Functional Medicine Bitesized
Functional Medicine Bitesized
"Liver Love: Unlocking the Secrets of Your Body's Superhero Organ"
In this eye-opening episode of Functional Medicine Bite-Sized, Pete Williams and liver health expert Cerine Cherkaoui of The Liver Clinic, dive deep into the unsung hero of our body - the liver. They explore its numerous metabolic functions, discuss how diet, stress, and lifestyle impact liver health, and reveal practical strategies for maintaining optimal liver function. From understanding fatty liver disease to debunking detox myths, this podcast offers actionable insights for anyone looking to protect and support their liver's incredible capabilities.
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Mon, May 12, 2025 11:47AM • 56:47
SUMMARY KEYWORDS
Liver health, fatty liver, liver scan, liver function, liver enzymes, liver inflammation, liver fibrosis, liver detox, liver supplement, liver diet, liver stress, liver ultrasound, liver damage, liver metabolism, liver glycogen.
SPEAKERS
Cerine Cherkaoui, Speaker 1, Peter Williams
Peter Williams 00:02
So welcome to our new episode of functional medicine, bite sized liver health. This is a recent topic for me, because I actually had a liver scan about four weeks ago, and we're gonna have a discussing discussion about that, but we're, we're going to talk to the people at The Liver Clinic in in central London, which, of course, is a place where they look after your liver. And we're going to speak to Cerine, who's part of them. Cerine, I'm really sorry, but can you just tell us your second name? Because I can never pronounce
Cerine Cherkaoui 00:39
it. Hi, Pete. My name is Cerine Cherkaoui. Okay,
Peter Williams 00:43
so there you go. Sorry, guys, English was never my strong point. And Cerine, so look, I I came to see you about a month ago. Didn't I to to have a liver scan so we can, sort of, we can sort of blend that into the conversation. But really what we were talking about when we though Weren't we is about just how important some basic understanding of what the liver does. How do we know whether it's performing well, and what can we do for it? We thought we'd make a really good podcast. So so here we are, and today is really around sort of using your expertise about liver health, I suppose. And really, that's the sort of, the sort of nuts and bolts of what's what we'd like to talk about. So can I start with just, and again, I think really just some basic questions here, is that, what role does the liver play, and what does it actually do? And why is it so important?
Cerine Cherkaoui 01:38
Alright, so first of all, thank you for inviting me for the podcast. Um, yeah, it's honestly my pleasure to educate everyone about I can speak about liver for ages. Oh, well,
Peter Williams 01:48
look, we're certainly looking for at least 40 minutes if that's if that's okay,
Speaker 1 01:53
of course. So as you mentioned, like the liver is not really so popular. Recently it's been, it's been becoming more and more popular. And when we think about the liver, the most common thing that people associate with the liver is alcohol, unfortunately. But the liver is actually much more amazing. It has over 500 functions, metabolic functions, which we really, need for our everyday life. And it had like, I'm going to tell you some of the most common functions, yup, um, one of them is basically controlling your metabolism and digest, helping you digest the food that you eat. For example, when we consume fatty a fatty meal, it's our liver that that is producing bile, which helps in digesting the fat and absorbing the fat. So ultimately, you need bile to absorb fats or both vitamins like vitamin A, D, E, K and so for example, for for some people who tend to have like issues with the liver, they tend sometimes to also be deficient in vitamin D, for example, also it has like, a huge role in regulating sugar, and most importantly, for example, when you're sleeping or when you're going for a run, it's your it's your liver that is supplying you with this sugar, so it stores sugar, excessive sugar, and it can also give you the sugar that you Need to like for your everyday life, because it's our only energy, main energy source for ourselves.
Peter Williams 03:26
So to just be clear on that, usually at night, obviously, we we have a little bit of sugar that's pushed through the system consistently in that and that, that's primary liver glycogen, isn't it? Liver stores the suagr
Speaker 1 03:39
Exactly. Because when you eat you're going to use this sugar, and all of the excessive sugar are going to be stored in the liver for later use. But when it comes to fatty liver, what happens is that when you when you over consume sugars, you're you have to think about your liver as a tank. So when you can over consume sugar, it's going to like there's no other place to put all these excess sugar. So what happens is that it's going to start depositing all these fats in this, in the liver cells, in these, all these excess sugar in the liver cells. So that's why people tend to have fatty liver because of excessive sugar intake as well.
Peter Williams 04:18
Okay, so can we? Can, we sort of jump into that particular area as well. So, can you just explain the, suppose, the physiology of what's going on there when we over consume simple sugars, and because obviously a lot of sugars will go into the muscle cells, but that's really dependent on, I suppose, how open the the receptors are on the muscle cells to take sugar, and how fit individuals are and how much they are emptying the muscles of muscle glycogen on any other day. Because if they're not doing that, then, of course, it overburdens the liver. So it's not just what goes to. The muscles, but also, how do what happens at the liver? So what's the process and what happens? And you know, how long does that take before we start to see the liver struggle?
Cerine Cherkaoui 05:10
Okay, so in a normal individual, what you eat, to be honest, like, once you start consuming sugar, your body can use it, like normally, you can use it, as you mentioned, like for the muscles, for the brain functions, because it's our main energy source. And what happens is that when you over consume sugar, it's going to be stored as fat inside the liver cells. So in these situations, it can it won't start showing, also, like a very common misconception that people rely on their blood test to see if they have a fatty liver, but it doesn't even show if you have a fatty liver. Like blood tests don't show you if you have a fat if you have any issues in the liver, until it almost becomes like a very advanced late stage, because it can show you if you have an inflammation in the liver which can progress from steatosis grade one, which is fatty liver, Grade 1-2,3, and then it can ultimately lead to fibrosis. So what happens is that once you consume excessive sugar, you like, over a period of period of time, you're going to develop fatty liver and, like, steatosis, grade one. So what happens is that it's not like, Oh, if I consume like so many people like, go on a holiday and come back and they're worried about having a fatty liver. It's not like that. Because you have a metabolism, you exercise your it's a cluster of so many factors, but the main contributor to a fatty liver is refined sugars, yeah, and mostly like stuff that you buy from the supermarket. So number one rule when I tell, like clients who come in when I'm trying to educate them about fatty liver and stuff. So the number one rule is to always look at the ingredients list and make sure that fructose or high fructose corn syrup, seed oils are not there. Sugar is not within the first few ingredients, because, like, the shorter, the shorter the ingredients list, the better. And we want to avoid as much as, like, we want to avoid ingredients that you can't even pronounce as much as you can. So there's a rule of thumb, if your grandma can't pronounce it, just keep it on the shelf. Yeah. Okay, okay, yeah.
