Fatty Liver (MASLD)

Digestive Health & Nutrition CareFull-Body Wellness & Prevention Care
Written By Jennifer Tang

Overview

Fatty liver occurs when excess fat accumulates in liver cells. One of the most common forms is metabolic dysfunction-associated steatotic liver disease (MASLD), formerly called non-alcoholic fatty liver disease (NAFLD). MASLD is strongly associated with metabolic factors such as insulin resistance, type 2 diabetes, high cholesterol or triglycerides, high blood pressure, and excess body weight. However, it can occur in people of different body sizes.¹˒²˒³

At Tangible Health, we take a comprehensive approach to fatty liver care by looking at liver health alongside blood sugar, cholesterol, blood pressure, nutrition, physical activity, medications, alcohol intake, sleep, and other aspects of metabolic health. Care focuses on sustainable changes that support liver and overall health while working alongside appropriate medical monitoring.

What Is Fatty Liver (MASLD)?

Steatotic liver disease is the broader medical term for conditions in which excess fat accumulates in the liver. MASLD refers specifically to liver fat that occurs alongside one or more metabolic risk factors.²˒³

The terminology changed in 2023:

  • MASLD replaces the older term NAFLD

  • MASH, or metabolic dysfunction-associated steatohepatitis, replaces the older term NASH and describes a more advanced form in which liver fat is accompanied by inflammation and liver-cell injury

  • MetALD describes people who have metabolic risk factors along with alcohol intake above the MASLD range

  • Alcohol-associated liver disease remains a separate form of liver disease in which alcohol is a primary contributor³˒⁴

MASLD can range from relatively simple fat accumulation to MASH, fibrosis (scarring), cirrhosis, and, in a smaller proportion of people, serious liver complications. The amount of fibrosis is particularly important because it helps predict long-term liver-related risk.³˒⁵

Common Symptoms of Fatty Liver

Fatty liver is often described as a silent condition because many people have few or no symptoms, particularly in its earlier stages.¹˒⁵

When symptoms do occur, they may include:

  • Fatigue or low energy

  • General weakness

  • Discomfort or fullness in the upper right abdomen

  • Reduced appetite in more advanced disease¹˒⁵

Fatty liver is often discovered through bloodwork or imaging performed for another reason rather than because someone has obvious liver symptoms. Liver enzymes can also be normal in some people with MASLD, so symptoms and liver enzymes alone do not determine disease severity.⁵ Signs such as jaundice, abdominal or leg swelling, confusion, significant unexplained weight loss, or other symptoms of advanced liver disease require medical assessment.¹

Causes & Contributing Factors

Fatty liver can develop through different pathways. For MASLD, metabolic health plays a central role.

Insulin Resistance & Blood Sugar
Insulin resistance and type 2 diabetes are strongly associated with MASLD. Changes in insulin signalling can increase the amount of fat produced and stored in the liver.³˒⁶

Cholesterol, Triglycerides & Cardiovascular Health
High triglycerides, abnormal cholesterol levels, and high blood pressure commonly occur alongside MASLD. Cardiovascular disease is also an important long-term health concern for people living with MASLD.³˒⁶

Body Weight & Fat Distribution
Having overweight or obesity increases the likelihood of MASLD, particularly when excess fat is stored around the abdomen. However, fatty liver can also occur in people who are not overweight, so weight alone does not determine risk.¹˒³

Nutrition & Physical Activity
Dietary patterns, total energy intake, physical activity, and other lifestyle factors can influence liver fat and metabolic health. These factors are important treatment targets, but fatty liver should not simply be reduced to “eating poorly.” Genetics, medications, metabolic conditions, and other factors can also contribute.¹˒³

Alcohol & Medications
Alcohol can contribute to liver fat and accelerate liver injury, particularly when metabolic risk factors are also present. Certain medications and other medical conditions can also cause or contribute to fat accumulation in the liver.³˒⁴

Our Approach to Fatty Liver

At Tangible Health, we focus on supporting both liver health and the metabolic factors that commonly accompany MASLD, rather than treating fatty liver as an isolated liver problem.

Your Liver & Metabolic Health
We review your liver tests and imaging alongside blood sugar, cholesterol, and triglycerides, blood pressure, weight history (when relevant), medications, alcohol intake, and other metabolic health factors.

Your Nutrition & Lifestyle
We look at eating patterns, physical activity, sleep, stress, alcohol, and other habits that may influence metabolic and liver health. The focus is on realistic, sustainable changes, not extreme diets or “liver detoxes.” Regular physical activity can improve MASLD even without weight loss. For people with overweight or obesity, gradual weight reduction can also reduce liver fat and, with greater sustained loss, may improve inflammation and fibrosis.⁶˒⁷

Your Goals
Your priorities may include improving liver or metabolic markers, reducing liver fat, managing blood sugar or cholesterol, supporting sustainable weight changes when relevant, understanding your fibrosis risk, or preventing progression of liver disease. Your care plan is developed around the outcomes that matter most to you.

