August 5, 2025 • 19 mins
Your liver could be in serious trouble—and you might not even know it. In this episode of The Health Pulse, we uncover the silent but growing epidemic of non-alcoholic steatohepatitis (NASH), the advanced and inflammatory form of non-alcoholic fatty liver disease (NAFLD) now emerging as a leading cause of liver failure worldwide.
We explore how insulin resistance, high-fructose diets, and modern sedentary lifestyles trigger a metabolic cascade that overloads the liver with fat, drives inflammation, and leads to scarring—even in people who feel perfectly healthy. You’ll learn how fructose metabolism, de novo lipogenesis, and oxidative stress play central roles in this condition, and why NASH is so often found in those with type 2 diabetes, obesity, and high triglycerides.
More importantly, we share hopeful, evidence-based strategies to reverse early-stage liver damage—including the benefits of weight loss, low-carb and Mediterranean diets, and regular physical activity, even without major weight change.
If you haven’t checked your liver enzymes lately, this episode could be the nudge that changes everything.
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📅 Book your appointment or learn more at:
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Disclaimer: The information provided in this podcast is for informational purposes only and should not be considered medical advice. The content discussed is based on research, expert insights, and reputable sources, but it does not replace professional medical consultation, diagnosis, or treatment. We strive to present accurate and up-to-date information, medical research is constantly evolving. Listeners should always verify details with trusted health organizations, before making any health-related decisions. If you are experiencing a medical emergency, such as severe pain, difficulty breathing, or other urgent symptoms, call your local emergency services immediately. By listening to this podcast, you acknowledge that The Health Pulse and its creators are not responsible for any actions taken based on the content of this episode. Your health and well-being should always be guided by the advice of qualified medical professionals.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:01):
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:25):
When you hear liver damage, what's the first thing
that probably pops into yourhead?
For most of us it's, you know,a longstanding, maybe
complicated, relationship withalcohol.
Speaker 3 (00:37):
Right, that's the common association.
Speaker 2 (00:39):
But here's the crucial insight we're diving
into today.
There's a rapidly growing kindof silent epidemic of liver
disease, and it's affectingmillions of people who have
never touched a drop of alcohol.
Speaker 3 (00:52):
It's really quite staggering when you look at the
numbers.
Speaker 2 (00:54):
Yeah, we're talking about non-alcoholic
steatohepatitis, or NASH.
It's quietly and wellshockingly quickly becoming one
of the fastest rising pauses ofcirrhosis, liver failure and
even liver transplants worldwide.
Speaker 3 (01:07):
That's correct, a major public health issue
unfolding.
Speaker 2 (01:10):
So our mission today is really to unpack this
stealthy condition.
Nash is often asymptomaticuntil it's dangerously advanced,
which is why it's so importantto understand.
Speaker 3 (01:19):
Absolutely.
Awareness is key.
Speaker 2 (01:21):
We're going to explore exactly what NANISH is,
why it happens, how you candetect it early and, maybe most
importantly, how it can often bereversed, often without
medication.
This deep dive is about givingyou the knowledge to truly take
control of your metabolic future.
Speaker 3 (01:36):
And just to really put the scale of this problem
into perspective, NASH isactually part of a much broader
condition.
It's called non-alcoholic fattyliver disease or NAFLD.
Speaker 2 (01:46):
NAFLD.
Speaker 3 (01:47):
And NAFLD affects astonishing maybe one in three
adults in the United States andpotentially up to 38 percent of
adults globally.
Speaker 2 (01:55):
It's huge Wow, one in three.
Speaker 3 (01:57):
Yeah, but the critical difference and this is
really important is that while asimple fatty liver can
sometimes be relatively harmless, nash involves active
inflammation and scarring.
That's what truly damages theliver over time.
Speaker 2 (02:11):
Okay, so that inflammation part is the danger
zone.
Speaker 3 (02:14):
Precisely.
Speaker 2 (02:15):
So if you're someone who deals with obesity or
insulin resistance or type 2diabetes, this deep diet is
going to be particularly crucialfor you.
Speaker 3 (02:23):
Definitely pay close attention, if that sounds like
you.
Speaker 2 (02:25):
Right, so let's start by clarifying those terms.
We just threw out NAFLD andNASH.
How do they relate and what'sthe crucial difference for our
listeners?
Speaker 3 (02:32):
Yeah, that's a great place to begin.
So NAFLD, or simple steatosis,that's the umbrella term.
It just means there's fatpresent in the liver.
Speaker 2 (02:39):
Okay.
Speaker 3 (02:40):
But crucially, there's no significant
inflammation or damage yet.
Speaker 2 (02:45):
Okay, so step one, just fat accumulation.
Speaker 3 (02:48):
Exactly.
Think of it as maybe a warningsign.
Naish, however, takes that astep further.
It means the fat has actuallytriggered inflammation and liver
cell injury, and in many casesthis also leads to fibrosis,
which is basically scarring ofthe liver tissue.
So, you could say NAFLD is awarning, NASH is the actual
damage occurring.
Speaker 2 (03:08):
Got it.
Warning versus damage, and ifleft unchecked, this condition
can really spiral into somethingfar more serious, can't it?
Speaker 3 (03:16):
Absolutely.
It typically progresses fromthat initial fatty liver, the
steatosis, to NASH, with thatongoing inflammation and damage.
From there it can lead tofibrosis, the scarring we
mentioned, which then canprogress to cirrhosis and that's
advanced, often irreversible,liver damage.
