Kristina Werner, DNP, AGACNP, FNP-BC, AF-AASLD, an advanced practice provider specializing in hepatology at Mayo Clinic Arizona, offers valuable insights into weight loss, particularly in the context of managing Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) and Metabolic Dysfunction-Associated Steatohepatitis (MASH). With over two decades of experience in hepatology, Dr. Werner emphasizes the crucial role of lifestyle interventions, including diet and exercise, in slowing or reversing disease progression. Her expertise extends to the use of non-invasive testing (NITs) for diagnosis and management of MASLD and MASH, highlighting the importance of personalized care strategies.
The Link Between Weight Loss and Liver Health
Dr. Werner's doctoral work focused on the effectiveness of combining behavior modification with diet and exercise in patients with non-alcoholic steatohepatitis (NASH), now known as MASH. This underscores the direct correlation between lifestyle choices and liver health. Fatty liver disease, whether discovered incidentally on imaging or in the presence of metabolic risk factors such as obesity, hypertension, hyperlipidemia, or diabetes, necessitates a comprehensive approach that includes weight loss as a primary strategy.
Lifestyle Modifications: The Cornerstone of MASH Management
In her educational sessions, Dr. Werner consistently emphasizes the importance of lifestyle modification, including 5-10% weight loss, regular exercise, and optimized management of metabolic conditions. These interventions are not merely supplementary; they are fundamental to slowing or reversing the progression of MASLD and MASH.
Dietary Adjustments
Werner highlights the benefits of specific dietary approaches:
- The Mediterranean Diet: Emphasizing fruits, vegetables, whole grains, lean proteins, and healthy fats, the Mediterranean diet is a well-established eating pattern that supports overall health and can aid in weight loss.
- Intermittent Fasting: This eating pattern involves cycling between periods of eating and voluntary fasting on a regular schedule.
- Avoiding Ultra-Processed Foods: These foods are often high in calories, unhealthy fats, added sugars, and sodium, contributing to weight gain and metabolic dysfunction.
Exercise Strategies
Werner also underscores the importance of incorporating exercise into a weight loss plan:
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- Regular Exercise: Consistent physical activity is essential for burning calories, improving insulin sensitivity, and reducing liver fat.
- Resistance Training: This type of exercise helps combat sarcopenia (loss of muscle mass) and maintain muscle mass, which is crucial for metabolic health.
Non-Invasive Testing (NITs) in Managing MASLD/MASH
Dr. Werner advocates for the use of non-invasive tests (NITs) to assess fibrosis risk in patients with MASLD and MASH. These tests play a critical role in guiding patient management, referrals, and surveillance, and in preventing unnecessary biopsies.
Key NITs and Their Role
- FIB-4 and NFS: These are serum-based tests that use blood markers to estimate the degree of fibrosis in the liver.
- ELF: Enhanced Liver Fibrosis (ELF) test is another serum-based marker providing a more direct assessment of fibrosis.
- FibroScan (VCTE): This imaging technique measures liver stiffness, which is an indicator of fibrosis.
- MRE: Magnetic Resonance Elastography is an advanced imaging technique that provides a detailed assessment of liver stiffness.
By integrating NIT results with patient history, comorbidities, and liver function tests, clinicians can stratify patients into low-, moderate-, and high-risk categories for advanced fibrosis or cirrhosis, helping to determine appropriate monitoring intervals and hepatology referrals.
Emerging Pharmacologic Treatments for MASH
While lifestyle modifications remain the cornerstone of MASH management, Dr. Werner also discusses emerging pharmacologic treatments and their tailored applications based on patient profiles. These include:
- FDA-Approved Therapies: Certain medications are already approved for use in specific cases of MASH.
- Drugs in Advanced Clinical Trials: Semaglutide and lanifibranor are examples of drugs currently being investigated in advanced clinical trials for their potential to treat MASH.
- Combination Treatments: The potential for combining different therapies to target both steatohepatitis and fibrosis is also being explored.
Dr. Werner emphasizes the importance of patient-specific approaches, considering metabolic profiles, obesity, and diabetes status, alongside lifestyle interventions when considering pharmacologic treatments.
Staying Proactive with Advanced Fibrosis or Compensated Cirrhosis
For patients with advanced fibrosis or compensated cirrhosis, Dr. Werner stresses the importance of ongoing monitoring, ultrasound or MRI surveillance every six months, and close follow-up with their hepatology team. These proactive measures can help detect any changes in liver health and allow for timely intervention.
