March 17, 2025 • 45 mins
The Missing Piece in Your Midlife Health: Why Your Liver Matters
You’re doing all the right things—eating well, moving, prioritizing sleep—but if your liver isn’t functioning optimally, your metabolism, hormones, and energy levels may still be working against you.
Your liver is a powerhouse, detoxifying your body, balancing hormones, and supporting fat metabolism. Yet, 30-40% of adults—especially midlife women—struggle with fatty liver disease without even knowing it. Symptoms like fatigue, stubborn weight gain, and poor sleep often appear long before lab work reveals a problem.
Dr. Supriya Joshi, a liver specialist, joins us to explain why midlife women are at higher risk and how simple habits—like strength training and even coffee—can support liver health. The best part? Your liver can heal in just months with the right approach.
Ready to optimize your health? Check out Dr. Joshi’s website for her liver health masterclass and 1:1 coaching.
You can find Dr. Supriya Joshi at:
_________________________________________
Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling run-down. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
https://www.fasterwaycoach.com/?aid=MicheleFolan
Have questions about Faster Way? Please email me at:
mfolanfasterway@gmail.com
After trying countless products that overpromised and underdelivered, RIMAN skincare finally gave me real, visible results—restoring my glow, firmness, and confidence in my skin at 61. RIMAN Korea's #1 Skincare Line - https://michelefolan.riman.com
*Transcripts are done with AI and may not be perfectly accurate.
**This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing, or other professional healthcare services, including the giving of medical advice. The content of this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice for any medical condition they may have and should seek the assistance of their healthcare professionals for any such conditions.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Michele Folan (00:00):
Hey there, if you've been watching from the
sidelines telling yourself I'llstart next week or I'll start
when things aren't so crazy inmy life, this is your wake-up
call.
Another year of feelingsluggish, frustrated with belly
and back fat and stuck no thanks, you deserve better, and I've
(00:22):
been where you are.
I know how hard midlife changescan be, but here's the truth.
Your body can feel strong,energized and capable again with
the right strategy and support.
That's exactly what I do in mycoaching.
So stop waiting.
Let's make this the year youactually put yourself first.
(00:42):
My next six-week midlife resetstarts soon, so grab your spot
now.
Just email me at mfolan that'sF as in Frank O-L-A-N.
Fasterway at gmailcom.
Your future self will thank you.
(01:03):
Health, wellness, fitness andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
Episode 87 on liver health wasa game changer and it's still
(01:25):
one of the top most listened toepisodes of Asking for a Friend
and honestly, I'm not surprised.
The liver is one of the mostpowerful yet often overlooked
organs when it comes to ouroverall health, especially in
midlife.
As I continue working withclients struggling with
metabolic issues, it's becomeeven more clear that supporting
(01:45):
the liver is key to betterenergy, hormone balance and
long-term wellness.
That's why I knew I had tobring back Dr Supriya Joshi for
a deeper dive into this criticaltopic.
In this episode, we'reunpacking why your liver health
really matters, how it impactseverything from metabolism to
aging, and what simple,practical steps you can take to
(02:07):
keep it thriving.
Dr Supriya Joshi, welcome toAsking for a Friend.
Supriya Joshi, MD (02:13):
Michele, thank you so much for having me
back.
I still remember how much fun Ihad the very first time we
chatted and I'm so grateful thatyour community and people who
are listening to you reallyrealize how important the liver
health can be for their futurehealth.
Michele Folan (02:27):
Well, again, we think of it as that organ that
processes alcohol, right, but ofcourse it does so much more.
Before we start and I do thisevery time I want to get rolling
into the topic, but it would bereally great for the audience
to learn a little bit more aboutyou, namely where you're from,
(02:50):
your background, where youstudied, and then also kind of
like some family details,because people are always
curious.
Supriya Joshi, MD (02:56):
Oh sure.
So I was born and raised in theToronto area in Canada and I
went to medical school, did myresidencies all at the
University of Western Ontario inToronto and I went to medical
school, did my residencies allat the University of Western
Ontario in Toronto and I'm apracticing gastroenterologist
and I did further specializationin liver disease, which took a
lot of years, and I've beeninitially in academic practice,
(03:16):
then moved most of my career tocommunity practice in one of the
largest urban centers outsideToronto and after 20 years in
full-time practice, I just wentpart-time a year ago to focus on
liver disease and metabolichealth and, realizing that
people need more information,I've taken some coursework and
coaching and lifestyle medicine.
I'm hoping to bring moreinformation and education to
(03:39):
empower my patients.
So that's me professionally.
I am married, I have an amazinghusband and partner in life,
I've got three great kids and myeldest is about to go to
university.
So we're at a very excitingphase in our lives and I'm
blessed to have my parentsnearby, who are aging.
I'm sure a lot of us can relateto being in the sandwich
generation and I'm the eldest ofthree siblings and I just love
(04:02):
being active and traveling whenI can.
Michele Folan (04:04):
Oh, wonderful.
And speaking of family, yourecently celebrated a great
aunt's 100th birthday and that'ssuch a huge milestone.
You know what do you feel likemade the biggest difference for
her?
How did she get so inspired toage intentionally?
Supriya Joshi, MD (04:23):
You know it's fascinating.
She's just such a vibrant woman.
She's still vibrant.
You know she's only now beingforced to use a walker, but she
can walk independently and she'sstill very sharp.
But I think her secret isalways learning, always having a
curious mind.
She's a very active reader,very knowledgeable on world
historic events, still remembersevery date to this day and she
(04:48):
is a social butterfly.
Even this past weekend you knowshe wasn't tired we kept asking
are you tired, want to get somerest?
Nope, she is out there tocelebrate and party as much as
she can.
And I remember growing up andvisiting them.
They were always hostingparties.
And I remember growing up andvisiting them.
They were always hostingparties.
So I think that active effortas social connections is a very
(05:09):
big part of her success in lifeand in health, those blue zones.
Michele Folan (05:12):
They talk about community and people that get
out and they go to the coffeeshop.
They're at the market shopping.
You know all those things aresuper important to longevity, so
we can't minimize that.
Supriya Joshi, MD (05:27):
Totally.
She lives her life with as manyfriends as she possibly can.
She's always got visitors, so Ithink that's a big message to
all of us.
You know, don't live inisolation, and if you see
someone reach out and make acomment about them or to them,
that engages someone else aswell, right, versus just walking
by in your own lane.
Michele Folan (05:45):
You know, what I love about following you,
Supriya, is that you aren't justfocused on liver health, you
talk about all aspects ofmidlife health and it just seems
that there's thisinterconnectedness in our bodies
with all these systems.
(06:06):
Can you talk a little bit aboutthat, because I think you going
from being a gastroenterologistto specializing in the liver, I
think there's a tie in here.
Supriya Joshi, MD (06:17):
Absolutely so .
When I see patients with myliver hat on, it's because
there's something going on withtheir liver health, whether it's
fatty liver or growth, or Ihave normal liver tests.
But when I talk about thetreatment, when it comes down to
their lifestyle which is reallya really underlying common
theme for so many diseases wesee today and that many of my
(06:39):
patients already have, when I'mtalking to them, so as a
gastroenterologist and peoplewill come to me with bloating
and heartburn or altered bowelhabit, a lot of the time the fix
is increase your fiber intake,cut back on the processed food
and junk food and sugar.
Same things apply to majorityof causes of liver disease and
the same thing applies toprediabetes, type 2 diabetes,
(07:01):
high blood pressure, highcholesterol, and the end result
here is reducing someone's risksof a cardiovascular fatality.
So there is a connectivenessand you've seen right through it
and it's convincing ourpatients and the community and
the people that there is aconnection and we aren't born
with the destiny to have theseoutcomes, but by making
(07:24):
consistent efforts we canactually alter that life path.
Michele Folan (07:27):
There are detoxes that get advertised out there
and I wanted to bring this upfirst because I see people
talking about them, advertisingthem.
You addressed this on the lastpodcast, but I think it is
important to bring back up again.
Are these liver detoxesnecessary and what is really the
(07:51):
end game with them?
Supriya Joshi, MD (07:53):
Companies that manufacture detoxes, which
is a supplement or a drink orsome concoction they want you to
buy and consume, is nothingmore than them preying on
someone's weaknesses orinability or not having the
knowledge that they can fixthings themselves, and you're
just putting money in their bankaccounts.
(08:15):
So there is nothing people canconsume to detox their liver or
improve their liver and healthby consuming something.
You actually have to pivot andchange what you're normally
eating and drinking and how muchyou move your body and your
sleep quality and your stressors.
So that's the whole basketunder the umbrella of lifestyle
(08:35):
and there's no point in spendingyour money buying these other
concoctions because they're notgoing to do anything.
In fact, they could cause moreharm.
Michele Folan (08:43):
Okay, you brought something up just a second ago
about sleep and stressors.
I don't know a lot of doctorsout there that are really
talking about sleep andstressors.
How does that relate to overallliver health?
Supriya Joshi, MD (09:01):
Oh, a great question, I'm glad you asked
that.
Actually, overall liver healthoh a great question, I'm glad
you asked that actually.
So when we don't sleep well fora variety of reasons whether
it's late night, eating, alcoholconsumption, sleep apnea,
vasomotor symptoms of menopauseor stress, keeping you up at
night when you don't sleep, datashows the next day our core
temperature is a little bitlower and we tend to seek
(09:25):
comfort with comfort foods, andthat can lead to weight gain and
people are less physicallyactive.
So poor sleep can have a roleon how you behave the next day,
and often those behaviors nextday aren't going to lead you to
improved health.
It's more about comfort seeking.
So poor sleep is a directcorrelation with a lot of
(09:47):
leading to a lot of potentialmetabolic dysfunction and weight
gain, and that ties into latenight snacking and eating and,
you know, even alcohol.
So that's one way sleepcontributes.
And then there's the underlyingreason why you're not sleeping,
like if sleep apnea is present.
That's already a manifestationof insulin resistance.
And then we talk about cortisolor stress.
(10:08):
We are tied into cortisol.
We're tied into again it's thehabits that lead people to seek
comfort when they're understress, and maladaptive coping
skills are evident in manypeople.
