Love Your Liver for Women’s Health

By Suzanne Fenske, MD, FACOG, ABOIM, MSCP

Love Your Liver for Women’s Health

Your liver is a three-pound organ that works tirelessly for you every second of the day, but we tend not to give it much thought until something goes wrong. Yet, it’s time to put liver health on the radar because how you care for your liver today, through diet, lifestyle, and toxin reduction, can shape your health tomorrow.

Women with PCOS or going through perimenopause are more at risk of developing nonalcoholic fatty liver disease (NAFLD), which can lead to liver complications and cardiovascular disease.

Since the best way to address liver issues is to prevent them in the first place, today’s article will explore how liver health influences women’s health and integrative approaches to show your liver some extra love. We’ll discuss:

• What is the liver? What does it do?
• What is NAFLD?
• PCOS and liver health
• Liver health in perimenopause
• Integrative strategies for liver support

Essential Liver Functions

The liver comprises only about 2% of body weight but is essential for over 500 distinct functions. Think about the liver as an organ of biotransformation – transforming one molecule into another. It’s crucial to metabolism, immunity, digestion, detoxification, hormone balance, and more.

One of the liver’s most significant roles is in metabolism. The liver takes the macronutrients from food and transforms them into usable forms. For example, the liver converts fructose into glucose and stores glucose as glycogen. Additionally, the liver regulates amino acids in the blood and converts some amino acids into others. It can also transform amino acids into glucose as necessary. The liver is also the site of cholesterol production. In these ways, the liver plays a central role in metabolism and helps maintain blood sugar balance and metabolic efficiency.

Here are some more noteworthy liver functions:

• Digestion – The liver makes bile out of cholesterol. Bile is stored in the gallbladder and released into the digestive system to aid in the digestion and absorption of dietary fat.

• Protein synthesis – The liver makes albumin, binding globulins (for hormone transportation), clotting factors, and immune factors.

• Detoxification – The liver transforms exogenous (environmental) toxins, hormones (including estrogen), and pharmaceutical drugs into forms the body can expel.

• Nutrient storage – The liver stores fat-soluble vitamins, including vitamin A, vitamin E, and vitamin D. It stores iron from the breakdown of hemoglobin (the liver breaks down old blood cells).

• Hormone activation – The liver is the primary conversion site of thyroid hormone T4 (thyroxine) into the active form, T3 (triiodothyronine).

With the liver playing so many essential roles, when it’s not functioning correctly, it can cause many problems and be incredibly harmful for health. Luckily, the liver is incredible and can maintain and improve its functionality when given the right conditions. It can even regenerate itself!

NAFLD and Women’s Health.

As we discuss women’s health as it relates to liver health, nonalcoholic fatty liver disease (NAFLD) is one of the most common conditions that comes up. It describes abnormal fat distribution where, in this case, fat is stored in liver cells (instead of fat cells). In this case, the fat build-up is not caused by alcohol use or abuse. NAFLD causes inflammation and affects how the liver functions.

NAFLD isn’t just about the liver, though; it’s part of a larger-multisystem picture of insulin resistance and metabolic syndrome, which increases cardiovascular disease risk. Heart disease is still the number one cause of death for women.

NAFLD negatively impacts women’s health. Looking at pregnancy outcomes, women with NAFLD have a greater risk of gestational diabetes, preeclampsia, preterm birth, and post-partum hemorrhage. It also increases the baby’s risk for NAFLD. NAFLD also relates to PCOS and perimenopause; let’s explore these connections next.

Liver Health and PCOS

Polycystic ovarian syndrome is the most common endocrine disorder in women and typically involves both metabolic and reproductive dysfunction. Women with PCOS are more likely to have insulin resistance, and insulin resistance can cause fat storage in the liver, leading to NAFLD. In fact, a PCOS diagnosis doubles the risk of NAFLD.

However, liver dysfunction also contributes to PCOS in a bidirectional relationship. Lipotoxicity, the fat accumulation in liver cells, causes liver dysregulation that drives insulin resistance and associated conditions, including PCOS.

Liver Health and Perimenopause

The hormone changes associated with perimenopause, notably the decline in estrogen and progesterone, shift metabolism towards a more insulin-resistant state. Additionally, hormone shifts can lead to body composition changes, including weight gain and abdominal fat accumulation. Both obesity and abdominal obesity promote NAFLD.

While aging is a risk factor for NAFLD in women, there is more at play in terms of hormones. The prevalence of NAFLD in premenopausal women is 6%, but the prevalence is 15% for postmenopausal women. The perimenopausal transition increases NAFLD by more than two times!

Estrogen plays a protective role in the liver, and when that protection is lost, liver dysfunction and NAFLD increase for women. Like your natural estrogen, bioidentical estrogen in hormone replacement therapy may also prove to be protective. We need more research in this area, but the prevalence of women on HRT with NAFLD is lower than in the population of women who aren’t replacing hormones. There is the argument that HRT supports liver function and reduces inflammation.

Nutrition and Lifestyle Strategies for Liver Support

From an integrative perspective, we have many tools to support liver health and prevent liver dysfunction that may come along with other women’s health issues, such as weight gain, PCOS, perimenopause, and more. The foundation consists of regular wellness checks and monitoring of liver function, along with personalized nutrition and lifestyle tools for optimizing total-body health.

The liver requires an abundance of nutrients, including micronutrients and phytonutrients, to perform all its daily functions. Here are some tips:

• Choose healthy fats from cold water fish, nuts, and seeds
• Meet your daily protein needs
• Utilize fiber-rich complex carbohydrates from beans, nuts, seeds, veggies, and fruit
• Reduce your intake of sugar, refined carbohydrates, and ultra-processed foods
• Eat cruciferous vegetables and choline-rich foods (including eggs and beets) for detoxification support

For women with NAFLD or other liver concerns, research supports the Mediterranean diet, ketogenic or low-carbohydrate diet, and intermittent fasting strategies for liver improvements. Using nutrition to support weight loss and achieve a healthy weight for your body is one of the most effective interventions for NAFLD. It’s important to find an approach that is effective but also sustainable for your body. Our TārāMD nutritionists can help guide you.

Other integrative approaches include:

• Reducing toxin exposures from the air, water, and food, paying attention to pesticides, heavy metals, BPA, and PFAS, which are associated with NAFLD.

• Moving your body and exercising regularly. Ten thousand steps per day and 150 minutes of moderate cardiovascular exercise per week can help improve liver health or prevent issues in the first place.

• Optimize vitamin D levels to support liver health, immunity, and healthy gene expression.

• Consider liver-supportive herbs where appropriate, such as artichoke, milk thistle, and turmeric. Work with a provider for guidance and monitoring.

If you have metabolic risk factors, PCOS, or are going through perimenopause, you will want to stay on top of liver health and establish a protective lifestyle. You can’t control your genetics or aging, but you can support liver health through simple daily actions, such as whole food meals, walking, and keeping up with preventative appointments with TārāMD.

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