November 17, 2025 • 12 mins
We break down metabolic-associated steatotic liver disease, why it’s so often missed, and how to catch it early with the right labs and imaging. We explain simple steps to lower risk, the medications with the best evidence, and when to see a specialist.
• What MASLD is and how it progresses
• Why incidental imaging findings matter
• ALT, AST, platelets and what they mean
• Using FIB-4 to estimate fibrosis risk
• How common MASLD is in adults and people with type 2 diabetes
• Evidence-based treatments, from GLP-1s to bariatric surgery
• Lifestyle targets including 5–10% weight loss
• When to ask for GI or hepatology referral
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Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker (00:00):
Welcome to the Modern Metabolic Health Podcast with
your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.
(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medicaltreatments.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.
One of the most overlookedmedical conditions is metabolic
(00:51):
associated steatatotic liverdisease.
Now, if you've never heard ofthat, don't be surprised because
this is a new term for whatused to be called non-alcoholic
fatty liver disease and is oftenshortened to fatty liver
disease.
But metabolic associatedsteatatotic liver disease or
(01:13):
massled, which is what I'll saymoving forward, is extremely
common and again very oftenoverlooked.
As a practicing primary careprovider and board-certified
obesity medicine physician, Isee this condition all of the
time.
And many times it has goneundiagnosed by other providers,
(01:37):
or patients know they have themedical condition, they have
mastled, but they don'tunderstand what it is or what
its implications may be longterm.
So today we're going to talkabout this very important
medical condition.
So you know if you need to bescreened for it, what to look
(01:57):
for if you do have thisdiagnosis, and how you can treat
it and even reverse it toprevent complications.
So to start with thedefinition, massold is an kind
of an umbrella term for multipleconditions and a spectrum of a
disease, really.
So it starts with the fattyinfiltration, or we call it the
(02:21):
steatosis of the liver, and itjust has to be 5% that is seen
on imaging.
So this often occurs ifsomebody gets imaging for
another reason.
If somebody's having belly painand they get an ultrasound or a
CT or an MRI, if that imageincidentally sees batty liver
(02:46):
and that's noted in thedocumentation, then that's
enough for the diagnosis ofmassold because it has at least
5% of the liver is that fattytissue.
So this is sometimes how it'sdiagnosed, just incidentally on
imaging, and it can be easilyoverlooked when, especially when
(03:09):
you're looking for somethingelse.
Especially if you went to theemergency room for this imaging,
they're ruling out the acute,urgent, bad things.
And mastold is a chroniccondition that they often leave
for the primary care provider tomanage.
And they're very busy and maynot be able to see that full
(03:29):
report.
So it's good to know you haveaccess to your lab.
So take a look at that imaging,and if you see a note of fatty
liver, definitely bring that upwith your doctor.
So that's the beginning of thatspectrum of disease, the fatty
liver disease or the steatosis.
Then we see inflammation andfibrosis, the scarring of the
(03:51):
liver after chronicinflammation, it can lead to
that scarring.
Which at this time in themiddle of the disease course,
it's reversible.
And this is when we really needto pay attention and intervene
before we get to the laterstages, which is cirrhosis, and
(04:12):
is almost always irreversible atthat time, and can also lead to
other complications like livercancer can develop in patients
who have cirrhosis and massold.
Not everybody who has thatinitial fatty liver, you know,
(04:34):
noted on imaging is going toprogress to develop to
cirrhosis.
It's about 4% of patients.
We don't right now know exactlywho those patients will be, so
we need to intervene witheverybody to prevent the
progression to cirrhosis andliver cancer.
Another way this is diagnosedis this is with routine labs.
(04:57):
And this is what I alsocommonly see overlooked.
If somebody has a slightlyelevated liver enzyme, the ALT
enzyme is typically what we'relooking for for mastold, and
sometimes even if it's in thenormal range, you can still have
mastold.
But I sometimes see patientshave a little bit elevated
(05:21):
enzyme and they're told, oh,don't worry about it, we'll
watch it over time, repeat nextyear.
But if this is something again,we need to intervene on as soon
as possible.
So if you're looking at yourlabs and you see alanine
aminotransferase ALT for menabove 29 or for women above 19,
(05:45):
you should ask your doctor ifthey think you may have mastold
or fatty liver disease and ifthere is additional testing that
should be done.
The other liver enzyme, theaspartate aminotransferase AST
is typically not as elevated inmastold and it's usually lower
(06:07):
relatively than the ALT.
AST is more sensitive foralcohol use.