They just don't realize it, youknow, seeking comfort from
comfort from alcohol or a sugarydrink or a piece of cake or
snacking.
They're not hungry, but they'reseeking comfort and I think
(10:31):
when people are under stressthat's a normal adaptive
behavior for a lot of people.
Michele Folan (10:36):
These are a lot of the same things that I talk
about with my clients is getgood sleep.
You know, when you're stressedyou get cortisol and then you
get more ghrelin and then you'rehungrier and you're making poor
food choices.
So I love this because it'slike if we can all get on the
(10:58):
same page and be speaking thesame language, people will
figure it out, but they're luckyto have you, because you
obviously are very passionateabout this and you really care.
So I do appreciate that let'stalk about fibrosis and fatty
liver, because I believe weprobably need to have some
(11:21):
differentiation here of the two,because I'm not sure we all
really know the differencebetween like fibrosis we think
of there's like we havecirrhosis, right?
Is cirrhosis part of fibrosis?
Supriya Joshi, MD (11:37):
Cirrhosis is the end result of ongoing
progressive liver fibrosis.
I'm happy to explain this.
This is a really importantthing to understand.
So when somebody has adiagnosis of fatty liver, which
means fat, the actual cell is inthe liver and liver fat or
fat's not supposed to be in theliver.
(11:58):
A normal, healthy liver doesnot have that much fat in it.
Under 5% is considered to be innormal health.
So when someone has issues intheir life that allows fat to be
paused in the liver, it's now adisease state.
So just the presence of liverfat means insulin resistance is
(12:18):
present.
Now the other options are thatliver fat just stays there but
the liver disease does notprogress.
So this person has fatty liverbut if they don't change the
reasons why it got there, thenthe liver fat will worsen.
But then there's two avenues ortwo paths to go down, and
(12:38):
sometimes they do overlap.
The first is you just getprogressive liver fat but you
don't get the response of liverfibrosis, liver inflammation or
liver cirrhosis.
So I've got many people thathave fatty liver disease without
fibrosis and I tell them youknow, your liver will last you
your lifetime.
You're not going to lead, getto develop cirrhosis and liver
(13:00):
transplant, and that risk isvery low.
But if you don't make thosechanges of why you got fatty
liver, you're going to go downthis path and develop type 2
diabetes, hypertension and havea higher risk of heart disease
and multiple cancers.
However, we also know thatpeople that have the
comorbidities of type 2 diabetes, obesity and hypertension those
(13:22):
people have the risk factors tohave progression of liver
fibrosis towards liver cirrhosis.
So it's the people that havealready developed multiple
metabolic diseases.
They're the ones at risk ofliver failure, liver cancer and
possibly needing a livertransplant in their lifetime.
So, just to make it clear,people can just have liver fat,
but no progressive liver disease, versus the people who have
(13:46):
progressive liver fibrosisthrough the inflammatory
response and liver scarring.
So there's two trajectories,both of which, though, are also
associated with metabolicdiseases.
Michele Folan (13:57):
Can you reverse fatty liver disease?
Supriya Joshi, MD (14:01):
Yes, and you can also reverse fibrosis if
it's early enough.
How do you do that?
Well, persistent, consistentchanges in whatever has led to
the cause.
So the terminology wasnon-alcoholic fatty liver
disease, but now we realizethere's actually an overlay.
There are people who do drinkalcohol.
Plus they have dysfunctionallifestyles, or dysfunction might
(14:24):
be a bit harsh, but you knownot the most adaptive mechanisms
in their lifestyle.
So you want to minimize andideally abstain from alcohol.
We know that low risk alcoholintake is under two drinks a
week, but none is best.
More than three drinks a weekis where you start to get the
increased risks of heart diseaseand multiple cancers.
So keeping a low is always bestfor overall health.
(14:45):
Then we talk about the othercauses in the lifestyle, and a
big part of it is nutrition andphysical activity and poor sleep
are the biggest factors in allof this, in addition to some
genetics susceptibility in someindividuals.
So when it comes to how youprevent it, I make people aware
well, what are your currenthabits?
(15:06):
You need to haveself-actualization Like what are
the habits you're livingthrough right now, and has it
been this way for the last fewyears, 10 years, your whole life
, or is it just a very recentepisode.
So then we want to know is doyou put sugar in your coffee or
tea?
Do you drink juice?
Do you drink pop?
Do you drink all those fancy,you know Starbucks drinks or
whatever coffee vendor you'regoing to?
And then what do you eat, youknow, are you a bagel, a morning
(15:30):
person?
Are you someone who puts jam ontheir bread every day?
Do you have cereal every day?
And what are your lunch anddinner choices?
And then do you snack and doyou eat late at night?
So that's the whole nutritionalcomponent of it.
And then making people reflectback on that many people did not
get the education onmacronutrients.
There's fats, proteins,carbohydrates, and are you
(15:53):
getting protein in your diet?
Are you getting enough fiber inyour diet?
Are you someone whose plate isfilled with, you know, rice and
beans, or you know, or a big,large bowl of pasta devoid of
any vegetables?
So those are the kind ofquestions people understand what
they're consuming on a regularbasis.
So what are their dietaryhabits?
Then comes are you moving?
(16:15):
Do you walk?
Do you get up after your meals?
Are you sedentary at a desk allday long?
And do you make any specificintentional effort to strengthen
and move your body.
So I think those are the mainthings that we try to focus on
and then often, I hope, a littlealarm bell goes off in their
minds to realize they have tomake some changes.
Michele Folan (16:37):
Yeah, because if you start painting the picture
of what the long-termconsequences are of possibly
liver transplant or somethinglike that, I mean I know that
would scare the heck out of me,but sometimes changing those
habits is a challenge in itself.
Supriya Joshi, MD (16:57):
Absolutely.
And so while they may notnecessarily have to worry about
having end-stage liver disease,but it's in five more years, do
you want to be on sevendifferent pills?
Yeah, you know, and if you canmake these changes, you might
come off some of these pills,and that's really an amazing
thing to think about.
And when we look at the globe,like what is the prevalence here
, 30 to 40% of adults will havemetabolic liver disease and 20%
(17:21):
of them will go on to haveprogressive fibrosis, and that's
the MASH metabolic dysfunctionassociated steatohepatitis, or
MASH, m-a-s-h for short.
And of those people with someelement of inflammation and
fibrosis, 6% are going todevelop end-age liver disease.
So when you look at those sheervolume of number of people
(17:44):
affected by this, this is goingto be a huge problem.
Michele Folan (17:47):
How are you diagnosing liver disease?
Is it blood tests?
Is it an ultrasound?
What's typically the protocolhere?
Sure.
Supriya Joshi, MD (17:57):
So I think, initially because I'm a
specialist people are oftendiagnosed or the alarm goes off
in their primary carepractitioner's office.
So it's most often they've hadblood work done for routine you
know part of their routinephysical or for monitoring of
the side effect of medicationsthey're already on and the liver
enzymes are elevated.
The other scenario is someonecomplaining of abdominal
(18:18):
discomfort and then they go getan ultrasound.
So if you have abnormal liverenzymes, an ultrasound needs to
be done to make sure thatthere's nothing anatomically
infiltrating the liver.
Is it gallstones?
Is there a growth?
That needs to be done?
So that's often how it's firstalerted to the individual and
then they get a furtherinvestigation.
(18:39):
So what is the cause?
Is there alcohol?
Are there any?
You know detoxes, herbaltherapies, supplements you're
taking.
Are there other medications?
You've seen other?
You know caregiver for that youhaven't shared with me.
It's always what are peopleconsuming is always the first
question we really need tointerrogate about.
And then it comes down tolooking for symptoms to be
(19:00):
suggestive of other causes.
You know, have you had healthcare in other countries?
Have you had contaminatedneedles?
You know hepatitis B, hepatitisC.
Have they been ever screenedfor those things before,
especially in the baby boomerpopulation.
You know where they're at riskof hepatitis C just by being a
birth cohort when were you born,where have you traveled?
And those give othersuggestions for viral hepatitis
(19:23):
risks.
And then there's symptoms.
You know, could they haveautoimmune liver disease?
Is there a family history ofliver disease?
And you're looking for geneticcomponents.
And then once we kind of figureout what the cause is, we then
want to know well, what is theseverity?
Do you have fibrosis or not?
Because that is really animportant question.
So that's a combination fromsome blood tests that we do
(19:44):
abdominal ultrasound, and thenfortunately most things today
are non-invasive.
So we can do a fibro scan,which is a non-invasive way to
measure for liver fat andfibrosis stage.
And there's also a blood testpeople can get calculated,
called a FIB4, where they justplug in into the algorithm.
You know their age, theirplatelet count and their AST
(20:06):
values and then that will tellyou are you low risk,
intermediate or high risk forliver fibrosis?
And then for very few people westill need to do a liver biopsy
.
But those are the traditionalways we assess someone for the
cause of their liver disease andwhat their stage is.
Michele Folan (20:24):
You brought up hepatitis and maybe a
differentiation here between Band C would be helpful, and then
kind of the prevalence of itand how often are you seeing it
in your practice?
Supriya Joshi, MD (20:39):
Okay, so we'll get down to the science
here.
So hepatitis B is a DNA virusand hepatitis C is an RNA virus,
and that differentiates them interms of how they work their
way into our bodies.
Both are blood-borne or bodyfluid-based infectious viruses
that enter the body, often withtainted blood.
(20:59):
Hepatitis B is extremely commonin Asia, sub-saharan Africa
versus.
Hepatitis C is pretty mucheverywhere else in the world.
Europe has also been affectedby it, often related to needles
or blood transfusions from wayback, you know, decades ago.
(21:20):
But both these viruses are oftensilent.
They don't cause peoplesymptoms.
Sometimes they might makesomeone have yellowing of the
eyes or jaundice, but most ofthe time there's no symptoms and
it's detectable by screeningfor these antigens or antibodies
and blood tests through liverenzymes and viral counts, and
(21:42):
then, based on that, they canthen be assessed for stage of
liver disease and then go ontowards treatment.
So hepatitis C is now very muchcurable with all oral
medications and as little aseight weeks and hardly any side
effects.