Peter Williams 07:21
So you were talking about, it's very it's very difficult, difficult to know whether your liver is in trouble. So what would be the most common signs? I mean, if we're, if we're looking at anyone who comes in to see us, number one, you know, are they experiencing, sort of lower right sided abdominal pain, just just below the ribs. Obviously, that's where the Liver is located, or when we start to see altered liver function tests on a blood test. But obviously, can we, I mean, and that might show us, and that's obviously showing us some degree of liver damage. However, that liver damage is is transient, because you'll see all the time. You know, maybe you've had, you know, a bit too much to drink the night before, and you've done a tiny bit of damage to your liver, and then it sorts itself out, and then you're good to go. But what about the more sort of consistent, long term, chronic changes in the liver. Can we go and actually talk because this probably one of the main reasons why I came and did your your your ultrasound. Can we sort of talk about the differences in testing and the differences in strategy and why the liver clinic is using a specific test? Can we go through all of that?
Speaker 1 08:40
Okay, of course. Shall we start with the risk factors. First of all, who
Peter Williams 08:44
go for it? Yeah, okay. So basically,
Cerine Cherkaoui 08:47
what happened? Most people think, as I mentioned, that it's just if I drink, I need to get my liver check. But it's not the case. There are so many people that are that are more prone to develop a fatty liver disease just because they're predisposed to to it. It can be, for example, if you have diabetes, there's a huge link between diabetes and fatty liver disease. Like almost 70% of people who have diabetes tend to have fatty liver disease. And up today, like until today, they still don't know which one started, because it can start from the liver. Like you can have, you can have a fatty liver which was left unaddressed that led you to develop diabetes and vice versa. Yeah, also people who have, for example, PCOS or other metabolic syndrome, which makes you more prone to actually store fat, which is a bit dangerous. So you need to look after yourself a bit more and be more mindful about what you eat and stuff and check your liver also.
Peter Williams 09:49
So can I just go back on what you're saying? Because what you're saying is the is that I mean not not in every, every case, but the reality is that maybe the heavier you get, the more overweight. Get, the fatter you get, the more likely that you're going to have fat storage in the liver. Is that? What is that? What you're saying, there,
Speaker 1 10:07
yes, obese people are also, like, predisposed. That's the number one, yeah. And because you don't want abdominal fat around the organs, because that's very dangerous, like, it can lead to fatty liver disease, heart heart disease and stroke, um, also a very, a very common misconception that people assume that if someone's obese, they directly tend to have a fatty liver. But some AF scan people that literally were obese and had no fatty liver. And I've scanned slim people that had fatty liver grade three, even with inflammation. So you can't just because what sometimes people tend to have, like, a very fast metabolism, but their diet is, like, completely unhealthy. They barely exercise. They drink a lot. They consume, like, a lot of takeaways and sugars. So yeah, there are very tiny exceptions. So
Peter Williams 11:00
are there any ethnicities where this is more prone? So fatty liver is more prone in in ethnic groups? Yes,
Speaker 1 11:09
mostly Indians or Pakistanis and Asians. Okay, they're more prone, and that's like, due to a whole history with famine and stuff. So their body is more prone to store fats, yeah, like as way of protection, yeah? Also people who have hemochromatosis, for example, because they have a lot of iron storage inside the liver. Yeah, so liver is more prone to have inflammation in it, like fibrosis, not necessarily fatty liver, but mostly the inflammation in the liver, which is fibrosis or scarring.
Peter Williams 11:40
Can we just sort of try and distinguish the difference? Obviously, hemochromatosis is a genetically induced iron overload disorder where it's not so much you can't get rid of iron, and unfortunately, it sort of goes all around the body, and one of the and causes have it, because iron essentially rusts you from the inside out. It's very specific with heredity hemochromatosis for the liver, and the liver is usually one of the first findings that sort of leads clinicians to investigate for heredity hemochromatosis. So can we just explain the difference between how iron causes damage on the liver, just to be specific, the difference between fibrosis and sort of fatty streaks,
Speaker 1 12:28
yeah. So basically, one of the main roles of the liver is also like vitamin and mineral storage, that the liver can store iron, B 12 and other minerals as well. But what happens is that if you, for example, as you mentioned, it can be a genetical disorder like hemochromatosis, and it can also be due to, for example, sometimes people tend to over consume iron, which can also causeinflammation in the liver. So the inflammation or fibrosis is basically how hard or elastic your liver is. So over time, your liver becomes more stiff, yeah. And this can ultimately lead to fibrosis, and this is when you start seeing, like, liver enzymes starting to elevate, because this is a sign of inflammation, which happens like later on,
Peter Williams 13:17
yeah. And what is it about the liver then, why does it need to for its optimal function. Why does it need this flexibility? What I mean when we're talking about stiffness, what do we actually mean is that, you know, the how does, how does that sort of trying to work out the sort of structural physiology of that. How does that? Does it just not work? It's not as flexible. Or is it the sort of systems in the physiology, or the biochemical pathways within it don't work as well. Or
Speaker 1 13:43
in order for it to work optimally, it needs to be soft and squishy, because when you're born as a baby, you have a soft and squishy liver, and the more you get exposed to environmental toxins, alcohol, medications, vaccinations, antibiotics, statins, paracetamol, so many things can affect the stiffness of your liver, but your liver it can heal by itself. It can repair itself. That's one of the superpowers of the liver. But over time, like over years of constant exposure, it's going to reach a point where it's going to start becoming stiffer. For example, I can give you the example of alcohol. Every time you drink alcohol, your liver gets bigger and goes back to its normal shape, and so many of your liver cells die. So what happens is that if you do it once and twice, it's fine, but over years, it's going to start scarring, and this scarring is going to lead you to inflammation, because so many of your liver cells are getting are getting inside your bloodstream as well. Um, so in this case, you need more antioxidants and anti inflammatory to replenish that damage.