So if somebody has alcohol usedisorder and it's affecting
their liver, we usually see theAST number higher than the ALT
number, but both can be elevatedin either condition.
(06:27):
So these are called liverfunction tests, but they're not
really looking at how the liveris functioning.
They're actually a measure ofinflammation in the liver.
So if the liver is inflamed,then it's going to leak these
enzymes.
One way we look at actual liverfunction is how well it is
filtering platelets.
(06:49):
And if we are seeing lowplatelets in your blood cell
counts, then that tells us thatthere is possibly liver
dysfunction, especially forseeing abnormal liver enzymes
along with that.
So if you're seeing low liver,low platelets, that's another
reason to talk to your doctorabout your liver function and
(07:10):
see if you need additionaltesting.
And oftentimes the first stepis repeating these labs.
I usually repeat in one tothree months just to make sure
that they are accurate.
But if these numbers continueto be off, then we really need
to take them seriously.
One of the next steps is to doa calculation called the Fib 4.
(07:32):
You input these numbers intothe Fib 4 calculator, the AST,
ALT, and platelets, and theywill give you a number which
will help to estimate if you areat low risk, intermediate, or
high risk of complications frommassold.
If you're at higher risk forthat fibrosis or scarring, and
(07:55):
if you are at intermediate orhigh risk, you should have
additional testing.
I'm not gonna go into whatthose additional testing
modalities are because it'llvary from location to location
and patient dependent.
But if your doctor, yourprimary care doctor is not
comfortable with that additionaltesting, that's when you need a
referral to agastroenterologist, a GI
(08:18):
specialist, or a liverspecialist, a hepatologist, and
they can order the appropriatetesting for you.
Taking a step back, let'sconsider how common is mastled.
It is extremely common.
It is estimated that one-thirdof American adults have mastold.
And you can see why, and withsomething that is so prevalent,
(08:43):
it may be surprising that morepeople aren't talking about it.
And this just goes into againwhy this is so often overlooked.
Because it is so common andbecause there's not an immediate
effect of this condition, it'snot until years, decades down
the line when there'scomplications.
So it's not an urgent thingthat providers feel like they
(09:06):
need to address right at thattime.
But for you and for yourhealth, it's important to start
addressing earlier rather thanlater.
So one-third of American adultshave mastold, but one half to
two-thirds of patients with type2 diabetes have mastold.
And an estimated one-sixth ofAmerican adults with type 2
(09:27):
diabetes have liver fibrosis.
And fibrosis and cirrhosis frommastold is now the leading
cause of liver failure and whyadults need a liver transplant.
It has surpassedalcohol-induced liver disease.
That is how common and howsignificant this condition is.
(09:49):
So we've talked about what ismastold, what's the spectrum of
disease, how common it is, howto diagnose it, how do we treat
it.
Luckily, we have some optionsat this time.
I think that this is whysometimes this condition was
ignored or you know continues tobe ignored by some primary care
(10:11):
doctors, is becausehistorically we did not have
great treatments for thiscondition or any treatments at
all, other than advising weightloss.
And now we have our GLP1medications, which have been
proven to be extremely promisingin the treatment of mastold.
And personally, I anticipatethat this is going to be an FDA
(10:33):
indication in the very nearfuture.
There have been studies forboth trisepatide and semaglutide
for mastold, and even forpatients who have fibrosis and
cirrhosis, seeing very promisingresults.
Metabolic and bariatric surgerycan also be extremely effective
for the treatment and reversalof mastold.
(10:55):
So that is another great optionfor patients who are struggling
with this very commoncondition.
Some other medications toconsider is one of our older
type 2 diabetes medications, PITglitazone, has some good
evidence for this indication.
And our SGLT2 inhibitors, whichare a newer type 2 diabetes
(11:17):
medication, also have someevidence for mastold.
In general, if we see a weightloss of 5 to 10%, we see
improvements in mastold.
So that's a great goal forweight loss.
That 5 to 10% range, you willsee improvements in your
mastold.
This is an episode that you aredefinitely gonna want to share
(11:39):
with a loved one, family member,friend, coworker because we
need to spread the awareness ofthis condition.
It is so often overlooked, butit is so important to address as
early as possible.
So again, please share withothers so they will know what to
look for and how to manage thiscondition.
(12:01):
I hope you have a beautifulweek.
Talk to you next week.
Thank you for listening andlearning how you can improve
your metabolic health in thismodern world.
If you found this informationhelpful, please share with a
friend, family member, orcolleague.
We need to do all we can tocombat the dangerous
(12:24):
misinformation that is outthere.
Please subscribe and write areview.
This will help others find thepodcast so they may also improve
their metabolic health.
