Using GLP-1s for MASH: Dos and Don’ts

If your doctor recommended you start taking a glucagon-like peptide-1 (GLP-1) receptor agonist like semaglutide to help manage your metabolic dysfunction-associated steatohepatitis (MASH) , you likely have questions about how to set yourself up for success with this treatment plan. Fortunately, making some key habit shifts with regards to healthy eating, exercising, and dosing can help you get the most from your new medication while making it easier to manage any potential side effects.
Do Choose Healthy Foods Healthy Eating A healthy diet is a must for anyone who takes semaglutide, including people with MASH. Because the medication helps you eat less, it’s important to prioritize nutrient-dense foods . Making every bite count helps keep potential nutrient deficiencies at bay, experts say.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b6e4a98-1304-4fdf-a550-610f7660eea3 Lean proteins like poultry, seafood, beans, eggs, low-fat dairy, and lean red meats should be the centerpiece of your plate. Aim to consume 20 to 30 grams (g) of protein per meal.e60dc2a1-f33c-4a05-9b50-8e3e8e597629e70599f9-e9d6-4842-9d34-49d9248d86ab “Protein-rich foods can help maintain muscle mass, which is an issue when patients are losing weight,” says Nestor de la Cruz-Muñoz, MD , director of metabolic and bariatric surgery at HCA Florida Weight Management and Metabolic Wellness in Miami. Round out your meals with vegetables, fruit, whole grains, and nuts and seeds, which offer plenty of vitamins, minerals, and dietary fiber.e60dc2a1-f33c-4a05-9b50-8e3e8e5976294b6e4a98-1304-4fdf-a550-610f7660eea3
Don’t Eat Large, Rich Meals Portion Sizes When you’re on a GLP-1 medication, “food that is eaten stays in every part of the gastrointestinal tract for longer,” says Jessica Cutler, MD , a weight loss surgeon with The Maryland Bariatric Center at Mercy Medical Center in Baltimore. As a result, big portions of food — especially those with a lot of fat (like fried foods, fatty meats, and pizza), which takes longer to digest — can leave you feeling uncomfortably full. They can also potentially trigger or worsen common GLP-1 side effects like nausea and bloating. Instead, stick with smaller, lighter bites, and pay attention to your satiety cues. Many GLP-1 users find that it’s easier to tolerate five or six mini meals versus three larger ones across the day. Think Greek yogurt with diced apple and flaxseed, a small chicken breast with a baked sweet potato, or a smoothie with berries, baby spinach, and protein powder.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d28b401d-edc6-41f4-9b44-e54875eee385
Do Take Side Effects Seriously GLP-1s are known for causing gastrointestinal side effects like nausea, vomiting, constipation, or diarrhea. While many people find that these symptoms subside as their body adjusts, the discomfort can cause some people to quit taking the medications or skip doses, both of which can make it harder to manage MASH.e60dc2a1-f33c-4a05-9b50-8e3e8e597629106f758e-b07d-4067-bee0-c09bedd031e0e60dc2a1-f33c-4a05-9b50-8e3e8e5976292ac1dfa0-eb15-47c7-8818-815d9a48db05 If you’re struggling with side effects, even mild ones like nausea or bloating , let your doctor know. Together you can find ways to manage your symptoms effectively so you can stay on your medication and improve your liver health, says Mir Ali, MD , a board-certified bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at Orange Coast Medical Center in Fountain Valley, California. And seek immediate medical attention if you experience severe vomiting or diarrhea, severe abdominal pain or tenderness, inability to pass gas, or jaundice (yellow skin color). These symptoms could be signs of rare but severe GLP-1 side effects that require medical attention or signs that your liver disease is worsening.e60dc2a1-f33c-4a05-9b50-8e3e8e59762983f541f0-c80c-414b-856f-15ddd03b6e43
Don’t Drink Too Much Alcohol Drinking Alcohol “It’s best to avoid alcohol for all patients on GLP-1s,” says Dr. Ali. Not only does booze contain empty calories that make it harder to lose weight, but it can also cause your blood sugar levels to plunge dangerously low .e60dc2a1-f33c-4a05-9b50-8e3e8e597629638701f6-5d97-4e71-a403-e25a1f11cef2 You may find that a drink hits you harder these days, too, because GLP-1s slow the rate at which the body processes alcohol.e60dc2a1-f33c-4a05-9b50-8e3e8e59762905e67e16-1f01-482b-87ed-4c097144be52 Most important of all, consuming alcohol makes it harder to manage MASH . Research shows that even a little bit of alcohol can worsen inflammation and fat buildup in your liver, which can hinder the organ’s healing process.e60dc2a1-f33c-4a05-9b50-8e3e8e5976297fbf3f44-3d1f-4b29-9821-54981af3d31f