Peter Williams 14:52
Okay, so can we? Can we go on? So I suppose the question is, um. So our usual regime is we'll run a well man or well woman blood test. We usually look at the test most associated with liver enzymes, and usually don't do anything more than that. But that doesn't mean to say that just because you have a normal liver function test panel. That doesn't mean to say that your liver isn't so actually, let me turn that around, because I'm sure you do see this, but what you're saying is that you can have completely normal scores on blood tests as far as liver function, but you can have a liver that is already showing signs of maybe maladaptation and sort of increased stiffness. So can we actually talk about and the other thing about this, yeah, sorry, I think the other thing about what this is leading is into Cerine is that I think if there's been a change in society with regards to healthcare, there's a bigger change. I think number one with more information, wherever that comes from. I think social media is good and bad, but, you know, you take the rough with the smooth. But I think we are increasingly in a society where we're taking charge a bit more we understand that we don't need to go through the conventional pathway, going to see the doctor, and I'm going to be sent off to to a consultant and to get my liver checked. And I think a lot of, I think a lot of society, is realizing that actually, you know what, I can just go independently and go and get this done, because I'm interested, and I want to know which is what I did with you guys. So can we go through that process and then actually talk about the scan, and we will talk about the process as it was super easy to do, and actually, I think, incredibly reasonable as a as a cost point as well. So can you take us through all of that? But can you all take us about why the liver clinic was set up in the first place?
Speaker 1 17:02
Yes, of course. So basically, we were trying, as you know, like the healthcare system as it needs a bit of like tweak. So as you mentioned, like you need to go private in order to actually get the answers to what you're asking for, or to be more, let's say proactive rather than reactive. Yeah. So for example, with like, with all my respected with the NHS and everything, because of like, the burden with everything, what happens is that if you want to check your liver test, like, if you want to do a liver check, the only thing that they can do is blood test. And based on that, whether it's healthy or not, you get advised based on your blood test. So for example, in a lot of like I've seen a lot of people that had elevated liver enzymes, and the only thing that they've been told is to stop drinking, regardless or not of whether these people drink or not. So that's the main rule of thumb when it happened, when someone sees like elevated liver enzymes,
Peter Williams 18:02
but there are so and to be fair, it's, it's, it's reasonably good advice. I mean, if you're, if you've got, no it's not that. It isn't, it isn't good advice. It's just maybe not optimal advice based but it is the advice that they would give best based off the data that they've got. So sort of makes sense on a population base, sort of view of it. But let's
Cerine Cherkaoui 18:25
because alcohol is in like, the whole like, your social life revolves around alcohol and stuff, I understand, especially in England and the UK, yeah. So that's the main advice. And then the second advice would be like, Okay, try to fix your diet and stuff. But what happens is that people get very overwhelmed, and then they stop drinking, like they go from like binge drinking to zero drinking, and then they go and relapse, which is really bad, so they don't really understand, from where did it come from, how to fix it and stuff. So what happens is that even if you qualify to get a fibro scan. It's going to be like six months. Wait even more, yeah, in certain cases. Thank you so much.
Peter Williams 19:07
Fibro scan is as far as if you were, if you were put on the list on the NHS, yes.
Cerine Cherkaoui 19:13
So a fibro scan is a more advanced type of ultrasound. It's based on shear waves, not normal imaging. So what happens it's it's very specific to the liver, so it sends sheer waves to your liver to detect the exact amount of fat and stiffness in the liver. So it can detect if you have an early stage of having any issues with the liver, which can start from the fat. So it can detect if you have steatosis, yeah. And second, it can check for fibrosis, for what we say, scarring, yeah, yeah. So, because in it with a normal ultrasound, you can see if there is a scarring, there is fat, but it can't really show you how advanced it is, yeah, yeah. So it's with the fibrous kind. It can actually quantifies it.
Peter Williams 20:03
And sorry, so my assumption is that whoever developed the liver clinic, your liver clinic, knew that there was a, there's a there was a market for it, because, as I said to you, that you know, the NHS is completely overwhelmed, and I do think there is, and we see this increasingly, there is that middle England that, you know, we have individuals who just want to be a bit more proactive, and they're not going to get it through the NHS, and they've got money, and they want to spend it on themselves. They want to, they want to find
Cerine Cherkaoui 20:35
out, gathering data. Yeah, I get that. So nowadays, like you're trying to be optimal, not just good. Yeah. So E who, sorry,
Peter Williams 20:45
no, go on, go on. I'm putting in I wanted to
Cerine Cherkaoui 20:47
tell you. How did it start? So Siggy, who's the founder of it's all started with our liver supplement, actually Deliverance. So he produced, he came up with this natural supplement to actually help people in reversing back a fatty liver. It's called the liver because he lost a family member to to liver disease. And as you know, like, there's no really cure for liver disease, like, once it reaches, like, really late stage, there's no going back. So he wanted to, like, educate people and, like, spread the word about you can do something about your liver in a natural way, not just, like, pharmaceuticals and stuff so and you can reverse it, like, within three months. So what we did is that we now, like anyone can, you can book your fibro scan, and you can get scanned within 30 minutes. You can get results instantly. And if you have a fatty liver, there is a solution for it, like, besides lifestyle changes, dietary changes, like, we provide you with that as well. And there is a supplement that can also support you with that. Okay, and it's non-invasive, so it's not gonna you're not. It's not like going for a biopsy to confirm that you have a fatty liver.