Speaker 2 (03:31):
Irreversible.
Speaker 3 (03:32):
Yeah, and potentially even liver cancer or outright
liver failure.
It's a progressive disease.
If you don't intervene.
Speaker 2 (03:37):
And the numbers on that progression, I mean they're
pretty sobering.
Speaker 3 (03:40):
They really are.
According to the NIH, up to 30%of people with just simple
fatty liver will go on todevelop nanosh 30%.
Wow, and among those who getnanosh up to maybe 20% may
progress all the way tocirrhosis.
What's truly fascinating, andfrankly a bit terrifying, is
that, unlike alcohol-relatedliver disease, where the cause
(04:02):
is often pretty obvious, nash isdriven primarily by metabolic
dysfunction.
Speaker 1 (04:06):
Right, not alcohol.
Speaker 3 (04:08):
Exactly.
This isn't about what you putin your glass, necessarily, but
how your body processes foodenergy, and that makes it
incredibly stealthy often misseduntil it's quite advanced.
Speaker 2 (04:22):
That's the crucial distinction here.
But there's a vital piece ofgood news amidst those numbers,
isn't there?
Speaker 3 (04:25):
Yeah.
Speaker 2 (04:25):
That nananosh, unlike advanced cirrhosis, is
potentially reversible,especially if you catch it early
.
Speaker 3 (04:30):
Precisely that's the hope.
If we intervene before fibrosisbecomes too severe, the liver
has this remarkable capacity toheal itself.
The inflammation can go down,the fat can reduce can reduce.
Speaker 2 (04:45):
Okay, that's really encouraging.
So we've talked about howwidespread natash is and how
it's not alcohol related, butyou mentioned it's driven by
metabolic dysfunction.
Can you help us connect thedots?
How does something like insulinresistance, which many of us
associate with blood sugardirectly, cause liver damage?
Speaker 3 (04:58):
Yeah, it's a very direct connection.
So when your body becomesresistant to insulin, meaning
your cells aren't respondingeffectively to insulin signals
anymore, your liver, it, triesto compensate.
Speaker 2 (05:09):
Okay.
Speaker 3 (05:09):
It starts producing more glucose, even when your
blood sugar is already high,which isn't helpful, right?
It also begins convertingexcess sugar into fat.
There's a specific processcalled de novo lipogenesis,
which literally means new fatcreation right there in the
liver.
Speaker 2 (05:24):
Making fat from sugar .
Speaker 3 (05:26):
Exactly and crucially , your liver also starts
retaining fat within its cells.
It doesn't export it as well.
So over time this buildup offat becomes well toxic to those
liver cells.
It triggers oxidative stress,inflammation and ultimately that
fibrosis or scarring we talkedabout.
Speaker 2 (05:42):
So this is why NASH is so often found alongside
conditions like type 2 diabetesand obesity.
It's all linked.
Speaker 3 (05:48):
Exactly.
This is precisely why NASH isso strongly associated with
things like high fasting insulin, elevated triglycerides,
abdominal obesity andprediabetes or type 2 diabetes.
They're all classic hallmarksof what we call metabolic
syndrome.
It indicates your body isn'tprocessing energy efficiently.
Speaker 2 (06:06):
And when we talk about what actually causes this
metabolic dysfunction in thefirst place?
Diet and lifestyle factors arehuge, aren't they?
Speaker 3 (06:13):
Oh, they are absolutely central.
We're looking at diets high inrefined sugars, especially
fructose, sodas, fruit juices,lots of processed sweeteners.
Speaker 2 (06:22):
Fructose okay.
Speaker 3 (06:23):
Also a high intake of processed foods in general,
unhealthy industrial seed oils,a sedentary lifestyle and just
chronic overconsumption ofcalories, particularly for
individuals who are alreadyinsulin resistant.
Their bodies just can't handlethe load.
Speaker 2 (06:37):
I want to really emphasize your point about
fructose.
You singled that one out.
How is it different from othersugars, like glucose, in terms
of its impact on the liver?
Speaker 3 (06:45):
Yeah, that's a critical distinction.
So, unlike glucose, whichpretty much every cell in your
body can use for energy,fructose is metabolized almost
exclusively by the liver.
Speaker 2 (06:55):
Ah okay, Primarily the liver's job.
Speaker 3 (06:57):
Right and once it gets to the liver it's very
rapidly converted to fat.
It kind of pushes that de novolipogenesis pathway hard.
This makes it a direct andfrankly potent driver of fatty
liver and NASH, bypassing someof the normal metabolic controls
that glucose goes through.
Speaker 2 (07:15):
So it's not just a liver problem, then, is it?
It's almost like fatty liver,and NASH especially, is the
canary in the coal mine for yourentire metabolic system.
Speaker 3 (07:23):
That's a perfect analogy, yeah.
Speaker 2 (07:25):
If your liver is struggling, it's a huge signal
that something bigger is goingon systemically.
Speaker 3 (07:29):
Absolutely.
Many experts now consider fattyliver a clear warning sign that
your entire metabolic system isunder stress.
This affects everything youknow, from your cardiovascular
health to your risk of diabetes,dementia, other issues.
The key message here for youlistening, is this If you have
insulin resistance, maybe hightriglycerides or central obesity
(07:50):
the belly fat you may alreadybe at risk for NADH, even if you
feel perfectly healthy rightnow.