I look forward to ourconversation next week.
Welcome to the Modern Metabolic Health Podcast with
your host, Dr.
Lindsay Ogle, Board CertifiedFamily Medicine and Obesity
Medicine Physician.
Here we learn how we can treatand prevent modern metabolic
conditions such as diabetes,PCOS, fatty liver disease,
metabolic syndrome, sleep apnea,and more.
(00:21):
We focus on optimizinglifestyle while utilizing safe
and effective medicaltreatments.
Please remember that while I ama physician, I am not your
physician.
Everything discussed here isprovided as general medical
knowledge and not direct medicaladvice.
Please talk to your doctorabout what is best for you.
One of the most overlookedmedical conditions is metabolic
(00:51):
associated steatatotic liverdisease.
Now, if you've never heard ofthat, don't be surprised because
this is a new term for whatused to be called non-alcoholic
fatty liver disease and is oftenshortened to fatty liver
disease.
But metabolic associatedsteatatotic liver disease or
(01:13):
massled, which is what I'll saymoving forward, is extremely
common and again very oftenoverlooked.
As a practicing primary careprovider and board-certified
obesity medicine physician, Isee this condition all of the
time.
And many times it has goneundiagnosed by other providers,
(01:37):
or patients know they have themedical condition, they have
mastled, but they don'tunderstand what it is or what
its implications may be longterm.
So today we're going to talkabout this very important
medical condition.
So you know if you need to bescreened for it, what to look
(01:57):
for if you do have thisdiagnosis, and how you can treat
it and even reverse it toprevent complications.
So to start with thedefinition, massold is an kind
of an umbrella term for multipleconditions and a spectrum of a
disease, really.
So it starts with the fattyinfiltration, or we call it the
(02:21):
steatosis of the liver, and itjust has to be 5% that is seen
on imaging.
So this often occurs ifsomebody gets imaging for
another reason.
If somebody's having belly painand they get an ultrasound or a
CT or an MRI, if that imageincidentally sees batty liver
(02:46):
and that's noted in thedocumentation, then that's
enough for the diagnosis ofmassold because it has at least
5% of the liver is that fattytissue.
So this is sometimes how it'sdiagnosed, just incidentally on
imaging, and it can be easilyoverlooked when, especially when
(03:09):
you're looking for somethingelse.
Especially if you went to theemergency room for this imaging,
they're ruling out the acute,urgent, bad things.
And mastold is a chroniccondition that they often leave
for the primary care provider tomanage.
And they're very busy and maynot be able to see that full
(03:29):
report.
So it's good to know you haveaccess to your lab.
So take a look at that imaging,and if you see a note of fatty
liver, definitely bring that upwith your doctor.
So that's the beginning of thatspectrum of disease, the fatty
liver disease or the steatosis.
Then we see inflammation andfibrosis, the scarring of the
(03:51):
liver after chronicinflammation, it can lead to
that scarring.
Which at this time in themiddle of the disease course,
it's reversible.
And this is when we really needto pay attention and intervene
before we get to the laterstages, which is cirrhosis, and
(04:12):
is almost always irreversible atthat time, and can also lead to
other complications like livercancer can develop in patients
who have cirrhosis and massold.
Not everybody who has thatinitial fatty liver, you know,
(04:34):
noted on imaging is going toprogress to develop to
cirrhosis.
It's about 4% of patients.
We don't right now know exactlywho those patients will be, so
we need to intervene witheverybody to prevent the
progression to cirrhosis andliver cancer.
Another way this is diagnosedis this is with routine labs.
(04:57):
And this is what I alsocommonly see overlooked.
If somebody has a slightlyelevated liver enzyme, the ALT
enzyme is typically what we'relooking for for mastold, and
sometimes even if it's in thenormal range, you can still have
mastold.
But I sometimes see patientshave a little bit elevated
(05:21):
enzyme and they're told, oh,don't worry about it, we'll
watch it over time, repeat nextyear.
But if this is something again,we need to intervene on as soon
as possible.
So if you're looking at yourlabs and you see alanine
aminotransferase ALT for menabove 29 or for women above 19,
(05:45):
you should ask your doctor ifthey think you may have mastold
or fatty liver disease and ifthere is additional testing that
should be done.
The other liver enzyme, theaspartate aminotransferase AST
is typically not as elevated inmastold and it's usually lower
(06:07):
relatively than the ALT.
AST is more sensitive foralcohol use.
So if somebody has alcohol usedisorder and it's affecting
their liver, we usually see theAST number higher than the ALT
number, but both can be elevatedin either condition.
