Polycystic ovary syndrome is a complex and under-considered endocrine disorder that is far-reaching and beyond a fertility issue. Although a significant number of research studies have been conducted on the topic, many areas remain unclear. PCOS is associated with several physiological alterations, including an increase in androgen production. 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 several physiological effects within the body and can present multiple unpleasant symptoms in those affected.
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 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.
People diagnosed with PCOS, if they have indicators, ought to consider being screened for non-alcoholic fatty liver disease due to the higher incidence amongst women with this syndrome. 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 occur 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 crucial, as certain health conditions can produce similar effects and symptoms to those of a fatty liver.
The first step is a physical examination.
When your liver is inflamed, your healthcare professional may feel it enlarged by pressing under the right side of your rib cage. They might also gently tap (called percussing) on the area to assess the size of your liver. It’s a little like tuning a musical instrument and listening to whether the notes sound right, except in the case of the body, where different densities produce 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 provide a definitive answer, but altered liver enzymes offer a clue to what has happened to this vital organ.
The third step is imaging.
An ultrasound is the primary imaging tool used 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 a small piece of 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 for Fatty Liver
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.
Treatment for the non-alcoholic fatty liver disease most often includes a first-line approach that includes a series of lifestyle changes. The liver has an incredible ability to regenerate and repair, and lifestyle changes can help address several issues that contribute to ongoing liver damage.
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.
Optimal food choices for a PCOS fatty liver
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))
Poor food choices to avoid
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 (table sugar)
A note on coffee
One study suggests that consuming 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, it 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 someone 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 vital to liver health. After all, inflammatory products can be absorbed from the gut and enter the body, then travel 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 puts it, NAFLD has a strong association with microbiota.
With this in mind…
- Refined sugars should be limited or removed from the diet
- Fibre intake should be sufficient
- Stress management implemented
- Easily absorbable nutrients can be taken
- Take time to eat meals slowly, chewing thoroughly
- Probiotics may help
For more recommendations on how to improve gut function, check out our article, The 16 Point Checklist For A Better PCOS Gut now.
The majority of studies on non-alcoholic fatty liver disease focus 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 reduce oxidative damage in the body, including the liver, and aid in other bodily functions.
Vitamin E is found in many food sources, including avocado, spinach, hazelnuts, almonds and sunflower seeds.
If you have PCOS and fatty liver, there is much you can do!
From PCOS to perfect health, with love,
Dr. Rebecca Harwin
The PCOS Expert
Chiropractor & Bestselling Author of
Conquer Your PCOS Naturally
www.ConquerYourPCOSNaturally.com
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