A Food-First Approach to MASLD & NAFLD
MASLD — metabolic dysfunction-associated steatotic liver disease, the updated clinical name for NAFLD — is one of the most common chronic conditions in the United States. It is also one of the most responsive to nutrition. Diet and lifestyle are the first-line treatment, and a well-built plan can meaningfully reduce liver fat, improve enzyme markers, and slow disease progression.
If you have been told you have a fatty liver, elevated ALT or AST, insulin resistance, or pre-diabetes, you are in the window where nutrition can change the trajectory of your liver health. This page is about how I work with clients to do that.
MASLD vs. NAFLD — What Changed
In 2023, leading hepatology societies renamed NAFLD (non-alcoholic fatty liver disease) to MASLD to better reflect the underlying biology. The newer term emphasizes that fatty liver is driven by metabolic dysfunction — insulin resistance, central adiposity, dyslipidemia, inflammation — not simply by what it is not. The inflammatory form (formerly NASH) is now called MASH.
The clinical care is similar; the framing is sharper. It also moves the focus where it belongs: metabolic health is liver health.
Conditions and Patterns I Work With
- MASLD / NAFLD (simple steatosis and inflammatory forms)
- Elevated liver enzymes (ALT, AST, GGT)
- Insulin resistance, pre-diabetes, and type 2 diabetes
- Metabolic syndrome and central adiposity
- Elevated triglycerides and atherogenic dyslipidemia
- Post-bariatric or rapid weight-loss liver concerns
- Family history of cirrhosis or chronic liver disease
How a MASLD Nutrition Plan Is Built
There is no single “MASLD diet.” The strongest evidence supports a Mediterranean-style eating pattern, but the version that actually works is the one a client will follow. I build plans around five practical pillars:
- Insulin sensitivity first. Refined carbohydrates and added sugars — especially fructose — drive liver fat accumulation. Adjusting carbohydrate quality, timing, and pairing is usually the highest-leverage change.
- Protein adequacy. Enough protein at each meal supports body composition, satiety, and metabolic flexibility — all relevant to liver outcomes.
- Fiber and plants. Soluble fiber, fermentable fiber, and polyphenol-rich plants support glucose regulation and the gut-liver axis.
- Fats with intention. Olive oil, fatty fish, nuts, and seeds support anti-inflammatory pathways. Ultra-processed seed oils, fried foods, and excess saturated fat go down.
- Alcohol honesty. Even moderate alcohol matters in MASLD. We discuss your real intake and what is sustainable.
The Gut-Liver Connection
The liver and the gut are in constant conversation through the portal vein. An imbalanced gut microbiome, leaky barrier function, or constipation can increase the inflammatory load reaching the liver. For many MASLD clients, supporting digestion and the microbiome — not just “eating clean” — is a meaningful part of the plan. Read more about my approach to gut health.
Testing & Markers I Watch
I work with your existing labs and order or recommend additional testing only when it changes the plan. Markers I commonly track and discuss with your physician:
- ALT, AST, GGT, alkaline phosphatase
- Fasting glucose, fasting insulin, HOMA-IR, HbA1c
- Lipid panel including triglycerides and non-HDL
- FIB-4 score (calculated from age, AST, ALT, and platelets) as a non-invasive fibrosis screen
- FibroScan or elastography results if your hepatologist has obtained them
- Continuous glucose monitoring data when appropriate — see my post on using a CGM
Want to self-order labs?
Visit my Fullscript storePlease note: Functional Testing is not covered by and not billable to insurance.
What I Do Not Do
I do not sell “liver detox” supplements, juice cleanses, or fear-based elimination protocols. Most generic liver-support supplements on the shelves have weak or no evidence in MASLD. The intervention with the strongest data — sustained dietary change paired with physical activity and metabolic management — is also the least flashy. That is what I do.
Related Reading
- Anti-Inflammatory Diet Foundations
- Using a Continuous Glucose Monitor
- Conditions Overview — Liver Disease (MASLD)
- Chronic Disease Nutrition
Goal: a sustainable, food-first plan that lowers your liver fat, improves your metabolic markers, and protects your liver for the decades ahead.
Fatty liver is one of the most diet-responsive conditions there is. The earlier you start, the more your liver can recover.