Demystifying Fatty Liver Disease: The Four-Phase Popkin Method for Sustainable Metabolic Health

Welcome back to The Popkin Method! In today’s episode, Dr. Matthew C. Popkin tackles one of the most misunderstood, yet critical, obstacles to lasting weight loss and wellness: fatty liver disease. Most people think of it as just a byproduct of poor diet or being overweight, but as you’ll learn today, fatty liver is actually a hidden metabolic bottleneck that could be sabotaging your best efforts to get healthy.

If you’ve ever felt inexplicably stuck with your weight, tired for no clear reason, frustrated by slow progress even with medications, or overwhelmed by conflicting health advice online, this episode is for you. Dr. Matthew C. Popkin will break down what fatty liver disease really is, why it develops silently, and most importantly, how his signature four-phase Popkin Method can help you reverse it with a sustainable, physician-guided approach that goes far beyond gimmicks, fad diets, or quick fixes.

We’ll cover the common symptoms, the pitfalls of “magic bullet” solutions, and exactly which steps you need to take, from food choices and sleep, to advanced therapies, to restore your liver health, unlock your metabolism, and finally achieve lasting change. Whether you’re new to The Popkin Method or following along since episode one, you’ll walk away with a clear, actionable blueprint to take control of your health.

Ready to cut through the noise? Let’s dive into the truth about fatty liver disease and discover how to get truly unstuck.

Timestamps:

00:00 Understanding fatty liver disease

09:57 Understanding fatty liver and GLP1 meds

14:04 Supporting fat utilization strategies

19:21 Understanding fasting and diet choices

25:06 Common intermittent fasting mistakes

30:07 Replacing carbs with veggies and fats

36:32 Anti-inflammatory foods and coffee benefits

37:44 Choosing the right protein shake

47:04 Trustworthy supplements for fatty liver

50:05 Discussing stem cell therapies

59:29 Hormone modulation with supplements

01:03:48 Steps for improving liver health

01:09:32 Understanding the Popkin Method

01:11:14 Sharing The Popkin Method

You can see Dr. Popkin through his online virtual functional medicine program anywhere in the country or the world for that matter.

You can visit Dr. Popkin in his Hollywood Florida office for an in person weight loss experience.

Visit thepopkinmethod.com to send a message to schedule an appointment with Dr. Popkin or email Dr. Popkin at mcpopkinmd@yahoo.com.

Podcast Website - https://thepopkinmethod.com/

Matthew C. Popkin, M.D. - https://thepopkinmethod.com/about

Podcast Partner - TopHealth - https://tophealth.care/

“Disclaimer: Informational only. Not medical advice. Consult your doctor for guidance.”

Transcript

SPEAKER_01 0:12

Most people diagnosed with fatty liver disease view it as a frustrating metabolic stuck point or a hidden culprit behind their inability to lose weight rather than just a consequence of it. Many understand that a fatty liver acts as a bottleneck, hindering the body's ability to convert fat into fuel and causing metabolic resistance that leads to frustration with weight loss. Then, there's the stigma and misunderstanding, as people may feel misunderstood, associating the disease primarily with bad habits, like unhealthy diet, despite it being a complex metabolic dysfunction. While many feel stuck, others are realizing that focusing on reducing fatty liver through specific dietary changes and lifestyle adjustments is the key to breaking the cycle. Unfortunately, there is the hidden culprit perspective. As many are aware, they have fatty liver disease because it often presents without obvious symptoms until advanced stages, making it a hidden cause of fatigue and weight loss plateaus. Today, Dr. Popkin will demystify the cause and consequences of this hidden culprit called fatty liver disease and how the Popkin method can easily create a path towards improved liver health to get you unstuck and lead you to achieve your weight loss and wellness goals. So let's dive in.

SPEAKER_02 1:25

Thank you, Jamie. So hello everybody, and welcome back to the Popkin Method. If you've been following this podcast from the beginning, thank you very much. We've now passed the midway point of this series, and I think it's the perfect time to begin doing something incredibly important. Putting everything together up to this point, we've spent time breaking down the major pillars of health optimization and functional medicine, including, but not limited to, insulin resistance, inflammation, gut health, the gut brain connection, sleep and stress physiology, mitochondrial health, fasting, muscle preservation, targeted supplementation, peptides, NAD plus, hormone modulation, and even more advanced biologic therapies like stem cell, exosome, and secretome therapies. And each of these topics matters on its own, but in truth, in clinical practice, none of them live in isolation. They're all connected. And that connection is exactly what the Popkin method is designed to address. At its core, the Popkin method is a structured, phased system. And it begins with the foundation, as we've talked about in all the podcasts, starts with lifestyle modification, diet, exercise, and some basic as well as targeted supplementation. And if you truly clean up those four pillars, you can often make meaningful improvements in the issues that keep people stuck. Then, when clinically appropriate, we consider the next layers, such as peptide therapy, mitochondrial support strategies like NAD, which we discussed at length in our previous podcast episode, hormone modulation, and in carefully selected patients, bioidentical hormone replacement, followed by more advanced biologic therapies like stem cell, exosome, and secretome-based regenerative strategies. But the order matters here, and that sequence is what protects the patient from chasing shortcuts. And it's also what makes the results more sustainable. So today I want to show you what this looks like in the real world. Because patients don't come to me and say, Dr. Popkin, I think my circadian rhythm is disrupted, or my mitochondrial signaling is impaired. Instead, they come in saying, I'm exhausted, or I can't lose weight, I'm doing everything I think I'm supposed to, and nothing is working, my GLP 1 medication is no longer working. I mean, do any of these things sound familiar? This is pretty much what you and all your friends and your family are complaining about. No one says my mitochondria aren't working correctly. They come in with these complaints that I just listed and many others. And one of the most common hidden patterns that I see in those patients is something many people don't even know that they have, and that's fatty liver disease. Now, fatty liver disease is often thought of as a liver issue, but clinically, I really want you to think of it as something much bigger. And in many cases, fatty liver is really a metabolic traffic jam. It's a sign that the body is struggling with insulin resistance, inflammatory overload, poor sleep, chronic stress, excess processed food exposure, low muscle mass, poor metabolic flexibility, and disrupted energy in handling. That's why this episode really matters, because if you understand fatty liver correctly, you start to understand why so many people feel stuck. And the good news is this in many cases, there is a very clear, structured, and highly actionable path to improving the physiology that contributes to fatty liver. And that path maps beautifully into the popkin method. So in today's episode, we're going to break down what fatty liver is and how people usually find out they have it, why a fatty liver often stalls your progress, how to approach fatty liver in a four-phase popkin method framework, which uh with lifestyle and food strategies and which ones matter most, how sleep and stress determine whether fatty liver returns once it's corrected, and where advanced therapies like peptides and hormone modulation and regenerative biologics may fit in with selected patients. So let's get into it.

SPEAKER_01 5:19

All right. Excellent recap of what we're going to talk about today. So, Dr. Bopkin, for many people, this fatty liver seems to come out of nowhere. Let's define it. What is fatty liver disease and how do most patients actually discover that they have it?

