Most people think of insulin resistance as a “blood sugar problem,” but did you know it’s also closely tied to your liver health? One complication of insulin resistance is non-alcoholic fatty liver disease (NAFLD) — and it’s becoming more common worldwide.
What is NAFLD?
NAFLD, or non-alcoholic fatty liver disease, means there’s too much fat stored in the liver. Unlike liver damage caused by alcohol, NAFLD develops because of how the body handles food and energy. A healthy liver normally has very little fat, but with NAFLD, fat gradually builds up inside liver cells and starts to interfere with liver function.
There are two main forms:
- Simple steatosis – fat in the liver without significant inflammation or damage
- Non-alcoholic steatohepatitis (NASH) – fat in the liver plus inflammation and liver cell injury
NASH is more serious because it can lead to scarring (fibrosis), permanent damage (cirrhosis), and in some cases, liver cancer.
NAFLD now affects up to 30% of adults and 10% of children in developed countries [Source].
How do you know if you have NAFLD?
NAFLD rarely causes symptoms in the early stages, though you may notice fatigue or pain in the upper right quadrant of the abdomen. Because of this, it’s often only discovered during routine health checks. Your healthcare provider might suspect NAFLD if:
Blood tests show elevated liver enzymes, particularly ALT and AST. When liver cells are under stress or damaged, these enzymes “leak” into your bloodstream. As one of my mentors used to say: “liver lysis leads to leaks!” — a memorable way to understand what’s happening.
Imaging scans like ultrasound, MRI, or CT reveal excess fat in your liver tissue. Sometimes a liver biopsy is needed to confirm the diagnosis and assess the extent of any damage.
Other possible causes of elevated liver enzymes will also need to be ruled out, including excess alcohol use, hepatitis, iron overload, thyroid disorders, celiac disease, and certain medications.
The NAFLD and insulin resistance connection: A vicious cycle
Insulin resistance and NAFLD have a two-way relationship. Understanding the connection can be genuinely empowering for your health.
So, what is insulin resistance? It’s when your body’s cells don’t respond properly to insulin, the hormone that moves sugar from your blood into cells for energy.
This can be driven by poor dietary choices, chronically elevated blood sugar, central obesity, sedentary lifestyle, chronic stress, poor sleep, hormonal changes and even genetics.
Insulin resistance often develops quietly. One clue can be an increased waistline (>35 inches for women, >40 inches for men). I also use fasting insulin blood tests and other markers to see how the body is handling sugar and insulin.
When the body becomes insulin-resistant, it creates the perfect storm for fatty liver:
- Normally, insulin acts like a “brake pedal” on fat breakdown in your fat tissue. But when insulin resistance develops, that brake stops working effectively. More fat gets broken down and released as free fatty acids (this will show up as high triglycerides in a blood test), which your liver then dutifully stores as fat
- Meanwhile, high insulin and glucose levels signal your liver to start manufacturing new fat from carbohydrates through a process called de novo lipogenesis. Your liver isn’t just storing incoming fat anymore — it’s actively creating extra fat
- Inflammation enters the picture: As fat accumulates, your liver becomes stressed and inflamed. This inflammation damages liver cells and disrupts insulin signalling throughout your body, making insulin resistance even worse
And there’s your vicious cycle: insulin resistance leads to fatty liver, which worsens insulin resistance, which leads to more fat storage, and so on.
Finally, this is where metabolic syndrome comes in. Insulin resistance is a key driver, and metabolic syndrome is also a strong predictor of NAFLD. Its five features include:
- A larger waist circumference
- High blood pressure
- High blood sugar levels
- Elevated triglycerides
- Low HDL (“good”) cholesterol
Addressing NAFLD early is key — not only to protect your liver, but also to lower your risk of type 2 diabetes, heart disease, and difficulty managing weight.
What you can do
The good news is, the liver is incredibly resilient 😊. Early-stage fatty liver can often be improved — or even reversed — with the right dietary and lifestyle changes. This is truly where naturopathic therapy shines: addressing root causes rather than just managing symptoms. Treatment focuses on healthy, sustainable weight loss, improving metabolic parameters (blood sugar, insulin levels, lipids, blood pressure, etc.), reducing inflammation, and supporting liver function.
Diet & lifestyle
- Anti-inflammatory, whole-food diet – focus on fresh fruits and vegetables (antioxidants!) fibre, and pure, filtered water
- Eliminate refined carbs and processed foods – including white flour, white rice, pasta, and anything with high-fructose corn syrup.
- Opt for healthy fats – minimise saturated fats and choose essential fats from oily fish, nuts, and seeds
- Start meals with bitter greens – salads with rocket, dandelion, watercress or kale help digestion and support liver function
- Regular movement – combine aerobic exercise with resistance training to support muscle mass and insulin sensitivity
- Reduce environmental toxins – think cleaning products, plastics, and chemical exposures where possible
- Avoid alcohol
- Stress management – focus on rest, mindfulness, social connection and time in nature, as chronic stress worsens inflammation, insulin resistance, and fat accumulation in the liver
Nutritional support
Choline helps the liver package and export fats (preventing build-up), and supports important metabolic processes (donates methyl groups) [Source].
Not getting enough can contribute to the development of NAFLD, so including choline-rich foods like egg yolks, liver, and other nutrient-dense sources is a smart choice. In fact, a large study of over 56,000 adults found that women with the highest choline intake (≈394 mg/day) had a 32% lower risk of NAFLD compared to those with the lowest intake (≈185 mg/day) [Source].
Meanwhile, inositol helps cells respond properly to insulin, supporting healthy blood sugar levels and efficient use of glucose. A deficiency has been linked to NAFLD [Source], which can be more likely in diets high in refined carbohydrates, since inositol is naturally found in the bran of grains and seeds that are often removed during processing.
Finally, omega-3 fats (EPA and DHA) can help the liver by lowering liver enzymes (specifically, ALT, GGT), reducing blood fat levels (triglycerides), and boosting “good” HDL cholesterol [Source].
Herbal support
In naturopathic practice, we have access to beautiful herbal medicines that can support liver function, reduce inflammation and oxidative stress, promote insulin sensitivity, improve fat metabolism, and enhance digestion. Some of my favourites include:
- Milk thistle – antioxidant, liver-protective
- Turmeric – anti-inflammatory
- Schisandra – antioxidant, liver-protective
- Coleus – supports metabolism
- Gymnema – supports blood sugar balance
The takeaway
NAFLD and insulin resistance are closely linked, but early intervention can make a big difference. Focusing on whole-food nutrition, regular movement, stress management, and targeted support like choline, inositol, essential fatty acids and liver-friendly herbs can help your liver recover and break the cycle of insulin resistance.
If you need further support, feel free to book in for a consult here.
Lauren ❤️🩹
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