So right now the World HealthOrganization has made a goal to
(22:03):
eradicate hepatitis C from theplanet by 2030.
Oh, wow.
So to do that, we need peopleto be actively screened.
You see, your primary carehealth provider, all you get is
a hepatitis C antibody test andthat will indicate if you are
someone who might be at risk andthen get that confirmed and
treated.
Whereas hepatitis B we have avaccination for.
(22:26):
This can be prevented and somany places around the world do
advocate for vaccination atbirth or around age 12.
That's the other school-agechildren but that's very much
preventable but not curable.
So we have to treat people forhepatitis B.
Michele Folan (22:45):
Thank you for the delineation between the two,
because I never really knew.
So thank you for that.
We're going to take a realquick break and we'll be right
back, and when we come back, Iwant to talk about the
prevalence of liver disease nowin some of our younger people.
Are you feeling overwhelmed bythe changes that come with
(23:08):
midlife, struggling with weight,energy or finding time for
yourself?
You're not alone.
I get it because I've beenthere too.
I specialize in helping midlifewomen, just like you, transform
their health and lives throughpersonalized nutrition and
coaching that fits your reallife.
Together we'll tackle thoseunique challenges, whether it's
(23:30):
balancing your hormones, dealingwith cravings or boosting your
energy.
It's not just about diets.
It's about reclaiming yourstrength and confidence one step
at a time.
Check out the show notes ofthis episode and shoot me an
email.
I'd love to learn more aboutyou and your challenges.
Welcome back to the show.
(23:54):
Before we took a break, Imentioned children, and maybe
even our young adults, about howmuch more prevalent liver
disease is in that group, andI'm making an assumption here
based on the fact that we areseeing diabetes and other
diseases creep into our youthmuch younger because of
(24:17):
lifestyle and our food source.
Are you seeing it in yourpractice?
Supriya Joshi, MD (24:23):
Well, I would have to say at first I'm an
adult specialist so I don't seekids, okay, but I do get
referred, and referred to mewhen they do turn 18.
And we're much more commonlyseeing fatty liver disease being
referred because children.
You know the prevalence ofobesity and being overweight in
children is more than doubledcompared to 1980.
So we are definitely seeing it.
(24:43):
We're seeing children withsignificant liver fibrosis.
We're seeing children with typetwo diabetes, high blood
pressure.
It's quite concerning.
It's very concerning and veryupsetting because it doesn't
need to be this way and it istreatable.
But it's really hard to treatwhen you know kids may not want
treatment at this phase in theirlives.
(25:04):
It's hard for them sometimes tosee where they're headed when
they're so young, and that'sjust an issue with maturity.
Michele Folan (25:10):
When we're looking at treatment.
Are the GLP-1s now part oftreatment for liver disease?
Supriya Joshi, MD (25:18):
Not yet, although I cannot wait for them
to be so.
So the GLP-1s, as you know,have shown evidence for improved
control, for type 2 diabetes,obesity management and, more
recently, even for patients withcardiac disease and for heart
failure, reducing episodes ofheart failure.
There was a trial published inthe New England Journal a few
years ago which failed when itcame to looking at fatty liver
(25:42):
disease, but, as liverspecialists we all knew the
biggest flaw was it just wasn'tlong enough.
It takes decades for liverfibrosis to occur.
It's not going to go away in 12months in the majority of
people or any significant amountof people.
So right now there's a five-yeartrial going on called the ESSEN
study, and the 72-week data wasliterally just put out a few
(26:02):
months ago, and it showed.
So week 72 of this five-yearstudy, there is already a
significant amount ofimprovement.
In fact, it showed about 62% ofindividuals had improvement and
reversal in hepatic fibrosisand about 37% had resolution of
the inflammation from fattyliver disease.
So very exciting.
(26:24):
So that's quite convincing andhopeful that this will be
something that we will have inour armamentarium to treat
people who need a prescriptionfor it.
And it should be clear, though,the people in these trials have
stage two or stage threefibrosis.
Michele Folan (26:39):
Okay, so let me ask this question Is the
reduction in the insulinresistance why this works, or is
it because there's actual GLP-1receptors in the liver?
Supriya Joshi, MD (26:50):
So there actually are not GLP-1 receptors
in the liver.
I think this is all due to theweight loss.
Yeah, okay, it's probably theweight loss effect and caloric
less calories in probably Okay.
Michele Folan (27:00):
I didn't know, because I know there's GLP-1
receptors in the brain and I wasthinking, okay, maybe there are
GLP-1 receptors in other organsas well.
Supriya Joshi, MD (27:09):
Yeah, I think it's all indirect, and it
certainly is from improvinginsulin sensitivity.
That's the main way, right.
You're improving insulinglucose metabolism and the liver
can more appropriately do itscorrect job.
Michele Folan (27:21):
You had brought up sugar and as part of you know
these conversations that youhave with your patients, and I
did a video a couple of weeksago about added sugars in food.
Do you have a recommendationfor a limit in added sugar to
food, and that does not includefruit, as we always try?
Supriya Joshi, MD (27:44):
to preface.
Yeah, so I really do advertiseand educate, but the WHO
guidelines that came out in 2015.
So you know, women should nothave more than you know six
added teaspoons a day, men nine,and children, you know three to
six, so that people can keeptrack of what they're consuming
and make an active effort tostay within that budget.
Michele Folan (28:05):
Okay, so six teaspoons would be about 24
grams, 25 grams of.
Supriya Joshi, MD (28:11):
You got it, four grams of sugar being one
teaspoon.
Everyone has to learn that math.
Michele Folan (28:16):
Yeah, and you know it's frightening because I
did a little comparison of addedsugars based on, like a grande
latte, vanilla latte, and thatwas 20 grams of added sugar
that's almost your wholeallotment for the day.
And like a McDonald's smallsweet tea and I've worked with
(28:41):
people who drank a couple ofthose a day and you think about
those.
Are that hidden, sneaky sugarthat people don't really account
for?
And it's just some of thesejust small, small changes that
we can make in our diets thatcan just pay off so big in the
long run?
Absolutely.
Yeah, you had mentionedsomething about coffee, though
(29:06):
Now we're not talking the sugarystuff from Starbucks.
But what is it about coffeethat is actually recommended for
liver health or just overallhealth?
I?
Supriya Joshi, MD (29:17):
know decaf also has the same capabilities.
Definitely it's one of thepolyphenols, the antioxidants,
and there's another part of thecoffee that is helpful in
reversing hepatic fibrosis andreducing even the risk of liver
cancer.
I should rephrase it doesn'treally reverse fibrosis but it
(29:40):
prevents progression in thefatty liver and reduces cancer
risk.
So there is definite benefit tocoffee and so if people can
tolerate it, if they're coffeedrinkers, I say you know, if you
can get two to three in before2 pm, it might be beneficial for
your health.
And I say that time cut off sothey get good sleep again.
Yeah, I was just going to saywe don't want to disrupt it.
Michele Folan (30:01):
Yeah, we don't want to disrupt your sleep, but
it's okay to get the coffee.
And yeah, and you mentionedearlier too about drug-induced
liver injury.
How common is that and fromwhat is this like supplements?
What are you seeing most often?
Supriya Joshi, MD (30:18):
Well, any medication can cause drug injury
.
So I think that's one part.
But when people, when doctors,are prescribing prescription
drugs, we're very aware whichones might cause a side effect
and the risk benefit has alreadybeen discussed with the patient
.
So if they're on it, we'remonitoring for it.
The issue is when people starttaking supplements because they
think, oh, it's natural, it'sgot to be better than a
(30:40):
prescription.
But what they don't realize,there is absolutely no FDA
regulation.
These have not been studied, andwhen you look at formulations
of herbal therapy or supplements, you're at risk of having
things that are impure.
You have interactions withother, cheaper compounds mixed
in there and you have megadosing.
Some people might think, oh,the more, the better, but
(31:02):
there's not and in fact there'sa lot of ingredients out there
that are very harmful to people,and people need them every day.
I'm talking about green teaextract, turmeric, ashwagandha.
You know these are things youhear people talk about all the
time, but they don't realize itcould cause you harm.
It can even cause, you know,liver failure.
Other ones include, you know,even high doses of turmeric,
(31:25):
black cohosh and red yeast rice.
Those are the ones that we knowcan more commonly lead to liver
dysfunction, especially ifyou're combining that with other
prescriptions that you're on,because they still get filtered
by your liver, they still gothrough the same cytochrome
metabolic pathways andespecially if it's too much.
That can cause dysfunction.
Michele Folan (31:47):
All right, so now you got me a little concerned
because I take turmeric and itdoes help.
It does help with my creakyjoints.
So is there a threshold that weknow like what's too much?
Is it just individual?
You know, I don't know theanswer to that.
Supriya Joshi, MD (32:07):
I think if it's something in a capsule form
, you know you'd have toindividually read about what
what it is you're taking to makesure it's not causing you harm.
All right, yeah, I don't havethat exact answer.
It's, I don't think.
Again, these are not FDAregulated, so we don't know.
Right, oh, and that's true.
Michele Folan (32:23):
I mean, we people ask me about supplements all
the time and I'm like look,number one.
I am not a doctor.
I take a certain number ofthings, but I've been taking
them for a long time.
I've run them by my doctor.
It's an individual choice totake supplements, but you've
(32:45):
really got to do your homework.
Supriya Joshi, MD (32:47):
And that's exactly it, and also disclose it
to your healthcare provider.
It's important to know whatyou're taking, because people
don't realize that supplementscan interact and that would be
really scary, because if you'renot conscious, you can't tell
someone.
Michele Folan (33:04):
You know that you're.
You're right, you can't tellsomeone.
Supriya Joshi, MD (33:09):
You got to tell people share your
information so that they knowwhat you're on, Because we've
had people come in, you know, inliver failure and literally
finding out what they're takingcan be a real challenge.
Michele Folan (33:20):
Yeah, oh, my goodness, hey.
Can you share a patient successstory where they made proactive
changes to reverse their liverdisease?
Supriya Joshi, MD (33:30):
Oh, gosh, I'm so blessed to have so many
stories.
I just I love them.
One of my favorite ones, thatwas just a few weeks ago and
this was someone who wasreferred to me and when he got
the appointment to see me he waswaiting there's still a wait
list.