SPEAKER_02 5:35

Well, fatty liver disease is a common condition where excess fat, defined as more than 5% of your liver weight, builds up in your liver cells, impairing their function. Think of it as your liver cells just being jammed up with fat and not being able to work well. And it's often linked to obesity, type 2 diabetes, and high-fat diets with two main types. There's non-alcoholic fatty liver disease, and then there's alcoholic-associated fatty liver disease. And key aspects of fatty liver include many different things. So the symptoms, fatty liver disease is usually a silent disease with no symptoms, though some experience fatigue or pain in the right upper quadrant underneath your ribs and the right upper abdomen. The progression of the disease, it can progress from just simple fatty buildup, what we call steatosis, and then it can lead on to inflammation of the liver, which we call steatohepatitis. And if it's unmanaged, it can lead to severe scarring, which we call cirrhosis, and eventually liver failure. So for the treatment, it's often reversible through lifestyle changes, including weight loss, a healthy diet, such as the Mediterranean diet, increased physical activity, and limiting alcohol. Because it's largely a silent disease, most people discover they have fatty liver incidentally. They're not usually walking around saying, I think I have fat accumulating in my liver. Most often it shows up in one of three ways. So one of them is just routine blood work shows elevated liver enzymes. We see this a lot. People come in, they may have pre-op testing, or they may get their routine annual labs and they get an elevation of AST or ALT, and that'll lead us to start to look at the liver, and then ultimately an ultrasound will tell us that there's fatty liver present. Other ways, such as imaging, uh maybe people get an ultrasound or a CT scan for something else, and it picks it up unexpectedly. Or they come in because they feel metabolically stuck, right? They're not losing weight, and we start connecting the dots. And this is how I diagnose most, if not all, of my patients with fatty liver disease. So I generally have a very high index of suspicion in anyone with obesity, diabetes, insulin resistance, severe systemic inflammation, or people whose weight loss is stuck despite weight loss efforts, including people that stall on the GLP 1 medications. And this is an area of high concern because so many people are on GLP1 medications. And those that are being managed by, you know, these uh let's say they get to the GLP1 medication by some internet uh Instagram influencer that points to a link and then they go to a telemedicine doctor that gives them a five-minute consult, and you know, the medication shows up at their door. They don't have any direction, they don't have any guidance, they don't have any dietary program that they're supposed to follow, exercise program. They're just taking the medications and think that that's going to do the work for them. And in a lot of cases, this doesn't happen. And so what happens is their their dose gets increased. And it's not necessarily that they need an increase of dose of their GLP1 medication. They need to un jam the liver. And without a doctor looking at these things and seeing if this is a possibility, typically what happens is these people go on higher and higher doses of the medications, they get side effects, and they eventually stop doing it, and you know, they don't fix the problem that they originally took this medication to solve. And that stuck feeling is very common. Patients describe having uh low energy, stubborn belly fat, increasing waste circumference, slower recovery from exercise, uh, or slower recovery from just, you know, weekend activities, uh brain fog, trouble losing weight, worsening metabolic markers, or just a general sense that their body just isn't responding the way it used to. I mean, Jamie, do any of these sound familiar to you or your family members or friends or coworkers? I mean, these are all very common symptoms that people complain of, right?

SPEAKER_01 9:31

Absolutely. I mean, I think as we as we age, we've all come across so one or four or five of those symptoms, hopefully not at the same time. But yes, definitely. I dealt with several of them last year for several months. We talked about on another episode. And most people think it's aging, but I have to ask you, is this specific to fatty liver? If you have these symptoms, does that mean that you always have fatty liver, or how does that work?

SPEAKER_02 9:57

Yeah, I'm glad you asked that. I mean, to be clear, these symptoms are not specific to fatty liver, but fatty liver is one of the more common hidden contributors that can absolutely be part of that clinical picture. And because it often develops gradually, people just frequently assume, like you said, it's, you know, because of aging. I mean, they think I'm just getting older, my metabolism is slowing down, this is just what happens. And in particular, I know I mentioned this before, but I think it's pretty important to mention again that when it happens in patients on the GLP one medications, they just assume they need a higher dose, when in reality, they need better lifestyle and better diet and better exercise habits, and usually the same or in fact lower doses of the medication. And this is why it's so important that a physician needs to be involved with your GLP1 prescribing, not some knucklehead Instagram influencer redirecting you to a link to purchase these medications when all you get is a five-minute telemed consultation by a physician who will basically prescribe the medication without a clear plan and course correction to help guide your weight loss journey. So that's why this is this is pretty important because as you can see, these symptoms are not just related to fatty liver, they're related to aging in general. But very often it's not simply aging, it's metabolic dysfunction being mistaken for normal aging. And this is this distinction matters here because fatty liver disease is rarely a standalone diagnosis. It's usually a sign that something deeper is happening: either insulin resistance, high inflammatory burden, poor metabolic flexibility, poor sleep, high stress, low muscle mass, or some combination of all of the above, all the things that we've talked about in previous podcast episodes. However, the encouraging part is that in many cases, this is a pattern that we can meaningfully improve. And that's where the Popkin method becomes very useful.

SPEAKER_01 11:53

Yeah, and to your point, I mean the name of the podcast and the name of your system is the popkin method. It's not just click a link and get some medication. So there really is, if you've been listening and tuning in with us every week, a rhyme, a rhythm, a process to how this system can be most successful and sustainable over years and years for the rest of your life, not just a quick fix kind of band-aid on a bullet hole solution. And, you know, it's kind of like um almost like you get what you pay for, right? If you go in looking for a quick fix, it's probably gonna be a quick fix and it's not gonna be sustainable over a longer course of life. So, you know, when you take the proper steps, like you've been saying, week in and week out, that really is something that can sustain and lead to even better results.

SPEAKER_02 12:43

100%. That's exactly it. You this is a physician-guided program, and it helps you get unstuck in the areas that you get stuck. So great point.

SPEAKER_01 12:52

Awesome. All right, next question here. When when you step back and look at this clinically as a physician, what is the simplest way to explain to someone how we actually reverse the physiology behind fatty liver disease? Put it in a normal people's terms, right?

SPEAKER_02 13:10

Yeah. Well, I mean, the simplest way to explain it is this you know, we use a structured, phased approach that is already present in the popkin method. And for this episode, I want the listeners to think about fatty liver through a four-phase popkin method approach, if you will. Stop the shift of energy into the liver by stopping the inciting causes. And this is where we reduce the forces that are pushing excess glucose and fat into the liver in the first place. So that usually means addressing all the things I've mentioned on previous podcast episodes, right? You want to reduce insulin resistance, decrease inflammatory load, poor food quality, sleep disruption, stress physiology, and repeated glucose volatility. So we want to stop insulting the liver in the first place, but that's the first step. Phase two, change the direction of flow to clear the liver of existing fat. So once the liver is under less metabolic pressure, the body can begin to handle that stored fat more effectively. And at that point, the question becomes how do we create that this metabolic demand to utilize that, those calories and that fat that's already stored in the liver? And how do we support fat utilization instead of continued fat storage? And that's where protein, fiber, meal timing, fasting when appropriate, and exercise become very important. So then we move on to phase three, where we stack the strategic food signals. And this is where we get more specific. We talk about protein-first meals, we talk about fiber-rich veggie carbs, we talk about reduced refined starchy carbs, having monounsaturated fats like extra virgin olive oil and selected food strategies that support metabolic balance. And then once we've corrected all that, we want to protect the wind, right? You know, we've got to lead in the game, you got to protect the wind. So once someone improves, the real question is how do we keep it from coming back? And this is really where, you know, people that are dieting, you know, this has been a common theme. People diet, they lose weight, they gain the weight back because they don't protect the wind, because they're not setting up a sustainable system. Because if sleep falls apart again or stress comes back in again, or muscle mass declines because you went on a GLP one medication and didn't support your muscle, and now you finished your program, you've lost your weight, but half of it was muscle mass and half of it was fat. Now you're going to gain that weight back because you have less metabolically active muscle to consume those calories. Ultra-processed foods return, or insulin resistance re-emerges, the physiology can drift back in the wrong direction and the liver begins to accumulate fat like it did before. So remember that the Popkin method is not a fad diet, rather, it's a sustainable lifestyle that promotes health and wellness. So phase four is where we turn progress into a lifestyle. And that to me is exactly what the Popkin method is all about. It's not just temporary improvement, but it talks about long-term physiologic stability. And that's what we promote.

