Fatty liver, Insulin, & PCOS

It’s liver health month and it’s nutrition month in Canada, so I’m combining those 2 topics in this blog post to cover the most common (and underdiagnosed) liver condition in Canada: NAFLD (Non-Alcoholic Fatty Liver Disease). 

picture of leafy green veggies with a liver icon on top in translucent red. there's text on top that says March is Liver Health & Nutrition Month


It’s when we find fatty deposits in the liver. If you have a fatty liver as well as inflammation of the liver, then it’s called NASH, Non-Alcoholic SteatoHepatitis. And if you begin to get more severe liver dysfunction where the organ’s cells are dying, you get liver cirrhosis.


The risk factors and relevant history involved include:

  • High amounts of visceral fat (fat around your organs), usually measured via waist circumference. 
  • Overeating on a regular basis (this looks different for everyone). What I mean is having an excess of energy going into your body than is being used by your body. 
  • Lack of exercise. 
  • High triglycerides on bloodwork. 
  • Elevated androgens (testosterone, DHEA)
  • Anatomically assigned male at birth (I would think that trans people who may be taking testosterone would fall in this category although there’s no research to my knowledge that backs that up). 
  • PCOS.
  • Menopause.
  • Insulin-resistance.
  • High intake of saturated fat, especially not balanced with high-fibre plant foods.

A small wooden bowl of whole flax seeds on lighter wood with flax seeds sprinkled around the bowl
golden sunset with the silhouette of a woman in the foreground punching her arm out to the left


Usually fatty liver is found incidentally via abdominal ultrasound when investigating some other issue. It is underdiagnosed. Liver function tests or liver enzyme tests on bloodwork can give us a bit of an idea, especially when combined with insulin + glucose to test for insulin resistance and your lipid/cholesterol panel. 

If you have elevated triglycerides, hypertension, cholesterol issues, pre-diabetes, or insulin-resistance, talk to your doctor about doing an abdominal ultrasound to check for fatty liver.

The gold standard, though, is liver biopsy which would also tell us if there’s significant inflammation in the liver.


Well, fatty liver is a marker for developing more significant liver disease and cardiovascular disease later.  Having fatty liver impairs insulin and blood sugar regulation. And impaired insulin and blood sugar regulation contributes to fatty liver. So, it ends up being a vicious cycle. 

All of this impacts how your liver functions, impacts cholesterol transport in your body, contributes to inflammation in your liver and the rest of your body, and can lead to plaques in your arteries that lead to vessel hardening and constriction i.e. cardiovascular disease.


  • Avoid overeating for your body – working with a doc or nutritionist/dietitian can help here.
  • Exercise regularly, especially focusing on adding/preserving lean muscle mass i.e. adding in weights/resistance/strength training. 
  • High-fibre nutrition works really well here and fibre comes from plant foods so having more plant foods is the way to go. Ground flax seeds ~30g or 2tbsp have been shown to be helpful (Yari 2016).
  • Decrease or avoid saturated fats found in high amounts in red meats (beef, pork, veal etc.), butter, and coconut oil. Focus on healthy fats like omega-3s, extra virgin olive oil,  and nuts and seeds (especially ground flax!).
  • Work on improving body composition especially if you’ve gained significant weight recently – talk to your doc. Weight loss has been shown to decrease the amount of fatty deposits in the liver in research on overweight subjects.
  • You do NOT need to follow a keto diet and I actually discourage you from doing this – this will worsen fatty liver and insulin resistance since you’re consuming more fat.
  • You also do NOT need to avoid carbs – focus on whole grains, legumes, beans, lentils, fruits, and veggies and that will improve fatty liver and insulin resistance. There’s lots of research on this too. 
  • Decrease alcohol consumption. Even though NAFLD is not caused by alcohol, most people do drink some alcohol and that can contribute to impaired liver function along with everything else. 
  • Manage healthy blood sugar levels by having balanced meals that have protein + carbohydrates/fibre + healthy fats

Obviously, this is not medical advice, so talk to your doc.

I see a lot of insulin resistance and fatty liver in my practice, especially since I see a lot of people with PCOS. If you’re looking for some support and are not a patient, you can always book in a discovery call (if you’re in Ontario).