Fatty Liver In PCOS: What’s The Connection & What Can You Do?

Polycystic ovary syndrome is a complex and under-considered endocrine disorder that is far-reaching and beyond a fertility issue. Even though a significant number of research studies have been conducted on the topic, many areas still remain unclear. PCOS is associated with a number of physiological alterations, including an increase in the production of androgens. Women tend to experience irregularities in their menstrual cycles. In some patients, small cysts may also develop on a single ovary or both ovaries simultaneously. And…

Recent studies have suggested a possible link between PCOS and fatty liver disease. Nonalcoholic fatty liver disease (‘fatty liver’ or NAFLD) is a common condition that leads to the development of chronic liver disease (1). The condition is associated with a number of physiological effects within the body and can present multiple unpleasant symptoms in those affected.

PCOS and NAFLD: A guide to what you must know (and do!)

In this post, we will address the possible presence of fatty liver in women with PCOS. We will also consider the most appropriate diagnostic approach and how the conditions can be effectively managed through both pharmaceutical intervention and lifestyle modifications.

The Connection Between Polycystic Ovary Syndrome And Non-alcoholic Fatty Liver Disease

Several studies have confirmed that the presence of nonalcoholic fatty liver disease is more prevalent among women with polycystic ovary syndrome. One study explains that several mechanisms involved in the development of  PCOS have also been linked to the increased risk of developing a nonalcoholic fatty liver disease. (2)

The study explains that several risk factors for nonalcoholic fatty liver disease become more evident in a woman with PCOS. These include the increased release of androgens. Elevated levels of androgens like testosterone have been associated with a higher incidence of insulin resistance, one of the primary risk factors, along with obesity.

testing pcos and fatty liver

Women diagnosed with PCOS ought to consider being screened for non-alcoholic fatty liver disease due to the higher incidence amongst women with this condition. Screening for the presence of a fatty liver becomes especially important when there are higher risk factors, like…

Obesity, with a particular focus on those patients who have developed abdominal obesity.

People (and their health professionals!) with metabolic syndrome and insulin resistance need to be educated about the connection between these conditions, as regular screenings may detect liver issues early on.

In many cases where non-alcoholic fatty liver disease is present, the disease will remain asymptomatic during the earlier stages of the disease (3). Symptoms only occurring when the liver has become overwhelmed and struggles with its role: or medically put when decompensation occurs. Yet early detection and action may stop a fatty liver in PCOS from getting a foothold and progressing.

The diagnosis of nonalcoholic fatty liver disease is conducted via a four-step process. Accurate diagnosis is important as certain health conditions may yield similar effects and symptoms of a fatty liver.

The first step is a physical examination.

When your liver is inflamed, your health professional may feel it enlarged by pressing under the right side of your right ribcage. They might also gently tap (called percussing) on the area to see how large your liver is… It’s a little like tuning a musical instrument and listening whether the notes sound right, except in the case of the body, there are different densities that give different sounds rather than different strings. Just like if you tap on wood and then tap on an empty milk carton.

The second step is testing the blood.

These don’t give a definitive answer but altered liver enzymes give a clue to what is happened with this important organ.

The third step is imaging.

An ultrasound is the usual imaging tool, able to detect the presence of excess fat in the liver.

The fourth step is a biopsy.

This is when a needle is inserted into the liver and some tissue is removed for examination. This is not always considered necessary, however, it is the definitive way to know.

The possibility of other health ailments contributing to liver problems needs to be ruled out before an official diagnosis of nonalcoholic fatty liver disease.

Appropriate Management Solutions

Early initiation of a treatment and management plan for non-alcoholic fatty liver disease can help to prevent further damage, and the right options can help to reduce the severity of existing symptoms. At the moment, however, no pharmaceutical approach has been approved by the FDA for the treatment of nonalcoholic fatty liver disease.

While no official pharmaceutical drugs have been approved, one study (4) explains that certain drugs can be repurposed and used to treat the condition. The most common types of drugs that are used today to assist in the treatment of non-alcoholic fatty liver disease include angiotensin receptor antagonists and pioglitazone. Recent clinical trials have also focused on obeticholic acid, a type of farnesoid X receptor agonist, in the treatment of this disease.

However, as our focus is on the word naturally, it’s key to look at how lifestyle and natural approaches may help…

pcos and fatty liver

Treatment for the non-alcoholic fatty liver disease most often includes a first-line approach that includes a series of lifestyle changes. The liver had an incredible ability to regenerate and repair and lifestyle changes can address a number of issues contributing to continued damage to the liver.

This is serious stuff for a serious health issue so please don’t fob this diagnosis off and think there is nothing you can do!

Weight loss, where needed

Issues such as insulin resistance need to be addressed through lifestyle modifications. This will take the pressure off the liver, so to speak.

The right food choices

The handy thing is, following a PCOS diet plan is key for weight loss, PCOS signs and symptoms, and for reducing a fatty liver. That’s three birds with one stone! So which foods are helpful?

Let’s take a look:

Low glycaemic load foods
Anti-oxidant rich fruits and vegetables
Healthy fats like those found in fish oil and flaxseed oil
Ideal levels of vitamins A and E (intakes of these vitamins have been shown to be lower in people with NAFLD (5))

The poor food choices

There is a range of foods and food components that have been shown to damage the liver and ought to be avoided in PCOS, and especially in women with PCOS and fatty liver.

These include:

High fructose corn syrup
Trans-fatty acids (found in chips, bakery products, deep-fried consumables) (6)
Sucrose (tables sugar)

A note on coffee

One study suggests the consumption of unfiltered, unsweetened coffee may aid in the treatment of non-alcoholic fatty liver disease. (5). Though, please, be careful of excess caffeine intake. This is a stimulant, as such, may not be ideal for women trying to lose weight or learning to de-stress.

A focus on the digestive system

As I’ve talked about before, I can’t recall ever having consulted with a woman with PCOS who doesn’t have some level of gut involvement. And with the gut linked to inflammation, insulin resistance, nutrient deficiencies, and more, it’s no wonder it’s important to liver health. After all, inflammatory products can be heaved from the gut and into the body and then head to the liver for processing and removal. As the author of the article Focus on emerging drugs for the treatment of patients with non-alcoholic fatty liver disease put it, NAFLD has a strong association with microbiota.

With this in mind…

For more recommendations on how to improve gut function, check out our article, The 16 Point CheckList For A Better PCOS Gut now.

PCOS and fatty liver

The majority of studies for non-alcoholic fatty liver disease are focused on the use of vitamin E. Vitamin E is a natural nutrient, considered one of the most potent antioxidants. The use of vitamin E supplements may help to reduce oxidative damage in the body, including the liver, as well as aid in other functions.

Vitamin E is found in many food sources including avocado, spinach, hazelnuts, almonds and sunflower seeds.

There are supplements that have been shown to improve insulin resistance and reduce inflammation, which is likely key in addressing both PCOS and fatty liver. So while the research studies may lag behind, do I believe that women with these dual challenges should supplement? Absolutely! Our health is to precious to wait.

From PCOS to perfect health, with love,

Dr. Rebecca Harwin
The PCOS Expert
Chiropractor & Bestselling Author of Conquer Your PCOS Naturally


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