SPEAKER_01 16:10

Love it. Love it. And to the point, your point, we were just saying it's a system. There are steps. And so here are the steps to make it sustainable and make sure, you know, you also have someone to hold you accountable and to instruct you and to make sure that you stay on the right track, right? If we're just kind of clicking and hoping something, a magic bullet shows up at our front door, you don't have that kind of accountability or even system to keep you on the right track, right? And we don't want to backslide.

SPEAKER_02 16:44

That's correct.

SPEAKER_01 16:45

All right. So let's break those four steps down. So let's start with phase one. What are the most important drivers that you're trying to shut down first?

SPEAKER_02 16:54

Well, phase one starts with one of the most important reframes in this whole conversation is that fatty liver is often less about dietary fat and more about metabolic signaling. So people think, oh, fatty liver, I'm eating a lot of fat, so I'll just stop eating a lot of fat. And that's not the case. A lot of this is related to sugar and insulin sensitivity, which is why people get confused of the name fatty liver. And in many patients, the major drivers of this are insulin resistance and repeated glucose spikes, inflammatory overload, poor sleep, chronic stress, low muscle mass, and a loss of metabolic flexibility, all things that I've talked about in previous Popkin method episodes. And this was intentional to lay down the foundation so that people can go back and they say, Yeah, I remember that from episode five when Dr. Popkin talked about stress and sleep. And I remember episodes seven, eight, and nine, how we talked about inflammatory foods and gut health and how inflammation affects the body. And this is all very intentional. And here's the simplified clinical picture. When somebody is repeatedly exposed to excess sugar and refined carbohydrates, notice I'm not talking about fats, I'm talking about excess sugar and refined carbohydrates, especially in the setting of poor sleep, high stress, high cortisol, inactivity, and inadequate muscle mass, then the system becomes less efficient at handling that incoming energy. And that energy gets stored in the liver. And it gets stored in the liver as fat and it becomes fatty liver disease. And over time, the liver can become one of the places where that excess metabolic burden gets redirected. Once that happens, you see a cycle develop. More insulin resistance, more fat storage, more inflammation, less efficient fat mobilization, and a progressively stuck metabolic state. So phase one is about removing the pressure. That means reducing ultra-processed food exposure. So if you remember, we talked about this. What are ultra-processed foods? They're liquid sugars like soda and other sources of high fructose corn syrup. And you get high fructose corn syrup in hidden areas too, like ketchup and other condiments and other things that you wouldn't think that they're hidden in. Highly refined snack foods. Those are obvious. You're eating Oreos and you know, and having sugary ice creams and things of that nature, frequent sugar heavy meals, constant grazing. We talked about this. There's this post-pernial inflammatory effect. So I don't want people grazing all throughout the day. That's where the fasting windows come in. You're fasting for 12, 16, 18 hours, and you're eating in a 12-hour window or an eight-hour window or a six-hour window. So your body creates that metabolic demand to pull from your stores and processed health foods, so-called health foods that still create major glucose swings. So these so-called healthy diet bars and things of that nature that just, yeah, they may be, you know, low in carbohydrates and high in protein, but they've got a lot of processed information, processed chemicals in there that cause inflammation. The second thing would be reducing the refined starch overload. I always say get rid of the starchy carbs, the bread, the pastas, the rice, the cereals, the chips, uh, crackers, desserts, sweetened beverages. You know, sorry, I'm taking all the fun stuff away, but these are the things that cause the issues. And I'm not saying you need to eliminate them 100%, although if you did, that would certainly help. But we want to decrease these and limit these. We want to improve sleep quality because, as I mentioned, sleep affects insulin sensitivity, appetite signaling, cortisol balance, recovery, and the body's overall metabolic rhythm. It's not just getting a good night's sleep so you're not tired the next day. It's all these things I just mentioned. And of course, we want to lower the stress load in an effort to calm cortisol signaling. Remember that stress causes cortisol to be overproduced and chronic stress can contribute to worsened insulin sensitivity. We talked about this, right? More glucose volatility, increased cravings, poor sleep, and more central fat patterns, more central fat storage patterns. Go back to episode five where I discuss sleep and stress, and it'll reinforce what I'm saying here. And essentially what we want to do is we want to rebuild the foundation. And this is where the Popkin method base is so powerful. Remember, we go back to lifestyle modification, diet, exercise, and foundational supplementation. And this is the key point I want our listeners to hear. This is not about a liver detox. You've heard, you know, oh, go online and get a liver detox and it'll clean out your liver. You're not going to clean out your liver by doing a 24-hour detox. This is something you have to do. You have to correct your bad habits and allow that fatty liver to release those stored fat molecules so that you can actually burn them and not and not keep storing them. This is not a one day detox. This is about restoring the signals that tell the body how to handle energy correctly, creating a sustainable lifestyle that protects your liver and other organs because you're not just protecting the liver when you do all this, right? You're protecting your heart, your kidneys, your skin, your hair, all the different things that that are being affected by a poor lifestyle. And that's a much more useful and much more clinically honest way to frame it.

SPEAKER_01 22:04

So it kind of is a liver detox, but it's not one of those liver detoxes you would go and click a link on it on an influencer from Instagram that they're trying to share, right?

SPEAKER_02 22:14

It's a long-term liver detox that you maintain, that you start and maintain through your lifestyle changes. Yes, perfectly said.

SPEAKER_01 22:22

Love it. Love it. We are detoxing, but not again, not in the magic bullet or magic kill sense of the term. All right. So once once we've reduced the incoming metabolic stress, what happens next? How do you help the body actually use that stored fat energy more effectively? How does it do that?

SPEAKER_02 22:41

Yeah, this is this is phase two now, right? So this is where a lot of people miss the opportunity. And once the body is under less metabolic pressure, we're not driving all these calories into the liver. It will become better able to access that stored energy and turn fat storage into fat into fat burning. Now we're reversing the flow of fat coming in, fat and calories into the liver, and we're turning it into fat calories coming out of the liver to be burned and used as fuel. So that doesn't automatically mean the body will use it efficiently. So phase two is about creating what I call metabolic demand, right? In other words, if the body starts becoming more capable of releasing the stored energy from the liver, we need to create a reason for that energy to be used. That means protein becomes a priority. Protein helps support lean muscle preservation, satiety, or feeling of being full, recovery, healthier body composition, and better overall metabolic demand. And as I've said many times on this podcast, muscle is your longevity reservoir. So we want to build and maintain as much muscle as possible. And the more metabolically active tissue you preserve, the better your body tends to handle glucose and insulin and energy partitioning and overall resilience. Now we talk about fiber, and fiber becomes strategic. Fiber helps by slowing carbohydrate absorption, reducing glucose volatility and insulin levels, improving satiety, supporting the gut liver access, and helping meals become more metabolically calmer. You know, this is where the veggie carbs come in. We get rid of the starchy carbs, we move the veggie carbs in because that's where your fiber is. Now we talk about meal timing, and meal timing matters. And this is where prior fasting framework that I discussed comes in, and I described it, and it fits in beautifully here. And for the right patient, structured fasting windows can help improve metabolic flexibility, energy demand and utilization, appetite control, and overall rhythm. But, and this is important, fasting should always be individualized. And not everybody needs the same fasting strategy. And some do well with a 12-hour fast, where others require 16 or 18-hour fasts. And where I see this in my in my office with my patients is they I ask them, have you tried, you know, what diets have you tried? And in particular, I ask if they've tried intermittent fasting and they go, Yeah, yeah, yeah, it doesn't work for me. And most of the time it doesn't work because they didn't select the proper window, right? They didn't, you know, some people need 12, some people need 16 hours to fast, some 18. And others don't really understand what a true fast means because a lot of times they don't eat, but they'll have coffee, which is fine. But then they put cream and sugar and other types of things in there. And I literally have had people that have done intermittent fasting and they and you know, and one of the culprits is, you know, they stop off at Starbucks and they get a coffee, which if it's black, is no problem. But when you put you take black coffee and you put all the sugary stuff in there, you're no longer fasting. Those are those liquid calories that we talked about before. So there's many ways that people can sabotage this, and that's why it's important to have somebody overlooking these and making those appropriate course corrections. Then we move on into movement, right? Movement and exercise is essential. Daily movement, walking, zone two cardio, all this stuff can be extremely helpful. And for selected patients, strategic fasted exercise may be useful. And again, some people do better on fasted exercising. Some people require calories to go in in order to make that exercise more efficient. And again, this is where you have to have physician oversight so that you can pick the right program. And resistance training is non-negotiable. Resistance training is weight training. And this is one of the most important clinical points of the entire episode. Resistance training supports glucose disposal, insulin sensitivity, lean mass preservation, mitochondrial demand, as we discussed during the last episode when we talked about NED plus and just better nutrient partitioning in general. So phase two is not just, hey, let's lose fat, it's let's build a body that handles stored fuel better. And that's a much more powerful long-term strategy that turns fat storage into fat utilization.