He was waiting there's still await list.
He was waiting a few months andhe found me on my social media
and actually went through somany of my old posts which I've
(33:51):
only been posting for about ayear and a half now and he
implemented pretty mucheverything and he did not
realize his lifestyle was thatmuch off key, leading to overall
health dysfunction.
He already was hyper, you know,pre-diabetic, he already had
high triglycerides, he had allthese other medical problems and
(34:12):
he started intermittent fasting.
He prioritized protein, tryingto get 100 grams a day,
prioritized fiber, cut back onrefined carbohydrates, exercised
, he started doing strengthtraining.
He did everything, startedtaking vitamin D supplementation
and magnesium glycinate.
So when I see him he does hisblood work for me two weeks
(34:34):
before our appointment, does hisfiber scan right before our
appointment and look at him go,fiber scan's normal.
There's no fibrosis, no liverfat.
His fasting, blood sugar wasnormal, triglycerides were
normal liver enzymes were normaland I asked him what you do,
because I followed everythingyou said and in three months you
lost 25 pounds.
(34:55):
Three months yeah, that'sfantastic he was thrilled and he
goes.
You know it's not hard.
The first couple weeks is hard,like any new.
It just takes doing somethingtwo or three times.
It's a new habit.
So he had a great outlook.
He also was in his forties.
His parents had heart disease.
(35:15):
Both his parents were diabeticand in his mind he goes.
I thought everyone becamediabetic when they're in their
fifties.
He thought that was just anautomatic destiny because
everyone he knew had type 2diabetes at that age.
The light bulb went off.
It's like it doesn't have to bethat way.
Michele Folan (35:34):
You know, I wonder how much better he felt,
too, just overall, that feelingof well-being, by just eating
better, sleeping better, allthose things that you preach on
your Instagram.
He did.
Supriya Joshi, MD (35:48):
His heartburn went away.
His bloating was much better.
Bowel habits improved mentalclarity.
A lot of people report moremental clarity and more focus
when they do intermittentfasting.
Part of it could be this you'renot filling your morning with
sugary cereal and refined carbsthat make you have that sugar
crash.
You know that partly could bewhy, but he felt fantastic.
Michele Folan (36:12):
I love these stories.
Again, this is what I coachwith my you know my clients, so
that they don't have to come seeyou.
You know that's the whole point, right?
Oh my gosh.
Hey, you brought up.
I know part of metabolicdisease is dyslipidemia, and
(36:35):
when our lipids get out of whack, I know that becomes a big
concern, and I've had clientshere who have not gotten a very
good report card from theirdoctor and they want to start
making some changes.
Do me a favor.
Could you shed a little lighton HDL versus triglycerides
(36:57):
versus LDL and what is of mostconcern to you when it comes to
liver disease and what reallyneeds to be treated?
Supriya Joshi, MD (37:07):
Yeah, the metabolic liver disease.
It's from the triglycerides.
Really, that is the biggestthing.
So high triglycerides, and allof this is developed from
increased delivery of free fattyacids to the liver.
The liver is doing its thing.
The LDL and HDL just how thelipid is a vehicle for how it's
carried in delivery to the othersystems in our body.
(37:28):
And we know that you want tohave a lower HDL and a higher
HDL, but they're not all bad.
I think LDL has had a lot ofbad press as well, but it really
is the whole ratio ofeverything.
Your APRA proteins areimportant as well, but, to keep
it simply, when thosetriglycerides are high, you are
heading towards metabolicdisease and worsening metabolic
(37:51):
dysfunction.
So identifying your triggersfor your hypertriglyceridemia is
really the important thing,which is coming from alcohol,
juice, excessive fruit, refinedcarbohydrates, essentially.
Michele Folan (38:04):
Yeah, people, when they think cholesterol,
they automatically think animalfats and that sort of thing, but
that's not necessarily the case.
So thank you for that.
Supriya Joshi, MD (38:13):
And we also know, you know, menopausal women
, they start to get dyslipidemia.
You know it's all very muchconnected.
So, as estrogen is declining,these issues start to occur.
So there's also a hormonalinfluence, you know, and and I
don't know if we talked about itthe last time it was on, but
you know, after the age of 50,that correlates with menopause
(38:34):
for women, and sopost-menopausal women are more
than double to have fatty liverdisease than pre-menopausal
women.
Wow, yeah, so there'sdefinitely the role of reduction
in estrogen and its role withinsulin resistance.
Michele Folan (38:48):
You know we get dealt a bad hand.
Supriya Joshi, MD (38:52):
It's hard but you know, speaking of menopause
, I feel like women we have totrain for menopause.
I feel like we have to train,starting in your almost like
your 30s and 40s, like startprioritizing your wellness
because and it's hard those arethe hard years.
You're career building, you'rehaving your families, you're
establishing, you know yourcommunity.
So you know it can be hard butyou can somehow socialize your
(39:20):
wellness and combine them.
You'll do better, you know, andthat might reduce that visceral
weight gain that happens.
That's all insulin resistance.
So it's strength training,protein intake optimizing,
getting good sleep andminimizing the alcohol.
I think those are really theimportant things as I talk to
women who's going intoperimenopause to optimize their
(39:40):
wellness.
Michele Folan (39:41):
Almost every episode now alcohol comes up and
it's an unpopular topic.
I say it all the time.
You know I'm getting eye rollsright now.
I know I can just imagine.
When you and I first spoke backat episode 87, we realized at
that time that Canada had muchmore strict guidelines around
(40:07):
alcohol than the United Statesdid.
And then Surgeon General cameout with their new
recommendation, basically sayingin the United States that no
amount of alcohol is safe andlinked to seven cancers.
Blah, blah, blah.
So it took a while for the USto catch up to Canada on that
(40:28):
one.
But I tell my clients look, I'mnot the person delivering the
no fun news, right?
I'm not saying you can neverhave a drink, but you really
need to think about long-termhealth and also how you're going
(40:49):
to feel the next day, becausewe don't handle alcohol as well
as we did when we were youngerand you had explained to me the
reason why that is.
Sure it's a few reasons.
Supriya Joshi, MD (41:02):
So, first of all, as we get older, we have
less amount of alcoholdehydrogenase, the enzyme that
metabolizes the alcohol.
So you have less of that, soyou're not metabolizing it, it's
still sitting in yourbloodstream, so it lasts longer.
And then, as you also know,over the age of 30, we all start
to lose a percent of musclemass per year, and that goes up
in each decade.
(41:23):
And when we have less musclemass we have overall less body
water, because they're tiedtogether and so now when the
alcohol is in there, it's moreconcentrated.
So the effects of alcohol arejust amplified in women, and
especially as we get older.
So that's the main reason, andI'm sure menopause plays a role
(41:43):
too with estrogen.
Michele Folan (41:45):
We're just blaming it on estrogen and
menopause.
Supriya Joshi, MD (41:48):
But those are the main reasons.
It's related to our muscle massand our metabolism and for some
people, yeah, they're onmedications.
I can then interact with it aswell.
Michele Folan (41:56):
Yeah, so it's a lot of things, but you're not
imagining it.
Let's just put it that way.
No, it's real.
I would love to know how yourown health habits have changed
over the years.
Supriya Joshi, MD (42:09):
I would say, paying way more attention to my
protein intake in the last fewyears, like I don't think I
really thought much aboutprotein before I was.
You know I definitely have beenpaying attention to being more.
You know my diet is more akinto a Mediterranean diet.
I keep my bread intake low, myrefined carbs are low and, yeah,
(42:32):
I do have treats.
So I don't live in a foodprison, but my daily habits have
been that way for a long time.
But more recently, as I wasmentioning just more protein,
I'm trying to get 30 grams ameal and it is hard, so I'm not
a big eater either, so that'shard to do and not having late
night snacking.
That's been an on purpose thingto change because I again want
(42:55):
to optimize my sleep and that'llbe the main one.
I've always exercised regularly,so that's not been a new change
.
But I have shifted what I doand that is I was probably like
you I've seen your posts.
Like I used to run cardio,cardio queen, all the time,
right, but now we're activelystrength training.
I just started working out withthe personal trainers.
(43:16):
I could do heavier things using, doing a squat rack and using
the bells in the gym, because Idon't have that stuff at home,
so it's been fantastic usingdifferent ways to strengthen
muscle groups.
Michele Folan (43:28):
Oh, I love this.
This is great, and this iscoming from a doctor, which I
love because I think there's somuch to learn.
Because you live it every day,you see the long-term benefits
of really taking care ofyourself.
Is there one self-carenon-negotiable that you have?
Supriya Joshi, MD (43:51):
I try to do yoga.
I love hot yoga, so I try to dothat at least once a week.
I used to have a lot more timeyears ago when I would do more
of it, but now I just I have tofit it in with all my spring
training.
It's hard to do it all in aweek.
You can't take care of yourfamily.
But yeah, I try to.
I think a non-negotiable meansI have to get to the hot yoga
(44:11):
studio at least once a week.
Michele Folan (44:12):
Yeah, the yoga thing I got to try to be better
about doing yoga, especially inthe hot yoga.
Supriya Joshi, MD (44:21):
There's also a benefit to sauna right, and
our sauna at home just broke,which is not ideal, but you get
that heat shock proteinactivation in the sauna.
So go to a class and try it thefirst couple of classes.
The first class is really hardbecause you're just sweating,
you're drenched, but you feel sogood when it's done.
Michele Folan (44:41):
You know doing the sauna.
I'm very intrigued about thatand I've thought about joining
the gym up the street because Iknow they have a sauna, because
I want to try that.
Go for it.
It's so relaxing.
Yeah, it's been ages since I'vebeen in a sauna.
All right, Dr Supriya Joshi,where can the listeners find you
?
Sure, they can find me.
Supriya Joshi, MD (45:03):
I have a website.
I'm wwwliverhealthmd.
com, so I finally launched mywebsite literally two weeks ago.
So, and then my handles onTikTok and Instagram are exactly
the same liverhealthmd.
That's where people can find me, and on my website I've got
(45:24):
webinars, information and youfollow me.
I'll be happy to send you someinformation to help you improve
your liver health.
