Food-derived extracellular vesicles (FEVs) are nanoscale membrane vesicles derived from dietary sources such as breast milk, plants, and probiotics. Unlike other extracellular vesicles (EVs), FEVs can survive the harsh degrading conditions in the gastrointestinal tract and reach the intestines, making them promising prebiotics and therapeutic agents for gut disorders like inflammatory bowel disease (IBD). Recent studies have also shown that FEVs can exert therapeutic effects on non-gastrointestinal diseases, though the underlying mechanisms remain unclear. This review discusses the potential mechanisms by which FEVs act locally in the intestine to modulate the gut-liver axis, thereby influencing remote organs such as the liver. The gut-liver axis is a reciprocal interaction between the gut and liver through the portal vein and bile duct, regulated by gut microbiota and the gut barrier. FEVs can influence these components, potentially leading to therapeutic effects on metabolic diseases such as non-alcoholic fatty liver disease (NAFLD), obesity, diabetes, and cardiovascular disease. The review also explores the sources, characterization, administration routes, and biodistribution of FEVs, highlighting their potential as natural drug delivery systems. Overall, FEVs show promise in treating a range of diseases through their actions on the gut-liver axis.Food-derived extracellular vesicles (FEVs) are nanoscale membrane vesicles derived from dietary sources such as breast milk, plants, and probiotics. Unlike other extracellular vesicles (EVs), FEVs can survive the harsh degrading conditions in the gastrointestinal tract and reach the intestines, making them promising prebiotics and therapeutic agents for gut disorders like inflammatory bowel disease (IBD). Recent studies have also shown that FEVs can exert therapeutic effects on non-gastrointestinal diseases, though the underlying mechanisms remain unclear. This review discusses the potential mechanisms by which FEVs act locally in the intestine to modulate the gut-liver axis, thereby influencing remote organs such as the liver. The gut-liver axis is a reciprocal interaction between the gut and liver through the portal vein and bile duct, regulated by gut microbiota and the gut barrier. FEVs can influence these components, potentially leading to therapeutic effects on metabolic diseases such as non-alcoholic fatty liver disease (NAFLD), obesity, diabetes, and cardiovascular disease. The review also explores the sources, characterization, administration routes, and biodistribution of FEVs, highlighting their potential as natural drug delivery systems. Overall, FEVs show promise in treating a range of diseases through their actions on the gut-liver axis.