Speaker 2 (07:55):
Which leads us to the symptoms or lack thereof.
One of the most dangerousthings about NADatch is how
quietly it progresses.
I mean, someone could have itfor years and feel completely
normal, right.
Speaker 3 (08:07):
You're absolutely right.
Most patients feel completelynormal in the early stages,
which is why it's so oftendiscovered, frankly, by accident
, maybe during routine tests.
For something else entirely Ifsymptoms do occur early on, they
tend to be very, very vague.
Speaker 2 (08:22):
So someone could experience, say, chronic fatigue
, maybe a bit of vaguediscomfort, maybe even
unexplained weight gain, andjust kind of attribute it to
getting older or being busy,right?
Speaker 3 (08:32):
Yeah.
Speaker 2 (08:32):
How often do you see patients surprised by this
diagnosis because they felt fine?
Speaker 3 (08:36):
It happens all the time.
Yeah, early symptoms, if theyexist, can be things like just
mild discomfort or a feeling offullness in the upper right
abdomen, where the liver is, orsometimes you see those darkened
skin patches known asacanthosis nigricans, often on
the neck or underarms.
Those are actually related tothe underlying insulin
resistance.
Speaker 2 (08:55):
Okay, a skin sign.
Speaker 3 (08:57):
Yeah, but it really raises this important question
If symptoms are so vague or evennon-existent early on, how do
you even begin to know you mighthave it?
Speaker 2 (09:06):
And here's the truly alarming part right by the time,
more serious, obvious symptomsappear like fluid buildup in the
abdomen, jaundice yellowingskin or even confusion.
The disease has oftenprogressed to advanced fibrosis
or full-blown cirrhosis.
Speaker 3 (09:22):
Exactly At that point , options become much more
limited.
That's where lab clues becomeabsolutely vital for early
detection.
Speaker 2 (09:28):
OK, labs are key.
Speaker 3 (09:29):
Key findings often include elevated ALT and AST.
Those are liver enzymes.
In fact, NASH is now the mostcommon cause of abnormal liver
enzymes in the US.
Speaker 2 (09:38):
Most common cause, more than alcohol or viruses.
Speaker 3 (09:41):
Currently yes for unexplained elevations in the US
.
Most common cause More thanalcohol or viruses.
Currently yes for unexplainedelevations in many populations.
Other important clues we lookfor are high fasting insulin and
triglycerides, often low HDLcholesterol the good cholesterol
and maybe elevated GGT orlevels as well.
And then imaging tools likeultrasound FibroScan, which
measures liver stiffness, or MRIelastography can also help
(10:03):
detect fatty liver or fibrosisnon-invasively.
Speaker 2 (10:07):
So how does this translate to your personal
health picture?
What it means is you can haveprogressive liver damage
happening silently and feelcompletely fine.
Speaker 3 (10:16):
That's the takeaway.
Speaker 2 (10:17):
Which is why proactive lab testing is so
essential, especially if youhave those risk factors like
insulin resistance or metabolicsyndrome.
Speaker 3 (10:24):
Absolutely crucial.
Don't wait for symptoms.
Speaker 2 (10:26):
Since symptoms are so unreliable in the early stages,
what specific lab tests shouldour listeners maybe be asking
their doctors about fordetection?
Speaker 3 (10:34):
Yeah, absolutely so.
The core blood tests we oftenstart with for suspected NASH
include ALT, that's alanineaminotransferase, and AST,
aspartate aminotransferase.
Speaker 2 (10:42):
The liver enzymes.
Speaker 3 (10:43):
Those are the main liver enzymes.
Yeah, elevated levels are oftenthe first sign of fatty liver
and ALT is usually considered abit more liver-specific than AST
.
Speaker 2 (10:51):
Okay.
Speaker 3 (10:52):
Then there's GGT or gamma-glutamyl transferase.
That's also important.
It can be elevated in manyliver conditions and often
reflects oxidative stresshappening in the liver.
Speaker 2 (11:02):
GGT got it.
Speaker 3 (11:03):
High ferritin levels can sometimes signal
inflammation or iron overload,both of which can be related to.
Speaker 2 (11:09):
NASH.
Speaker 3 (11:09):
Okay, and of course, fasting.
Insulin and glucose areabsolutely crucial.
We use those to calculatesomething called OPAIR.
Speaker 2 (11:17):
Homeir yeah.
Speaker 3 (11:18):
It stands for homeostatic model assessment for
insulin resistance.
It's a really good early markerof that underlying insulin
resistance which, as we said,drives the fat accumulation in
the liver.
Speaker 2 (11:28):
Makes sense.
So you need insulin and glucosetogether.
Speaker 3 (11:31):
Correct.
And finally, your standardlipid panel.
Specifically, triglycerides andHDL are often abnormal in
people with NASH or metabolicsyndrome.
High triglycerides, low HDL arecommon patterns.
Right, the classic metabolicsyndrome High triglycerides low
HDL are common patterns.
Speaker 2 (11:43):
Right, the classic metabolic syndrome pattern.
Speaker 3 (11:44):
Exactly, and beyond those basic blood tests, there
are also some specializednon-invasive fibrosis scores
that can help us assess risk abit deeper without needing a
biopsy right away.
Speaker 2 (11:54):
Oh, interesting Like what.
Speaker 3 (11:56):
Well, there's the FA4 index.
It uses your age, ast, alt andyour platelet count to estimate
fibrosis risk.