Do Adjust Your Dosing Schedule to Fit Your Life Scheduling Doses Some GLP-1 users find that their side effects peak within a day or two of an injection. If you have a big event like a job interview or air travel planned for your usual dosing day and would rather avoid dealing with potential gastrointestinal problems during that time, it’s likely okay to shift your shot timing a little bit. “If it has to be delayed by a day, that wouldn’t be a problem,” says Dr. de la Cruz-Muñoz. That’s not permission to make sweeping schedule changes, though. If you need to shift your dose by more than a day for whatever reason, check with your doctor first, says de la Cruz-Muñoz. Going too long between doses can make your medication less effective.e60dc2a1-f33c-4a05-9b50-8e3e8e5976296fe4eeaa-dd36-4f06-9110-229d1205b1dc
Don’t Skip Doses Entirely Skipping Doses Even though you have a little bit of wiggle room when it comes to your medication schedule, skipping your weekly shot completely is a bad idea. It may be tempting to do so if you have a big holiday meal or a vacation coming up and want to really indulge, but doing so will make your medication less effective and slow your weight loss and the rate at which your liver can start to recover. Since GLP-1s dampen your appetite, you can enjoy treats in smaller portions more easily, participating without overdoing it. “These medicines don’t cause a feeling of missing out,” says de la Cruz-Muñoz. “Patients feel very satisfied with the amount of food they’re eating.” And if you truly forget a dose, take it as soon as you remember if it’s within five days of your scheduled dose. If it’s been longer, take your next dose at your normal scheduled time, and don’t double up.e60dc2a1-f33c-4a05-9b50-8e3e8e5976299cb5729b-edc7-4b82-8146-d1f460304d92
Do Start Lifting Weights Strength Training Regular exercise is a cornerstone for managing MASH, including when you’re on a GLP-1 medication. Being active helps you burn more body fat and improves your insulin sensitivity , both of which are important for liver health. When it comes to the type of exercise to prioritize, strength training is just as important as aerobic activity for those on GLP-1s. Rapid weight loss from GLP-1 use can cause you to lose lean muscle tissue , which can set the stage for frailty and related injuries.e60dc2a1-f33c-4a05-9b50-8e3e8e597629bf100e80-06c0-4cfa-b2b1-bd303547e7a3 Such muscle loss can also make it harder to control your blood sugar and manage MASH.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291e134982-d718-4886-851e-358554f2e8a5 Activities like lifting weights or performing body-weight exercises can help you hang onto as much lean muscle mass as possible, says Ali. Aim for three strength training sessions per week and 150 minutes of moderate-intensity aerobic activity each week.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cd05076b-813e-41ab-95df-2322aeaad6f9
Don’t Expect It to Be a Short-Term Treatment Long-Term Planning GLP-1 medications aren’t a quick fix for weight loss or diabetes . Both are chronic conditions, and the effects the treatment often wear off when an individual stops taking the medication.e60dc2a1-f33c-4a05-9b50-8e3e8e59762913875b7d-b308-447c-a3ee-d90c606b7504 While more long-term studies are needed to know for sure, the same is likely true for MASH. “We know that most people who use semaglutide for a year and stop using it regain the weight,” says Dr. Cutler. “It would make sense that problems like MASH would reoccur, too, though we don’t have strong enough data yet to prove that.”
The Takeaway To support MASH treatment with a GLP-1 medication, eat a nutrient-dense diet that prioritizes lean protein and dietary fiber, and avoid large, rich, high-fat meals to prevent common gastrointestinal side effects experienced with these drugs. Incorporate regular strength training, such as lifting weights, alongside aerobic activity to mitigate the loss of lean muscle mass that can occur with weight loss aided by GLP-1s, which is essential for effective MASH management. Don’t skip medication doses entirely, consult your doctor if you need to adjust your weekly injection timing by more than a day to manage side effects, report any side effects you experience, and seek immediate medical attention for severe symptoms. Recognize that GLP-1 therapy is a long-term treatment for a chronic condition, with effects likely reversing if the medication is discontinued.
Resources We Trust Cleveland Clinic: 8 Lifestyle Changes to Help Manage MASH U.S. Food and Drug Administration: FDA Approves Treatment for Serious Liver Disease Known as ‘MASH’ Harvard Health Publishing: Diabetes and Obesity Drug Shows Promise for Fatty Liver Disease American Association for the Study of Liver Diseases: Why Are GLP-1 Agonists Being Used to Treat Patients With Nonalcoholic Fatty Liver Disease? American College of Gastroenterology: Semaglutide for the Treatment of Metabolic Dysfunction-Associated Steatohepatitis

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