Episode 43: The Fatty Liver Epidemic: Why It’s Rising and What You Can Do with Kyle Bloomfield

Fatty liver disease is one of the fastest-growing liver conditions worldwide, often linked with obesity, diabetes, and other metabolic health issues. Many people don’t realize they have it until it progresses to more serious complications like cirrhosis. In this episode, we sit down with gastroenterology nurse practitioner Kyle Bloomfield to uncover the risks, warning signs, and connections between fatty liver disease and metabolic syndrome. We also dive into lifestyle strategies, supplements, and treatment options that can help prevent progression and even reverse fatty liver disease—empowering you to take control of your liver and overall health.

Your liver health matters: we cover the steps you can take to reverse this hidden epidemic.

For More Resources:

American Liver Foundation

American Gastroenterology Association - GI Patient Center

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specific individual’s medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis or treatment. This podcast does not create a physician- patient relationship and is not a substitute for professional medical advice, diagnosis or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different so make sure you consult your own healthcare professional before seeking any new treatment and before you alter, suspend, or initiate a new change in your routine.

Transcript

Episode 43: The Fatty Liver Epidemic: Why It’s Rising and What You Can Do with Kyle Bloomfield

[00:00:00] Before we start today's episode, I would like to quickly read you our podcast disclaimer. The content in this podcast is for general reference and educational purposes only. It is not meant to be complete or exhaustive or to be applicable to any specific individual's medical condition. No information provided in this podcast constitutes medical advice and is not an attempt to practice medicine or to provide specific medical advice, diagnosis, or treatment.

This podcast does not create a physician patient relationship, and it's not a substitute for professional medical advice, diagnosis, or treatment. Please do not rely on this podcast for emergency medical treatment. Remember that everyone is different, so make sure you consult your own healthcare professional before seeking any new treatment, and before you alter, suspend, or initiate a new change in your routine.

Welcome to the starting game. We're your host, Dr. Kitty Dotson and Dr. Sarah Sheets. Two internal medicine doctors who spent years practicing traditional primary care. Over time, we realized something was missing from modern healthcare, a [00:01:00] real understanding of how everyday lifestyle choices impact overall health.

We'll help you cut through the noise of the countless health influencers and their conflicting opinions because no matter who you follow, the basics of lifestyle medicine are at the heart of it all.

Welcome back to the starting gate. We're your host, Dr. Kitty Dotson and Dr. Sarah Schuetz. So today we are continuing on our topic of gastrointestinal issues and we're talking about a disease that is on the rise and it's actually the most common cause of liver disease in the world, and that is fatty liver disease.

And today we have a very special guest to help us unpack this diagnosis. Kyle Bloomfield, who is a nurse practitioner at Baptist Health here locally in Lexington, and he has specialized in gastroenterology and worked in this department for many years now. Thank you all so very much to have me here. It's an absolute honor to be on your podcast today. 

We're glad to have you. We are. And can you give our listeners [00:02:00] a little bit of an introduction about yourself? 

Alright I have been born and raised here in the great bluegrass state of Kentucky.

I'm originally from Northeastern Kentucky. Bit of a conundrum. I was essentially had a Lewis County address my whole life, but went to school in Carter County. They went to undergrad in Pikeville before I moved up here to Lexington. I've been at Central Baptist, or Baptist, south Lexington ever since.

Education-wise. Undergrad was on Pikeville. I got my RN, BSN in there. When I came to Baptist Health, I had the privilege of working with two attendings there who really encouraged me to go on to graduate school. I got my master's as an adult gerontology, acute care nurse practitioner.

And along the way too, I developed this fascination and love for GI as well as, general surgery, colorectal surgery, anything in the belly was really the things I was most interested in. And then the things with the liver really caught my eye from a very early stage. And then also too, those same attendings told me to go on to school and I went and got a doctorate where I spent two and a half years researching liver disease, in particular on a focus of fatty liver diet, lifestyle, nutrition.

Yeah. 

That's great. We are looking forward to [00:03:00] diving into a lot more depth with fatty liver disease with you And we're gonna be talking about what fatty liver disease is, why some people develop fatty liver disease. Also the new names for fatty liver disease. 'cause it's changed. I know now it's just very confusing, more complicated for sure.

And then we're gonna talk about how someone might know they have it, what tests are involved, and then of course what we can do about it, particularly with lifestyle, because this is a disease that although it's alarming with the rates going up and we're even seeing fatty liver disease in children, it is something that we do have some control over and new medications coming out to help.

So I'm excited to get a chance to. Talk about this topic with you today. 

So to get us started, can you tell our listeners what is fatty liver disease? 

Yeah. So when I'm meeting a patient for the very first time and we're talking about fatty liver, I try to break it down into as simple terms as possible.

So fatty liver at its core is just us saying, your liver has went on [00:04:00] as little rampage, has decided to store extra fat in the liver. What does that truly mean? And the analogy always uses. Imagine you're building a home and you're having someone come out and brick that house for you. You want nothing on one side of your house, but just nice queen-sized bricks, stacked neatly and uniformly.

Your liver is structured much like a brick wall made up of all these millions of little hepatocytes that are nice and neat and uniform. You have this nice clean wall. Your neighbor, on the other hand, has a house that has a doorway, an archway, a stained glass window, a mounted TV bracket in the middle.

Those cells, instead of being nice and uniform, now have big gaps in them, fatty livers, much like that wall. And you now have all these gaps in these deposits where they're not supposed to be. In and of itself, not a dangerous situation to have those deposits and those gaps in your cells, but over time you can get some weakness around the mortar joints and around the caulking around those windows, and that can create some instability, some inflammation over time, you can have issues.

That's a great way to think about it. I think another thing we just need to clarify from the very beginning is some of the nomenclature around this disease [00:05:00] state, because it was called one thing and now there's another name for it, and it's just gotten a little confusing, so let's just.

Give some of those definitions so our listeners understand exactly what we're talking about when we use words like NASH or NAFLD or even the new one, the metabolic dysfunction associated steatotic liver disease. That's a mouthful. It's MASLD. Yeah, MASLD. So can you just define these \ for us? 

Yeah, of course.

So back in, the earliest I can recall was in 2023, the American Association for a Study of Liver Disease released these joint statements who were wanting us to start calling things more of what they are as opposed to what they are not. Back in the day we were using phrases like non-alcoholic fatty liver or nash, and really we weren't dialing into what was truly going on in those livers.

So now we have this new stenotic liver disease classification system. And the big thing that we remember is we want to look at this more broad term. In the olden days you had NASH and NAFLD or non-alcoholic steato hepatitis or [00:06:00] non-alcoholic fatty liver disease. Those two got an upgrade and they are now metabolic associated steato hepatitis and then the metabolic associated steato liver disease.