Michele Folan (45:27):
Wonderful, Dr Supriya Joshi, thank you for
being a guest today.
Thank you for having me.
Hey, thanks for tuning in.
Please rate and review the showwhere you listen to the podcast
, and did you know that Askingfor a Friend is available now to
listen on YouTube?
You can subscribe to thepodcast there as well.
Your support is appreciated andit helps others find the show.
(45:55):
Thank you.
Hey there, if you've been watching from the
sidelines telling yourself I'llstart next week or I'll start
when things aren't so crazy inmy life, this is your wake-up
call.
Another year of feelingsluggish, frustrated with belly
and back fat and stuck no thanks, you deserve better, and I've
(00:22):
been where you are.
I know how hard midlife changescan be, but here's the truth.
Your body can feel strong,energized and capable again with
the right strategy and support.
That's exactly what I do in mycoaching.
So stop waiting.
Let's make this the year youactually put yourself first.
(00:42):
My next six-week midlife resetstarts soon, so grab your spot
now.
Just email me at mfolan that'sF as in Frank O-L-A-N.
Fasterway at gmailcom.
Your future self will thank you.
(01:03):
Health, wellness, fitness andeverything in between.
We're removing the taboo fromwhat really matters in midlife.
I'm your host, Michele Folan,and this is Asking for a Friend.
Episode 87 on liver health wasa game changer and it's still
(01:25):
one of the top most listened toepisodes of Asking for a Friend
and honestly, I'm not surprised.
The liver is one of the mostpowerful yet often overlooked
organs when it comes to ouroverall health, especially in
midlife.
As I continue working withclients struggling with
metabolic issues, it's becomeeven more clear that supporting
(01:45):
the liver is key to betterenergy, hormone balance and
long-term wellness.
That's why I knew I had tobring back Dr Supriya Joshi for
a deeper dive into this criticaltopic.
In this episode, we'reunpacking why your liver health
really matters, how it impactseverything from metabolism to
aging, and what simple,practical steps you can take to
(02:07):
keep it thriving.
Dr Supriya Joshi, welcome toAsking for a Friend.
Supriya Joshi, MD (02:13):
Michele, thank you so much for having me
back.
I still remember how much fun Ihad the very first time we
chatted and I'm so grateful thatyour community and people who
are listening to you reallyrealize how important the liver
health can be for their futurehealth.
Michele Folan (02:27):
Well, again, we think of it as that organ that
processes alcohol, right, but ofcourse it does so much more.
Before we start and I do thisevery time I want to get rolling
into the topic, but it would bereally great for the audience
to learn a little bit more aboutyou, namely where you're from,
(02:50):
your background, where youstudied, and then also kind of
like some family details,because people are always
curious.
Supriya Joshi, MD (02:56):
Oh sure.
So I was born and raised in theToronto area in Canada and I
went to medical school, did myresidencies all at the
University of Western Ontario inToronto and I went to medical
school, did my residencies allat the University of Western
Ontario in Toronto and I'm apracticing gastroenterologist
and I did further specializationin liver disease, which took a
lot of years, and I've beeninitially in academic practice,
(03:16):
then moved most of my career tocommunity practice in one of the
largest urban centers outsideToronto and after 20 years in
full-time practice, I just wentpart-time a year ago to focus on
liver disease and metabolichealth and, realizing that
people need more information,I've taken some coursework and
coaching and lifestyle medicine.
I'm hoping to bring moreinformation and education to
(03:39):
empower my patients.
So that's me professionally.
I am married, I have an amazinghusband and partner in life,
I've got three great kids and myeldest is about to go to
university.
So we're at a very excitingphase in our lives and I'm
blessed to have my parentsnearby, who are aging.
I'm sure a lot of us can relateto being in the sandwich
generation and I'm the eldest ofthree siblings and I just love
(04:02):
being active and traveling whenI can.
Michele Folan (04:04):
Oh, wonderful.
And speaking of family, yourecently celebrated a great
aunt's 100th birthday and that'ssuch a huge milestone.
You know what do you feel likemade the biggest difference for
her?
How did she get so inspired toage intentionally?
Supriya Joshi, MD (04:23):
You know it's fascinating.
She's just such a vibrant woman.
She's still vibrant.
You know she's only now beingforced to use a walker, but she
can walk independently and she'sstill very sharp.
But I think her secret isalways learning, always having a
curious mind.
She's a very active reader,very knowledgeable on world
historic events, still remembersevery date to this day and she
(04:48):
is a social butterfly.
Even this past weekend you knowshe wasn't tired we kept asking
are you tired, want to get somerest?
Nope, she is out there tocelebrate and party as much as
she can.
And I remember growing up andvisiting them.
They were always hostingparties.
And I remember growing up andvisiting them.
They were always hostingparties.
So I think that active effortas social connections is a very
(05:09):
big part of her success in lifeand in health, those blue zones.
Michele Folan (05:12):
They talk about community and people that get
out and they go to the coffeeshop.
They're at the market shopping.
You know all those things aresuper important to longevity, so
we can't minimize that.
Supriya Joshi, MD (05:27):
Totally.
She lives her life with as manyfriends as she possibly can.
She's always got visitors, so Ithink that's a big message to
all of us.
You know, don't live inisolation, and if you see
someone reach out and make acomment about them or to them,
that engages someone else aswell, right, versus just walking
by in your own lane.
Michele Folan (05:45):
You know, what I love about following you,
Supriya, is that you aren't justfocused on liver health, you
talk about all aspects ofmidlife health and it just seems
that there's thisinterconnectedness in our bodies
with all these systems.
(06:06):
Can you talk a little bit aboutthat, because I think you going
from being a gastroenterologistto specializing in the liver, I
think there's a tie in here.
Supriya Joshi, MD (06:17):
Absolutely so .
When I see patients with myliver hat on, it's because
there's something going on withtheir liver health, whether it's
fatty liver or growth, or Ihave normal liver tests.
But when I talk about thetreatment, when it comes down to
their lifestyle which is reallya really underlying common
theme for so many diseases wesee today and that many of my
(06:39):
patients already have, when I'mtalking to them, so as a
gastroenterologist and peoplewill come to me with bloating
and heartburn or altered bowelhabit, a lot of the time the fix
is increase your fiber intake,cut back on the processed food
and junk food and sugar.
Same things apply to majorityof causes of liver disease and
the same thing applies toprediabetes, type 2 diabetes,
(07:01):
high blood pressure, highcholesterol, and the end result
here is reducing someone's risksof a cardiovascular fatality.
So there is a connectivenessand you've seen right through it
and it's convincing ourpatients and the community and
the people that there is aconnection and we aren't born
with the destiny to have theseoutcomes, but by making
(07:24):
consistent efforts we canactually alter that life path.
Michele Folan (07:27):
There are detoxes that get advertised out there
and I wanted to bring this upfirst because I see people
talking about them, advertisingthem.
You addressed this on the lastpodcast, but I think it is
important to bring back up again.
Are these liver detoxesnecessary and what is really the
(07:51):
end game with them?
Supriya Joshi, MD (07:53):
Companies that manufacture detoxes, which
is a supplement or a drink orsome concoction they want you to
buy and consume, is nothingmore than them preying on
someone's weaknesses orinability or not having the
knowledge that they can fixthings themselves, and you're
just putting money in their bankaccounts.
(08:15):
So there is nothing people canconsume to detox their liver or
improve their liver and healthby consuming something.
You actually have to pivot andchange what you're normally
eating and drinking and how muchyou move your body and your
sleep quality and your stressors.
So that's the whole basketunder the umbrella of lifestyle
(08:35):
and there's no point in spendingyour money buying these other
concoctions because they're notgoing to do anything.
In fact, they could cause moreharm.
Michele Folan (08:43):
Okay, you brought something up just a second ago
about sleep and stressors.
I don't know a lot of doctorsout there that are really
talking about sleep andstressors.
How does that relate to overallliver health?
Supriya Joshi, MD (09:01):
Oh, a great question, I'm glad you asked
that.
Actually, overall liver healthoh a great question, I'm glad
you asked that actually.
So when we don't sleep well fora variety of reasons whether
it's late night, eating, alcoholconsumption, sleep apnea,
vasomotor symptoms of menopauseor stress, keeping you up at
night when you don't sleep, datashows the next day our core
temperature is a little bitlower and we tend to seek
(09:25):
comfort with comfort foods, andthat can lead to weight gain and
people are less physicallyactive.
So poor sleep can have a roleon how you behave the next day,
and often those behaviors nextday aren't going to lead you to
improved health.
It's more about comfort seeking.
So poor sleep is a directcorrelation with a lot of
(09:47):
leading to a lot of potentialmetabolic dysfunction and weight
gain, and that ties into latenight snacking and eating and,
you know, even alcohol.
So that's one way sleepcontributes.
And then there's the underlyingreason why you're not sleeping,
like if sleep apnea is present.
That's already a manifestationof insulin resistance.
And then we talk about cortisolor stress.
(10:08):
We are tied into cortisol.
We're tied into again it's thehabits that lead people to seek
comfort when they're understress, and maladaptive coping
skills are evident in manypeople.
They just don't realize it, youknow, seeking comfort from
comfort from alcohol or a sugarydrink or a piece of cake or
snacking.
They're not hungry, but they'reseeking comfort and I think
(10:31):
when people are under stressthat's a normal adaptive
behavior for a lot of people.
Michele Folan (10:36):
These are a lot of the same things that I talk
about with my clients is getgood sleep.
You know, when you're stressedyou get cortisol and then you
get more ghrelin and then you'rehungrier and you're making poor
food choices.
So I love this because it'slike if we can all get on the
(10:58):
same page and be speaking thesame language, people will
figure it out, but they're luckyto have you, because you
obviously are very passionateabout this and you really care.
So I do appreciate that let'stalk about fibrosis and fatty
liver, because I believe weprobably need to have some
(11:21):
differentiation here of the two,because I'm not sure we all
really know the differencebetween like fibrosis we think
of there's like we havecirrhosis, right?
Is cirrhosis part of fibrosis?
Supriya Joshi, MD (11:37):
Cirrhosis is the end result of ongoing
progressive liver fibrosis.
I'm happy to explain this.
This is a really importantthing to understand.