SPEAKER_01 27:02

Right. So the detox is not so much cleaning out the liver, it's making it so that the parts inside of us can actually just filter what we're putting through a better, and also at the same time putting better things through our body and using it. So we have like a almost like a threefold kind of going on there.

SPEAKER_02 27:20

Yeah. You want to, you know, again, it's not click the button below and here's your liver detox. It's hey, let's, you know, let's change the flow of of insulin, of glucose and fat into the liver, and let's let's decrease that insulin demand. Let's pull those calories out of the liver and let's create a lifestyle that supports long-term sustainable liver health and weight loss.

SPEAKER_01 27:40

All right. So when you move into the nutrition strategy itself, what does a true popkin method, a fatty liver disease plate, actually look like?

SPEAKER_02 27:51

Well, unfortunately, it's not, you know, it's not a plate of wings and curly fries and and it's not.

SPEAKER_01 27:57

Are you sure? It's what about during football season? I heard calories don't count on Saturdays and Sundays.

SPEAKER_02 28:03

They well, you know, it depends. If if you're following, again, if you're following that 80% or 90% rule and you're you're doing well 80 to 90% of the time, then of course you can you can have the things that you like. And it's we talk about this, it's not about, you know, it's not about total restriction. It's about setting up a sustainable lifestyle that, you know, I don't like to call it cheating because then it gives a negative connotation, but you can enjoy the things that you like in moderation. And that's where I think we as you know, as Americans with our Americanized lifestyle, we there's so much excess, and you know, everything is supersized, and everything is, you know, when you look at reviews on restaurants, you know, they don't even talk so much about the food quality as much as the quantity. And you look, you know, people get disappointed when the plate isn't just massively full and they don't leave, you know, they're not rolled out of the restaurant in a wheelbarrow. So, yeah, moderation for everything. And you know, I I love the the initial question, Jamie, because this is where the method becomes very practical. And when I think about food strategy here, right? Like what is your what is the typical popkin method plate look like? I'm not thinking in terms of random food rules, I'm thinking in terms of stacking metabolic signals. And this is why I really love this question, because it means we build meals that make the body's job easier, not harder. And a very practical popkin method plate for this type of patient, uh, not on football days, often looks like this: protein first. Yes, chicken wings are protein, so you're okay there to some extent, but protein first and a quality protein anchor, like eggs, fish, chicken, uh, turkey, Greek yogurt, cottage cheese, whey protein, or other clean protein sources. So we start with protein first, then veggie carbs as the base. I always say, you know, get rid of the starchy carbs and replace them with veggie carbs. And this is a classic popkin method food strategy, as it fits in exactly right here. And examples of, you know, veggie carbs, you know, leafy greens, broccoli, cauliflowers, zucchini, I mean, you know, green beans, you know, I could list keep listing veggies here, but you get the point, Jamie. Replace the starchy carbs with veggie carbs, I always say, because these provide fiber and volume and micronutrients, a lower glycemic load, and just better overall meal architecture. And they make you feel fuller. So you don't feel hungry. Whereas when you have more sugary and refined foods, you feel more hungry and you eat more. And they're designed that way, you know. So this is where the starchy carbs are replaced by the veggie carbs. That's where you get your fiber. And next is your healthy fats, especially the monounsaturated fats. And this is where extra virgin olive oil really shines here, right? It helps support satiety, makes you feel full, meal stability, adherence to a diet plan because it tends to make things taste better and have a better mouthfeel to it. And it has the calories that are healthy rather than the calories that are unhealthy, and just a more favorable overall meal composition. And then, as we talked about, we reduce the refined starchy excess. And that means being much more intentional with removing all the bread, rice, cereals, chips, crackers, desserts, and you know, these so-called healthy snacks that still behave like processed carbs. An example would be granola bars and some of the other, you know, crap that these internet influencers are promoting for monetary gain. You know, these are the click the link below for my discount code on this particular product that uh or food source or food replacement. And they think that those things are going to be a good replacement for healthy foods. And really, it just shows that these internet influencers clearly have an imperfect understanding of how the body works, despite people feeding their bank accounts with this blind faith because of the image that they see on the screen. So please don't don't fall for that clickbait. You want healthy foods, and healthy foods are the simple ingredients, they don't have lots of ingredients in them. And some of these packaged foods that you see that they talk about low fat or high protein or low sugar, they've got all these chemicals in them, and they are just they're just not good for you. So I use the triple anchor method that that the popkin method promotes. And if my listeners remember one practical framework, it should be this triple anchor meal structure: protein, fiber, and healthy fat. And that combination often creates a better satiety or feeling of fullness when you're eating, so you eat less, less glucose volatility, so you're not spiking insulin and jamming the liver full of sugars, a fewer cravings, so you're not grazing and snacking, which I said is bad as you go on throughout your day. You don't want to be grazing, better energy stability, so you don't get that mental and physical crash in the midday that you get when you have a sugary type meal or snack, and then a few hours later your insulin drops, and then you know your energy goes low, and now you start snacking again. And just a much more metabolically favorable meal. And that's how you make the popkin method actionable at the plate level, and it starts at the grocery store. So feel free to message me at thepopkinnethod.com and I'll send you my popkin method grocery list that supports reversal of fatty liver disease. And spoiler alert, Jamie, it's the same popkin method grocery list uh for everything that the popkin method teaches, just a little bit more specific for fatty liver disease.

SPEAKER_01 33:33

Awesome. You know, something I didn't hear you mention in this list is potatoes. Where do they live? Are they a yay or a nay? I mean, definitely noted on you know, the crackers, the chips, and the breads and the pasta. But how do we feel about like a baked potato every now and then? Or, you know, some sort of variation of the potato, which there are so many that we know and love.