Speaker 2 (12:04):
Okay.
Speaker 3 (12:05):
And another one is the NAFLD fibrosis score, or NFS
.
That combines multiple markerslike BMI, glucose levels, liver
enzymes, age, platelet count andalbumin.
Both of these are calculations.
They're non-invasive and theycan help guide decisions like
determining if maybe moreadvanced imaging or rarely a
biopsy might be needed.
Speaker 2 (12:24):
And speaking of advanced testing, are there
situations where more in-depthimaging is necessary?
Speaker 3 (12:28):
Yes, sometimes, while not always needed up front,
some patients might benefit from, say, an ultrasound or a
FibroScan to get a better lookat the liver texture and check
for stiffness, which indicatesfibrosis.
Speaker 2 (12:40):
FibroScan measures stiffness.
Speaker 3 (12:42):
Yes, it's a type of ultrasound technology that does
that, and ostography MRI canalso provide even more precise
fibrosis staging if needed, andlook in very rare, uncertain
cases, a liver biopsy mightstill be performed for a
definitive diagnosis.
But honestly, with these newernon-invasive tools, it's
becoming less common than itused to be.
Speaker 2 (13:02):
That's good news.
Fewer biopsies Definitely.
So the crucial implication hereis really clear the earlier you
catch NARASH, the easier it isto potentially reverse.
And those first signs are oftenhiding in your lab work, not in
how you feel day to day.
Speaker 3 (13:17):
That's exactly right, which leads us to, I think, the
most hopeful part of our deepdive.
Yeah, narash is, unlikeadvanced cirrhosis, which often
involves permanent scarring, theinflammation and the fat
accumulation that definenanorash can improve
significantly.
Speaker 2 (13:32):
Yeah.
Speaker 3 (13:32):
And the way to do that is by targeting the root
cause, that metabolicdysfunction we've been talking
about.
Speaker 2 (13:37):
Okay, so targeting the root cause.
What's truly empowering aboutall of this is the idea that the
path to healing your livermight not start with a
prescription pad at all.
Where do you begin whentackling Menesh?
Speaker 3 (13:49):
naturally, you almost always begin with weight loss.
Assuming weight is an issue,which it often is.
Clinical studies are very clearon this Losing just 5 to 10
percent of your body weight cansignificantly reduce liver fat,
improve the inflammation andeven reverse early fibrosis.
Speaker 2 (14:04):
Just 5 to 10 percent.
That sounds achievable for manypeople.
Speaker 3 (14:08):
It is, and the data supports specific targets.
For example, losing just 5percent or more of body weight
can noticeably reduce liver fat.
Getting to 7 percent or moreoften improves the actual NASH
histology, the inflammation andcell injury, and achieving 10
percent weight loss or more mayeven lead to reversal of
fibrosis in some cases.
Speaker 2 (14:26):
That sounds incredibly promising that NASH
is irreversible with theselifestyle changes.
But you know, for someone who'smaybe struggled with weight
loss before, what are some ofthe biggest hurdles they might
face and how can they overcomethem.
Speaker 3 (14:38):
Yeah, that's a vital question, because knowing what
to do is different from doing itconsistently.
The biggest hurdles are often,well, consistency itself and
breaking ingrained habits.
It's really not about crashdieting or extreme measures
those rarely last.
It's about finding sustainable,nutrient-dense ways of eating
and incorporating consistentphysical activity into your
(15:01):
daily life.
Speaker 2 (15:01):
Sustainability is key .
Speaker 3 (15:03):
Absolutely Focusing on whole foods, really
minimizing or eliminating thoseultra-processed items and
prioritizing daily movement,even just walking.
It's those small, consistentchanges that add up to profound
results over time.
Speaker 2 (15:16):
And when it comes to the best diets for liver health,
are there specific approachesthat show particularly strong
evidence?
Speaker 3 (15:23):
Yeah, there are a couple of dietary patterns that
consistently show strongevidence for improving liver
health.
In the context of NFLD and NASH, low-carb or ketogenic diets
have been shown quiteeffectively to reduce insulin
resistance and also decreasethat fat production.
The de novo lipogenesis in theliver Studies show they can
improve ALT, triglycerides andliver fat, sometimes within just
(15:43):
a few weeks.
Speaker 2 (15:44):
Wow Weeks.
Speaker 3 (15:46):
Yeah, can be quite rapid.
The other well-studied approachis the Mediterranean diet.
Speaker 2 (15:50):
Ah, the Mediterranean , Exactly.
Speaker 3 (15:52):
Rich in monounsaturated fats from olive
oil, lots of fiber fromvegetables, fruits, legumes,
nuts and plenty of antioxidants.
It's consistently linked tolower liver fat, better glucose
control and reduced inflammationmarkers.
Speaker 2 (16:08):
So different approaches, but is there a
common thread?
Speaker 3 (16:10):
Absolutely.
The common thread between bothsuccessful approaches is clear
they are naturally low in addedsugars, especially fructose, low
in refined grains andultra-processed foods, and high
in nutrient density from wholefoods.
That seems to be the magiccombination.
Speaker 2 (16:24):
Makes sense.
Are there any supplements thatmight offer support?
Always with the caveat, ofcourse, to consult a health care
provider first before startinganything new.
Speaker 3 (16:32):
Yes, definitely consult your provider, but there
are some supplements withemerging and, in some cases,
decent evidence.