So when somebody has adiagnosis of fatty liver, which
means fat, the actual cell is inthe liver and liver fat or
fat's not supposed to be in theliver.
(11:58):
A normal, healthy liver doesnot have that much fat in it.
Under 5% is considered to be innormal health.
So when someone has issues intheir life that allows fat to be
paused in the liver, it's now adisease state.
So just the presence of liverfat means insulin resistance is
(12:18):
present.
Now the other options are thatliver fat just stays there but
the liver disease does notprogress.
So this person has fatty liverbut if they don't change the
reasons why it got there, thenthe liver fat will worsen.
But then there's two avenues ortwo paths to go down, and
(12:38):
sometimes they do overlap.
The first is you just getprogressive liver fat but you
don't get the response of liverfibrosis, liver inflammation or
liver cirrhosis.
So I've got many people thathave fatty liver disease without
fibrosis and I tell them youknow, your liver will last you
your lifetime.
You're not going to lead, getto develop cirrhosis and liver
(13:00):
transplant, and that risk isvery low.
But if you don't make thosechanges of why you got fatty
liver, you're going to go downthis path and develop type 2
diabetes, hypertension and havea higher risk of heart disease
and multiple cancers.
However, we also know thatpeople that have the
comorbidities of type 2 diabetes, obesity and hypertension those
(13:22):
people have the risk factors tohave progression of liver
fibrosis towards liver cirrhosis.
So it's the people that havealready developed multiple
metabolic diseases.
They're the ones at risk ofliver failure, liver cancer and
possibly needing a livertransplant in their lifetime.
So, just to make it clear,people can just have liver fat,
but no progressive liver disease, versus the people who have
(13:46):
progressive liver fibrosisthrough the inflammatory
response and liver scarring.
So there's two trajectories,both of which, though, are also
associated with metabolicdiseases.
Michele Folan (13:57):
Can you reverse fatty liver disease?
Supriya Joshi, MD (14:01):
Yes, and you can also reverse fibrosis if
it's early enough.
How do you do that?
Well, persistent, consistentchanges in whatever has led to
the cause.
So the terminology wasnon-alcoholic fatty liver
disease, but now we realizethere's actually an overlay.
There are people who do drinkalcohol.
Plus they have dysfunctionallifestyles, or dysfunction might
(14:24):
be a bit harsh, but you knownot the most adaptive mechanisms
in their lifestyle.
So you want to minimize andideally abstain from alcohol.
We know that low risk alcoholintake is under two drinks a
week, but none is best.
More than three drinks a weekis where you start to get the
increased risks of heart diseaseand multiple cancers.
So keeping a low is always bestfor overall health.
(14:45):
Then we talk about the othercauses in the lifestyle, and a
big part of it is nutrition andphysical activity and poor sleep
are the biggest factors in allof this, in addition to some
genetics susceptibility in someindividuals.
So when it comes to how youprevent it, I make people aware
well, what are your currenthabits?
(15:06):
You need to haveself-actualization Like what are
the habits you're livingthrough right now, and has it
been this way for the last fewyears, 10 years, your whole life
, or is it just a very recentepisode.
So then we want to know is doyou put sugar in your coffee or
tea?
Do you drink juice?
Do you drink pop?
Do you drink all those fancy,you know Starbucks drinks or
whatever coffee vendor you'regoing to?
And then what do you eat, youknow, are you a bagel, a morning
(15:30):
person?
Are you someone who puts jam ontheir bread every day?
Do you have cereal every day?
And what are your lunch anddinner choices?
And then do you snack and doyou eat late at night?
So that's the whole nutritionalcomponent of it.
And then making people reflectback on that many people did not
get the education onmacronutrients.
There's fats, proteins,carbohydrates, and are you
(15:53):
getting protein in your diet?
Are you getting enough fiber inyour diet?
Are you someone whose plate isfilled with, you know, rice and
beans, or you know, or a big,large bowl of pasta devoid of
any vegetables?
So those are the kind ofquestions people understand what
they're consuming on a regularbasis.
So what are their dietaryhabits?
Then comes are you moving?
(16:15):
Do you walk?
Do you get up after your meals?
Are you sedentary at a desk allday long?
And do you make any specificintentional effort to strengthen
and move your body.
So I think those are the mainthings that we try to focus on
and then often, I hope, a littlealarm bell goes off in their
minds to realize they have tomake some changes.
Michele Folan (16:37):
Yeah, because if you start painting the picture
of what the long-termconsequences are of possibly
liver transplant or somethinglike that, I mean I know that
would scare the heck out of me,but sometimes changing those
habits is a challenge in itself.
Supriya Joshi, MD (16:57):
Absolutely.
And so while they may notnecessarily have to worry about
having end-stage liver disease,but it's in five more years, do
you want to be on sevendifferent pills?
Yeah, you know, and if you canmake these changes, you might
come off some of these pills,and that's really an amazing
thing to think about.
And when we look at the globe,like what is the prevalence here
, 30 to 40% of adults will havemetabolic liver disease and 20%
(17:21):
of them will go on to haveprogressive fibrosis, and that's
the MASH metabolic dysfunctionassociated steatohepatitis, or
MASH, m-a-s-h for short.
And of those people with someelement of inflammation and
fibrosis, 6% are going todevelop end-age liver disease.
So when you look at those sheervolume of number of people
(17:44):
affected by this, this is goingto be a huge problem.
Michele Folan (17:47):
How are you diagnosing liver disease?
Is it blood tests?
Is it an ultrasound?
What's typically the protocolhere?
Sure.
Supriya Joshi, MD (17:57):
So I think, initially because I'm a
specialist people are oftendiagnosed or the alarm goes off
in their primary carepractitioner's office.
So it's most often they've hadblood work done for routine you
know part of their routinephysical or for monitoring of
the side effect of medicationsthey're already on and the liver
enzymes are elevated.
The other scenario is someonecomplaining of abdominal
(18:18):
discomfort and then they go getan ultrasound.
So if you have abnormal liverenzymes, an ultrasound needs to
be done to make sure thatthere's nothing anatomically
infiltrating the liver.
Is it gallstones?
Is there a growth?
That needs to be done?
So that's often how it's firstalerted to the individual and
then they get a furtherinvestigation.
(18:39):
So what is the cause?
Is there alcohol?
Are there any?
You know detoxes, herbaltherapies, supplements you're
taking.
Are there other medications?
You've seen other?
You know caregiver for that youhaven't shared with me.
It's always what are peopleconsuming is always the first
question we really need tointerrogate about.
And then it comes down tolooking for symptoms to be
(19:00):
suggestive of other causes.
You know, have you had healthcare in other countries?
Have you had contaminatedneedles?
You know hepatitis B, hepatitisC.
Have they been ever screenedfor those things before,
especially in the baby boomerpopulation.
You know where they're at riskof hepatitis C just by being a
birth cohort when were you born,where have you traveled?
And those give othersuggestions for viral hepatitis
(19:23):
risks.
And then there's symptoms.
You know, could they haveautoimmune liver disease?
Is there a family history ofliver disease?
And you're looking for geneticcomponents.
And then once we kind of figureout what the cause is, we then
want to know well, what is theseverity?
Do you have fibrosis or not?
Because that is really animportant question.
So that's a combination fromsome blood tests that we do
(19:44):
abdominal ultrasound, and thenfortunately most things today
are non-invasive.
So we can do a fibro scan,which is a non-invasive way to
measure for liver fat andfibrosis stage.
And there's also a blood testpeople can get calculated,
called a FIB4, where they justplug in into the algorithm.
You know their age, theirplatelet count and their AST
(20:06):
values and then that will tellyou are you low risk,
intermediate or high risk forliver fibrosis?
And then for very few people westill need to do a liver biopsy
.
But those are the traditionalways we assess someone for the
cause of their liver disease andwhat their stage is.
Michele Folan (20:24):
You brought up hepatitis and maybe a
differentiation here between Band C would be helpful, and then
kind of the prevalence of itand how often are you seeing it
in your practice?
Supriya Joshi, MD (20:39):
Okay, so we'll get down to the science
here.
So hepatitis B is a DNA virusand hepatitis C is an RNA virus,
and that differentiates them interms of how they work their
way into our bodies.
Both are blood-borne or bodyfluid-based infectious viruses
that enter the body, often withtainted blood.
(20:59):
Hepatitis B is extremely commonin Asia, sub-saharan Africa
versus.
Hepatitis C is pretty mucheverywhere else in the world.
Europe has also been affectedby it, often related to needles
or blood transfusions from wayback, you know, decades ago.
(21:20):
But both these viruses are oftensilent.
They don't cause peoplesymptoms.
Sometimes they might makesomeone have yellowing of the
eyes or jaundice, but most ofthe time there's no symptoms and
it's detectable by screeningfor these antigens or antibodies
and blood tests through liverenzymes and viral counts, and
(21:42):
then, based on that, they canthen be assessed for stage of
liver disease and then go ontowards treatment.
So hepatitis C is now very muchcurable with all oral
medications and as little aseight weeks and hardly any side
effects.
So right now the World HealthOrganization has made a goal to
(22:03):
eradicate hepatitis C from theplanet by 2030.
Oh, wow.
So to do that, we need peopleto be actively screened.
You see, your primary carehealth provider, all you get is
a hepatitis C antibody test andthat will indicate if you are
someone who might be at risk andthen get that confirmed and
treated.
Whereas hepatitis B we have avaccination for.
(22:26):
This can be prevented and somany places around the world do
advocate for vaccination atbirth or around age 12.
That's the other school-agechildren but that's very much
preventable but not curable.
So we have to treat people forhepatitis B.
Michele Folan (22:45):
Thank you for the delineation between the two,
because I never really knew.
So thank you for that.
We're going to take a realquick break and we'll be right
back, and when we come back, Iwant to talk about the
prevalence of liver disease nowin some of our younger people.
Are you feeling overwhelmed bythe changes that come with
(23:08):
midlife, struggling with weight,energy or finding time for
yourself?
You're not alone.
I get it because I've beenthere too.
I specialize in helping midlifewomen, just like you, transform
their health and lives throughpersonalized nutrition and
coaching that fits your reallife.
