Healing Fatty Liver Disease: A Functional Medicine Perspective

Non-alcoholic fatty liver disease, like so many other chronic diseases, is on the rise. We work with NAFLD patients often in my telehealth functional medicine practice, and the good news is that it’s very possible to overcome with the help of the right diet and lifestyle strategies. 

NAFLD is a form of, or you could say a symptom of, metabolic dysfunction. It’s the body’s response to an imbalance, and that imbalance can almost always be corrected. When that happens, your body can refocus on healing and regeneration from within. 

Today, I’m going to cover what’s going on behind the scenes in the body with fatty liver disease, and how to heal with a simple functional medicine approach. Let’s get started. 

What Causes Non-Alcoholic Fatty Liver Disease? 

Most cases of non-alcoholic fatty liver disease come down to insulin resistance, which starts with irregular or elevated blood sugar levels. When blood sugar levels are consistently high, your body looks for ways to lower them, including moving excess glucose into fat stores. 

This might show up in a few different ways, including as abdominal weight gain or fat accumulation in the liver. 

In other words, fat accumulation in the liver (fatty liver disease) is essentially a strategy the body uses to try to overcome a core issue, which is the metabolic dysfunction, blood sugar dysregulation, and insulin resistance. 

This is also why NAFLD often comes alongside other metabolic health problems including more general weight gain, hormonal imbalances, or fertility issues. 

And when we address those core metabolic issues holistically, we often see really great improvements. 

Risk factors for NAFLD, or co-occurring conditions, may also include obesity, type 2 diabetes, high cholesterol, high triglycerides, heart disease, and high blood pressure, all of which are related to metabolic function. 

If untreated, NAFLD can lead to an increased risk of cirrhosis and other types of liver damage.

The Functional Medicine Approach: Treatment Options

While genetics play a role in susceptibility to insulin resistance, non-alcoholic fatty liver disease responds very well to a functional medicine approach involving diet and lifestyle changes, and supplements as needed. 

Rather than trying to treat the liver by itself, we want to treat the underlying metabolic issues that have led to the disease. By treating these root causes and supporting the whole body holistically, over time and with consistency, we see so many people get their vibrancy and wellness back. 

This is also a condition where there are really no pharmaceutical options that have been shown to be successful. And yet, to quote a 2022 review published in the Euroasian Journal of Hepatogastroenterology: “Despite being inexpensive and highly efficacious in prevention and treatment of different manifestations of NAFLD, lifestyle intervention often fails to gather sufficient interest among patients and physicians alike.” (1) 

I find it so unfortunate when lifestyle and nutrition changes are underestimated by the medical community even when published research supports them. We have such an opportunity to help more people bring their bodies back into balance naturally. 

With that in mind, here are some of the best natural and functional medicine treatment options for NAFLD, backed by research. 

Dietary Strategies 

Nutrition is almost always the best place to start. To support blood sugar balance and metabolism in fatty liver disease, a whole foods based, anti-inflammatory diet is key. The best studied example is the Mediterranean Diet, which is balanced and rich in healthy fats, protein, fruits, and vegetables. 

In one study, 6 weeks on a Mediterranean style diet was found to reduce liver fat by 39% compared to a low fat diet for those with NAFLD. (2) The Mediterranean Diet has also been shown to reduce markers of cardiovascular risk, improve insulin resistance, support healthy weight loss, and maintain a healthy gut microbiome. (3) 

A ketogenic diet, high in fats and low in carbohydrates, may also be helpful for some people especially over the short term. (4) 

Check out my book Ketotarian for a plant-forward, whole food, metabolism supporting approach to keto. 

Regardless of which specific eating plan you choose to follow, you want to make sure you’re emphasizing whole foods, consuming plenty of healthy fats and polyphenols from plant-based foods, and avoiding eating processed foods and sugar, as well as drinking alcohol.   

Once you have your healthy diet pattern down, you can also increase your intake of a few more specific foods that have been shown to support liver health and NAFLD. These are basically your bonus points. The overall pattern of eating is what matters most. With that in mind, a few specific foods and drinks that may be beneficial include: 

• Coffee (in moderation) 
• Cruciferous vegetables including kale, broccoli, and cauliflower 
• Green vegetables (5) 
• Choline-rich foods including eggs, animal protein, and legumes if tolerated (cruciferous vegetables, listed above, are also rich in choline) 

Intermittent Fasting 

In addition to what you eat, consider when you eat. Intermittent fasting is one of the best ways to improve metabolic flexibility and balance. Several clinical trials have found benefits related to liver health and weight loss for those with NAFLD. (6) 

There are several different approaches to fasting or time-restricted eating, and you can choose the one that works best for you and your body. Check out my more detailed article on intermittent fasting here, or for a more complete (but flexible) program, read Intuitive Fasting. 

Aerobic and Resistance Training 

Physical activity is an essential component of managing and treating NAFLD. Research has shown that both aerobic exercise and resistance training can reduce liver fat in patients with fatty liver disease. (7) And, of course, there are several other metabolic and overall health benefits to regular movement. 

If you’re newer to exercising, you can start slow, but I do recommend aiming to incorporate both aerobic and resistance forms of training into your routine if you can, as they may have synergistic effects when done together. (8)   

The Best Supplements for NAFLD

Beyond nutrition, time-restricted eating or fasting, and exercise, there are a number of supplements that can support liver health and metabolism, and that can be incorporated into a holistic protocol for NAFLD. 