We're talking about things likeomega-3 fatty acids,
particularly EPA and DHA, whichcan help reduce liver fat and
triglycerides.
Speaker 2 (16:46):
Okay, omega-3s.
Speaker 3 (16:47):
Vitamin E, which is a potent antioxidant, has shown
benefit, particularly innon-diabetic patients with NASH,
though there are some safetyconsiderations at high doses.
Berberine is anotherinteresting one.
It's a plant compound thatseems to improve insulin
sensitivity and lipid metabolism, and also NAC, or
N-acetylcysteine NAC yeah, it'sa precursor to glutathione, a
(17:09):
major antioxidant in the body,and it supports liver detox
pathways.
So these can be supportiveelements within a broader
lifestyle approach, but theyaren't magic bullets on their
own.
Lifestyle is foundational.
Speaker 2 (17:19):
Right Lifestyle first , and let's not forget exercise.
You mentioned it earlier.
Independent of weight loss,what kind of impact can just
physical activity have on itsown?
Speaker 3 (17:29):
It's significant.
Even without moving the scale,much exercise has independent
benefits.
Just 20 to 30 minutes a day ofmoderate activity like brisk
walking, or adding in somestrength training or interval
training, can make a measurableimpact on reducing liver fat and
improving insulin sensitivity.
Speaker 2 (17:45):
So you don't have to become like an elite athlete.
Speaker 3 (17:48):
Not at all.
Consistency is really the keyFinding something you enjoy and
can stick with.
It really boils down to thesewell, seemingly simple choices,
doesn't it?
Cutting down on sugar, eatingreal food, getting active it
almost sounds too simple forsuch a serious condition.
Is that part of the challengethat people underestimate the
(18:09):
power of these fundamentalchanges?
Speaker 2 (18:11):
I think you're right Sometimes the simplest solutions
are actually the hardest tostick with consistently.
But what you're saying is, withthat consistency, with those
lifestyle changes and maybeusing lab testing to guide the
way, many patients can seereally dramatic improvements in
their Nahash markers withinmonths.
Speaker 3 (18:27):
Absolutely.
It's incredibly empowering.
So just to kind of connect thisall back to the bigger picture
Nashash really is a silentthreat.
Speaker 1 (18:33):
Yes.
Speaker 3 (18:33):
But it's also a very clear warning sign that your
body's entire metabolic systemis under significant pressure.
Speaker 2 (18:39):
But the truly good news, the hopeful message here,
is that it is treatable andoften reversible, especially
when you catch it early throughthat proactive lab testing and
make those consistent lifestylechanges.
You don't necessarily need aprescription medication to start
healing your liver.
What you need is good data,clear direction and, most
importantly, that, day-inday-out consistency.
Speaker 3 (19:02):
Couldn't agree more.
And if you're listening andwondering how to get started
with getting that crucial data,maybe consider exploring options
like at-home lab testing forthose key markers liver enzymes,
insulin resistance markers likeHOMA, ir inflammation markers.
It can give you those crucialinsights into your current
metabolic health.
Speaker 2 (19:19):
Right.
Knowledge is power here.
Ultimately, when you spot NASHearly and you take action, you
don't just save your liver, youreally save your entire
metabolic future.
So the question for you is whatstands out to you most about
this silent threat and what willbe your first step toward
protecting your metabolic future?
Speaker 1 (19:37):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
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Stay informed, stay healthy andwe'll catch you in the next
episode.
Welcome to the Health Pulse, your go-to source for
quick, actionable insights onhealth, wellness and diagnostics
.
Whether you're looking tooptimize your well-being or stay
informed about the latest inmedical testing, we've got you
covered.
Join us as we break down keyhealth topics in just minutes.
Let's dive in.
Speaker 2 (00:25):
When you hear liver damage, what's the first thing
that probably pops into yourhead?
For most of us it's, you know,a longstanding, maybe
complicated, relationship withalcohol.
Speaker 3 (00:37):
Right, that's the common association.
Speaker 2 (00:39):
But here's the crucial insight we're diving
into today.
There's a rapidly growing kindof silent epidemic of liver
disease, and it's affectingmillions of people who have
never touched a drop of alcohol.
Speaker 3 (00:52):
It's really quite staggering when you look at the
numbers.
Speaker 2 (00:54):
Yeah, we're talking about non-alcoholic
steatohepatitis, or NASH.
It's quietly and wellshockingly quickly becoming one
of the fastest rising pauses ofcirrhosis, liver failure and
even liver transplants worldwide.
Speaker 3 (01:07):
That's correct, a major public health issue
unfolding.
Speaker 2 (01:10):
So our mission today is really to unpack this
stealthy condition.
Nash is often asymptomaticuntil it's dangerously advanced,
which is why it's so importantto understand.
Speaker 3 (01:19):
Absolutely.
Awareness is key.
Speaker 2 (01:21):
We're going to explore exactly what NANISH is,
why it happens, how you candetect it early and, maybe most
importantly, how it can often bereversed, often without
medication.
This deep dive is about givingyou the knowledge to truly take
control of your metabolic future.
Speaker 3 (01:36):
And just to really put the scale of this problem
into perspective, NASH isactually part of a much broader
condition.
It's called non-alcoholic fattyliver disease or NAFLD.
Speaker 2 (01:46):
NAFLD.
Speaker 3 (01:47):
And NAFLD affects astonishing maybe one in three
adults in the United States andpotentially up to 38 percent of
adults globally.