SPEAKER_02 33:55

Yeah, that's that's a great, that's a great point here. And I this actually just came up last week with one of my patients. So regular potatoes, the white, the white potatoes, if you want to call them that, they again it's a starchy carb. So starchy, complex carb. And it's it and it is one of the healthier ways that you could have carbohydrates. And if you want to step it up and make it even healthier, you know, people talk about, you know, they talk about other potato sources that you mentioned. And those other potato sources, I believe you're probably talking about sweet potatoes. And sweet potatoes, you would think inherently they're sweet, so they're probably not as good, but they are they do tend to be less have less of a glycemic index as do regular white potatoes. So again, in moderation, right? Potatoes are good. And last week I had a patient who was stuck on a GLP1 medication and and from another physician, she came in and I was consulted to see what we can do to get her unstuck. And I looked at her, looked at her food log, and she had a lot of sweet potatoes in her diet and was told that they were healthy, that she was okay to have that. And yeah, some people can and some people can't. So in her particular case, uh I had her remove all potatoes, you know. So she wasn't really eating the regular potatoes, she was eating a lot of sweet potatoes, and I removed those sweet potatoes in favor of more starchy veg of less starchy, more fiber-rich vegetables. And we'll see how she how she does with that. But that's a great point because again, people say, Oh, you know, I'm okay with potatoes or sweet potatoes. And again, it's it's individualized. So, you know, some people do well with it and some people don't, which is why you need to have course correction based on the type of foods that you're eating.

SPEAKER_01 35:38

All right. Good to know. Good to know. Are there any other specific foods or targeted nutrition tools that you find especially useful when supporting liver health within the larger plan, the larger scheme of things?

SPEAKER_02 35:52

Absolutely, but I always want to frame this carefully because there's no single, you know, magic liver food. And I never want patients to think that one ingredient will override a poor overall pattern. Like the lady I mentioned, who you know thought that the that the sweet potatoes was her her magic thing there, and she was overdoing it with that. So, that said, there are several helpful tools that can be layered into this, the larger strategy. And some of these foods I'll list off here extra virgin olive oil. This is one of my favorites because it fits in so well with the popkin method framework because it supports healthy meal composition, a feeling of fullness or satiety. It gives you that monounsaturated fat intake, which is anti-inflammatory in nature, and just adding more anti-inflammatory dietary patterns that we've talked about in previous uh podcast episodes, which in a lot of cases is removing inflammatory foods to make your your diet less inflammatory. Um, other foods like garlic, garlic is a great example of a simple food that can support a healthier anti-inflammatory environment. And it fits in nicely into meals because it helps with flavoring. Coffee, coffee is an interesting tool here, right? In the right patient, it can support alertness and appetite control, exercise performance, which is why caffeine is included in many of these um athletic supplements and potentially some favorable liver-related associations that are noted in the literature. But it's got to be individualized again, right? Because if coffee worsens your anxiety or your sleep or gives you palpitations because maybe you have an underlying arrhythmia, uh, if it causes your reflux or or reflux esophagitis or increases stress reactivity, then it may not be the right tool for you. Again, this is why you want to individualize your you know, your care and your diet program. This is where a good nutritionist would come into play as well to work with the physician and the patient to help select the right for the right foods. And this is where you know the right tool for the right patient at the right time comes in, right? I talk about whey protein, which fits in nicely here because for the right patient, whey protein in the form of protein shakes can be very useful and very convenient because it makes it easier to hit your protein goals, your satiety goals, or feeling full, lean muscle mass goals, and recovery goals. So making a healthy protein shake in favor of either skipping a meal or in favor of some other unhealthy food really fits in nicely here. Just the caveat is to make sure that your protein replacement or your protein powder is from a trusted source. Because again, this is where people get a lot of contaminants and they get a lot of calories as well because some of these protein powders have a lot of sugar in them. So you want to be careful what you select. Omega-3, omega-3 support, right? Omega-3 fish oils, whether it's from food or from supplementation, omega-3 support fits in beautifully here because it aligns with my core five supplement framework, right? It's one of the core five that I like to recommend. And it supports the broader goal of an anti-inflammatory environment and it broadens the goal of inflammatory balance. And we talked about it before, but fiber-rich vegetables. And honestly, this may be one of the most underappreciated tools in the whole conversation because when you move into adding and improving your fiber intake through real foods, you often improve meal stability, gut signaling, satiety as these foods make you feel fuller longer. So you eat more of the starchy carbs. Uh, I'm sorry, you replace the starchy carbs with the veggie carbs, you feel fuller. So you're not, you're not snacking later, you're not eating more during that meal, you get more bowel regularities. You don't, you know, you're hopefully eliminating or or helping patients that have constipation or even diarrhea issues. And just the overall metabolic tone of the diet is improved with fiber-rich vegetables. So, again, the message is not, you know, here's the miracle food. The message is build a repeatable food pattern that lowers your metabolic friction. And I'll say that again because it's very important. The message is build a repeatable food pattern that lowers metabolic friction. And that's how the body starts responding differently when you give it something consistently that it can that it can improve how it functions in the long term.

SPEAKER_01 40:13

Excellent. So once someone does start improving, they're doing all the right things, how do we help protect that progress and keep fatty liver disease from returning and rearing its ugly head yet again?

SPEAKER_02 40:26

Yep. Well, this is phase four, right, Jamie? And this is where long-term success is really determined because the reality is that someone can improve, they can do everything that we talked about, but if the same metabolic stressors return, then the physiology can absolutely drift backward. So phase four is about what I call protecting the wind. And there are four major pillars here. One, you want to protect sleep architecture. And I'm going to talk about sleep. You know, I've talked about it before. I'm going to keep talking about it. Uh, if sleep quality declines, you often see worse, worse insulin sensitivity, more cravings, higher stress reactivity, a poorer recovery to exercise and other stressors, and just less metabolic stability overall. This is why sleep is not a luxury. It's a metabolic intervention and is a popkin method non-negotiable. Number two, we want to rebuild and preserve circadian rhythm. Again, we've talked about this a lot. Go back to episode five. We talk about this. This is where your lifestyle messaging is so strong. And how do we fix your circadian rhythm? Consistent wake times, consistent sleep times, early morning natural light, movement early, movement early in the day, electronic sundown at night, meaning turn off your phones and all of your electronic devices before you're going to bed. Uh, please don't go to bed with with your phone in your hand and you know, get the phone and you're scrolling at night with your, you know, with your phone above your head, wondering why you can't sleep, because you got, you know, you got light energy going into your eyes and your brain, and you can't sleep. So you want to create that electronic sundown at night, turn that turn the lights down, reduce blue light exposure, avoid late-night meals. So these are not just wellness hacks, these are metabolic control levers that you need to pull in order to get your body to respond. Number three, manage stress and cortisol load. This is super important because when stress stays high, the body keeps receiving a signal that it's under threat. And that can affect your appetite, sleep, glucose stability, fat storage patterns, and just overall inflammatory tone. And it's so important that I have an entire podcast dedicated to the effect of poor sleep and stress on your body. So go back to episode five, brush up on this important principle, the Popkin method. And that's why it's so important to calm the system first, right? That's one of the most important teachings of the Popkin method. The next is equally important, and that's to gain, maintain, and preserve muscle. We've talked about this as a common theme, right? This may be the most overlooked long-term strategy, because if people lose muscle, as a lot of them do on the GLP1 medications, I'm going to keep going back to that because if the GLP1 strategy isn't done properly, you're going to lose equal amounts of fat uh as you do muscle. And that muscle is really what is preserving your longevity. So if people lose muscle, they lose metabolic flexibility, glucose handling worsens, overall resilience declines, and the body just becomes a more vulnerable target again. And this is the most important pitfall with the GLP1 medications like semaglutide or terzipatide, because without a proper weight loss care plan, you can, as I mentioned, lose equal amounts of muscle as you as you do fat, which makes sustained weight loss impossible. So long term protection means prioritizing protein, doing resistance exercise training to gain muscle, proper recovery strategies like quality sleep, some of the supplements I talk about, the use of creatine to help support lean muscle. Mass and energy production and consistency above all else, right? Jamie, make these daily habits and your success will be sustainable. This is not just fitness, uh, this is not just click here, we're gonna solve your problems. This is true functional metabolic medicine.