So they're uniform and they can be interchanged. The same thing. But what they did for us is they gave us murky middle. So what do you say to a patient who tells you, Hey, I drink two glasses of wine with dinner two or three nights a week. Is that playing a role with their liver disease? So what they did is they created this new middle category that we call met a LD or and that's how you're supposed to say it met a LD and that is for your patients with social to low ranges of alcohol consumption.

So we can now quantify, hey, is your alcohol consumption. Playing in any way into your liver disease or fatty liver. So for example, if you're a female and you're drinking two glasses of wine three nights a week, that would only be 84 grams of alcohol consumed in that week period. So you'd still be in the MASLD into the spectrum, whereas if you double that or even triple that, you'd fall into the more alcohol leaning ALD into that spectrum.

So it just gave us a better tool to [00:07:00] tell patients, Hey, this is what's going on in your liver and this is why it's happening. 

Yeah. So to try to simplify that, it seems like there's the MASLD is fatty deposits in the liver. Correct. Due to non-alcohol due to diet and other things which we'll get into.

Correct. And then the Met a LD is. Probably both. 

It can be, yeah, it's the confusing part is it can be both and there's a sliding scale, so you just look at their alcohol consumption and you say, okay, you're drinking how many drinks? You calculate it in grams per week and you just put a line down, okay, you're right in the middle.

So this could be either or it's heavier towards the metabolic alcohol lit into the spectrum. 

I'm glad they did that 'cause I always found that really confusing because, there are many people that don't fall on wind end of the spectrum and when trying to provide advice of what to do or what was the actual etiology.

When you're in that middle ground, it's. It's easier now to say hey, it's likely both. 

Yeah. And in my first few years in practice, that was one of the most frustrating things for me. 'cause I like to be really concise with my documentation and when I'm like, oh [00:08:00] there's fatty liver, but they drink some alcohol and I had to say Nash with occasional alcohol.

It wasn't real clean and concise like I like. So this was a great adjustment. It's just taking the society a long time to roll out the education and get people on board with using it. I myself am guilty. I will still call something NAFLD instead of the MASLD and it's gonna take time. 

So really we want our listeners to know, you might hear all these terms 'cause doctors are trying to get used to using some of this new terminology, but we're slowly adjusting.

Yeah. Yeah. It'll be a process for sure. And then the other thing for the listeners is when you're getting imaging, you'll see some people say fatty liver infiltration on a ultrasound and then another radiologist will say hepatic steatosis. So this whole thing, there's a whole myriad of words we use, but it all comes back to the same thing.

Yeah. And it might be something that your doctor's never brought up to you, but you might see like on your after visit summary and there's all those diagnoses on there, and you might see one of these, the nafld or the mast or the NASH or mash or hepatic steatosis listed. Correct. So if you [00:09:00] see any of those things, it all basically means.

Fatty liver. Correct. Which is probably how we'll talk about it today. For sure. This show is for you. 

Yeah. When it comes to that, because many times when you've even seen it on imaging. Someone may not have even brought it up to you because they may have been getting an image of some other part of your body and they just mentioned this in your liver and they didn't talk about, the fatty infiltration that was seen in your liver.

So if you have seen that, this is something I would go back to your primary care doctor and say, Hey, when I had this CT scan, a few months ago it mentioned this. Can we talk about that? Because sometimes if you get an image with a different specialist or in the er, et cetera, it's not brought up.

So yeah. 

And I think we're just so immune to it as doctors because we see it on almost every scan we order. So mention of that, that we get to where we just don't even. Bring it up. And when it is at those mild stages, that's when we really do need to be bringing it up. 

Correct. That's when it is the most reversible and the [00:10:00] easiest to address.

So we are 100% just immune to seeing it every day on every scan 

because these numbers have just skyrocketed. 

Absolutely. Yeah. When you look at the numbers, one in four adults now have fatty liver in America. And the scary statistic for me is when you look at the new pediatric data, up to 10% of kids have fatty liver.

So one in 10 in your classroom. And a lot of that's just mind boggling to me as a provider to see that even if I'm making these changes in my adult patients, the foundation for that's already been started well before I come in contact with them. 

And this was just not something we saw in pediatrics.

30 years ago. 

before we get into a lot of details, can you just tell us why do we even care? You mentioned having a little fat in your liver isn't that big of a deal. So why do we care about this? What could potentially happen? 

Going back to my analogy of the house and the bricks, when you start getting those fatty deposits in your brick wall, you start to end up with inflammation.

Those things start to break down around your mortar joist within your liver. That same process happens and you [00:11:00] start. With the fat. The fat leads to inflammation that leads to fibrosis and long term you end up with cirrhosis of the liver, which is a pretty much a non-changeable condition that's a chronic condition from that point forward, my role as a gastroenterology provider is to identify your fatty liver well before we progress to cirrhosis.

'cause at that point, it's just a strictly management thing that we try to manage your symptoms and things as best we can as opposed to being really curative. So the big thing to know is the fatty liver in and of itself may not be dangerous, but if we don't do anything about it long term over the course of 15, 20, 30 years, it can become a very real problem for you.

Now, you had mentioned the fatty liver can turn into fibrosis. Is fibrosis in itself reversible at that point?

Fibrosis. As long as we catch it before you get to F four is reversible. F four on the classification system is when we start calling that fibrosis cirrhosis.

So as long as we catch it in time and we see it in time, then there's plenty we can do about it.

Yeah, I think of it as , if you get a bad scrape on your [00:12:00] leg, falling on the sidewalk. And that turns into a scar. You can picture that in your mind. You had all that inflammation and then that eventually left a scar. The same thing is happening in your liver when you leave that inflammation unchecked.

Correct. And then if you're replacing all of those wonderful hepatocytes, those liver cells with scar tissue, the scar tissue doesn't do the cleaning and all the wonderful things that our liver does for our body. So you're left with fewer and fewer cells to actually do the job of the liver. If you're, if you get to the point where you're actually getting scarring, which.

It's basically cirrhosis at that point. 

Correct. That's a great analogy. And very accurate to the process that's happening within that liver. 

So we talked about how common this condition is, but we also know that it's linked to many of these other conditions that are on the rise as well. What are some of those other chronic conditions that tend to go hand in hand with fatty liver disease?

Yeah, so the patients that we are [00:13:00] seeing the most fatty liver disease in that includes your patients with diabetes and pre-diabetes. So the entire spectrum of what we would call insulin resistance on that end of the spectrum. But then you also have those with other metabolic syndromes, and within the umbrella you have obesity, which is also on the rise.

