MASH - “Just get on with it.”
When Your Liver Becomes a Storage Locker
Reviewed by Dr. Peter Rawlek, MD and Dr. Scott Rollo, PhD
If there is one modern disease that quietly worries me as a physician, it is MASH. Most people have never heard of it, yet today about 20% of Canadians have fatty liver disease, the first step along the pathway. The step when we can make a difference through our choices.
What does MASH mean? MASH = Metabolic Dysfunction Associated Steatohepatitis. What the... is that?
What makes MASH so concerning is that it starts off silently. Those 20% with fatty liver disease feel completely fine while fat is slowly building up inside their liver. But the liver was never designed to be a storage locker for large amounts of fat.
Here is the problem: Every time you eat, your body asks a simple question: "Do I need this energy right now?"
If the answer is yes, the energy is used. Your muscles are moving, your organs working, and your body burns the fuel. But If the answer is no, there is excess energy immediately and that excess energy is stored.
For thousands of years, this was a brilliant survival system. Food was not always available, so storing extra energy helped humans survive. Today, however, many of us spend much of our day sitting. At the same time, food is everywhere. Energy comes in, but not enough energy goes out. And the excess becomes our excess storage.
When muscles are not active, they do not use much fuel. The body then has to find somewhere to stuff the extra energy. Some is stored under the skin. Some is stored around organs. And some ends up inside the liver. This is called fatty liver disease.
At first, the liver simply stores the fat. Over time, however, the fat begins interfering with normal liver function. The liver becomes irritated and inflamed. This is the early stage of what is called MASH.
When the inflammation continues for years unabated, scar tissue begins to form. Eventually, severe scarring called cirrhosis can develop. In some people, liver cancer may follow.
The concerning part is that MASH does not just affect the liver. People with fatty liver disease are more likely to develop type 2 diabetes, heart disease, high blood pressure, stroke, and other chronic diseases. In fact, many people with fatty liver are more likely to experience complications from cardiovascular disease than from liver disease itself.
So what can you do?
First, move more. Active muscles are one of the body's biggest users of energy. Every walk, every bike ride, every workout, and every active chore helps use fuel that might otherwise be stored.
And Second, it's critically important when you move. Most important after meals! The 5-10 minute "post meal exercise snack". The short brisk walk or body resistance activities opens up muscle receptors, and muscle cells grab sugar out of the bloodstream before it gets sent into storage.
Third, eat more slowly. Let food sit on your tongue. Your brain reads the signals, having the time to recognize that food has arrived. Slowing down helps you feel satisfied with less than overeating .
Fourth, choose more fibre-rich foods. Fibre slows the delivery of sugar into the bloodstream, reducing the large surges that encourage storage. No unprocessed foods will pass this mouth (well occasionally :))
Fifth, avoid eating close to bedtime. Food that arrives just before sleep is more likely to be stored because your body has little immediate need for the energy.
Finally, limit alcohol. Alcohol is processed by the liver and can accelerate the same pathway of fat accumulation and liver injury.
MASH does not happen overnight. It develops one day, one meal, and one habit at a time.
The encouraging news is that recovery works the same way. Small changes. Repeated often. Over time. Your liver is remarkably good at healing when given the chance.