SPEAKER_01 44:16

Awesome. It really is. It in one area of your life feeds into the next, and it helps we have to have them all working together in order for the system to work on the inside. But it is so amazing how the outside and our habits and our routines uh really are affect what's going on inside and how well that works. And I don't think we give enough weight to that. We're just like, this is just how it is. So what can I take to fix the inside? And at the end of the day, we are simply responsible for it. So it is wildly important for those patients who need more than lifestyle and foundational support, okay, that we were just talking about. Where do targeted supplements, peptides, and advanced biologic therapies fit into the conversation? How do we know after we have controlled all we can control that we need some extra help?

SPEAKER_02 45:10

Yeah, and and this is where the popkin method philosophy becomes especially important. Advanced therapies should support the foundation, not replace the foundation. So if someone is sleeping poorly, eating ultra-processed foods, under consuming protein, not moving or exercising regularly, chronically stressed, and not addressing the basics, then I don't want them thinking that that that a peptide or a supplement or anything is going to fix the problem. That's not how I practice. And that said, in carefully selected patients, advanced therapies can be absolutely useful adjuncts to your program. So regarding targeted supplements, since we're talking about fatty liver disease today, things like milk thistle and NAC or Nacetylcysteine, these increase glutathione and superoxide dismutase production in the liver, which acts as antioxidants in the liver. Your cumin and milk thistle, we've heard about these as well. They will improve bile production and flow from the gallbladder through the biliary system into the intestines where it's needed to digest these fatty foods. And something called phosphatidylcholine, this increases choline levels in the liver, which helps transport fats out of the liver. And, you know, these are all important. You can get them at CVS, you can get them at Walgreens, you can get them online. Remember, I caution people against some of the products on Amazon because they are either counterfeit or they they're underdosed or they have nothing in them or they have contaminants. So if you're looking for quality liver support supplements, I always tell patients, you know, one of the brands I consider is Thorn, because Thorn is a science-driven wellness company, and they've won numerous awards which stand as a testament to their quality and safety and efficacy of their products. So I generally direct people towards them and some other product lines as well. I like their clean formulations and their label transparency, meaning what they say is on the label is actually in the supplement, which is pretty important. And it makes them a trusted source for supplements that I recommend for my patients and some people that have uh that have fatty liver that need supplemental support. Some of the products that I use from them to help reverse fatty liver disease are Thorne's NAC product, the Nacetylcysteine that I talked about. Also, they have a product called SAT, which has a couple of different ingredients in there. And their liver cleanse products are all excellent, safe choices. And that's something you're going to take and cleanse the liver in 24 hours. These are things that go along with a program that I talked about where we incorporate all the things that I just mentioned, uh, as far as the basics of diet and exercise and so forth. So if you're interested, you can find a link to their website at thepopkinmethod.com. And using this professional link, they'll give you 10% off and give you free shipping on all of your orders. So it's just one of the trusted sources. Uh, you can also find them on Amazon as well. And these are physician-backed supplements, not Instagram influencer, you know, clickbait gimmicks. So again, I want to I just want to reiterate that these are safe products that I direct my patients towards. So, regarding peptides, which a lot of people, you know, really are hearing a lot about peptides now, and the FDA is now unbanned, like 11 new peptides, which is nice. So, you're going to be seeing a lot of these peptides coming up on social media and so forth. But we talk about the GLP1 and the GIP-based peptide therapies. And in the right patient, these may help by supporting appetite control and weight reduction, improved adherence to a weight loss care plan, improved insulin sensitivity, and reductions in in visceral fat, but again, only in selected people. Uh, and we'll make sure that it's in a program, not just click here, get the GLP1 medication and start taking it without any, you know, physician-guided oversight. Some other peptides we talk about, growth hormone, secretive pathway support. What that means is making your body produce its own, more of its own growth hormones. So depending on the patient, this can include peptides like strmorlin, hippomorin, tesmorlin, CJC1295, and they may support body composition, recovery, like polysis, and metabolic demand in certain individuals. So just Google, you know, the effects of growth hormone, and you'll ask, you know, where have these been all of our, you know, all our lives? But the most important thing you can do for growth hormone secretion is get better sleep, right? You don't have to get a peptide to do that. Just get better sleep, get on a good week sleep cycle, get morning light, all the things we talked about that don't cost you anything. Then there are the mitochondrial and metabolic support peptides. And this is where compounds like MOTS C, which increases mitochondrial efficiency and mitochondrial production, comes in. AOD9604, which specifically targets fat lipolysis. And while it's not a protein, NAD plus, which I discussed at length in the previous podcast episode. And I've still get lots of questions on this almost on a daily basis about NAD plus. And these peptides, they can fit conceptually into a broader metabolic support framework. And then after that, we can consider some of the more advanced biologic therapies like stem cell exosome and secretome biologic therapies. I want to spend a little bit of time here because we're getting you know a lot of interest in in stem cell therapies. And I get a lot of patients that inquire to they ask me questions and inquire about travel medicine, right? They go outside of the country to get these, to get these these treatments. And you know, I caution people against that because there's no quality control and it just frightens me to hear someone flying to Mexico or Thailand and getting some unapproved treatment, and then they fly back and there's no, there's no oversight, there's no follow-up, you know. So I would caution people against that. And importantly, you can research this on your own. Data from PubMed Central shows that stem cell-derived exosomes and secret tone therapies can show significant potential to treat fatty liver disease by helping the body reduce fat accumulation, inflammation, and fibrosis. It's very important that you understand it helps the body to do this, it doesn't do this on its own. And these therapies, particularly from what we call mesenchymal stem cells, they act as regenerative acellular agents that improve liver function, they can reduce liver injury and regulate metabolism. Again, you can go to PubMed Central, PubMedcentral.gov and check this stuff out. You can research it on your own. But some key therapeutic benefits that you'll find there for fatty delivery, fatty liver disease include a reduced lipid accumulation, is possible with these with these treatments, as the exosomes and the secretomes can help reverse fatty liver by reducing hepatic lipid buildup and fatty acid synthesis. So it helps with that flow, as I mentioned, decreasing the flow into the liver and improving the flow out of the liver. Um they can also help reduce inflammation and reduce fibrosis, as these exosomes and secretomes can actually modulate the immune microenvironment. They can reduce inflammation, they can inhibit the progression of liver fibrosis and scarring, which is what happens if fatty liver goes on over months and years of time. We don't want that liver to fibrose down and scar, causing cirrhosis. So this can help with that as well. And there is regenerative action that's possible as these exosomes and these secretones can promote hepatocyte regeneration, repair, and improve liver function because your liver will regenerate on its own when it's damaged. These therapies can help the liver to do that. So, what is their mechanism of action? I don't want to geek out too much here, Jamie, because you know, our listeners are not biochemists and they're not, you know, most of the people here are not, you know, they're not physicians and they don't understand the mechanism. But these exosomes and secretomes can promote liver recovery by activating some key pathways, such as AMPK, which inhibits pro-inflammatory macrophages and improves fatty acid oxidation. Essentially, it helps the liver to become more anti-inflammatory, which goes along with the Popkin method, anti-inflammatory diet and anti-inflammatory lifestyle. So, to kind of wrap things up, some key takeaways for exosome and secretome biologic therapies would be that these are acellular options. Unlike full stem cell transplants, these secretomes, which are molecules that are released by stem cells and exosome therapy, exosomes are small vesicles that are released by the stem cells. Uh, they offer potential lower risk alternatives to actual stem cell transplant procedures. And as far as preclinical success, some studies, primarily in animals, have demonstrated reduced liver steatosis and fat deposition. And liver steatosis is just another, it's just another name for fatty liver to make it more simplified for everybody here. And regarding future potential, these exosome and secretome therapies are promising for non-alcoholic fatty liver disease as well as metabolic dysfunction associated steatotic liver disease. And I'm going into this because I'm getting a lot of people who are interested in stem cell exosome and secretome therapies. And I want to put this on the podcast here and give some very important context that I think is necessary for our listeners. Further research is definitely needed, right? While these preclinical trials are promising, many of these applications are still in the experimental stage and require more human clinical trials, which is why I would caution people to not go abroad for these therapies. You want, if you're going to do this, you want this to be associated in a good medical program, uh, coincided with a care plan that is overseen by either your primary care physician or a functional medicine physician who is an expert in using stem cell exosome and secretome therapies. Because these can be very targeted delivery systems, right? These are engineered exosomes that are being researched to improve targeting efficiency directly into the liver. And it's getting very specialized, Jamie. And it's it's exciting, but has to be, you know, the excitement has to be tempered. And again, all this information you can find it on PubMed Central. Just go to PubMedCentral.gov and you can look these things up for yourselves. And a very, very important disclaimer whether you're getting stem cells, exosomes, or secretomes here in the US or you're going out, you're going abroad. It's important to note that these regenerative therapies, including peptides and stem cells, and exosomes and secretomes, they're investigational in many, many applications. And they're not FDA approved for hormone restoration or anti-aging or a lot of the different things that we're using them for. Um, these therapies are considered only in very carefully selected cases and within regulatory guidelines. And the outcomes vary and no specific results are guaranteed. So, again, that's where I say, you know, if you're gonna do this, do this in a very trusted environment within the United States, not outside of the country for the reasons that I mentioned earlier. And the key principle here, I'm gonna wrap this up because I don't want to go uh too long on this, but I do get a lot of requests for this. So I wanted to put this on the podcast. The key principle regarding any advanced therapies beyond lifestyle, diet, exercise, and basic supplementation is this. And this is the point I want listeners to remember: neither peptides nor stem cells, exosomes, or secretone therapies can replace physiology. They can only support the physiology. Go back to the basics: lifestyle modification, diet, exercise, and some basic supplementation, and then move into those therapies. So, again, the Popkin method supports making the fundamental changes to your lifestyle, diet, and exercise habits before employing any of these strategic advanced therapies.