You have hypertension. The other two biggies to know about would be even the patients with hypercholesterolemia and hyper triglycerides, they're also within that metabolic syndrome pathway, and that also increases their risk of fatty liver disease. 

And how do all these. Cause fat to build up in the liver.

The big takeaway for this is the insulin resistance. That is really the pathway within your body that's gone haywire on you in this metabolic syndrome, which is all those conditions we just mentioned, that your body cannot handle the sugars, the foods, the things you're taking in and getting rid of it in an effective manner.

So the end of that is your body doesn't know where to put it. So it likes to store it in places, and the liver is just very prone to that process. 

So if you are a someone that might meet the definition of metabolic syndrome that [00:14:00] would be having a larger waist circumference and having elevated blood pressure.

Elevated glucose, high triglycerides or low HDL. So if you have any three of those, then you would meet that. And that puts you at really high risk of diabetes, stroke, coronary artery disease, and fatty liver. Fatty liver. So something to be aware of. I think a lot of people meet that diagnosis and we don't ever really tell them that.

And 

we spend so much time when we're talking about those other conditions and talking about heart attacks and strokes and the liver isn't always brought up. Yeah. That it's also impacting that organ as well. 

Yeah. And the other thing too is when we're talking about diagnosing somebody with MASLD, it only takes an imaging finding of steatosis in your liver, plus only one of those criteria for metabolic syndrome to have your diagnosis of fatty liver disease.

So it doesn't take much to truly get that diagnosis 

On that. I know that something that also can be confusing for [00:15:00] people is you can have this show up on imaging, but then you get your labs and they're still in the normal range. Should you even be concerned?

Yeah, and that's something I see almost daily in our practice is I'll see patients who have had, they might be seeing me for pancreatitis or , an ulcer and I'll look back through their chart and I'll see, oh, ultrasound in 2020 with steatosis. But no one brought it up. It, like we were talking earlier, it's something that we have all just gotten so used to that we're not addressing.

So what I would say to the patient that, Hey, you have steatosis on imaging, but your liver enzymes are fine, that means you fall into that non-inflamed part or the mass or nap part of the spectrum. The true. Fatty liver. If we don't do anything about that, we can progress over to NASH or mash and that's when those cells are getting inflamed from the process.

And that's when you start having the issues with the inflammatory pathway, the fibrosis and the cirrhosis over time. Just because it's not inflamed now doesn't mean it won't necessarily get inflamed later on. So I call that the early stages of the disease process. 

[00:16:00] And do we know why some people progress onto the inflamed part and some people do not?

We do not have a good understanding of that at present. A lot of it, we think is going back to genetics 'cause we are finding more genes and things. There's coding and sequencing for fatty storage. It's just like why some people are not necessarily overweight or have that metabolic syndrome pattern, but they have fatty liver.

 We don't have a full understanding of that as of present. 

And when we talk about. Labs that help us know maybe if there's more inflammation or not. What are some of these labs that patients should pay attention to or maybe, they've been told have been abnormal in the past but not actually been made aware Why?

Yeah. So when we're looking at someone's liver function, there's, four key tests we look at. We look at their total bilirubin, we're looking at their transaminases, which is ALT and AST. Then we look at their alkaline phosphate level. If those transaminases or the a ST and the a LT on your lab value are ever elevated, a little bit above normal and it's never gonna be in the hundreds of fatty liver, it's usually 60, 70, this [00:17:00] little smoldering numbers, that's when we should be concerned in having the conversation about, hey, I might have mash, or hey, you might have Nash mash, however you wanna call it.

And that's the things to look at and that's the cheapest test that will give you the most information about your liver in a pinch, is getting that complete metabolic panel. The other things I always tell people look at is, Hey, just look at your. CB, C, see what your platelets are. As long as those are up, let's just do some more work in the background setting.

Yeah that's one good thing is we do have labs that are able to give us an idea of how our liver is doing, which is an easy test and a cheap test to figure that out if we do have concerns, Ooh, my liver enzymes are climbing, but how is my overall liver function doing? We have other tests that are just simple lab work.

Correct. 

And a lot of these are probably things you've had done with your physical exams. So we're talking about the A ST and A LT, which would be on your CMP or comprehensive metabolic panel that your doctor probably got. And that platelet count would be on a CBC or [00:18:00] a complete blood count would be. What that's called. So you might have access just to look at those and there's some calculators online that you can calculate. This fib four Yeah. Number. Is that something that, that you use when you're assessing? Is it something we should worry about? 

Yeah, it's a quick, easy test just to give you an idea of if there is more on the line of fibrosis in the liver.

And all you really need is your metabolic panel to get that answer. So if you're someone who's getting your Fib four and it's a little bit elevated, that would be an indicator for the PCP to go ahead and make the referral out to GI for further evaluation. 

And when we talk about further evaluation, we're usually talking about additional imaging.

What are some of those tests that someone might recommend if we need to evaluate more about that fibrosis that we were talking about? 

Yeah, so in my personal practice and per guidelines, right upper quadrant quadrant, ultrasound or liver ultrasound is the cheapest and most economic test, and most patients have quick access and I personally like it 'cause there's no radiation involved.

Now, if I get an abnormal finding on an [00:19:00] ultrasound, maybe there's a little cystic looking structure or something abnormal, then we make the decision between the other imaging modalities, including things like CT imaging versus MRI imaging. And when we're looking at the liver for that, we would always use contrast as well.

So I try to do the least that's effective, which would be the ultrasound. Then if I need to pull the trigger and go beyond that, we can, but really ultrasound would be the gold standard to get a good look at the liver and really see if there's any fatty deposition within that liver. 

And then if you did see some fatty deposition, and let's say their numbers are.

Either normal or just mildly above normal. Do you have to go on and do further testing at that point? 

No. For the d for the diagnosis of MASLD, the only thing you would need to make the diagnosis would be that imaging finding with steatosis plus one of the metabolic syndrome criterion. Now there is a pathway you can follow was, is this is or is it not this?

And then you're either gonna end up with massed or needing to expand to look for other cryptogenic causes of liver disease. But in my clinical practice, if I see somebody who has steatosis and they have [00:20:00] that criteria, me personally, I will also check what's called a fibro sure, which I tell patients, Hey, this is like a chemical biopsy's, a pretty good accuracy, and give me a steatosis score, a stiffness score, and they'll give me a NASH score.

And if we are below in that fibrosis, that tells me we can still work on this quite a bit. 

And that's always helpful to know early on, Hey, I have plenty of time to try to improve this before I have too much fibrosis and are headed to cirrhosis. So I think those advancements and being able to have that knowledge for patients is just huge today.

