How to Use a GLP-1 to Treat MASH
Health ConditionsLiver Disease

Using GLP-1s for MASH: Dos and Don’ts

Using GLP-1s for MASH: Dos and Don’ts
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Updated on January 12, 2026
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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

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.

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.

“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.

Don’t Eat Large, Rich Meals

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.

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.

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 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.

Don’t Drink Too Much 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.

 You may find a drink hits you harder these days, too, because GLP-1s slow the rate at which the body processes alcohol.

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.

Do Adjust Your Dosing Schedule to Fit Your Life

Some GLP-1 users find that their side effects peak within a day or two of taking a dose. If you’re using the injectable form of a GLP-1 and you have a big event like a job interview or air travel planned, you’ll probably want to avoid dealing with potential gastrointestinal issues during that time. In that type of situation, 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.

Don’t Skip Doses Entirely

Even though you have a little bit of wiggle room when it comes to your medication schedule, consistently missing doses 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 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, check the drug label to see if you should take it now or skip it until your next dose. For example, you can take a dose of injectable semaglutide if it’s within five days of your scheduled dose. But a missed day of oral semaglutide should be skipped.

Do Start Lifting Weights

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.

 Such muscle loss can also make it harder to control your blood sugar and manage MASH.

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.

Don’t Expect It to Be a Short-Term Treatment

GLP-1 medications aren’t a quick fix for weight loss or diabetes. Both are ongoing conditions, and the effects of the treatment often wear off when you stop taking the medication. 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 having 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. Talk with your doctor if you need to adjust your dosage to manage side effects. Also, report any side effects you notice, and get medical care right away 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

EDITORIAL SOURCES
Everyday Health follows strict sourcing guidelines to ensure the accuracy of its content, outlined in our editorial policy. We use only trustworthy sources, including peer-reviewed studies, board-certified medical experts, patients with lived experience, and information from top institutions.
Resources
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Allison Buttarazzi, MD

Allison Buttarazzi, MD

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Castle Connolly Top Doctor, Member of American College of Lifestyle Medicine

Allison Buttarazzi, MD, is board-certified in internal medicine and lifestyle medicine, and is a certified health and well-being coach. In her primary care practice, Dr. Buttarazzi focuses on lifestyle medicine to help her patients improve their health and longevity, and her passion is helping patients prevent and reverse chronic diseases (like heart disease, high blood pressure, and diabetes) by improving their lifestyle habits.

She is a graduate of Tufts University School of Medicine and completed a residency at Maine Medical Center. Diagnosed with celiac disease during medical school, she realized the power of improving one's health through diet and lifestyle habits, which she later incorporated into her practice.

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Marygrace Taylor

Marygrace Taylor

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Marygrace Taylor is an award-winning freelance health and wellness writer with more than 15 years of experience covering topics including women’s health, nutrition, chronic conditions, and preventive medicine. Her work has appeared in top national outlets like Prevention, Parade, Women’s Health, and O, The Oprah Magazine.

She's also the coauthor of three books: Eat Clean, Stay Lean: The Diet, Prevention Mediterranean Table, and Allergy-Friendly Food for Families. She lives in Philadelphia.

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