Peter Williams 21:52
No, actually, I think that was the key thing about it. It's very easy to implement, isn't it, and sort of from from start to finish, it's less than 30 minutes, if I remember, non invasive, and was was done rather quickly. I can't remember. My results were pretty good, weren't they, to be
Cerine Cherkaoui 22:09
fair, yeah, you were green. Green, like a baby,
Peter Williams 22:13
yeah? So which is interesting, because and you want
Cerine Cherkaoui 22:17
to maintain it within that range? Well,
Peter Williams 22:19
yeah, I think that. But you know, if I look back is I'm not really drinking at all. Well, very rarely drink these days. You know, I hada Dad who died as an alcoholic through, you know, cirrhosis of the liver. And unfortunately, I've got an elder brother who died, unfortunately, the same way, from, from out, from, you know, the the effects of alcohol, unfortunately, and part of that was through as well. So maybe I've got a keener interest than, than than most people on that side. But, you know, I think it's, again, it's a question of, I really do think there's a middle ground where, you know, you're prepared to pay a little bit more money to get a deeper understanding of of where you are So we've got this very simple test. It's not prohibitively expensive. I can't remember how much it was, about 260 pound was it to have it done? £249 for half an hour? Again, I think is very reasonably priced. How often would you so let's imagine we've got a pretty healthy person. How often would you recommend that they would have the liver scan done? Or is that dependent on your consultation with regards to the lifestyle that they're leading? Yeah,
Cerine Cherkaoui 23:32
there is a question that I didn't answer, actually, because you mentioned that, what are the symptoms of having like, a fatty liver? Yeah, yeah. Sometimes people assume that, oh yeah, I need to have, like, any because the liver doesn't hurt. It's not like the kidneys or the heart, or it doesn't really have signs. It has, like, general signs, like, for example, waking up fatigued, even though you had, like, a full night of good sleep, or, like, sometimes getting bruises easily, or brain fog, which is one of the most common one, because your blood is not really detoxifying properly through the liver, so all these toxins remain inside your bloodstream and it goes to your brain. That's why you can tend to suffer from brain fog. That's the most common one. Um, also like digestive issues or bloating. So if so, we have a lot of people that come in, like, trying to investigate or rule out what the issue is. It can be from the liver or other organs, but because it doesn't have any signs, it's always good to check, like, if you're if you fall under any of the risk, the people that are more prone or at risk of having a fatty liver disease, like people who have gout, for example, which is like excess uric acid or inflammation in the body, especially if you're on medication, it's better to go to go and have a check. People who have a history of fatty liver disease, people who are, for example, Asians, or tend to drink a lot of alcohol, diabete, Obesity. People who with metabolic syndrome can also come in. It's always good to check at least once a year, so you would know it's like going to going to the dentist or having an MOT for your liver. However, if you happen to have a fatty liver, it's recommended to come back again after three months if you do something about it, like if you took the supplement, or if you did some dietary changes and stuff, because it can take up to three months for your liver to have totally different fat results. Okay, so 90 days it can move from like, steatosis grade three to zero. Okay,
Peter Williams 25:36
so that would be minimum time frame, I'm assuming. And what do you see? Because I'm assuming you've seen hundreds of patients, so you know you've seen them weird and wonderful, but I'm pretty sure you probably see sort of some consistent patterns as well. What do you see? And, you know, has there been any real surprises? As far as you went from quite significant grades to, you know, a liver that looks pretty normal, yeah,
Cerine Cherkaoui 25:59
to be honest, I found out that stress, it can like we so underestimate stress. Stress can actually worsen your fibrosis scores like the stiffness or inflammation or the scarring of your liver, because it puts a lot of pressure on your liver. So for example, if you are physic like, I mean stress in general, if you can't control your stress, it makes your if you had, like, fibrosis, it's going to keep them it it's going to take you much longer to bring it back to normal.
Peter Williams 26:28
What's the mechanism that's driving that is that just purely stress hormone production,
Cerine Cherkaoui 26:33
yeah, cortisol, because it's mainly controlled by the liver as well. Okay, yeah, like cortisol production and homeostasis and everything is like, the liver plays a huge role in that. Also, there is a really, like nobody, really, I'm not sure if you know about it, but people who do like late night shifts or chronic jet lag, like they constantly travel across different time zones, they tend to be also more prone to have inflammation in the liver as well, or fatty liver as well. So
Peter Williams 27:07
why is that? Do you think that's just basically disruption of circadian rhythm? Yes,
Cerine Cherkaoui 27:11
Yes besides that, which can lead to disruption with the glucose metabolism. So when your cortiso, because you're not sleeping well, your cortisol is always elevated, so ultimately, you're going to crave sugar, and it's going to lead you into, like, this vicious cycle of consuming sugar, which can lead to fatty liver and not sleeping. And interestingly, according to like, Chinese medicine, traditional Chinese medicine, from one to three, and this is when your liver is working on resetting and recovering. So people who tend to wake up around that time, it's mostly like because of their liver, and if you tend to eat, or, for example, not be asleep during that time, your liver is not really resetting and recharging. Because, as we're speaking now, like every second there's your blood is just passing through the liver yeah, and it's clearing it out.