Yeah. And one thing I wanna bring up too, you notice we skipped straight to labs and imaging instead of patient symptoms from this disease. And I think that's because most of the time patients don't have symptoms. Is that right? 

That is. 1000% correct. It is very much an asymptomatic disease process.

Once in a blue moon, I'll have somebody who had just really rapid fatty deposition within the liver, and they'll have some like capsular kind of pain, right? Upper quadrant pains. And then I'll see somebody who's complaining of [00:21:00] fatigues and generalized malaise like symptoms. But liver disease isn't something that's gonna give you nausea, vomiting, diarrhea, shortness of breath, chest pain.

It's very much a silent process. So most of the time when I'm meeting patients with this, it's because somebody ordered a scan, it showed something and they wanted something else done about it. 

That can be confusing because some people associate liver disease with just cirrhosis. Correct.

And so if you've ever known someone who's had cirrhosis, they have lots of symptoms. And so that's how this. Condition is just very sneaky because very early on, unless you're having labs or imaging you're unsure if you even have this diagnosis and you don't want to find out when it's too late.

Yeah. And the other thing on that same topic there's so many patients with fatty liver and there's this stigma around liver disease. So I see all these sweet little memaw and pee paws and we're saying, Hey, you've got cirrhosis of the liver. And they're like, no, I don't drink alcohol.

I don't do this. So there's, we have this negative connotation with liver care, cirrhosis of the liver, and this old mindset that, [00:22:00] Hey, I have to drink alcohol to end up in this situation. But that is one of my pet peeves and something I'm very passionate about, making sure people know, Hey, this is diet driven.

This is fatty liver driven. There's nothing necessarily that you did to get here. 

So let's talk about how we get there. 

What are we doing that's making this happen more and more often? 

 . So when you look at the data, what you will see is over the last 30 years, there has been this massive explosion of not just fatty liver, but all of the domain of metabolic disease processes.

Then I have to take just a retrospective look and say, what changed 30 plus years ago? So I'm a 1993 model. That'd be right around the time I come into this world. We had a lot of fast food. We had a lot of processed foods, but it didn't start. With my generation, if you extrapolate and go back 30 more years, you're at that turn of the war timeframe.

And at that point in time, we went from being always equate things back to the sociological principles. We went from more of a hunter gatherer. We went from growing up on farms, having access to really clean whole foods, to real clean ingredient [00:23:00] foods, to relying on the box boxed, processed, getting bombarded with things that are not good for ourselves.

So it has to do with multi-generational food changes and how it progresses to where we are now. It's not something that just happened 30 years ago, but what we were seeing is the people 30 years beyond that are now presenting with fatty liver. So it's something that is interesting to watch and interesting to follow.

But the unfortunate news in that frame of thought is if you look at the geo statistics, the patients with liver disease is going to double by the end of the decade. And that's just any form of cirrhosis in and of itself doubled by the end. 

Cirrhosis is a disease state that requires a lot of care and frequent treatments and is very costly as well.

So that is not exciting to hear that those rates are gonna be that high, that quick. Yeah, and as you already 

mentioned, patients with cirrhosis have a lot of symptoms. It's a particularly uncomfortable disease to have because it does cause so many issues. And fatty liver disease is the most common reason someone even gets a liver transplant.

Now, we [00:24:00] really need to be trying to intervene so people don't get to that point. But it seems to me in my, this is my personal kitty views it's like the emergence of high fructose corn syrup and the sudden ability to make these quick, easy access. Ultra processed foods that seem to correlate with this rise in metabolic disease and subsequent rise in fatty liver disease.

So I feel like that's gotta be a main driver of this. 

Yeah. The corn syrup and all the preservatives, all those dietary changes that we all just inadvertently went through without thinking about it, is certainly leading to this increased rates of. Metabolic syndrome and fatty liver in particular.

And on just other gi note, the corn syrup thing. And you look at the data on colon cancer that is being driven too by the corn syrup and the increased sugars and fructose and it's quite the conundrum we're finding ourselves in today. 

And I know one of our very early shows that we did on this podcast, we [00:25:00] talked about just the rapid increase in those added sugars that have been placed in our diet over this period of time.

Because just as we had mentioned, this isn't just with fatty liver disease. This is also why prediabetes and diabetes are just skyrocketing because again, they're all linked to insulin resistance in our population. While we're 

on the topic of diet, can you talk to us about what someone should do if they are wanting to improve their diet to help their liver?

Yeah. So when it comes to diet modifications for fatty liver disease, I try to keep it as simple as humanly possible. So the biggest change I tell patients is let's cut out any refined sugars. Let's work on eating whole food nutrition. Make sure that you can recognize the ingredients of the foods you're putting into your body and let's increase that protein intake.

'cause protein is paramount to function within your liver. And beyond that, the only major recommendation, there's two that I make in addition to weight losses. Put all that together. Things like the [00:26:00] Mediterranean diet is very helpful for liver disease. And then black coffee is very helpful for liver disease.

So when you're looking at diet, I try to say, okay, eat a Mediterranean diet, increase that protein intake and drink that coffee. 

And that Mediterranean diet is one that's very high in fruits and vegetables and whole grains. It's all these things we talk about on our show. Yeah. 

And so more of those monounsaturated fats, less of the saturated fat and and then really getting rid of the added sugars.

It's the one diet I tell patients. It helps address all domains of your metabolic syndrome. So if you have hypertension, there's not a lot of sodium . If you're someone with diabetes is pretty low in sugar, pretty low in carbs, it can be a good option for you. So when we're trying to tie this up, I like putting things in nice, neat bows.

It would be these single easiest option for most patients. And then on the diet topic, with my research and looking at fatty liver even before I started looking into this at the graduate student level, I realized very early on that we have a health literacy problem [00:27:00] in our population that we're taking care of.

So I'd be telling patients, Hey, eat more protein. And then I would ask them, what is a protein? And most patients couldn't answer that question, I think too, when we're having these conversations, really giving clean cut examples of what a protein is, what you know, to eat or not eat is very important going forward.

'cause most patients can't read a food label

and yes I really do think that sometimes as healthcare professionals, we give too broad of recommendations and then leave our patients trying to search for the answers on their own.

And that's what gets them stuck with the wrong advice many times because you can search. And find whatever answer on the internet today, whether or not it's the right one or the wrong one. And so trying to give that more targeted information. And the great thing is, for instance, the Mediterranean Diet advising that there's lots of information about the Mediterranean diet and can steer someone in the right direction when providing that.

Yeah. 