Speaker 2 (01:55):
It's huge Wow, one in three.
Speaker 3 (01:57):
Yeah, but the critical difference and this is
really important is that while asimple fatty liver can
sometimes be relatively harmless, nash involves active
inflammation and scarring.
That's what truly damages theliver over time.
Speaker 2 (02:11):
Okay, so that inflammation part is the danger
zone.
Speaker 3 (02:14):
Precisely.
Speaker 2 (02:15):
So if you're someone who deals with obesity or
insulin resistance or type 2diabetes, this deep diet is
going to be particularly crucialfor you.
Speaker 3 (02:23):
Definitely pay close attention, if that sounds like
you.
Speaker 2 (02:25):
Right, so let's start by clarifying those terms.
We just threw out NAFLD andNASH.
How do they relate and what'sthe crucial difference for our
listeners?
Speaker 3 (02:32):
Yeah, that's a great place to begin.
So NAFLD, or simple steatosis,that's the umbrella term.
It just means there's fatpresent in the liver.
Speaker 2 (02:39):
Okay.
Speaker 3 (02:40):
But crucially, there's no significant
inflammation or damage yet.
Speaker 2 (02:45):
Okay, so step one, just fat accumulation.
Speaker 3 (02:48):
Exactly.
Think of it as maybe a warningsign.
Naish, however, takes that astep further.
It means the fat has actuallytriggered inflammation and liver
cell injury, and in many casesthis also leads to fibrosis,
which is basically scarring ofthe liver tissue.
So, you could say NAFLD is awarning, NASH is the actual
damage occurring.
Speaker 2 (03:08):
Got it.
Warning versus damage, and ifleft unchecked, this condition
can really spiral into somethingfar more serious, can't it?
Speaker 3 (03:16):
Absolutely.
It typically progresses fromthat initial fatty liver, the
steatosis, to NASH, with thatongoing inflammation and damage.
From there it can lead tofibrosis, the scarring we
mentioned, which then canprogress to cirrhosis and that's
advanced, often irreversible,liver damage.
Speaker 2 (03:31):
Irreversible.
Speaker 3 (03:32):
Yeah, and potentially even liver cancer or outright
liver failure.
It's a progressive disease.
If you don't intervene.
Speaker 2 (03:37):
And the numbers on that progression, I mean they're
pretty sobering.
Speaker 3 (03:40):
They really are.
According to the NIH, up to 30%of people with just simple
fatty liver will go on todevelop nanosh 30%.
Wow, and among those who getnanosh up to maybe 20% may
progress all the way tocirrhosis.
What's truly fascinating, andfrankly a bit terrifying, is
that, unlike alcohol-relatedliver disease, where the cause
(04:02):
is often pretty obvious, nash isdriven primarily by metabolic
dysfunction.
Speaker 1 (04:06):
Right, not alcohol.
Speaker 3 (04:08):
Exactly.
This isn't about what you putin your glass, necessarily, but
how your body processes foodenergy, and that makes it
incredibly stealthy often misseduntil it's quite advanced.
Speaker 2 (04:22):
That's the crucial distinction here.
But there's a vital piece ofgood news amidst those numbers,
isn't there?
Speaker 3 (04:25):
Yeah.
Speaker 2 (04:25):
That nananosh, unlike advanced cirrhosis, is
potentially reversible,especially if you catch it early
.
Speaker 3 (04:30):
Precisely that's the hope.
If we intervene before fibrosisbecomes too severe, the liver
has this remarkable capacity toheal itself.
The inflammation can go down,the fat can reduce can reduce.
Speaker 2 (04:45):
Okay, that's really encouraging.
So we've talked about howwidespread natash is and how
it's not alcohol related, butyou mentioned it's driven by
metabolic dysfunction.
Can you help us connect thedots?
How does something like insulinresistance, which many of us
associate with blood sugardirectly, cause liver damage?
Speaker 3 (04:58):
Yeah, it's a very direct connection.
So when your body becomesresistant to insulin, meaning
your cells aren't respondingeffectively to insulin signals
anymore, your liver, it, triesto compensate.
Speaker 2 (05:09):
Okay.
Speaker 3 (05:09):
It starts producing more glucose, even when your
blood sugar is already high,which isn't helpful, right?
It also begins convertingexcess sugar into fat.
There's a specific processcalled de novo lipogenesis,
which literally means new fatcreation right there in the
liver.
Speaker 2 (05:24):
Making fat from sugar .
Speaker 3 (05:26):
Exactly and crucially , your liver also starts
retaining fat within its cells.
It doesn't export it as well.
So over time this buildup offat becomes well toxic to those
liver cells.
It triggers oxidative stress,inflammation and ultimately that
fibrosis or scarring we talkedabout.
Speaker 2 (05:42):
So this is why NASH is so often found alongside
conditions like type 2 diabetesand obesity.
It's all linked.
Speaker 3 (05:48):
Exactly.
This is precisely why NASH isso strongly associated with
things like high fasting insulin, elevated triglycerides,
abdominal obesity andprediabetes or type 2 diabetes.
They're all classic hallmarksof what we call metabolic
syndrome.
It indicates your body isn'tprocessing energy efficiently.
Speaker 2 (06:06):
And when we talk about what actually causes this
metabolic dysfunction in thefirst place?
Diet and lifestyle factors arehuge, aren't they?
Speaker 3 (06:13):
Oh, they are absolutely central.