Peter Williams 28:07
Um, let me, let me bring it back to, I want to bring it back to, almost like a really simple question, which is, which I wrote down, and one was, and again, I noticed, probably what's different for one is different for another. But from your point of view, how much alcohol is too much when it comes to liver damage,
Cerine Cherkaoui 28:29
to be honest, it's very, very subjective, but based on the recommendation in the UK, it's like 14 units a week. But sometimes you we have people that come in telling me that they don't drink the whole week, but they binge drink over the weekend. And sometimes this is really like you would assume, that it's not really going to show on your liver, but it can actually increase the stiffness or fibrosis. And it's very subjective, because, for example, your limits might be, I don't know, 14 units. For someone else, it can be like they have, they tend to have a lower tolerance, so their liver tends to get affected more. And also, it also depends on your you have to think about it as the full picture. Like your diet plays a role. Your exert, whether you exercise or not, also plays a role. I always tell people, it's like carrying a backpack full of rocks and you're trying to climb a mountain, like you would still be able to climb the mountain. But over time, you're going to start noticing that it's super heavy, and you're going to start compromising on other on other stuff. So so this happnes with your liver basica
Peter Williams 29:33
So I just want to sort of in my assumption on this, obviously alcohol when it's been metabolized by alcohol dehydrogenase. And some people, as you say, have genetic predispositions on that, meaning that alcohol dehydrogenase doesn't work as well, making the sort of aldehydes that that once you break alcohol down, become incredibly toxic. Because they induce a massive amount of oxidative stress. And then, of course, with that comes inflammation. Is that the, the key mechanism that drives alcohol to damage the liver? Or is there, is there another, another way?
Cerine Cherkaoui 30:14
No, basically, every time you drink alcohol, so many of your liver cells die. And when that's happened directly
Peter Williams 30:19
over years. How does that how does that work? Is it just alcohol is just incredibly toxic, and is it information that just kills the kills the cells? Yes,
Cerine Cherkaoui 30:30
exactly like even now, according to the WHO and like the CDC, if you don't drink, just don't start drinking. Yeah. But if you want to drink, try to, like, spread them out, or it's like two drinks for men or less, or one drink for women. Yeah.
Peter Williams 30:45
And I think they've redefined binge drinking, haven't they? They've redefined binge drinking as more than two drinks, which,
Cerine Cherkaoui 30:54
you know, I think it used to be six drinks. Imagine,
Peter Williams 30:57
yeah. So it's really come down. I think, I think, sadly, the problem is alcohol. It's just such a wonderful molecule, because it makes you high as kite. It also makes you sad. But it, you know, it takes all those really lovely neurotransmitters to a point, and you get into that lovely sort of zone where it makes you feel great. But the consequences of that, seem to be so extreme that it's unfortunately not showing anything that's good, really, unfortunately, and unfortunately, yeah, and I think you have
Cerine Cherkaoui 31:25
it in moderation. And for example, when it comes to alcohol, try to have, like red wines, and also benefit from the antioxidants and flavonoids in it, still better than a beer full of sugar. So it also depends on each person, of course.
Peter Williams 31:40
So let me just sort of in the realm of, I sort of, you know, when you I mean, I just say I'm not a huge fan of the terminology, but, you know, are the liver detoxes and cleanses. I mean, you see them all. You see them all the time on social media, and they just, I can't say I'm a huge fan of you know this.
Cerine Cherkaoui 32:03
I am with you. I hate the word detox
Peter Williams 32:07
but I'm assuming there's some, there's some ingredients, because this leads us back into the development of Deliverance, doesn't it? And again, we can just sort of blend that in. But you know, I mean, what's, your thought about the you hear, I'm going to go on a detox. Do you think that is something that actually helps the liver, or do you think, I mean, again, is it? Is it if I because I think back and I think, well, if you're on a crappy diet, and you decide to do that, and you're probably at least giving yourself ingredients that were better than you were before, and that might be helpful, or is it that your liver will always look after itself, or is there a point where your liver can't do the job that it needs to do, and maybe needs quite a lot of additional help? So what's your thoughts on that?
Cerine Cherkaoui 33:00
I hate the word detox. I'm not a fan like you, but the liver and the kidneys are the only two organs in our body that can actually detoxify your bloodstream, and you don't need something from outside to actually, for example, lemon water or, you know, like so many people, tend to kick start their detoxification process. Your liver doesn't need, like, lemon water to start detoxifying. It just needs antioxidants. It needs, like it's normal enzymes, and it can heal by itself. So even when I'm talking about the livers, I never mentioned, I never mentioned the word Oh, it it helps you, and it helps your liver in working in an optimal way, which is like, one of the things that it does is detoxifying bloodstreams, controlling your hormones and everything. But what happens is that people who did, like, go on detox diet. It's mostly before summer or, like, after, over indulging in alcohol, like post Christmas, post holidays and stuff. So what happens is that most people put this target as, okay, I'm going to lose weight. It's going to help me with the detoxifying process, or it's going to flush everything away. These are the words that you're going to mostly hear that I'm using. But there's no such thing as flushing waste away, because your liver is already doing that. And most of the time these are dangerous because it's not, they're not really controlled, like it can be tea or, like, you know, like some supplements that are not really controlled, it can lead to dehydration. And most of the times, people lose weight because they're not. They actually eliminated all, all the refined sugars and carbs and stuff, which has led them the unnecessary food, like ultra processed food and stuff, which has ultimately led them to gain weight, or, like, feel unhealthy, or So ultimately it reduced their inflammation. Yeah, but it's not this drink doing that. It's their liver doing that, and they're just supporting it. And most of the time, when people go on detox for like, one to two days, they assume that it's like a quick fix, but it's not. You can't just, like, reverse years of damages in two days. It doesn't happen that way. It takes time, like, it's even based on studies, like, it takes five to six months for your liver to completely reset and, like, reduce all the inflammation, and, like, reverse fibrosis. So when it comes to fatty liver, for example, you can change it, and then within 90 days, you can have totally different results. But with the fibrosis, it takes a lot of time, yeah, because it's inflammation and, like, constant drinking and stuff. So it's not, it's not like this.