And most patients are very successful with that because it's not a super restrictive diet. You still have access [00:28:00] to really clean protein sources, nice whole grains, good healthy fats. So it's something that you can make that dietary and lifestyle change to and not feel like you're starving yourself.

And if you are someone that is struggling with fatty liver disease, I would say. If you are drinking sodas or some type of sugary drink or juice, juice sodas on a regular basis, that's probably the best place for you to start. 

Alcohol and liquids across the board is the easiest adjustment for patients to make to really clean up their diet and get rid of a lot of these excess sugar.

So I had one patient in the hospital diagnosed with Nash back in the day, now mash. And they were like I don't know how I got fatty liver. We were just going back and forth and then I saw the family bring in two of those big gallon jugs of Milo sweet tea. And I'm like, how much of that do you drink a day?

And they're like, oh, I drink about one of those a day. I'm. okay, that's your problem. Let's get rid of that. Let's try to drink more water unsweetened beverages. And then that's a great starting point for all patients. 

Yeah, we [00:29:00] like simple. Yes, same. Yeah, that makes it very simple.

You I do wanna backtrack before we go down that alcohol I realm, you mentioned coffee and I, wanna put this information out here because our coffee drinkers out there may be really excited to hear what coffee can do for their livers. So can you please explain how coffee can be a positive for these 

coffee is if you ever have the privilege of, or dis privilege of reading one of my notes at work when we're talking about fatty liver coffee is. Second thing that's bulleted behind 10% body mass reduction. So for many decades now, we have known that coffee has a great effect on the liver.

In particular, it helps reduce fibrosis, helps with the fatty liver deposits within the liver as well. But when you look at it in broader terms, depending on the site you're looking at, it can reduce your incidents and progression into cirrhosis by up to 60%. It can reduce your cancer progression by about 47% depending on what site you're looking at.

There was a really fun statistic a few years ago that said if you drink two cups of coffee a day, it reduces your risk of all cause mortality by [00:30:00] 25%. But the big thing is knowing that you can reduce your mortality. can reduce your progression to cirrhosis, you can reduce your risk of getting liver cancer from fatty liver disease, which would be the hepatocellular carcinoma branch of cancer of the liver by a significant amount.

So the recommendation is three to five cups a day. But if you're someone who's already a coffee drinker, try to shoot for at least two cups beyond that, which is proven to be most beneficial to you. The other question I get is, does caffeine play a role in this? And they, the short answer is yes and no. So not a great answer, but I would tell patients, try to get as much of the caffeinated version as you can, but.

Getting the coffee and in any variety is better than no coffee at all. The other question I often get is, does it have to be black coffee? And unfortunately you would think in the 40 years of data, we would be looking at black coffee decaf versus full calf versus caramel macchiato for Starbucks. But no one has really looked at that.

And the big reason why is you have one with fatty liver disease and that was just too much excess sugar. So to get the peak benefit, no cream, no sugar, nothing. That's being as an additive to [00:31:00] that product. 

And when we talk about a cup of coffee, we're just talking about eight ounces of coffee, right?

Correct. Because I know sometimes we're like, oh, my coffee, but my morning coffee's probably more two cups actually than I'm having first thing in the morning. Keep that in mind. The actual ounces, a cup is eight ounces. Yeah. 

Measure it out. And then the other concern patients have is Hey, I. I have issues with AFib, I have other issues, I might have too much urination or whatnot from the caffeine.

So I always say, try to get as much as you can, and if you're having issues with the caffeine, cut it to the decaf or no calf and then cut it off at noon. Get whatever you can in by noon. That way you are not affecting your sleep cycle, not having any of these other unwanted side effects of the coffee.

Yes, we talked about that in our sleep series. Yes. We want that caffeine before noon, so we also don't mess up our sleep. 

Oh yeah. I, I'm now to the point in life that if I have a Diet Coke or any type of caffeinated beverage after three o'clock, it has definitely had a negative effect on my sleep.

I just sit there like staring at the ceiling. So I'm the same way. 

Yes. So that is a win for [00:32:00] the coffee drinkers of the world. Woo. Great. But now let's flip back to the other beverage you mentioned. So we talked about how alcohol, most people know alcohol is not good for their liver, but. What about this moderate use of alcohol?

How can that impact our liver? And if someone does have fatty changes, what should they be doing with their alcohol consumption as well if they're trying to decrease that risk of progression? 

Yeah, so my recommendation across the board for even mild to moderate alcohol use and setting of fatty liver is to just take it off the table, remove that variable from the equation and let your liver de fatt size.

That's not a real word, but I like it though. Yeah it makes sense for what I'm saying, just to take that off the table, give it a chance to heal itself up. I always have the conversation with patients and I say. What is an alcohol at its base? Let's go back to chemistry class. An alcohol is nothing more than fermented sugar, and when your liver is breaking that up, it's gonna have part of it stored as fat.

The other part is gonna be this really [00:33:00] toxic inflammatory compound that leads to that inflammation and things that we see with like alcohol, hepatitis. I'm like, take it outta the equation. Remove that variable and give your liver the chance to do the things it's supposed to do. Now, that's why we also have met a LD, so that way we can further quantify.

But if you're on that other end of the spectrum, I say no alcohol is best. 

And so let's say somebody has had some mildly elevated liver enzymes and they were found to have some fatty liver disease. They saw you,, they had been drinking, let's say five to 10 drinks a week. You told them no alcohol is best.

And they said, okay, I'm gonna go no alcohol. How long would you expect it to take before you. Saw those liver numbers come back down to normal 

with all things in alcohol. Tell patients give it 90 days, so about three months if you come in with alcohol, hepatitis, the well-known pathway that we all know is the remodeling, the stability of the liver happens in about a three month process.

So I say, Hey, take it off the table. [00:34:00] Come back, let's get repeat labs in 90 days. See where we're at. Usually as long as the alcohol's been removed and there's no underlying liver disease at play, it is better typically in the 90 day window. 

I think that's really important to say to someone. We always talk about how important expectations are, 'cause a lot of people will think, okay, well I'll quit drinking for two weeks, and then they come back and don't see that it's made a difference and then probably feel like that.

That doesn't make a difference for me, so I'll just go back to drinking. 

Yeah you can get patients who might have had just a weekend bender or whatnot. Their enzymes might be just acutely elevated in the window and it could look better in two weeks. But I always had the realistic expectation, Hey, give it three months.

Let's hone in on your nutrition, really do the right things here for the next 90 days. And they get repeat labs. 

Now for someone who on imaging, maybe their labs were normal, but they were found to have some of these changes on their liver of the fat deposition, how long does it take to see that go away on imaging?