Specific recommendations may vary depending on your individual health profile, but here are a few of the supplements that may be the most helpful. 

• Milk thistle (silymarin): Silymarin (from milk thistle) is a superstar herbal extract when it comes to supporting liver health, and it’s been shown to significantly reduce elevated liver enzymes and liver steatosis, as well as insulin levels and fasting glucose, in NAFLD. (9) You can find milk thistle in my Liver Guard blend here.
• Berberine: Berberine can help with NAFLD through multiple pathways including by supporting glucose metabolism, gut microbiome balance, and insulin sensitivity. (10) 
• Omega-3 fatty acids (fish oil): Supplementation of omega-3 fatty acids has been shown to significantly improve levels of GGT and reduce hepatic steatosis. (11) 
• Green tea extract: Green tea extract may significantly reduce liver enzymes for those with NAFLD. (12) Try my supplement blend Stabilize, which includes green tea extract along with other blood sugar and insulin sensitivity supporting herbs and nutrients. 

Other supplements, including vitamin D, vitamin E, and probiotics, may also be recommended. 

Tracking Your Progress 

One of the best ways to determine whether your holistic protocol is working is to pay attention to how you feel! If your quality of life has improved and you feel better, this is a massive win. We also want to run labs to get a clearer sense of what’s improving, what’s looking great, and what may still need additional attention. 

In functional medicine, we look at the same markers as in conventional medicine for fatty liver disease, but we aim for a more narrow and optimal, rather than just “normal”, range. We may also run additional tests to look at various metabolic and other markers for a more complete picture of your overall health. 

Blood tests and other tests to run at baseline and to assess treatment progress may include: 

• Liver enzymes (ALT, AST, GGT)
• Ultrasound for liver fat 
• Metabolic markers (fasting insulin, glucose, lipids, HbA1c) 
• Gut health testing 

An Empowered Approach to NAFLD 

The body has so many smart strategies for protecting itself and bringing itself back into balance. When we work with the intelligence of our bodies, we have the best chance of restoring health and feeling our best. 

There is so much you can do naturally to slow or stop the progress of fatty liver disease and improve your health. 

If you’re looking for more personalized guidance, you can also book a consultation with our functional medicine telehealth center. We’d love to help. 

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

Sources

• Shrestha, A., & Pradhananga, S. (2022). Holistic approach in the management of nonalcoholic fatty liver disease. Euroasian journal of hepato-gastroenterology, 12(Suppl 1), S51.
• Ryan, M. C., Itsiopoulos, C., Thodis, T., Ward, G., Trost, N., Hofferberth, S., … & Wilson, A. M. (2013). The Mediterranean diet improves hepatic steatosis and insulin sensitivity in individuals with non-alcoholic fatty liver disease. Journal of hepatology, 59(1), 138-143.
• Kastorini, C. M., Milionis, H. J., Esposito, K., Giugliano, D., Goudevenos, J. A., & Panagiotakos, D. B. (2011). The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individuals. Journal of the American college of cardiology, 57(11), 1299-1313.
• Tendler, D., Lin, S., Yancy Jr, W. S., Mavropoulos, J., Sylvestre, P., Rockey, D. C., & Westman, E. C. (2007). The effect of a low-carbohydrate, ketogenic diet on nonalcoholic fatty liver disease: a pilot study. Digestive diseases and sciences, 52(2), 589-593.
• Dufour, J. F., Anstee, Q. M., Bugianesi, E., Harrison, S., Loomba, R., Paradis, V., … & Zelber-Sagi, S. (2022). Current therapies and new developments in NASH. Gut, 71(10), 2123-2134.
• Lange, M., Nadkarni, D., Martin, L., Newberry, C., Kumar, S., & Kushner, T. (2023). Intermittent fasting improves hepatic end points in nonalcoholic fatty liver disease: A systematic review and meta-analysis. Hepatology Communications, 7(8), e0212.
• Hashida, R., Kawaguchi, T., Bekki, M., Omoto, M., Matsuse, H., Nago, T., … & Torimura, T. (2017). Aerobic vs. resistance exercise in non-alcoholic fatty liver disease: A systematic review. Journal of hepatology, 66(1), 142-152.
• Cho, J. Y., & Sohn, W. (2023). Synergistic Preventive Effect of Aerobic and Resistance Exercises on Nonalcoholic Fatty Liver Disease. Gut and liver, 17(4), 487.
• Cicero, A. F., Colletti, A., & Bellentani, S. (2018). Nutraceutical approach to non-alcoholic fatty liver disease (NAFLD): the available clinical evidence. Nutrients, 10(9), 1153.
• Koperska, A., Wesołek, A., Moszak, M., & Szulińska, M. (2022). Berberine in non-alcoholic fatty liver disease—A review. Nutrients, 14(17), 3459.
• Kim, S. J., Cho, S. H., & Yun, J. M. (2025). Omega-3 polyunsaturated fatty acids and Nonalcoholic fatty liver disease in adults: a meta-analysis of randomized controlled trials. Clinical Nutrition.
• Pezeshki, A., Safi, S., Feizi, A., Askari, G., & Karami, F. (2016). The effect of green tea extract supplementation on liver enzymes in patients with nonalcoholic fatty liver disease. International journal of preventive medicine, 7(1), 28.