Peter Williams 35:40
So what you're saying is that, so it's interesting, isn't it? Because I think what we're both saying is that we need to take a systemic view on health, and, you know, we need to think about a full on, just normal, healthy dietary approach that is, you know, giving us huge amounts of fiber, but lots of phytochemicals and anti inflammatory components that come from foods. And not only is that going to transfer to all of the body, it's going to help the liver just get on top of some processes that that may be getting away from, like, you know, like, like, localized inflammation, if you like. So it is a question of, I suppose the key on this is that everyone wants the magic bullet, and really there isn't one. So, you know, I don't have a problem with I think it's a, for me, it's a it's a question of semantics. If, if someone's an absolute crappy diet and they want to go and buy some kind of, you know, detox diet for a week that actually has more phytochemicals than they were before, then inherently, I don't have a problem with that. But again, I sort of have a, you know, a bit of a bug bear with using the word I'm going to go on the detox, like, Well, okay, alright.
Cerine Cherkaoui 36:49
Because also not really consuming protein, they're not consuming fibers, they're they're just consuming like, you know, like blended juices or greens.
Peter Williams 36:57
And is there a problem for that. Because, let's assume that, you know, because I think about, you know, once you start mobilizing fat stores, the risk of, you know, mobilizing fat stores is that you do increase toxicity levels as well depending on what the fat stores are containing. Because, you know, we do live in a pretty, pretty toxic society, particularly if you're going to live in a big city. So, you know, there is an argument in the science that some degree of obesity may be induced by environmental you know, the, if you like, the sort of storage of environmental toxins. And we know that most toxic materials are lipophilic by nature, so they're fat loving by nature. And there are definitely, I can remember reading papers years back saying, you know, you lose weight, but increase toxicity in the bloodstream. So I think there is an argument there that, again, sometimes maybe these detoxes are, you know, and causing more harm than good, you know, from that perspective.
Cerine Cherkaoui 37:54
So everything that you apply on your skin and everything that you inhale, yeah, well, and pass through the liver as well, like all of these can add up.
Peter Williams 38:04
obviously, medications are always, are always a part of things to think about. I'm assuming you know, painkillers, antibiotics, any other medications that are notorious for, things to think about,
Cerine Cherkaoui 38:19
a very common one that everyone takes every single of, mostly most days, paracetamol or Lem sip, for example, yeah, because it can actually like it has a lot of damages to the liver, especially if you consume it like regularly, and so many people are
Peter Williams 38:38
and why Is that? Is there a specific pathways that the paracetamol goes down, or is it just really toxic to the liver?
Cerine Cherkaoui 38:46
It is toxic. I don't know the exact pathway, to be fair, but even when you read on the side effects on on any type of, on any paracetamol, you're going to see like it's very toxic to the liver. Also statins, for example, on the long term, it can lead to stiffness in the liver, which is inflammation, um, antibiotics, um, even acne treatments, which a lot of people are on, um corticosteroids, so people who are like on immunosuppressive drugs as well, uh, anti certain antidepressants or anti anxiety drugs. Also, because we do a lot of scans in health shows I've seen a very high levels of fibrosis in people that are super healthy but consume a lot of supplements in a pill form. Okay, interesting, which, yeah, which can actually lead to stiffness in the liver. And it's not like it's doing more harm than good, because like, you're and when I ask these people about like, Oh, what do you take? And stuff, and people would take, like, 40 supplements a day, and it's actually crazy, because your liver is not able to cope with that much, so it leads to much more stiffness. Also,
Peter Williams 40:01
okay, is there any, is that anecdotal, or is there any, any science on that? Because that's a really interesting observation. Is that just what you're
Cerine Cherkaoui 40:11
anecdotal? Yeah, that's based on my observations, okay, based on what I've seen, yeah, my experience. But also there is, like, a scientifically proven one with ashwagandha, actually, okay, yeah, most people like take ashwagandha just to help them with relaxation and like stress and stuff. But not many people know that they need to actually cycle, so they need to stop after three months to actually allow the liver to rest, and there are so many studies that have actually shown that consuming ashwagandha over a long period of time without stopping can actually lead to inflammation in the liver and liver damage.
Peter Williams 40:51
Really interesting, because, you know, there are some very classic aren't they? Like milk thistle. It's a I mean, what are the ones that we definitely know has a beneficial impact on the liver. I mean, clearly milk thistle would be one of them
Cerine Cherkaoui 41:07
Deliverance is mostly antioxidants and anti inflammatory base. So it's based on like 17 herbal ingredients, and they all work to improve liver health. So,
Peter Williams 41:17
but you talked about how that was developed, because I can remember, I think, how all of this started. As I said to you when I first came, is that I had a patient? God, what was his name? John, who came to me, great guy, and I think he'd probably seen your professor, and he was on De-liver-ance. And I think, if I remember the reason, I think originally, was De-liver-ance. And again, maybe you can tell me whether this was right or wrong. But De-liver-ance was originally, sort of touted as you're not going to have a hangover if you take this, that was the sort of the original.
Cerine Cherkaoui 42:02
It was actually named Sober Up before.
Peter Williams 42:04
Okay, interesting. So, can you just tell us the story of this? Then,
Cerine Cherkaoui 42:08
yeah. So Siggy, the founder, created this product basically to because, as I mentioned, we lost a family member due to liver disease. So he started this formula, but then it changed over time, like we added other ingredients and now the main focus is not to help with hangovers. Like the liver is actually much more, much more important than just eliminating alcohol. Yeah. So you can use it in multiple ways. Actually, you can use it one of, one of the ways to use it is to actually use it around alcohol, because it can take help in eliminating the alcohol in a better way. So it makes your liver, yeah, just gives the support to your liver to actually eliminate the alcohol. Because, as you know, if someone has a fatty liver, or like any issues with the liver, it's not able to do its proper, normal functions, so the liver is just giving a push to that it can also help.