So that is a. Bit of a conundrum in and of itself. So the process, if we do all the right [00:35:00] things, we're doing the 10% body weight, we're doing some of these medicines to help. All the studies look at about a year, so 52 weeks from onset of us doing something to seeing good resolution both in labs and imaging.

So it's not a quick fix by no means. So as something to be slow and steady wins this race. It's a marathon, not a sprint. 

And is that the same amount of time needed to see changes with fibrosis as well? 

Yes. 

Okay. 

You have brought up a couple of times now losing 10% of your body weight. Can you tell us a little bit more about that number and what the importance of that is?

Yeah, so when you look at some of the older hepatology studies, this is something that we have been recommending for decades at this point. So what they found is if someone loses 3% of their body weight, it slows that storage process of fat in the liver. If they lose 5%, it pauses it temporarily. And when you cross between that seven and 10% mark, you actually start reversing that fatty liver.

So the very first recommendation besides getting rid of the sodis and getting rid of your liquor is to lose that 10% of your body weight. 'cause that's the single most impactful thing you can do to help [00:36:00] reverse this process. There's a great study that came out I just found it in an article probably within the last couple of weeks, and they looked at the use of semaglutide and everybody who's listening is probably familiar with the weight loss shots as we're all calling them.

And they looked at patients with diabetes and fatty liver who is using this medicine versus a controlled group who did not have exposure to this medicine. And what they found over 52 weeks is the patients on the GLP one medicine lost 10.5% of their body mass, and their steatosis scores were completely reversed.

Whereas you have this second control group and they only lost about 3% of their body fat percentage or 3% of their body weight. And then less than a third of them had made any meaningful impact in their fatty liver. 

Yeah. 'cause 10% of your body weight can be difficult to do. I think that's one other really great benefit from this class of medicines that has come out to really help people that are struggling with fatty liver disease to get it to really 

start turning around.

Yeah, absolutely. 

And I know we wanna talk some about the medicines that can help in addition to that. But before, I want to [00:37:00] go back to a little bit of the lifestyle aspect. What about exercise? Does exercise make an impact on this condition? 

 Like all metabolic syndromes? Yes. 1000%. And when you go look at A SLD guidelines, there's no tried and true guideline for exercise recommendations.

But in my personal clinical practice, I do the American Heart Association 150 minutes of, light aerobic exercise weekly. For most patients, that's an easy starting point 'cause it's just walking your dog around the block a few extra times a week. And then from there, once we see 'em in clinic and follow up, we'll say, hey.

Have you thought about just like TheraBands, just something lightweight, low resistance, just to help build some muscle. 'cause that's something that most patients with liver disease, especially as it's progressing, will start to lose muscle over time. 

Yeah. And that's a symptom that sometimes people might be one of their first symptoms that they realize they have liver disease is that muscle loss that comes outta nowhere and they're like, what happened?

Correct. And patients look at me like I got three heads when I'm talking to 'em. 'cause that's none of my questions in my first time. Meeting you for liver disease is gonna be, does your belly hurt? Are you having nausea? Do you have diarrhea? No. It's how is your [00:38:00] sleep? How is your appetite? And when did you start losing muscle mass?

'cause those three indicators are telling me that, okay, we're having some issues with circadian rhythm. We're having issues with just how your liver's metabolizing and albumin and all these other things. I'm like, okay, that's something we need to get some more imaging and look at this a little bit more closer.

Can you elaborate a little bit more on the connection with sleep? 

 Liver disease has been well documented to have a negative effect on your circadian rhythm. And I actually talked to a colleague about this within the last couple of months, and the theory is most patients with cirrhosis is zinc deficient at baseline, and zinc is a vital component of that metabolism.

'cause we all know tryptophan to serotonin, serotonin melt that whole pathway. Zinc is utilized to convert that serotonin over to melatonin to help with your sleep. So what you end up with, patients with liver diseases, they'll fall asleep, but they wake up all night long and then they catnap during the day as a result.

So that's usually a very good indicator that someone's having issues early on. 

And I know it was talked about a lot with my patients with cirrhosis, how awful their sleep [00:39:00] was. Like it is. And they, it's frustrating 'cause it's really hard to help them with that as well. 

Correct. 'cause the sleep medicines, the Ambien, the Seroquel and all these other medicines within that class, they're not a great option for liver disease patients, even they're not the easiest to metabolize.

Most of 'em are metabolized in the liver and then they'll take it and they'll take it at nine o'clock at night, but then I'll see 'em in the hospital the next morning. They're groggy and sleepy and they just don't look well because of it. There's not good options in that besides your usual zinc replacement.

And then also like melatonin for that, pretty benign things for them. 

So all these pillars of lifestyle medicine, so we've got diet, exercise getting good sleep 

absolutely would be 

helpful.

And probably just stress reduction in general and having a lower cortisol, lower inflammatory state would be helpful as well. 

Absolutely. 

And alcohol, we have covered, look at that. All of our pillars of lifestyle happy. 

That's what I, that's what I was thinking when I was coming out. I was like, wow.

Liver disease is like the best diet and lifestyle podcast topic that you possibly have. Because [00:40:00] everything I tell patients, I jokingly say, Hey, 90% of this is you in your kitchen. Only 10% of it is you seeing me in clinic, getting an ultrasound and a blood test every six months. This is all on you. And that's why I do what I do.

Just the ability to teach and educate and empower patients to really take control of their health, to make these changes, to prevent these really horrid complications down the road. 

I, and that's the exciting thing. There are so many conditions that people may encounter that they have no control, right?

Like they get a diagnosis. There's nothing that they personally can do to reverse it. But this is one that you can feel power back and know that if I make changes, I can reverse this. And that's. That's exciting. It's because if you have experienced a condition that you can't have any control over you wish that you could just change your diet in order to feel better.

Yeah. 

And I would say I doubt it's, you have to be perfect when we're talking about doing all these things right, that can also feel overwhelming if your lifestyle right now is not great, you don't have to be perfect with all of these things. Just [00:41:00] remember making a little change, just starting somewhere.

You will see progress and improvement in this. 

Yeah, absolutely. I work with or I worked as a client for, with Beth Kroenenberg here in town. And she has this great saying about, okay, you're planning your meals for the week. You know you're gonna have 21 real meals and some snacks during the week.

Shoot for that 80% mark. Really try to hone in and get as close to perfect as you can with the expectation that we're all busy. We all have life. Try to get as good as you can, knowing that's the best you can do. 

And you can go back and listen to our episode with Beth Kroenenberg for more thoughts from her.

Yeah, we did that 

one back in January. It was excellent. So another question is, ' there's lots of supplements out there that are promoted as helping with liver health, liver cleanse, and I feel like I see a million things out there. There's of things talking about the liver. Is there anything out there that patients should be very cautious on?