Treatments That May Be Included

Your individualized fatty-liver care plan may include:

  • Clinical Nutrition to support liver and metabolic health through sustainable eating patterns, adequate fibre, and individualized nutrition strategies

  • Lifestyle Medicine to support physical activity, muscle health, sleep, stress management, alcohol reduction, and sustainable weight management when relevant

  • Nutraceuticals & Supplements when there is a specific nutritional or clinical indication and the product is appropriate for your liver health

  • Botanical Medicine only when clinically appropriate, with careful consideration of liver safety, medications, and available evidence

  • Naturopathic Counselling to support sustainable behavioural and lifestyle changes

  • Medication & Supplement Review to identify medications, supplements, alcohol, or other exposures relevant to liver health

  • Collaborative Care with your family doctor, endocrinologist, hepatologist, dietitian, or other healthcare providers when appropriate

There is no standard “liver detox” required to treat MASLD. Some herbs and supplements can actually cause liver injury, so products marketed for liver cleansing or detoxification should not automatically be assumed to be safe.⁷

What to Expect

Initial Assessment
We begin with a comprehensive review of your fatty-liver diagnosis, previous bloodwork or imaging, metabolic health, medications and supplements, alcohol intake, nutrition, movement, sleep, medical and family history, and overall health goals.

Liver & Metabolic Assessment
We review available liver enzymes, blood-sugar markers, cholesterol and triglycerides, blood pressure, and previous imaging. When fatty liver is identified, assessing whether significant fibrosis or liver scarring may be present is an important part of determining risk. Blood-based tools such as FIB-4 and imaging such as FibroScan or other elastography may be used by your medical team when appropriate.³˒⁵˒⁸

Personalized Plan
You’ll receive a personalized care plan designed around your liver findings, metabolic health, nutrition, activity level, medications, alcohol intake, health history, and goals. Recommendations focus on practical changes that can be maintained over time.

Ongoing Support
Fatty-liver care is usually long-term and may involve monitoring liver and metabolic markers over time. Follow-up allows us to adjust your plan, review new bloodwork or imaging, and coordinate medical assessment if there are signs of increasing fibrosis or other liver concerns.

When to Seek Support for Fatty Liver

Consider speaking with a healthcare provider if you:

  • Have been told that imaging shows fat in your liver

  • Have persistent or unexplained abnormal liver tests

  • Have type 2 diabetes or significant insulin resistance

  • Have high triglycerides, cholesterol, or blood pressure alongside other metabolic risk factors

  • Have a history of significant alcohol intake

  • Take medications or supplements that may affect the liver

  • Have concerns about your risk of liver fibrosis or progression

MASLD is often silent, so the goal is not simply to wait for symptoms to appear. Once fatty liver is identified, assessing metabolic health and the risk of fibrosis is more informative than relying on symptoms alone.³˒⁵

Seek prompt medical assessment if you develop:

  • Yellowing of the skin or eyes

  • Significant swelling of the abdomen or legs

  • Vomiting blood or black stools

  • New confusion or unusual drowsiness

  • Severe or worsening abdominal pain

  • Significant unexplained weight loss or loss of appetite¹

Book An Appointment

Frequently Asked Questions

  • “Fatty liver” is a general term for excess fat in the liver. MASLD is the newer name for the condition previously called NAFLD when liver fat occurs alongside metabolic risk factors.³˒⁴

  • MASH is a more advanced form of MASLD in which liver fat is accompanied by inflammation and liver-cell injury. Over time, some people with MASH can develop fibrosis or cirrhosis.¹˒³

  • Often it does not. Many people discover fatty liver through bloodwork or imaging performed for another reason. Fatigue or discomfort in the upper-right abdomen can occur, but symptoms do not reliably indicate how advanced the condition is.¹˒⁵

  • Liver fat can often be substantially reduced, particularly in earlier disease, through sustained lifestyle and metabolic-health changes. For people with overweight or obesity, gradual weight loss can reduce liver fat and may improve inflammation and fibrosis. Physical activity is beneficial even without weight loss.⁶˒⁷

  • Not everyone with MASLD is overweight. If weight loss is clinically appropriate, it can improve liver health, but care should also address physical activity, nutrition, blood sugar, cholesterol, blood pressure, alcohol, and other individual risk factors.¹˒³

  • There is no single food that causes or cures MASLD. Care generally focuses on an overall nutritious eating pattern, limiting excess added sugars and highly processed foods, and choosing sustainable dietary changes rather than following an extreme “liver cleanse.”³˒⁷

  • Blood tests and imaging can identify liver abnormalities, while tools such as FIB-4 and liver elastography can help assess the likelihood of fibrosis. Liver biopsy is reserved for selected situations and is not necessary for everyone.⁵˒⁸

  • There is no established supplement-based liver cleanse for MASLD. Some supplements and herbal products can cause liver injury, so anything marketed for “detoxification” should be reviewed carefully before use.⁷

  • Naturopathic care can support nutrition, physical activity, sleep, sustainable weight management when appropriate, alcohol reduction, and other metabolic-health factors alongside medical monitoring of liver health.

 

Related Care

Fatty liver may overlap with several areas of health. You may also benefit from:

Jennifer Tang
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