Peter Williams 43:02
So before you answer that, can I, can I sort of put a scenario here, because we always get patience. Well, Pete, listen, Christmas is coming up, and the reality is I am going to have probably too much to drink over several days. Is there anything I can take that may help? So is this an, is this an argument that that product is going to help in that perspective? Now, there's good and bad to this, because we could say, I took that product and I thought, I'm going to drink twice as much, and that's not how we want to use it. Because there's, for me, there's, there's, you know, there's, there's nothing that the amount of alcohol is always, you know, the you know, the the damages in in the in the poison and the amount of poison. So that's not how I'm trying to do it. But my point is, is that we have sensible patients who are going to, you know, who are trying to be as healthy as possible. But like everyone, you know, Christmas is coming and, yeah, I'm going to be probably drinking, you know, five days out of five. And is there anything I can take that is going to be maybe just, just helpful for me within that scenario, given that I'm probably going to eat too much, and I know my liver is going to probably be working overtime over those five days. So is that ultimately a product that you could go this is worth a shot. It's probably going to be helpful in that period.
Cerine Cherkaoui 44:20
Exactly as you said, it's gonna help, but it's not gonna like, all these, all these alcohol are not gonna like, go to waste. So that's why I don't usually promote it, like I just mentioned the alcohol part as a bonus, yeah, because we're not trying to encourage people to drink more. It's like, if you want to drink, keep like you can drink and enjoy your time in moderation, but you also have, like, an SPF to your liver to protect you. Yeah, yeah. Like, you're still getting the damages and the toxins. You're gonna have, like, much more damage, much less damage. Sorry,
Peter Williams 44:54
in many ways, it's a little about a bit, what we were talking about. About, you know, external environmental exposure. It's, it's the key to detoxification, or is making sure that the exposure levels are reduced in the first place. That's the key. Number one, I always tell people, there's no point those trying to super support you when the amount of, you know, the amount you're being exposed to is, is getting higher and higher. So the key thing is, is that there's trying to deal with exposure first, and then we'll worry about everything else from there exactly.
Cerine Cherkaoui 45:25
That's why I love functional medicine, because, like, you treat the root cause of an issue, not just masking all the symptoms.
Peter Williams 45:32
So what was I going to say on my on my other questions, it'd be good place here. So look, I think what we said here is that, you know, there are, we're definitely in this, I think in this time in healthcare, where you're not going to get what you need from the NHS, or you might do, but you're going to have to wait for a very long time. We're definitely seeing this middle ground now, or this understanding that, you know, we can take charge. We don't need a we don't need a referral. We can just, you know, go online and tap in, you know, liver ultrasound London. And, you know, liver clinic will come up, as many other places do, and we can go and get it done. And we can get great advice, and great advice that is, you know, is, I think, is really sort of, it's not prohibitive cost wise. Certainly I don't think it was anyway, and, you know, you're getting really good advice. What would be so again, I'm trying to just sort of bring all this to sort of summary from this, apart from, you know, I think we should be all doing, you know, certainly when you get over 40 because, as you say, everything that you did before, the that that exposome is all related to, you know, where your liver is. And as you said to you, it's really interesting, isn't
Cerine Cherkaoui 46:49
it? That drops down after, yeah,
Peter Williams 46:52
when you and as I said to you, when we talked about sort of cardio metabolic health, which I think liver is ultimatelyinvolved w is, you know, there are some ethnicities that you know are really more at risk. And South South East Asian, sort of ethnicities that you know, sort of much more of the bigger risk group. And from that perspective, there's not anything sort of Afro Caribbean. They're not at increased risk, are they? They're more
Cerine Cherkaoui 47:15
They are more prone, like to diabetes. And
Peter Williams 47:19
so with that being offset with that relationship with with liver fibrosis, from that perspective, or in
Cerine Cherkaoui 47:25
terms of, actually, 80% of your cholesterol is produced by the liver, and only percent is taken from the food that we eat. But it's not necessarily, yeah, I mean, it's not a rule that if you have high cholesterol, you're you tend to have elevated fat.
Peter Williams 47:40
So, so here's question for you then, and just just on that you brought it up. So one of the key arguments in in the lipid research and cardiovascular disease, as we know that cardiovascular disease is, is, well, it's really two sides to it. It's a metabolic dysfunction where we see damage to the to the outside of the arterial wall, but also then we see the other side, which is the lipid. So it's a combination of both. But what we also see, one of the main things of why we tend to have more and more elevated LDL cholesterol as we age, is because the receptor sites for LDL on the liver down regulate over over time. Is that a indication of, is that a normal process, or would that be accelerated in increasingly sort of stiffness to the liver and fibrosis to the liver, and, you know, increasing fatty liver will that influence the LDL receptor? Because, of course, one of the whole points about what the recept the LDL receptor does is that it takes, it takes, I'm not going to say bad cholesterol, but because the LDL is, is a lipoprotein, it's a delivery source for for various different lipids. But in a sense, it's, it's taking cholesterol out of the system.
Cerine Cherkaoui 49:02
You mean, HDL as well. Well, it does,
Peter Williams 49:05
it does both. But, you know, as I said to you, we're sort of talking about, you know, how well that, how good the liver is at up taking cholesterol out of the system. You know, that's one of the mechanisms that, you know, we understand. There's a reason why cholesterol levels do go up as we age. So is that part of also, that is part of, you know, increasingly, a liver that's not performing as well as it should do as we age is influencing that lipid aspect.