And then the reverse, is there something that could actually show some benefit? We don't have to talk about all 'em. 'cause literally there is [00:42:00] a bazillion marketed. 

Correct. So the first thing I always tell patients is no to anything that's labeled as a liver cleanse. I have had more than one patient in the hospital.

'cause remember, I'm not a community gastro provider. I'm not in the clinic. I'm a hospitalist based provider. I've had more than one patient come in with an acute liver injury or drug induced liver injury from these unregulated, really toxic, highly potent detox cleanse products. So across the board I say stay away from those.

Don't order it from the Amazon. Talk to me before you're gonna take any supplement of that variety. When it comes to these supplements I try not to overcomplicate it. The biggest one that I give everybody is, okay, you're gonna take a multivitamin with minerals 'cause you're gonna be depleted on everything just at baseline.

From there, the biggest things I also add is a fiber supplement. 'cause you all have covered fiber on the podcast. The US diet is terrible at getting into fiber. And so I say, okay, if you're somebody that doesn't have bloating, you're gonna take some Metamucil. If you're someone who has bloating, you're gonna take some FiberCon.

And we're work our way from there. When you look at the other data on the common things, if you [00:43:00] Google it, the first thing that will pop up will be vitamin E for example. In the right patient, that's an okay thing, but when you start digging into the data, it's 51 way, or as my partner says, six, one way half dozen the other.

You can get studies that show good benefits, some that don't. And the right person in the right population, it's a pretty benign supplement to take. So anywhere from 60 to 800 units is fine. Unless you're someone with biopsy proven cirrhosis, someone with prostate cancer history, either personal within your family or someone with heart disease.

So I wouldn't be using that in that particular patient population. Other than that, I try to keep it as clean and simple as possible 'cause I'm already inundating these patients with so much information and the compliance with taking supplements is not the best 

Another one I just wanted to bring up is what about thoughts on the omega threes since we do know that omega threes are anti-inflammatory, can help triglycerides, is that one that you ever see any benefit for the liver?

That is something I actually use in my patients with known hyper triglycerides. [00:44:00] I go ahead and just start it because of the benefit and the fact that our diet is so poor in our country. I don't know if there's any good studies that show its benefit in fatty liver disease, but if you have those triglycerides that are elevated, it is a pretty benign thing to try.

And the other thing you can do is increase it in your diet kitty. Remind everyone those serious, because I'm already like, yes, I 

have a, I have an in to say. You could sprinkle your hemp seed on there and that would be a great source of Omega-3 or your chia seeds. Seeds and nuts, ma'am? Walnuts. 

Yeah. And those fatty fish.

That's another way to get the omega threes in our diet. And the Mediterranean diet is high in omega threes in general. So another connection there when we talked about that. 

Yeah. You know what I've started telling patients, 'cause the big thing, like I said, health literacy is bad and they don't know what a protein is.

So I'm like animal meats and I'm like which one should I be eating? I'm like, okay, how do I explain this? So my father-in-law actually had a diabetes educator. I was like. Eat the animal with the fewest number of legs. And that was mind blowing for my [00:45:00] patients. So like your fish is the healthiest and you get your fish shrimp and whatnot.

And then from there you can get your chicken and your Turkey pretty lean cuts of meat. And then you can get your four legged critters and then it's just what have you. But that has been so helpful in explaining the right proteins for patients being so try to eat more things with fewer legs.

And that's a little bit better for you. But I have 

not heard that. I haven't either, 

but it helps so much. 

You mentioned already the GLP ones, the Ozempic and Mounjaro and all of those that have come out, is it indicated to actually use those for fatty liver? Like I know a lot of people struggle with getting insurance to cover it when they're wanting to take it just for obesity.

If it's someone that has obesity and fatty liver disease, are they covering using that now? 

. So the ones for obesity, yes. So what is it, Zep bound or Mja, one of the two that has a true obesity indication. If they are obese, we can send them to I use the medically managed weight loss clinics for that, but there is no clear indication for its use just for fatty liver as of yet.

But [00:46:00] we have had three really good studies looking at its use that shows its benefit. In my personal practice, I've had more than one patient say, Hey, I can't lose this weight. Across the board. I say, okay, six months from now, come back. We're gonna weigh you. We're gonna look at how well your labs are looking.

And we make that decision. And if they're still struggling, I say, okay, there's two options here. We can either go down the medically managed weight loss route, or we could try this new class of medicine designed specifically for fatty liver. And I won't exhaust both of 'em at the same time out of the gate.

And I say, we can try to navigate this whichever way you want. And then we. Risk stratification. Just talk about the two different options there. 

So what is this new drug? 

So it's a new medicine. It's been out for, I would say, a little bit over a year, and it's called Rezdiffra. I won't even try to say the chemical name of it 'cause I would butcher that.

But it's within this class of thyroid hormone receptor beta agonist, and it helps block that fatty infiltration, that lipid pathway within the liver. So if patients have fatty liver up to F two slash F three fibrosis, we can start this medicine, keep an eye on this fibro, or the chemical biopsy as I call it.

And it's proven to help [00:47:00] reverse fatty liver in most patients. 

That's amazing. It is. Is it pretty well tolerated? 

Yeah. The biggest side effects like any GI medicine, nausea, vomiting, and GI upset. Beyond that, there is some weird risk for gallstone formation in certain patients, but it is pretty well tolerated by most patients.

And is that something that a patient would have to be on lifelong or is it something that you take until you see the reversal and then you're able to stop it? 

We usually stop it and we have that conversation at the one year mark. 

That's great. We love when you don't have to stay on something forever.

Yeah. So even if they haven't changed their diet much, it seems to have some lasting benefits. It has 

a good effect, yes. 

Oh, that's great. Yeah. But 

most of my patients, when I start 'em on it, we it's not like those controlled substance contracts, but I sit down, we have a very good heart to heart and we're talking about the fatty liver and why I'm so passionate about keeping them from this progression.

And by the time they see the eye care, they care, we care. They're really invested in these changes.

Another one I wanted to bring up because I think it gets confused a lot, is statins. So our cholesterol medication, we know [00:48:00] elevated liver enzymes can be a side effect of statins. And so I feel like I, I see a lot of times people have elevated liver enzymes more from their fatty liver disease and then they get their statins stopped because it's worried that Yeah, that's causing it.

What's your thought on that? 

So at our practice facility, we don't regulate that anymore. If you are on a statin for your cholesterol, we allow you to continue that. Unless we have concerns for drug induced liver injury, which we all know that's, you're not gonna present with that same kind of LFT pattern with that.