SPEAKER_01 57:13

All right. Well, you are the expert on the advanced therapies, but let's talk about the next one. How do hormones fit into this equation? Do they? And how do you think about hormone modulation in men and women when fatty liver or metabolic dysfunction is in the picture?

SPEAKER_02 57:32

Yeah, that's a great question. And hormones are deeply intertwined with metabolic health. We've talked about hormones in the past, Jamie, and clinically, one of the most important points is this that hormone dysfunction can worsen metabolic dysfunction, and metabolic dysfunction can worsen hormone signaling. So, again, we're we're talking about this vicious cycle, right? In men, when testosterone is low, you may see lower muscle mass, increased visceral or belly fat, and that visceral fat is on the inside, and it's very dangerous because it's on it's around the organs on the inside of the abdominal cavity, which which can lead to heart disease and so forth, reduced training capacity, poor insulin sensitivity, lower motivation and recovery, and more central fat accumulation. So testosterone is necessary in men. In women, hormonal transitions we see with the hormone issues, especially perimenopause, menopause itself, polycystic ovarian syndrome-related insulin resistance patterns, especially those women that are obese, and more broader endocrine imbalances that we talked about in previous episodes. These can all shift your body composition, your insulin sensitivity, your sleep quality, and inflammatory tone. And as I mentioned now, your all that drives glucose and fat into the liver. So we want to correct this if possible. And in both men and women, cortisol is a major player, right? We talked about cortisone a lot in the past, Jamie. Uh, and cortisol dysregulation, you know, can affect glucose handling, sleep, food cravings, fat storage patterns, and inflammatory signaling. And that's why my emphasis on sleep and circadian rhythm is so important. Stress reduction, grounding techniques. You know, take your shoes off and walk in the grass and get, you know, get yourself grounded. Food quality, resistance training, protein. It's all the same, you know, things that I've been recommending to treat any of our other issues that we've been talking about in the past, right? So it's not just a soft wellness program, it's a foundational part of endocrine support and it's non-negotiable. So this is how I frame hormone modulation in the popkin method. Remember, we're not talking about hormone replacement therapy. We're talking about hormone modulation, making your body produce more of its own natural hormones. And it goes back to the things I've been saying for everything else, right? Improve your sleep, improve recovery, stabilize insulin, reduce stress, increase your resistance training to build more muscle, optimize protein, and then in some cases using targeted supplementation like ashwagandha, which decreases cortisol, which improves your hormone balance, taking boron, things like toncatali and phydogia restus, zinc, as well as some other supplements, are very uh can be very important. And then I asked, can the body produce and regulate hormones more effectively on its own with this supplemental support? And that's what hormone modulation is: getting the body to produce more of its own natural hormones. And only after that, and properly evaluated selected patients, do we discuss actual bioidentical hormone replacement therapy with testosterone replacement in men, or estrogen and progesterone replacement strategies in women, or DHEA, pregnetolone, or other individualized support when clinically appropriate for both men and women. So this is a very important point when it comes to hormone support, Jamie, is that we're not chasing hormones. We're restoring the environment in which the hormones can work better. Make your body produce more of its own natural hormones if possible. And if not, then we can support it with more advanced biologic therapies. And that's a very powerful concept of the Popkin method.

SPEAKER_01 1:01:10

Absolutely. Let's take what we have, optimize it first, and then add in what we need. If we need to, we might not even need to, but we got the right guy if we do. All right. If someone listening today feels like that they're doing all the right things, but they still feel stuck or they're not seeing results. Um, what should their takeaway be from this episode?