Cerine Cherkaoui 49:31
Yeah, I believe that if you have a fatty liver, this is mainly due to an unhealthy diet, and most of the time it's the diet is not addressed. So if you fix your diet, your liver is going to be improved. And ultimately, once you fix your liver, your cholesterol is going to be improved, so your liver is going to be able to actually produce and eliminate and like all, because most people who have fatty liver disease also have low HDL levels, which is heart protect, protective. Mm. So what happens is that your HDL is not working properly, so it's failing to eliminate all these plaques and, you know, toxins. So, yeah, what happens is that you're going to be more prone if you have a fatty liver disease, you're going to also be more prone to have stroke and heart disease. So they're all linked, yeah, they're all linked, and diabetes and insuline resistance as welltes as well, and insulin resistance. So, so
Peter Williams 50:21
do you believe that, as you say, within that, as I say, when we were sort of talking about that sort of cardio metabolic disease, aren't we really here with the liver, is almost like sort of being a bit of a central player, if you like, you know. So, you know, within all of this, I say to everyone again, is that we have to be able to get your weight within a certain, you know, we've got to continue to work on trying to get your weight down over time. And you know, we've gotta, almost like, allow everything to clear itself out, and give it room to clear clear things out, and then just help and support all of these structures and biochemical pathways over time. Is that the way you see it?
Cerine Cherkaoui 50:55
Yes, I see it as baby steps, and it's not something that's going to happen overnight. And I always advise people, like, even a slight change, like, even if you just, I don't, know, take the stairs instead of taking the elevator. Or, like, park your car. Like, take the take another, like, take the further away bus stop, just to walk a little bit more if you can't really walk during the day, if you, especially if you have, like, a desk based work, just all these tiny little bits can actually add up during the week, and studies have shown that even as little as five losing 5% of your weight can actually have amazing improvements on your blood glucose levels and on your liver and everything.
Peter Williams 51:38
So let me, we sort of went off on a good tangent there. But let me sort of try and bring this back to summarize what would be the practical everyday tips that you would give, pardon me, you would give to someone who can adopt and as well. Of course, as I said to you, I'm very much, you know, if you can't measure, you can't monitor. So I think there's definitely a role in there for testing. But if we were looking to adapt some strategies that would keep our liver healthy, what would they be, practical, everyday tips, what would what would we look at?
Cerine Cherkaoui 52:19
Okay, the first thing is, diet. Stay away from refined sugars. Try to consume a lot of cruciferous veggies. A lot of cruciferous veggies can be like cabbage, kale, broccoli, cauliflower, and try to also add a lot of garlic to your diet, which is amazing. A lot of also beetroots and artichoke are so amazing food for the liver. Healthy fats can be avocados, extra virgin olive oil, nuts, seeds, as much as you can even sprinkle sprinkling them on your salad can be great, uh, staying away, as I mentioned, from seed oils, fructose, which is very damaging to the liver because it can induce fat.
Peter Williams 53:06
me asking you to summarize, but there's so many questions coming up, but I'm assuming fructose from processed foods rather than fructose from fruits
Cerine Cherkaoui 53:15
Yes, exactly, because in their fruits, you consume antioxidants, fibres, water, so, yeah, fructose can be inside, you know, the sauces or drinks as well. Yeah, yeah, uh, prioritize sleep. Try to sleep like and like during mindful hours, and not just like after 1am because that's really important, like, to the circadian rhythm and everything. And everything and you can about it more. Also limit unnecessary medications. If you don't need paracetamol, you don't really have to. I mean, try to go through the natural way, through teas, honey, normal anti inflammatory remedies. Also try to manage stress as much as you can. Blood tests are not horrible,iblebut it won't give you the full picture. Blood tests can show you a part of the picture, for example, if you if you're predisposed to have diabetes, for example, or insulin resistance, it won't show you the early like the early signs or symptoms or early signs of having a liver damage. So it's always good to at least have a liver check, have a liver fiber scan once a year, so you would know, and then you get it out of here, so you would know that you're healthy, and then you carry on with your life. Do
Peter Williams 54:35
you know what I think the thing about this, though, isn't it? It's
Cerine Cherkaoui 54:38
exciting, of course, sorry, is that
Peter Williams 54:41
the scans create that basis to make a decision of either I'm good or I'm bad. And you know, for me, a lot of the time is that, I think a lot of tests, it's the call to arms, it's, oh shit, okay, I better do something about this, because actually, this has come back, and it's not how I wanted to so I think, as I said to you, when you work it, working out there's such real value in I mean, it's, you know, it's not nice having a test and you realize that you're not as perfect as you should be. But I think what's really good about testing is ill scanning, is that at least you know where you stand and you can make
Cerine Cherkaoui 55:13
it there's a solution for it. Yeah, like, yeah, exactly. Because once you reach cirrhosis, there's nothing that you can do anymore, and then you're going to be like, I wish I actually had a scan, or I wish I knew before so I would do something about it. Yeah, really. Because, as I mentioned, liver doesn't even show you, like it doesn't hurt, so you're not going to know until you check.
Peter Williams 55:34
So what we're talking about, aren't we, is preventative and proactive as we go forward, particularly, once we're getting up 40. Cerine l ook fantastic. Thanks so much for doing a really great explanation of, you know, it's almost like it's, it's doing all this amazing work every day, and we sort of don't really spend too much time on it, really and
Cerine Cherkaoui 55:55
changing lives.
Peter Williams 55:58
Well, yeah, as you say, there's a there's a lot that goes through that there's a lot that it needs to control. And you know, it's central to a lot of things. And hormones, metabolic, as you say, our metabolism in particular, so pretty important, but pretty easy to follow, I suppose, and pretty easy to check.I mean as I said to you that the scan was less than 30 minutes. It's, it's not invasive, so there's no needles. I'm not being punctured. You know, it's, it's a very easy process, and you get told straight away, it's not like you've gotta wait for a couple of weeks to get your result back. You know, you're taking us through the report there and then very simple procedure. So look, we'll put your we'll put your details on the podcast, and I really appreciate your time today.
Cerine Cherkaoui 56:43
Thank you, Pete, it's been a pl