But the older literature said, Hey, stop statins can be harm harmful in the liver, but unless you're someone in that immuno allergic pathway with that drug-induced injury, it's perfectly safe to continue taking your statin to address this other part of your metabolic syndrome pathway. 

Yeah, probably 'cause they have an anti-inflammatory effect as well, which I would think would be possibly 

protective.

Yeah. 

So we have talked about a lot about wanting to be aggressive, get this diagnosis, do these things to reverse it because we want to prevent cirrhosis. How long [00:49:00] does it take for cirrhosis to actually develop from someone who has fatty liver that then goes to fibrosis and then to cirrhosis? Is this something that happens within a couple years?

Does this take a decade? What is that normal timeline? 

So that varies based upon the citation you're looking at, but what I can tell you from clinical experiences, typically from your diagnosis of fatty liver, 'cause we're not diagnosing it right as it's happening. We're seeing it, 10 years after you gain 50 pounds or whatnot.

The progression to go from fatty liver to cirrhosis of liver is typically a decades long process. Much like our diet changes that led to the fatty liver, it also takes a while to progress to that point. As the GI provider, it's so frustrating when I see people coming in with fatty liver cirrhosis.

'cause had we had this conversation 10, 15 years ago, we could have reversed this outcome for you. 

Yeah. So I think that's great to know because again, it's hard to totally change your lifestyle if you are someone that's has fatty liver disease and you need to be making a lot of changes. You don't have to do them all in a three month [00:50:00] period of time.

You have time to just. Doing things one at a time and get to where your liver can heal itself from this inflammation. 

Yeah, and I encourage patients set tiny goals of what I'm telling you. I don't expect you to go from a no coffee drinker a day to drinking three to five cups of black coffee a day.

So I say set your goal, say, okay, today we're gonna do a cup, but we're not gonna do the whole cup of coffee. We're gonna do the trick to get 'em to drink. It would be do half a cup and then put some hot water, make an Americana with it. That takes the bitterness out. That lets 'em be more tolerated. It's a little easier on their stomach.

So try it that way and then say, okay, this week, one cup of half, the next week we're gonna go to two of these, and then next week, maybe three of these. And then over time we remove some of that water from it just to empower them to, Hey, I can do this. Small and tiny changes will make a big improvement over time.

I love coffee so much that it's like I'm hearing, wait, someone doesn't wanna drink coffee? This person exists. 

Oh, that is the hardest. I, trust me, I can get someone to quit drinking alcohol or quit doing things like meth quicker than I can a lot of [00:51:00] people to actually drink coffee. So I'm like, really? I love this.

I just have the pot just go around the hospital. I'm having a good old time, but yeah. 

So I, I do think something else that we want you to think about if you're listening to this is if you are unsure about your liver and no one's ever mentioned, Hey we're concerned that you may have fatty liver, but you have these other diagnoses of obesity, diabetes, metabolic syndrome high triglycerides.

This is something that maybe having that discussion with your primary care, do you have any concerns that I may be developing fatty liver or can we look into that just because of that strong correlation with those other conditions so you can know where you stand. Not someone that goes many years without knowing that it's occurring.

Do you recommend anyone that, let's say, has had an ultrasound or a CT scan of their abdomen for other reasons and has been found to have some fatty liver disease, do they all need to come see you or is this something that they can just start working on their own and with their primary care doctor?

Yeah, so [00:52:00] unless there's inflammation, we're seeing that, NASH slash mash it is okay just to work on it on your own and then go see your PCP to talk it through. Once you start having that inflammation, though, it's a good idea to come see us just so that way we can be addressing any other modifiable risk factors and addressing that inflammatory pathway may be considering some of this medication assistance that we have at our disposal.

The only other thing I would say is if you're someone with diabetes in particular, the latest statistics for patients with diabetes is greater than half of them have fatty liver.

So that is a very high risk population and that's the ones that we're seeing this kind of emerge and a little bit quicker progression to cirrhosis than those around them probably 'cause of the insulin pathway. So I say if you're a diabetic, talk to your family doctor about getting a screening or getting an ultrasound.

Just looking at that for you. And if you're someone who is in that high risk category, just go ahead and come see us. 'cause the sooner we know about, the sooner we can do something about it. Especially if you're in that diabetic, pre-diabetic, really high risk group. 

Well, You've given us so much great information today and I feel like this has been just a course in lifestyle medicine as related to the liver, [00:53:00] so that's wonderful.

So what we wanna leave you with today is, remember there's a lot of names for fatty liver disease. So you might see fatty liver, you might see something called nafld or non-alcoholic fatty liver MASLD, old metabolic dysfunction associated steatotic liver disease. You may see mention of hepatic steatosis on an ultrasound.

All of that stuff means there is some fat in your liver and you need to pay attention to that. We get more worried when that fat starts having inflammation and then you're at risk of scarring and cirrhosis. So we wanna act before you get to that point, and we wanna do that mostly with lifestyle change.

So remember to really look at the. Ultra processed foods. You wanna reduce the drinks that you have that have added sugar. You wanna reduce your saturated fat. Anything that's packaged and easy is probably something that's not great for your liver and you wanna increase those whole foods, fruits and vegetables.

We wanna exercise [00:54:00] because we know that helps on multiple different realms with the liver, basically what you told us today, Kyle, is no, alcohol is the best amount of alcohol if you're dealing with this. And so really try to minimize that the best you can. If you can make some significant changes, you're probably gonna see your lab start improving within that first 90 days and about a year to see improvement in your imaging.

So losing 10% of your body weight would be our goal, but you're even gonna see benefits at that 5% of halting that fat accumulation. Even little bits are going to help. He wants to make sure that you are avoiding anything that says liver cleanse, and instead really focus on your nutrition as the main avenue of fueling your liver.

Luckily we know that there are some medicines out there now that have promise, both in the obesity realm and the GLP realm as well as this newer medicine that specifically [00:55:00] targets fatty liver disease. So that's great to think that we have more options for patients as well, and hopefully we can decrease the rates that we're seeing this 

in our community and we can't forget that coffee is actually medicine here.

Absolutely. So hopefully you all have enjoyed this show, and please don't forget to share this show with others. Leave us a review. Be sure to like our show. We love to hear from you. If there's other episodes that you want us to do, you can always click send us a text or send us an email at contact at the starting gate podcast.com because we love to hear what you want to hear from us.

 We're looking forward to talking next week with Dr. Son Sohi. . A gastroenterologist a little bit more about the gut microbiome, some common GI complaints, irritable bowel syndrome, and every other question we can thank to ask her while we've got her.

 look forward to talking to you all next week.