness can keep you from leading an active life, so tell your doctor if you feel like your strength is lagging. They may recommend one or more of the following:
Add protein to your diet. Protein builds muscle, so you may need to increase your intake of this essential nutrient. However, high-protein diets aren’t right for everyone, so be sure to talk to your doctor or a registered dietitian before you change your meal plan.
Add strength training to your routine. More than two-thirds of adults fail to meet recommended guidelines for strength training, which are to work all major muscle groups on at least two days a week. If you do not currently perform strength training as part of your routine, discuss the best options for you with your doctor. You can choose from options such as weight training or resistance tubing. However, simply using your own body weight by doing exercises such as pushups, lunges, or squats will help, too.
Try testosterone therapy. Men with MASLD have an increased risk for low levels of the hormone testosterone, which helps you maintain muscle mass. While more study is needed on the role of testosterone therapy as a treatment for sarcopenia related to MASH, your doctor may suggest it as a possibility.
Unintentional Weight Loss
Weight loss can help people who are overweight or have obesity manage MASH and other types of liver disease. However, some people with liver disease may lose weight unintentionally because they lose their appetites or just feel crummy and lose interest in eating. If you have MASH and you’re losing weight without trying, talk to your doctor. Some strategies to get back to a normal weight include:
Eat frequent small meals. Instead of the usual three major meals a day, consider eating small meals every few hours. So-called “grazing” can keep your body from burning up protein for energy, which can cause your muscles to shrink and weaken.
Eat more calories, especially from protein. Increasing your calories can help you regain lost weight. If you have lost weight, you have probably lost muscle, so eating more protein to rebuild your body is important. Healthy sources include beans, lentils, nuts, eggs, low-fat dairy, fish, and lean cuts of beef and poultry.
Cut back on salt. If your liver is damaged, it may not be regulating your salt levels properly. That can lead to fluid retention and swollen feet or legs. Avoid packaged foods that have a high sodium content, and go easy with the saltshaker.
Jaundice From Liver Disease
MASH and other forms of liver disease may cause the condition known as jaundice, which can make your skin and eyes appear yellowish. When your body breaks down old red blood cells, a yellow substance called bilirubin forms. Normally, your liver removes bilirubin from the blood and processes it to be excreted -- mostly in your poop, though you pass a small amount when you pee, too. If your liver isn’t working right, bilirubin remains in your circulation, which can change your skin pigment. Jaundice is a sign that your liver may be failing, so see a doctor immediately if your skin and eyes turn yellow.
Swelling and Liver Disease
One important role your liver plays is to help maintain the right balance of water and salt (or sodium) in your blood. If you have advanced metabolic dysfunction-associated steatohepatitis, your liver may not perform this function effectively, which can cause your body to retain fluid. That can produce swelling in your legs, ankles, and feet, which is called edema. It can also cause fluid to be retained in your belly, which is called ascites.
Edema and ascites are uncomfortable and require prompt medical attention, so see a doctor soon if you have MASH and develop swelling in your lower extremities or midsection.
Dark Urine
If you have worsening MASH, your urine may turn a dark shade. That’s because your blood has high levels of bilirubin (which gives bile its yellow color), so your body tries to get rid of it in your pee. Dark urine is a sign that you may have advanced liver disease, so see a doctor soon.
Nausea and Vomiting
If you have severe MASH, you may struggle with nausea and vomiting. These gastrointestinal symptoms may be due to swelling in your abdomen (ascites), medications you’re taking, or other causes. Vomiting can cause dehydration, so it’s important to consume clear liquids. Some people find that ginger tea or candy helps with nausea. If you have a persistent problem with nausea and vomiting, talk to your doctor, who may prescribe medicine to curb these problems.
Takeaways
Metabolic dysfunction-associated steatohepatitis, or MASH, is a form of liver disease. It happens when fat builds up in the liver, which can cause inflammation and scarring. Common symptoms of MASH to watch out for include fatigue, weakness, pain in the upper right portion of your abdomen, unintentional weight loss, and others. If you develop these symptoms, talk to a doctor soon.
MASH Symptoms FAQs
What are the symptoms of an advanced fatty liver?
Advanced fatty liver is known as metabolic dysfunction-associated steatohepatitis, or MASH. Some common symptoms include fatigue, weakness, pain in the upper right portion of your abdomen, unintentional weight loss, yellowing of the skin (known as jaundice), dark urine, and others.
What are the symptoms of MASH?
MASH is an acronym for metabolic dysfunction-associated steatohepatitis, a type of liver disease. Some symptoms you may develop if you have MASH include fatigue, weakness, pain in the upper right portion of your abdomen, unintentional weight loss, yellowing of the skin (known as jaundice), dark urine, and others.