We're looking at diets high inrefined sugars, especially
fructose, sodas, fruit juices,lots of processed sweeteners.
Speaker 2 (06:22):
Fructose okay.
Speaker 3 (06:23):
Also a high intake of processed foods in general,
unhealthy industrial seed oils,a sedentary lifestyle and just
chronic overconsumption ofcalories, particularly for
individuals who are alreadyinsulin resistant.
Their bodies just can't handlethe load.
Speaker 2 (06:37):
I want to really emphasize your point about
fructose.
You singled that one out.
How is it different from othersugars, like glucose, in terms
of its impact on the liver?
Speaker 3 (06:45):
Yeah, that's a critical distinction.
So, unlike glucose, whichpretty much every cell in your
body can use for energy,fructose is metabolized almost
exclusively by the liver.
Speaker 2 (06:55):
Ah okay, Primarily the liver's job.
Speaker 3 (06:57):
Right and once it gets to the liver it's very
rapidly converted to fat.
It kind of pushes that de novolipogenesis pathway hard.
This makes it a direct andfrankly potent driver of fatty
liver and NASH, bypassing someof the normal metabolic controls
that glucose goes through.
Speaker 2 (07:15):
So it's not just a liver problem, then, is it?
It's almost like fatty liver,and NASH especially, is the
canary in the coal mine for yourentire metabolic system.
Speaker 3 (07:23):
That's a perfect analogy, yeah.
Speaker 2 (07:25):
If your liver is struggling, it's a huge signal
that something bigger is goingon systemically.
Speaker 3 (07:29):
Absolutely.
Many experts now consider fattyliver a clear warning sign that
your entire metabolic system isunder stress.
This affects everything youknow, from your cardiovascular
health to your risk of diabetes,dementia, other issues.
The key message here for youlistening, is this If you have
insulin resistance, maybe hightriglycerides or central obesity
(07:50):
the belly fat you may alreadybe at risk for NADH, even if you
feel perfectly healthy rightnow.
Speaker 2 (07:55):
Which leads us to the symptoms or lack thereof.
One of the most dangerousthings about NADatch is how
quietly it progresses.
I mean, someone could have itfor years and feel completely
normal, right.
Speaker 3 (08:07):
You're absolutely right.
Most patients feel completelynormal in the early stages,
which is why it's so oftendiscovered, frankly, by accident
, maybe during routine tests.
For something else entirely Ifsymptoms do occur early on, they
tend to be very, very vague.
Speaker 2 (08:22):
So someone could experience, say, chronic fatigue
, maybe a bit of vaguediscomfort, maybe even
unexplained weight gain, andjust kind of attribute it to
getting older or being busy,right?
Speaker 3 (08:32):
Yeah.
Speaker 2 (08:32):
How often do you see patients surprised by this
diagnosis because they felt fine?
Speaker 3 (08:36):
It happens all the time.
Yeah, early symptoms, if theyexist, can be things like just
mild discomfort or a feeling offullness in the upper right
abdomen, where the liver is, orsometimes you see those darkened
skin patches known asacanthosis nigricans, often on
the neck or underarms.
Those are actually related tothe underlying insulin
resistance.
Speaker 2 (08:55):
Okay, a skin sign.
Speaker 3 (08:57):
Yeah, but it really raises this important question
If symptoms are so vague or evennon-existent early on, how do
you even begin to know you mighthave it?
Speaker 2 (09:06):
And here's the truly alarming part right by the time,
more serious, obvious symptomsappear like fluid buildup in the
abdomen, jaundice yellowingskin or even confusion.
The disease has oftenprogressed to advanced fibrosis
or full-blown cirrhosis.
Speaker 3 (09:22):
Exactly At that point , options become much more
limited.
That's where lab clues becomeabsolutely vital for early
detection.
Speaker 2 (09:28):
OK, labs are key.
Speaker 3 (09:29):
Key findings often include elevated ALT and AST.
Those are liver enzymes.
In fact, NASH is now the mostcommon cause of abnormal liver
enzymes in the US.
Speaker 2 (09:38):
Most common cause, more than alcohol or viruses.
Speaker 3 (09:41):
Currently yes for unexplained elevations in the US
.
Most common cause More thanalcohol or viruses.
Currently yes for unexplainedelevations in many populations.
Other important clues we lookfor are high fasting insulin and
triglycerides, often low HDLcholesterol the good cholesterol
and maybe elevated GGT orlevels as well.
And then imaging tools likeultrasound FibroScan, which
measures liver stiffness, or MRIelastography can also help
(10:03):
detect fatty liver or fibrosisnon-invasively.
Speaker 2 (10:07):
So how does this translate to your personal
health picture?
What it means is you can haveprogressive liver damage
happening silently and feelcompletely fine.
Speaker 3 (10:16):
That's the takeaway.
Speaker 2 (10:17):
Which is why proactive lab testing is so
essential, especially if youhave those risk factors like
insulin resistance or metabolicsyndrome.
Speaker 3 (10:24):
Absolutely crucial.
Don't wait for symptoms.
Speaker 2 (10:26):
Since symptoms are so unreliable in the early stages,
what specific lab tests shouldour listeners maybe be asking
their doctors about fordetection?
Speaker 3 (10:34):
Yeah, absolutely so.
The core blood tests we oftenstart with for suspected NASH
include ALT, that's alanineaminotransferase, and AST,
aspartate aminotransferase.
Speaker 2 (10:42):
The liver enzymes.