(06:27):
So these are called liverfunction tests, but they're not
really looking at how the liveris functioning.
They're actually a measure ofinflammation in the liver.
So if the liver is inflamed,then it's going to leak these
enzymes.
One way we look at actual liverfunction is how well it is
filtering platelets.
(06:49):
And if we are seeing lowplatelets in your blood cell
counts, then that tells us thatthere is possibly liver
dysfunction, especially forseeing abnormal liver enzymes
along with that.
So if you're seeing low liver,low platelets, that's another
reason to talk to your doctorabout your liver function and
(07:10):
see if you need additionaltesting.
And oftentimes the first stepis repeating these labs.
I usually repeat in one tothree months just to make sure
that they are accurate.
But if these numbers continueto be off, then we really need
to take them seriously.
One of the next steps is to doa calculation called the Fib 4.
(07:32):
You input these numbers intothe Fib 4 calculator, the AST,
ALT, and platelets, and theywill give you a number which
will help to estimate if you areat low risk, intermediate, or
high risk of complications frommassold.
If you're at higher risk forthat fibrosis or scarring, and
(07:55):
if you are at intermediate orhigh risk, you should have
additional testing.
I'm not gonna go into whatthose additional testing
modalities are because it'llvary from location to location
and patient dependent.
But if your doctor, yourprimary care doctor is not
comfortable with that additionaltesting, that's when you need a
referral to agastroenterologist, a GI
(08:18):
specialist, or a liverspecialist, a hepatologist, and
they can order the appropriatetesting for you.
Taking a step back, let'sconsider how common is mastled.
It is extremely common.
It is estimated that one-thirdof American adults have mastold.
And you can see why, and withsomething that is so prevalent,
(08:43):
it may be surprising that morepeople aren't talking about it.
And this just goes into againwhy this is so often overlooked.
Because it is so common andbecause there's not an immediate
effect of this condition, it'snot until years, decades down
the line when there'scomplications.
So it's not an urgent thingthat providers feel like they
(09:06):
need to address right at thattime.
But for you and for yourhealth, it's important to start
addressing earlier rather thanlater.
So one-third of American adultshave mastold, but one half to
two-thirds of patients with type2 diabetes have mastold.
And an estimated one-sixth ofAmerican adults with type 2
(09:27):
diabetes have liver fibrosis.
And fibrosis and cirrhosis frommastold is now the leading
cause of liver failure and whyadults need a liver transplant.
It has surpassedalcohol-induced liver disease.
That is how common and howsignificant this condition is.
(09:49):
So we've talked about what ismastold, what's the spectrum of
disease, how common it is, howto diagnose it, how do we treat
it.
Luckily, we have some optionsat this time.
I think that this is whysometimes this condition was
ignored or you know continues tobe ignored by some primary care
(10:11):
doctors, is becausehistorically we did not have
great treatments for thiscondition or any treatments at
all, other than advising weightloss.
And now we have our GLP1medications, which have been
proven to be extremely promisingin the treatment of mastold.
And personally, I anticipatethat this is going to be an FDA
(10:33):
indication in the very nearfuture.
There have been studies forboth trisepatide and semaglutide
for mastold, and even forpatients who have fibrosis and
cirrhosis, seeing very promisingresults.
Metabolic and bariatric surgerycan also be extremely effective
for the treatment and reversalof mastold.
(10:55):
So that is another great optionfor patients who are struggling
with this very commoncondition.
Some other medications toconsider is one of our older
type 2 diabetes medications, PITglitazone, has some good
evidence for this indication.
And our SGLT2 inhibitors, whichare a newer type 2 diabetes
(11:17):
medication, also have someevidence for mastold.
In general, if we see a weightloss of 5 to 10%, we see
improvements in mastold.
So that's a great goal forweight loss.
That 5 to 10% range, you willsee improvements in your
mastold.
This is an episode that you aredefinitely gonna want to share
(11:39):
with a loved one, family member,friend, coworker because we
need to spread the awareness ofthis condition.
It is so often overlooked, butit is so important to address as
early as possible.
So again, please share withothers so they will know what to
look for and how to manage thiscondition.
(12:01):
I hope you have a beautifulweek.
Talk to you next week.
Thank you for listening andlearning how you can improve
your metabolic health in thismodern world.
If you found this informationhelpful, please share with a
friend, family member, orcolleague.
We need to do all we can tocombat the dangerous
(12:24):
misinformation that is outthere.
Please subscribe and write areview.
This will help others find thepodcast so they may also improve
their metabolic health.
I look forward to ourconversation next week.
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