SPEAKER_02 1:01:31

Well, Jamie, I think the biggest takeaway is this that feeling stuck is not always a willpower problem. Sometimes it's a physiology problem. And that's a big distinction because people tend to not give themselves grace, right? They think they they put it on themselves. I think it's a willpower issue, and and and they just they lose the steam to go forward and try to make the changes. And fatty liver disease is one of the clearest examples of that. I mean, it's a horrible name, by the way, because fatty liver disease, you know, implies that, you know, that only people that are that are heavy get this, and that's not true. And then, you know, there are people that have fatty liver disease that are not obese. And then in patients that are obese, you know, now they're there's they're almost stigmatized, as you as you mentioned in the intro, right? Um, you know, fatty liver disease almost implies that they're doing something wrong or that their lifestyle is pointing a finger at their lifestyle, which in a lot of cases, yes, it is the problem, but it becomes a stigma. And then unfortunately, it's not something that is helpful to people in their minds because it makes them not necessarily motivated to address it. In some cases, they're ashamed of it and want to retreat. So we don't want it, we don't want that feeling. There's no stigma here because fatty liver is often not just about the liver, as we talked about, right? It's a signal that the body may be dealing with things like too much insulin load, too much inflammatory burden, too much metabolic stress, too little muscle, too little recovery, too little, too much cortisol, and certainly too much ultra-processed food exposure and not enough metabolic structure. So if I were to summarize the Popkin method in an approach, redo the sentence, and we would start right after and not enough metabolic structure. So if I were to summarize the Popkin method approach in one clean framework, it would be this phase one, stop the shift of excess going to the liver, reduce the signals that are pushing excess glucose and fat into the liver by lowering sugar exposure, reducing refined starch overload. Again, replace the starchy carbs with veggie carbs, improve your sleep, lower your stress level, calm the system, restore the foundation. And after that, we're gonna change the direction of flow. We're gonna build the conditions for better fuel handling where we utilize sugar and fat instead of storing it through the use of protein and fiber, structured meal timing, fasting when appropriate, daily movement and resistance training. We're reversing that flow now out of the liver. And then how are we gonna do this? That's phase three, stacking smart food signals. And this goes with any of the things we've talked about, Jamie, but it is particularly important here with fatty liver disease. We build meals that support metabolic control with protein, veggie carbs, healthy fats, extra virgin olive oil, omega-3s, less processed food exposure, and fewer random glucose spikes. And then phase four, protect the wind, baby, right? Keep the physiology stable, protect your sleep, protect your circadian rhythm, manage your stress, maintain muscle, stay consistent, right? This is, you know, these consistencies, it's like a sports team. Remain consistent, you know, get the wind, protect the wind. And then, if appropriate, you know, we can layer in some targeted supplements like milk fixel, NEC, Nacetylcysteine, glutathione, phosphatylcholine, all of which helps transport fats out of the liver. Then we can consider some peptides like we talked about, the GLP1 and GIP1 peptides. We can utilize some growth hormone secretogogs to increase growth hormone. We can provide some mitochondrial peptide support with things like MOTC or use targeted fat-burning peptides like AOD9604, support hormone modulation, and if needed, hormone replacement therapy. And in selected cases, some of the advanced regenerative biologic strategies I discussed, like the stem cell, exosome, and secretome therapies, but always in that order, Jamie. And that's what we keep talking about every time we do these podcasts, because that order is what protects the patient from false shortcuts. Uh, that's what makes the results more durable and sustainable. So if you've been listening to this series and wondering how all these concepts fit together, this is how fatty liver disease is one of the clearest real-world examples of why sleep matters, muscle matters, food quality matters, insulin levels matter, inflammation matters, gut health matters, hormones. Matter and recovery matters. This is what the Popkin method is all about. It's not just treating the symptoms, it's it's helping to restore the physiology that allows the body to work better. Again, Jamie, any any any thoughts on any of this? I mean, I know this is, it seems to be a repetitive theme, but it's intentional. This is a very repetitive process. And if you follow it, it'll not only help fatty liver, but it'll help most of the other issues that we've talked about in these podcasts.

SPEAKER_01 1:06:30

Well, what I love hearing as a constant throughout all the episodes is it's in not that it matters kind of what is off in the body. However, the solutions are pretty much standard and pretty much the same. So I think once you have a good understanding of, like you said, the order of the steps and the process that we can solve pretty much anything physiologically where there's a chink in the armor inside, right? By just following that same process. And you kind of can't mess up, right? It's not like, oh, for this problem, it's this, for that problem, it's that. It really does go back to optimizing your life in a really intentional and structured way, which, you know, if you're used to not having that, it it definitely is going to take focus. And like I said, intentionality. But that is the magic bullet, it seems like. And then after we take care of that, we can add in any extras. But I just I love hearing that, you know, with the proper sleep, with the proper nutrition, with making sure that we're active and exercising and using weights and, you know, kind of doing all the all the right things, going to sleep, waking up at the right hours. Um, we can pretty much reset the inside of our body, which is tremendous.

SPEAKER_02 1:07:50

Yeah, you you hit the nail on the head, and it's, you know, it's not, you know, one of these, you know, click below and I have the you know, the magic bullet for you. It really is that simple where you just clean up your lifestyle, clean up your diet, add in some exercise, take some basic supplements, and then from there, if you need more targeted support, make sure you're doing it with the the right provider. So, yeah, that was that was a great summary, Jamie.

SPEAKER_01 1:08:17

And and you know, and you know what too? It's it's not necessarily like the fun or sexy answer because it it is gonna take work, it is gonna take habit changing, it is gonna take lifestyle changes, right? And if you're used to living one way, you know, but it's like choose your heart, right? Do you want the brain fog? Do you want the extra bloating? Do you want the, you know, not being able to function as you once did? Do you want that hard heart, or do you want the heart of, you know, making some lifestyle changes and kind of getting back into fighting shape like we were once upon a time?

SPEAKER_02 1:08:53

Yeah, that that magic bullet doesn't exist. And our closest thing that we have right now to the magic bullet, you know, the GLP one medications, they even again, you look at this, right? I mean, it's all the rage, you can get them everywhere. But if you don't have a good foundation, if you don't have a good lifestyle, diet, and exercise, even those medications are not gonna, they're they're not only not gonna help you, but in some cases they can hurt you because they'll get you to lose weight, but you'll lose muscle. And we talked about this. You lose muscle, you lose so many different things that you that your body needs. And and so it's important there is no magic bullet. And if we do find something that helps, you have to, it has to be supported by that, by that solid base that we talked about. And it really is, like I said, it is that that simple that if you look at lifestyle, diet, exercise, and some basic supplements, you can fix most of what you know of what is is causing you difficulty. And, you know, again, I mean, this is what the popkin method is all about. And, you know, I want to thank everyone here, you know, again for joining me on the popkin method. And if this episode resonated with you, I want you to remember one thing. And Jamie summarized it perfectly, and I'll reiterate that here. You know, everything we've talked about, you know, your body is not broken. It may just be bottlenecked. And if you can identify that bottleneck, you can often begin to change the outcome. For many people, that bottleneck is hidden metabolic dysfunction that is being disguised as fatty liver disease. So insulin resistance, poor sleep, chronic stress, loss of muscle, inflammatory overload, and yes, fatty liver disease. The good news here, Jamie, is that these are patterns. And as we know, patterns can be changed. And that's exactly what the Popkin method does. And that's why everything that we're doing here at the Popkin Method on the podcast, that's why this all exists. That's why we're doing this. So if this episode helped you, share it with someone who feels like they're doing everything right, but still not getting the results that they want. And as always, your health span is built by what you do daily, not occasionally. So if you want, feel free to message me at thepopkinmethod.com and I'll send you the popkin method fatty liver reset, which is a seven-day action plan that you can follow as well. I can send you the popkin method fatty liver recovery grocery lists. So you can shop for the necessary foods to help you on your weight loss journey. And, you know, if you found this episode helpful, I encourage you to share it with someone who may also be trying to navigate the complexity of modern healthcare. Because the reality is that many people today are stuck in what I call the revolving door of treatment plans. They see multiple specialists, they receive fragmented advice, they're being bombarded by so-called internet influencers and experts who offer no real solutions other than purchasing products and never quite developing a clear strategy that ties everything in together. And the goal of the Popkin method is to change that, right? This podcast series is designed not only to educate, but to help people understand that there is a more structured and integrated way to approach health, one that combines the principles of internal medicine with functional and regenerative medicine in a very thoughtful coordinated care plan. So if you feel like you're ready to move beyond scattered treatment plans and start building a personalized care strategy to address fatty liver disease, as we discussed today, or any other health concerns you may have, I invite you to start a conversation with me. You can learn more by visiting thepopkinmethod.com. And from there, you can schedule a discovery call, you can schedule a virtual virtual functional medicine consult, or you can schedule an in-person consultation with me at my office in Hollywood, Florida. You can also follow along with additional education and updates on my social media platforms, including Facebook, Instagram, LinkedIn, and you can find longer educational content and lectures on my YouTube channel as well. And my goal with all of this is simple to help patients understand their physiology, organize their care, and develop a clear path toward better health. So thank you so much for listening to the Popkin Method podcast. And I look forward to continuing the conversation in the next episode.

SPEAKER_01 1:13:09

But like Dr. Popkins said, you don't need more options, opinions, or overhyped social media gimmicks. You simply need the sequence and structure that the Popkin Method provides. And that starts with one plan that's built to last. So if you're ready to explore these therapies the right way, visit thepopkinmethod.com to learn more and schedule a discovery call, an online consultation, or an in-person visit with Dr. Popkin today. This is the Popkin Method, and we will see you next time.