Together we'll tackle thoseunique challenges, whether it's
(23:30):
balancing your hormones, dealingwith cravings or boosting your
energy.
It's not just about diets.
It's about reclaiming yourstrength and confidence one step
at a time.
Check out the show notes ofthis episode and shoot me an
email.
I'd love to learn more aboutyou and your challenges.
Welcome back to the show.
(23:54):
Before we took a break, Imentioned children, and maybe
even our young adults, about howmuch more prevalent liver
disease is in that group, andI'm making an assumption here
based on the fact that we areseeing diabetes and other
diseases creep into our youthmuch younger because of
(24:17):
lifestyle and our food source.
Are you seeing it in yourpractice?
Supriya Joshi, MD (24:23):
Well, I would have to say at first I'm an
adult specialist so I don't seekids, okay, but I do get
referred, and referred to mewhen they do turn 18.
And we're much more commonlyseeing fatty liver disease being
referred because children.
You know the prevalence ofobesity and being overweight in
children is more than doubledcompared to 1980.
So we are definitely seeing it.
(24:43):
We're seeing children withsignificant liver fibrosis.
We're seeing children with typetwo diabetes, high blood
pressure.
It's quite concerning.
It's very concerning and veryupsetting because it doesn't
need to be this way and it istreatable.
But it's really hard to treatwhen you know kids may not want
treatment at this phase in theirlives.
(25:04):
It's hard for them sometimes tosee where they're headed when
they're so young, and that'sjust an issue with maturity.
Michele Folan (25:10):
When we're looking at treatment.
Are the GLP-1s now part oftreatment for liver disease?
Supriya Joshi, MD (25:18):
Not yet, although I cannot wait for them
to be so.
So the GLP-1s, as you know,have shown evidence for improved
control, for type 2 diabetes,obesity management and, more
recently, even for patients withcardiac disease and for heart
failure, reducing episodes ofheart failure.
There was a trial published inthe New England Journal a few
years ago which failed when itcame to looking at fatty liver
(25:42):
disease, but, as liverspecialists we all knew the
biggest flaw was it just wasn'tlong enough.
It takes decades for liverfibrosis to occur.
It's not going to go away in 12months in the majority of
people or any significant amountof people.
So right now there's a five-yeartrial going on called the ESSEN
study, and the 72-week data wasliterally just put out a few
(26:02):
months ago, and it showed.
So week 72 of this five-yearstudy, there is already a
significant amount ofimprovement.
In fact, it showed about 62% ofindividuals had improvement and
reversal in hepatic fibrosisand about 37% had resolution of
the inflammation from fattyliver disease.
So very exciting.
(26:24):
So that's quite convincing andhopeful that this will be
something that we will have inour armamentarium to treat
people who need a prescriptionfor it.
And it should be clear, though,the people in these trials have
stage two or stage threefibrosis.
Michele Folan (26:39):
Okay, so let me ask this question Is the
reduction in the insulinresistance why this works, or is
it because there's actual GLP-1receptors in the liver?
Supriya Joshi, MD (26:50):
So there actually are not GLP-1 receptors
in the liver.
I think this is all due to theweight loss.
Yeah, okay, it's probably theweight loss effect and caloric
less calories in probably Okay.
Michele Folan (27:00):
I didn't know, because I know there's GLP-1
receptors in the brain and I wasthinking, okay, maybe there are
GLP-1 receptors in other organsas well.
Supriya Joshi, MD (27:09):
Yeah, I think it's all indirect, and it
certainly is from improvinginsulin sensitivity.
That's the main way, right.
You're improving insulinglucose metabolism and the liver
can more appropriately do itscorrect job.
Michele Folan (27:21):
You had brought up sugar and as part of you know
these conversations that youhave with your patients, and I
did a video a couple of weeksago about added sugars in food.
Do you have a recommendationfor a limit in added sugar to
food, and that does not includefruit, as we always try?
Supriya Joshi, MD (27:44):
to preface.
Yeah, so I really do advertiseand educate, but the WHO
guidelines that came out in 2015.
So you know, women should nothave more than you know six
added teaspoons a day, men nine,and children, you know three to
six, so that people can keeptrack of what they're consuming
and make an active effort tostay within that budget.
Michele Folan (28:05):
Okay, so six teaspoons would be about 24
grams, 25 grams of.
Supriya Joshi, MD (28:11):
You got it, four grams of sugar being one
teaspoon.
Everyone has to learn that math.
Michele Folan (28:16):
Yeah, and you know it's frightening because I
did a little comparison of addedsugars based on, like a grande
latte, vanilla latte, and thatwas 20 grams of added sugar
that's almost your wholeallotment for the day.
And like a McDonald's smallsweet tea and I've worked with
(28:41):
people who drank a couple ofthose a day and you think about
those.
Are that hidden, sneaky sugarthat people don't really account
for?
And it's just some of thesejust small, small changes that
we can make in our diets thatcan just pay off so big in the
long run?
Absolutely.
Yeah, you had mentionedsomething about coffee, though
(29:06):
Now we're not talking the sugarystuff from Starbucks.
But what is it about coffeethat is actually recommended for
liver health or just overallhealth?
I?
Supriya Joshi, MD (29:17):
know decaf also has the same capabilities.
Definitely it's one of thepolyphenols, the antioxidants,
and there's another part of thecoffee that is helpful in
reversing hepatic fibrosis andreducing even the risk of liver
cancer.
I should rephrase it doesn'treally reverse fibrosis but it
(29:40):
prevents progression in thefatty liver and reduces cancer
risk.
So there is definite benefit tocoffee and so if people can
tolerate it, if they're coffeedrinkers, I say you know, if you
can get two to three in before2 pm, it might be beneficial for
your health.
And I say that time cut off sothey get good sleep again.
Yeah, I was just going to saywe don't want to disrupt it.
Michele Folan (30:01):
Yeah, we don't want to disrupt your sleep, but
it's okay to get the coffee.
And yeah, and you mentionedearlier too about drug-induced
liver injury.
How common is that and fromwhat is this like supplements?
What are you seeing most often?
Supriya Joshi, MD (30:18):
Well, any medication can cause drug injury
.
So I think that's one part.
But when people, when doctors,are prescribing prescription
drugs, we're very aware whichones might cause a side effect
and the risk benefit has alreadybeen discussed with the patient
.
So if they're on it, we'remonitoring for it.
The issue is when people starttaking supplements because they
think, oh, it's natural, it'sgot to be better than a
(30:40):
prescription.
But what they don't realize,there is absolutely no FDA
regulation.
These have not been studied, andwhen you look at formulations
of herbal therapy or supplements, you're at risk of having
things that are impure.
You have interactions withother, cheaper compounds mixed
in there and you have megadosing.
Some people might think, oh,the more, the better, but
(31:02):
there's not and in fact there'sa lot of ingredients out there
that are very harmful to people,and people need them every day.
I'm talking about green teaextract, turmeric, ashwagandha.
You know these are things youhear people talk about all the
time, but they don't realize itcould cause you harm.
It can even cause, you know,liver failure.
Other ones include, you know,even high doses of turmeric,
(31:25):
black cohosh and red yeast rice.
Those are the ones that we knowcan more commonly lead to liver
dysfunction, especially ifyou're combining that with other
prescriptions that you're on,because they still get filtered
by your liver, they still gothrough the same cytochrome
metabolic pathways andespecially if it's too much.
That can cause dysfunction.
Michele Folan (31:47):
All right, so now you got me a little concerned
because I take turmeric and itdoes help.
It does help with my creakyjoints.
So is there a threshold that weknow like what's too much?
Is it just individual?
You know, I don't know theanswer to that.
Supriya Joshi, MD (32:07):
I think if it's something in a capsule form
, you know you'd have toindividually read about what
what it is you're taking to makesure it's not causing you harm.
All right, yeah, I don't havethat exact answer.
It's, I don't think.
Again, these are not FDAregulated, so we don't know.
Right, oh, and that's true.
Michele Folan (32:23):
I mean, we people ask me about supplements all
the time and I'm like look,number one.
I am not a doctor.
I take a certain number ofthings, but I've been taking
them for a long time.
I've run them by my doctor.
It's an individual choice totake supplements, but you've
(32:45):
really got to do your homework.
Supriya Joshi, MD (32:47):
And that's exactly it, and also disclose it
to your healthcare provider.
It's important to know whatyou're taking, because people
don't realize that supplementscan interact and that would be
really scary, because if you'renot conscious, you can't tell
someone.
Michele Folan (33:04):
You know that you're.
You're right, you can't tellsomeone.
Supriya Joshi, MD (33:09):
You got to tell people share your
information so that they knowwhat you're on, Because we've
had people come in, you know, inliver failure and literally
finding out what they're takingcan be a real challenge.
Michele Folan (33:20):
Yeah, oh, my goodness, hey.
Can you share a patient successstory where they made proactive
changes to reverse their liverdisease?
Supriya Joshi, MD (33:30):
Oh, gosh, I'm so blessed to have so many
stories.
I just I love them.
One of my favorite ones, thatwas just a few weeks ago and
this was someone who wasreferred to me and when he got
the appointment to see me he waswaiting there's still a wait
list.
He was waiting there's still await list.
He was waiting a few months andhe found me on my social media
and actually went through somany of my old posts which I've
(33:51):
only been posting for about ayear and a half now and he
implemented pretty mucheverything and he did not
realize his lifestyle was thatmuch off key, leading to overall
health dysfunction.
He already was hyper, you know,pre-diabetic, he already had
high triglycerides, he had allthese other medical problems and
(34:12):
he started intermittent fasting.
He prioritized protein, tryingto get 100 grams a day,
prioritized fiber, cut back onrefined carbohydrates, exercised
, he started doing strengthtraining.
He did everything, startedtaking vitamin D supplementation
and magnesium glycinate.
So when I see him he does hisblood work for me two weeks
(34:34):
before our appointment, does hisfiber scan right before our
appointment and look at him go,fiber scan's normal.
There's no fibrosis, no liverfat.
His fasting, blood sugar wasnormal, triglycerides were
normal liver enzymes were normaland I asked him what you do,
because I followed everythingyou said and in three months you
lost 25 pounds.