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The Importance of Personalized Care Strategies
Throughout her discussions, Dr. Werner highlights the need for personalized care strategies in managing MASLD and MASH. This involves:
- Accurately Identifying Fibrosis Risk: Using NITs to determine disease severity and guide treatment decisions.
- Addressing Metabolic Risk Factors: Managing obesity, hypertension, hyperlipidemia, and diabetes through lifestyle modifications and, when necessary, pharmacologic interventions.
- Tailoring Treatment Approaches: Considering individual patient characteristics and preferences when developing a management plan.
By adopting a personalized approach, healthcare professionals can optimize outcomes for patients with MASLD and MASH, helping them achieve weight loss and improve their overall liver health.
Additional Tips
Beyond the specific advice from Kristina Werner, here’s some additional information that could be helpful for weight loss.
Pack Smart for Travel
When traveling, the key is to pack foods that don’t need to be refrigerated and will maintain good texture. A rice and beet salad is a good option because the veggies will maintain their freshness. Plane food is often mushy, so pack carrot sticks, cucumber, bell peppers, apples, sprouts, rice cakes, and crispy granola. If you are going to eat greens, stick to romaine. Spinach, butter lettuces, and mixed greens wilt and get soggy. Also, pack foods in a specific order in your containers. With the rice and beet salad, you’ll notice that the rice and beets are on the bottom, while the romaine and cilantro are on top.
Pack foods that are easy to eat. Sandwiches do not always fit in this category. If you do make a sandwich, keep the fillings small and non-liquid-y so that they are not oozing all over you when you take a bite. Sometimes I like to take a wrap with me because I can roll it up in a piece of parchment, which prevents dripping. Oranges and grapefruits are a bad call because they often require a hand washing.
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Be considerate. No one wants to sit beside Mrs. Garlic n’ Onions. Smelly cheeses, curry, and cooked cruciferous vegetables can stink up an entire plane with the flip of a Tupperware lid. The bean dip I made uses roasted garlic, which is far mellower and less offensive than raw garlic. The beet salad is rather inoffensive as well - the main smell is mustard, but it’s very mild.
Stay Hydrated
Jetlag is a serious bummer. The secret to combating this very common affliction is staying hydrated and avoiding those things that cause dehydration. Drink as much water as you can the day you are traveling before you get to the airport. Take a bottle with you on the plane and have the flight attendants refill it often, or ask if you can have their 2-liter bottle for long-haul flights. For every hour you are flying, drink at least 500ml / 17oz. of water (I aim for double this). This sounds like a lot, but it helps more than anything else.
No alcohol, coffee or tea. Alcohol and caffeine are also dehydrating, which will exacerbate any feelings of jetlag you may have. Save the celebrations for when you actually get to your destination instead of suffering through a jetlag fueled hangover. Limit or avoid the plane food, because food tastes blander at high altitudes. To dilute both salt and sugar, your cells excrete water and send a thirst message to your brain saying they need more fluids. Wine does not help the situation. Nor does a cold beer, an iced tea, or coffee. Drink water on the plane only, and stick to high water content fruits and veggies.
Recipes
Here are a couple of recipes that are great options for travel or any time.
Rice and Beet Salad
Dressing
- 1 Tbsp. Dijon mustard
- 2 tsp. balsamic vinegar
- 1 tsp. maple syrup
- 1 tsp. olive oil
Whisk all ingredients together.
- To roast beets, wrap whole unpeeled beets in foil, and place in a 400°F / 200°C oven for 30-45 minutes, until tender.
- While the beets are roasting, rinse the rice, combine it with the water and a pinch of salt in a small saucepan. Bring to a boil, reduce to simmer and cook covered, for about 45 minutes.
- Chop beets into large chunks and toss with half of the dressing. When rice is cool, toss with the other half of the dressing.
- Chop romaine and cilantro and place on top of the rice and beets. Sprinkle with walnuts.
Roasted Garlic White Bean and Tarragon Dip
- 1 Tbsp. olive oil
- 1 tsp. olive oil
- 5 Tbsp. water
- To roast garlic, cut the top off the head to expose the cloves beneath. Drizzle with 1 tsp. olive oil and wrap tightly with foil.
- Cook beans if using dried. Let cool completely.
- In a dry skillet over medium heat, lightly toast sunflower seeds.
- In a food processor pulse sunflower seeds until ground. Add all other ingredients and blend until smooth. Season to taste.