The Impact of Omega-3s on NASH Progression

Woman taking fish oil capsule

Can Omega-3s Make a Difference in NASH?

A few years back, a patient of mine, a middle-aged man with a fondness for fatty foods and minimal interest in exercise, sat across from me in my office with an expression of mild disbelief. He had been diagnosed with nonalcoholic steatohepatitis, or NASH, a progressive form of liver disease tied to fat buildup, and his latest labs showed liver inflammation and scarring were steadily progressing. As I suggested omega-3 supplementation, he leaned forward and quipped, “Fish oil? Really? I thought that stuff was for joints and memory.” His lighthearted skepticism reminded me how easy it is to underestimate the impact of omega-3s on NASH progression, especially when the conversation around liver health often revolves around diet and exercise alone.

Understanding NASH and Its Risks

Nonalcoholic steatohepatitis (NASH) is a severe form of nonalcoholic fatty liver disease (NAFLD). Characterized by liver inflammation and fibrosis, NASH poses a high risk of advancing to cirrhosis or liver cancer if left unchecked. While excess fat buildup in liver cells is one of the defining markers of this condition, ongoing inflammation is what tends to cause long-term liver damage. For patients diagnosed with NASH, managing inflammation is essential, and omega-3 fatty acids have increasingly gained attention for their role in mitigating liver inflammation.

What Makes Omega-3s Unique?

Omega-3 fatty acids—specifically eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA)—are potent anti-inflammatory agents. Found abundantly in fish and fish oil supplements, omega-3s are essential fats that our bodies can’t produce on their own, making dietary sources crucial. Their effectiveness in reducing inflammation has been documented across a range of conditions, from cardiovascular disease to arthritis, but their impact on liver disease, especially NASH, has been a more recent area of focus.

The Impact of Omega-3s on NASH Progression

Studies on omega-3 supplementation show promising potential for slowing the advancement of NASH. Omega-3s appear to help reduce liver fat content, ease inflammation, and improve insulin sensitivity, all factors that contribute to NASH progression. Clinical trials have documented how regular intake of EPA and DHA reduces liver enzyme levels and inflammation markers in patients with NAFLD and NASH, underscoring the role of these fatty acids in liver health. The exact mechanisms are still being studied, but current findings suggest omega-3s support the liver’s natural repair processes, which is significant for slowing fibrosis or scarring.

How Omega-3s Work in the Liver

Omega-3s affect the liver in a few essential ways:

  • Reduction of Fatty Deposits: Omega-3s decrease triglycerides and other fats in the liver, addressing one of the core issues in NASH. With less fat accumulating in liver cells, there’s less inflammation triggered by excess lipid presence.
  • Anti-Inflammatory Effects: EPA and DHA are converted into compounds that actively reduce inflammation, which is crucial for NASH patients. Lower inflammation levels in the liver help reduce overall stress on the organ.
  • Improved Insulin Sensitivity: Insulin resistance is a known contributor to fatty liver disease. Omega-3s improve insulin sensitivity, enabling the body to regulate blood sugar more effectively and prevent further fat buildup in the liver.

Clinical Evidence for Omega-3s in NASH Treatment

While there’s still a need for long-term studies, several clinical trials have shown that omega-3 supplementation is beneficial for individuals with NASH. Patients who took omega-3s saw reductions in their liver fat, lowered inflammation markers, and, in some cases, improvements in liver function tests. In one notable study, patients who supplemented with EPA and DHA for 12 months experienced an average decrease of 30% in liver fat, with some patients also showing decreased fibrosis progression.

Integrating Omega-3s in a NASH Treatment Plan

For patients with NASH, lifestyle changes remain the cornerstone of treatment. Regular exercise, a balanced diet, and weight management are essential in controlling disease progression. Omega-3s, however, can serve as a valuable adjunct to these lifestyle changes, offering additional support in slowing liver damage. While omega-3s alone aren’t a cure, they can help patients take control of their liver health alongside other interventions.

Recommended Dosages for Omega-3 Supplementation

The right dosage for omega-3s varies, but most studies on liver disease have used doses ranging from 1,000 to 4,000 mg per day of combined EPA and DHA. Patients should consult their healthcare provider before starting high doses of omega-3s, as certain factors, like blood-thinning medication, can interact with high doses of fish oil.

Omega-3 Sources for NASH Patients

Patients looking to incorporate omega-3s into their diet have several options:

  • Fish Oil Supplements: Widely available and convenient, fish oil capsules offer a concentrated source of EPA and DHA. Look for products that are certified for purity and potency to avoid contaminants.
  • Dietary Sources: Fatty fish, such as salmon, mackerel, sardines, and herring, are rich in EPA and DHA. Consuming fish twice a week can offer significant omega-3 intake without the need for supplements.
  • Plant-Based Omega-3s: For those who follow a vegetarian or vegan diet, plant-based options like flaxseeds and chia seeds provide alpha-linolenic acid (ALA), a precursor to EPA and DHA. While the conversion rate is lower, these can still support liver health in combination with a balanced diet.

The Role of Omega-3s in Preventing Liver Disease Progression

Omega-3s not only help reduce liver fat but also prevent further damage by addressing inflammation and supporting liver function. For patients managing NASH, omega-3 supplementation is a practical, accessible approach that works in tandem with medical treatment and lifestyle adjustments to improve liver health. While they may not reverse liver disease, omega-3s provide valuable support for slowing its progression, particularly for those at risk of advancing to cirrhosis.

Conclusion: A Practical Ally in NASH Management

For individuals diagnosed with NASH, finding sustainable ways to manage and slow the disease’s progression is essential. Omega-3s offer an effective and scientifically supported tool for reducing inflammation and supporting liver function. From fish oil supplements to fatty fish in one’s diet, omega-3s are easy to incorporate and can provide measurable benefits in liver health.

The research supporting the impact of omega-3s on NASH progression is growing, making them a valuable component of a comprehensive liver health plan. By addressing core factors in liver disease, omega-3s empower patients with a natural, research-backed option to help them take control of their condition and work toward a healthier future.

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Alinda Mae Gordola

Dr. Alinda Mae Gordola, MD

I am a board-certified internist and gastroenterologist specializing in the diagnosis and treatment of digestive system disorders. See Full Bio.


    1. Kang S, Huang J, Lee BK, Jung YS, Im E, Koh JM, et al. Omega-3 polyunsaturated fatty acids protect human hepatoma cells from developing steatosis through FFA4 (GPR120). [DOI]
    2. Scorletti E, Byrne CD. Omega-3 fatty acids and non-alcoholic fatty liver disease: Evidence of efficacy and mechanism of action.
    3. Okada L, Oliveira CP, Stefano JT, Nogueira MA, Silva I, Cordeiro FB, et al. Omega-3 PUFA modulate lipogenesis, ER stress, and mitochondrial dysfunction markers in NASH - Proteomic and lipidomic insight.
    4. Yu L, Yuan M, Wang L. The effect of omega-3 unsaturated fatty acids on non-alcoholic fatty liver disease: A systematic review and meta-analysis of RCTs.
    5. Musa-Veloso K, Venditti C, Lee HY, Darch M, Floyd S, West S, et al. Systematic review and meta-analysis of controlled intervention studies on the effectiveness of long-chain omega-3 fatty acids in patients with nonalcoholic fatty liver disease.

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