Fatty Liver Disease (MASLD), Insulin Resistance, and Hormonal Health: A Naturopathic Perspective

Fatty liver disease, now more commonly called metabolic dysfunction-associated steatotic liver disease (MASLD), is becoming increasingly common in the United States, including here in the Pacific Northwest. Many patients are surprised to learn that fatty liver is often closely tied to insulin resistance and hormonal shifts, especially during perimenopause and menopause. These conditions rarely occur in isolation. Instead, they are deeply interconnected through metabolism, inflammation, and endocrine function. For naturopathic physicians, understanding these relationships allows for a more comprehensive and individualized approach to care.

One of the strongest drivers of fatty liver disease is insulin resistance. When the body becomes less responsive to insulin, glucose regulation becomes impaired, and the liver begins storing excess fat. Research published in the Journal of Clinical Endocrinology & Metabolism described insulin resistance as an “almost universal finding” in nonalcoholic fatty liver disease. (OUP Academic) Over time, this can contribute not only to liver inflammation, but also to increased cardiovascular risk, weight gain around the abdomen, fatigue, elevated triglycerides, and blood sugar instability. Many patients with fatty liver also meet criteria for metabolic syndrome, which includes elevated blood pressure, blood sugar dysregulation, and central adiposity. (Taylor & Francis Online)

Hormonal changes, particularly declining estrogen levels during menopause, can further influence this metabolic cascade. Estrogen plays an important protective role in liver health, insulin sensitivity, and fat distribution. As estrogen declines, many women notice an increase in abdominal weight gain and worsening blood sugar regulation. Studies published in JHEP Reports and Healthcare found that postmenopausal women experience increased susceptibility to fatty liver disease, insulin resistance, and visceral fat accumulation. (JHEP Reports) Additional research has shown that menopause itself may independently increase the risk of developing MASLD, even in women without significant obesity. (ScienceDirect) This helps explain why some women begin experiencing metabolic changes seemingly “out of nowhere” during midlife.

The relationship between hormones, insulin resistance, and liver health is also influenced by inflammation and stress physiology. Chronic inflammation, disrupted sleep, elevated cortisol, sedentary lifestyle patterns, nutrient deficiencies, and highly processed diets can all worsen metabolic dysfunction. Researchers continue to explore how oxidative stress and inflammatory signaling contribute to liver damage progression. (MDPI) In naturopathic medicine, addressing these root causes often involves a combination of nutrition counseling, blood sugar support, stress management, movement, sleep optimization, and targeted supplementation. Therapeutic nutrition plans emphasizing whole foods, fiber, protein balance, omega-3 fats, and reduced refined sugar intake may help improve both insulin sensitivity and liver function.

For patients in Bellevue and the greater Eastside area, these metabolic and hormonal concerns are increasingly common, especially among adults navigating busy lifestyles, chronic stress, and midlife hormonal transitions. A naturopathic approach focuses on identifying early warning signs before more advanced disease develops. Comprehensive care may include evaluating fasting insulin, liver enzymes, lipid markers, inflammatory markers, hormone balance, body composition, and lifestyle factors together rather than viewing each symptom separately. By understanding the interconnectedness of fatty liver disease, insulin resistance, and hormonal health, patients can take proactive steps toward improving energy, metabolic resilience, and long-term wellness.

Schedule a consultation today to explore personalized treatment options. To book an appointment with Dr. Barnett, call 425-539-0800 or email staff@drclara.com. Her offices are conveniently located in Seattle and Bellevue, and telemedicine appointments are also available.