(34:55):
Three months yeah, that'sfantastic he was thrilled and he
goes.
You know it's not hard.
The first couple weeks is hard,like any new.
It just takes doing somethingtwo or three times.
It's a new habit.
So he had a great outlook.
He also was in his forties.
His parents had heart disease.
(35:15):
Both his parents were diabeticand in his mind he goes.
I thought everyone becamediabetic when they're in their
fifties.
He thought that was just anautomatic destiny because
everyone he knew had type 2diabetes at that age.
The light bulb went off.
It's like it doesn't have to bethat way.
Michele Folan (35:34):
You know, I wonder how much better he felt,
too, just overall, that feelingof well-being, by just eating
better, sleeping better, allthose things that you preach on
your Instagram.
He did.
Supriya Joshi, MD (35:48):
His heartburn went away.
His bloating was much better.
Bowel habits improved mentalclarity.
A lot of people report moremental clarity and more focus
when they do intermittentfasting.
Part of it could be this you'renot filling your morning with
sugary cereal and refined carbsthat make you have that sugar
crash.
You know that partly could bewhy, but he felt fantastic.
Michele Folan (36:12):
I love these stories.
Again, this is what I coachwith my you know my clients, so
that they don't have to come seeyou.
You know that's the whole point, right?
Oh my gosh.
Hey, you brought up.
I know part of metabolicdisease is dyslipidemia, and
(36:35):
when our lipids get out of whack, I know that becomes a big
concern, and I've had clientshere who have not gotten a very
good report card from theirdoctor and they want to start
making some changes.
Do me a favor.
Could you shed a little lighton HDL versus triglycerides
(36:57):
versus LDL and what is of mostconcern to you when it comes to
liver disease and what reallyneeds to be treated?
Supriya Joshi, MD (37:07):
Yeah, the metabolic liver disease.
It's from the triglycerides.
Really, that is the biggestthing.
So high triglycerides, and allof this is developed from
increased delivery of free fattyacids to the liver.
The liver is doing its thing.
The LDL and HDL just how thelipid is a vehicle for how it's
carried in delivery to the othersystems in our body.
(37:28):
And we know that you want tohave a lower HDL and a higher
HDL, but they're not all bad.
I think LDL has had a lot ofbad press as well, but it really
is the whole ratio ofeverything.
Your APRA proteins areimportant as well, but, to keep
it simply, when thosetriglycerides are high, you are
heading towards metabolicdisease and worsening metabolic
(37:51):
dysfunction.
So identifying your triggersfor your hypertriglyceridemia is
really the important thing,which is coming from alcohol,
juice, excessive fruit, refinedcarbohydrates, essentially.
Michele Folan (38:04):
Yeah, people, when they think cholesterol,
they automatically think animalfats and that sort of thing, but
that's not necessarily the case.
So thank you for that.
Supriya Joshi, MD (38:13):
And we also know, you know, menopausal women
, they start to get dyslipidemia.
You know it's all very muchconnected.
So, as estrogen is declining,these issues start to occur.
So there's also a hormonalinfluence, you know, and and I
don't know if we talked about itthe last time it was on, but
you know, after the age of 50,that correlates with menopause
(38:34):
for women, and sopost-menopausal women are more
than double to have fatty liverdisease than pre-menopausal
women.
Wow, yeah, so there'sdefinitely the role of reduction
in estrogen and its role withinsulin resistance.
Michele Folan (38:48):
You know we get dealt a bad hand.
Supriya Joshi, MD (38:52):
It's hard but you know, speaking of menopause
, I feel like women we have totrain for menopause.
I feel like we have to train,starting in your almost like
your 30s and 40s, like startprioritizing your wellness
because and it's hard those arethe hard years.
You're career building, you'rehaving your families, you're
establishing, you know yourcommunity.
So you know it can be hard butyou can somehow socialize your
(39:20):
wellness and combine them.
You'll do better, you know, andthat might reduce that visceral
weight gain that happens.
That's all insulin resistance.
So it's strength training,protein intake optimizing,
getting good sleep andminimizing the alcohol.
I think those are really theimportant things as I talk to
women who's going intoperimenopause to optimize their
(39:40):
wellness.
Michele Folan (39:41):
Almost every episode now alcohol comes up and
it's an unpopular topic.
I say it all the time.
You know I'm getting eye rollsright now.
I know I can just imagine.
When you and I first spoke backat episode 87, we realized at
that time that Canada had muchmore strict guidelines around
(40:07):
alcohol than the United Statesdid.
And then Surgeon General cameout with their new
recommendation, basically sayingin the United States that no
amount of alcohol is safe andlinked to seven cancers.
Blah, blah, blah.
So it took a while for the USto catch up to Canada on that
(40:28):
one.
But I tell my clients look, I'mnot the person delivering the
no fun news, right?
I'm not saying you can neverhave a drink, but you really
need to think about long-termhealth and also how you're going
(40:49):
to feel the next day, becausewe don't handle alcohol as well
as we did when we were youngerand you had explained to me the
reason why that is.
Sure it's a few reasons.
Supriya Joshi, MD (41:02):
So, first of all, as we get older, we have
less amount of alcoholdehydrogenase, the enzyme that
metabolizes the alcohol.
So you have less of that, soyou're not metabolizing it, it's
still sitting in yourbloodstream, so it lasts longer.
And then, as you also know,over the age of 30, we all start
to lose a percent of musclemass per year, and that goes up
in each decade.
(41:23):
And when we have less musclemass we have overall less body
water, because they're tiedtogether and so now when the
alcohol is in there, it's moreconcentrated.
So the effects of alcohol arejust amplified in women, and
especially as we get older.
So that's the main reason, andI'm sure menopause plays a role
(41:43):
too with estrogen.
Michele Folan (41:45):
We're just blaming it on estrogen and
menopause.
Supriya Joshi, MD (41:48):
But those are the main reasons.
It's related to our muscle massand our metabolism and for some
people, yeah, they're onmedications.
I can then interact with it aswell.
Michele Folan (41:56):
Yeah, so it's a lot of things, but you're not
imagining it.
Let's just put it that way.
No, it's real.
I would love to know how yourown health habits have changed
over the years.
Supriya Joshi, MD (42:09):
I would say, paying way more attention to my
protein intake in the last fewyears, like I don't think I
really thought much aboutprotein before I was.
You know I definitely have beenpaying attention to being more.
You know my diet is more akinto a Mediterranean diet.
I keep my bread intake low, myrefined carbs are low and, yeah,
(42:32):
I do have treats.
So I don't live in a foodprison, but my daily habits have
been that way for a long time.
But more recently, as I wasmentioning just more protein,
I'm trying to get 30 grams ameal and it is hard, so I'm not
a big eater either, so that'shard to do and not having late
night snacking.
That's been an on purpose thingto change because I again want
(42:55):
to optimize my sleep and that'llbe the main one.
I've always exercised regularly,so that's not been a new change
.
But I have shifted what I doand that is I was probably like
you I've seen your posts.
Like I used to run cardio,cardio queen, all the time,
right, but now we're activelystrength training.
I just started working out withthe personal trainers.
(43:16):
I could do heavier things using, doing a squat rack and using
the bells in the gym, because Idon't have that stuff at home,
so it's been fantastic usingdifferent ways to strengthen
muscle groups.
Michele Folan (43:28):
Oh, I love this.
This is great, and this iscoming from a doctor, which I
love because I think there's somuch to learn.
Because you live it every day,you see the long-term benefits
of really taking care ofyourself.
Is there one self-carenon-negotiable that you have?
Supriya Joshi, MD (43:51):
I try to do yoga.
I love hot yoga, so I try to dothat at least once a week.
I used to have a lot more timeyears ago when I would do more
of it, but now I just I have tofit it in with all my spring
training.
It's hard to do it all in aweek.
You can't take care of yourfamily.
But yeah, I try to.
I think a non-negotiable meansI have to get to the hot yoga
(44:11):
studio at least once a week.
Michele Folan (44:12):
Yeah, the yoga thing I got to try to be better
about doing yoga, especially inthe hot yoga.
Supriya Joshi, MD (44:21):
There's also a benefit to sauna right, and
our sauna at home just broke,which is not ideal, but you get
that heat shock proteinactivation in the sauna.
So go to a class and try it thefirst couple of classes.
The first class is really hardbecause you're just sweating,
you're drenched, but you feel sogood when it's done.
Michele Folan (44:41):
You know doing the sauna.
I'm very intrigued about thatand I've thought about joining
the gym up the street because Iknow they have a sauna, because
I want to try that.
Go for it.
It's so relaxing.
Yeah, it's been ages since I'vebeen in a sauna.
All right, Dr Supriya Joshi,where can the listeners find you
?
Sure, they can find me.
Supriya Joshi, MD (45:03):
I have a website.
I'm wwwliverhealthmd.
com, so I finally launched mywebsite literally two weeks ago.
So, and then my handles onTikTok and Instagram are exactly
the same liverhealthmd.
That's where people can find me, and on my website I've got
(45:24):
webinars, information and youfollow me.
I'll be happy to send you someinformation to help you improve
your liver health.
Michele Folan (45:27):
Wonderful, Dr Supriya Joshi, thank you for
being a guest today.
Thank you for having me.
Hey, thanks for tuning in.
Please rate and review the showwhere you listen to the podcast
, and did you know that Askingfor a Friend is available now to
listen on YouTube?
You can subscribe to thepodcast there as well.
Your support is appreciated andit helps others find the show.
(45:55):
Thank you.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
On Purpose with Jay Shetty
I’m Jay Shetty host of On Purpose the worlds #1 Mental Health podcast and I’m so grateful you found us. I started this podcast 5 years ago to invite you into conversations and workshops that are designed to help make you happier, healthier and more healed. I believe that when you (yes you) feel seen, heard and understood you’re able to deal with relationship struggles, work challenges and life’s ups and downs with more ease and grace. I interview experts, celebrities, thought leaders and athletes so that we can grow our mindset, build better habits and uncover a side of them we’ve never seen before. New episodes every Monday and Friday. Your support means the world to me and I don’t take it for granted — click the follow button and leave a review to help us spread the love with On Purpose. I can’t wait for you to listen to your first or 500th episode!