Fatty Liver (MASLD)

Fatty liver is a metabolic signal, often of insulin resistance. It is common and frequently reversible. We address the drivers and support the liver to heal.

What you may be noticing

Often nothing. Fatty liver is usually discovered through elevated liver enzymes or an ultrasound ordered for another reason. Some people notice fatigue, brain fog, a heavy feeling under the right ribs, poor tolerance of fatty meals, or difficulty losing weight around the middle.

Yellowing of the skin or eyes, swelling of the abdomen, vomiting blood, or confusion needs emergency care.

Why it is rarely one thing

Fatty liver, now called metabolic dysfunction-associated steatotic liver disease, or MASLD, occurs when fat builds up inside liver cells. It is one of the most common liver conditions and is closely tied to insulin resistance. When insulin is chronically high, the liver converts excess sugar, especially fructose, into fat and stores it, and visceral fat sends more fatty acids its way.

I also see the liver as a central drainage organ, so I look at congestion along the whole route. When bile flow is sluggish and bowels are irregular, the liver carries more of the toxic burden bucket, including environmental chemicals, some of which are linked in research to fatty liver. The gut and liver share a direct circulation, so gut imbalance and repeated antibiotic courses send inflammatory signals straight to the liver. Poor sleep, sleep apnea, an underactive thyroid, and alcohol add to the load. The encouraging news: early fatty liver often improves when these drivers change. Not only a liver problem, but a metabolism and drainage problem.

Patterns we look for

• Insulin resistance: fasting insulin, HbA1c, and triglycerides.
• Liver enzymes, including GGT, and fibrosis risk scores.
• Bile flow, bowel regularity, and gallbladder health.
• Visceral fat and waist circumference.
• Sugar, fructose, and alcohol intake.
• Toxic burden and medication history.
• Gut microbiome balance and intestinal permeability.
• Thyroid function, sleep apnea, and sleep quality.
• Choline intake, essential for moving fat out of the liver.

How I evaluate it

The comprehensive functional neurological exam assesses autonomic function and energy, and it screens for brain fog and fatigue that often accompany metabolic dysfunction.

Functional labs may include liver enzymes, fasting insulin, HbA1c, lipids, a thyroid panel, ferritin, inflammatory markers, and fibrosis scores. I coordinate with your physician for imaging such as ultrasound or elastography.

How we address it

1. Coordinate with your physician on monitoring and fibrosis assessment.
2. Open drainage first: bile flow, daily bowel movements, hydration, and lymphatic movement, before any deeper detoxification.
3. Restore insulin sensitivity with whole-food nutrition, fewer refined carbohydrates, and minimal added fructose.
4. Reduce or eliminate alcohol and lower household and food toxin exposure.
5. Move daily, combining aerobic and strength training, which reduces liver fat even before weight changes.
6. Support liver regeneration with choline-rich, omega-3 rich, and colorful antioxidant foods, and with traditional drainage practices such as castor oil packs over the liver.
7. Support the gut microbiome, thyroid function, and sleep.

Even modest weight loss can meaningfully reduce liver fat, and many people see their liver enzymes improve within a few months.

Fatty liver is increasingly seen in children and lean adults, which is why it is a metabolic rather than a weight label. The same upstream levers apply.

A liver given open drainage and the right conditions has a remarkable capacity to heal.

Book your Comprehensive Functional Medicine Eval/Neurological Exam today to discover what the contributing root causes are that are underlying your health concerns.