Hepatic fat & fatty liver
One of 4 mechanistic pathways to 📉 Metabolic health & insulin sensitivity · 17 options
The liver is where insulin resistance usually starts. Fat accumulating in hepatocytes impairs insulin's ability to suppress glucose output, which raises circulating insulin, which drives more storage. Break that loop and the systemic picture follows.
An ALT above 30 with insulin resistance is fatty liver until proven otherwise, even inside the 'normal' range — the reference range was set on a population that largely had it. The ELF score estimates fibrosis without a biopsy.
Comprehensive Metabolic Panel (CMP)Enhanced Liver Fibrosis (ELF) TestFasting InsulinHbA1c (Hemoglobin A1c)Lipid Panel (Cholesterol, HDL, LDL, Triglycerides)FerritinUric Acid🫀 Fatty Liver & Liver Health covers these in one panel →
What engages this pathway
Ordered by how directly each one acts on the mechanism above — never by how much trial evidence exists. Each links to its full breakdown with dosing, half-life and vendor.
💉 Retatrutide
The glucagon component drives hepatic fat oxidation directly. Phase-2 liver-fat reductions were substantial and are among the most striking results in the field.
💉 Survodutide
GLP-1/glucagon with MASH as an explicit development target.
💉 Pemvidutide
A GLP-1/glucagon dual developed with hepatic fat and lean-mass preservation as the explicit design targets rather than as secondary endpoints.
💉 Semaglutide
Improves steatohepatitis resolution in randomised trials, largely via weight loss.
💉 Tesamorelin
Reduces visceral AND hepatic fat in trials, with the GH axis as the mechanism rather than appetite.
💉 Metformin
Reduces hepatic glucose output; the liver-fat effect is modest.
🧬 Berberine
Trials show reduced hepatic steatosis alongside its lipid and glucose effects.
🧬 TUDCA
Reduces endoplasmic reticulum stress in hepatocytes — a mechanism upstream of the fat accumulation itself.
🧬 Milk Thistle (Siliphos)
Silybin phytosome improves liver enzymes and, in some trials, steatosis. The phytosome form is what was studied.
🧬 Choline Bitartrate
Choline is required to package fat into VLDL for export. Deficiency causes fatty liver directly and reproducibly in humans — one of the cleanest nutrient-disease relationships known.
🧬 Phosphatidylcholine
The form choline is used in for lipoprotein assembly.
🧬 Betaine Anhydrous (TMG)
Methyl donor that supports phosphatidylcholine synthesis; trials show improved liver enzymes.
🧬 Omega-3 (Fish Oil)
Reduces hepatic triglyceride content in meta-analysis.
🧬 Vitamin E
The PIVENS trial showed histological improvement in non-diabetic NASH — one of few things with biopsy-proven benefit.
🧬 NAC
Glutathione restoration in a tissue with very high oxidative load.
💉 Lipo-C
Methionine, inositol and choline — the lipotropic combination aimed directly at hepatic fat export.
🧬 Artichoke Leaf Extract
Trials show reduced liver enzymes and improved steatosis on ultrasound.
The other 3 routes to metabolic health & insulin sensitivity
Pick the pathway that matches where you are actually stuck. An appetite drug does nothing for someone who already undereats.
Want the protocols behind these?
Dosing schedules, stacking, cycle timing and Coach Cam's notes live inside the Academy — plus the full interactive Vault.
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Frequently asked questions
The liver is where insulin resistance usually starts. Fat accumulating in hepatocytes impairs insulin's ability to suppress glucose output, which raises circulating insulin, which drives more storage. Break that loop and the systemic picture follows.
17 options are mapped to this pathway in the Vault, including Retatrutide, Survodutide, Pemvidutide, Semaglutide. They are grouped by the mechanism they act through rather than ranked by how much trial evidence exists — 16 carry clinical validation and 1 are mechanistic predictions.
An ALT above 30 with insulin resistance is fatty liver until proven otherwise, even inside the 'normal' range — the reference range was set on a population that largely had it. The ELF score estimates fibrosis without a biopsy. The markers worth checking are Comprehensive Metabolic Panel (CMP), Enhanced Liver Fibrosis (ELF) Test, Fasting Insulin, HbA1c (Hemoglobin A1c).
Unproven is not the same as ineffective. Of the 17 options on this pathway, 16 have clinical validation and 1 are graded theoretical — meaning the mechanism is sound but the specific human trial has not been run, which is true of a great deal of what works in this space. Nothing on this page is ordered by evidence tier, because sorting by trial count would bury the compounds you came looking for.