Speaker 3 (10:43):
Those are the main liver enzymes.
Yeah, elevated levels are oftenthe first sign of fatty liver
and ALT is usually considered abit more liver-specific than AST
.
Speaker 2 (10:51):
Okay.
Speaker 3 (10:52):
Then there's GGT or gamma-glutamyl transferase.
That's also important.
It can be elevated in manyliver conditions and often
reflects oxidative stresshappening in the liver.
Speaker 2 (11:02):
GGT got it.
Speaker 3 (11:03):
High ferritin levels can sometimes signal
inflammation or iron overload,both of which can be related to.
Speaker 2 (11:09):
NASH.
Speaker 3 (11:09):
Okay, and of course, fasting.
Insulin and glucose areabsolutely crucial.
We use those to calculatesomething called OPAIR.
Speaker 2 (11:17):
Homeir yeah.
Speaker 3 (11:18):
It stands for homeostatic model assessment for
insulin resistance.
It's a really good early markerof that underlying insulin
resistance which, as we said,drives the fat accumulation in
the liver.
Speaker 2 (11:28):
Makes sense.
So you need insulin and glucosetogether.
Speaker 3 (11:31):
Correct.
And finally, your standardlipid panel.
Specifically, triglycerides andHDL are often abnormal in
people with NASH or metabolicsyndrome.
High triglycerides, low HDL arecommon patterns.
Right, the classic metabolicsyndrome High triglycerides low
HDL are common patterns.
Speaker 2 (11:43):
Right, the classic metabolic syndrome pattern.
Speaker 3 (11:44):
Exactly, and beyond those basic blood tests, there
are also some specializednon-invasive fibrosis scores
that can help us assess risk abit deeper without needing a
biopsy right away.
Speaker 2 (11:54):
Oh, interesting Like what.
Speaker 3 (11:56):
Well, there's the FA4 index.
It uses your age, ast, alt andyour platelet count to estimate
fibrosis risk.
Speaker 2 (12:04):
Okay.
Speaker 3 (12:05):
And another one is the NAFLD fibrosis score, or NFS
.
That combines multiple markerslike BMI, glucose levels, liver
enzymes, age, platelet count andalbumin.
Both of these are calculations.
They're non-invasive and theycan help guide decisions like
determining if maybe moreadvanced imaging or rarely a
biopsy might be needed.
Speaker 2 (12:24):
And speaking of advanced testing, are there
situations where more in-depthimaging is necessary?
Speaker 3 (12:28):
Yes, sometimes, while not always needed up front,
some patients might benefit from, say, an ultrasound or a
FibroScan to get a better lookat the liver texture and check
for stiffness, which indicatesfibrosis.
Speaker 2 (12:40):
FibroScan measures stiffness.
Speaker 3 (12:42):
Yes, it's a type of ultrasound technology that does
that, and ostography MRI canalso provide even more precise
fibrosis staging if needed, andlook in very rare, uncertain
cases, a liver biopsy mightstill be performed for a
definitive diagnosis.
But honestly, with these newernon-invasive tools, it's
becoming less common than itused to be.
Speaker 2 (13:02):
That's good news.
Fewer biopsies Definitely.
So the crucial implication hereis really clear the earlier you
catch NARASH, the easier it isto potentially reverse.
And those first signs are oftenhiding in your lab work, not in
how you feel day to day.
Speaker 3 (13:17):
That's exactly right, which leads us to, I think, the
most hopeful part of our deepdive.
Yeah, narash is, unlikeadvanced cirrhosis, which often
involves permanent scarring, theinflammation and the fat
accumulation that definenanorash can improve
significantly.
Speaker 2 (13:32):
Yeah.
Speaker 3 (13:32):
And the way to do that is by targeting the root
cause, that metabolicdysfunction we've been talking
about.
Speaker 2 (13:37):
Okay, so targeting the root cause.
What's truly empowering aboutall of this is the idea that the
path to healing your livermight not start with a
prescription pad at all.
Where do you begin whentackling Menesh?
Speaker 3 (13:49):
naturally, you almost always begin with weight loss.
Assuming weight is an issue,which it often is.
Clinical studies are very clearon this Losing just 5 to 10
percent of your body weight cansignificantly reduce liver fat,
improve the inflammation andeven reverse early fibrosis.
Speaker 2 (14:04):
Just 5 to 10 percent.
That sounds achievable for manypeople.
Speaker 3 (14:08):
It is, and the data supports specific targets.
For example, losing just 5percent or more of body weight
can noticeably reduce liver fat.
Getting to 7 percent or moreoften improves the actual NASH
histology, the inflammation andcell injury, and achieving 10
percent weight loss or more mayeven lead to reversal of
fibrosis in some cases.
Speaker 2 (14:26):
That sounds incredibly promising that NASH
is irreversible with theselifestyle changes.
But you know, for someone who'smaybe struggled with weight
loss before, what are some ofthe biggest hurdles they might
face and how can they overcomethem.
Speaker 3 (14:38):
Yeah, that's a vital question, because knowing what
to do is different from doing itconsistently.
The biggest hurdles are often,well, consistency itself and
breaking ingrained habits.
It's really not about crashdieting or extreme measures
those rarely last.
It's about finding sustainable,nutrient-dense ways of eating
and incorporating consistentphysical activity into your
(15:01):
daily life.
Speaker 2 (15:01):
Sustainability is key .
Speaker 3 (15:03):
Absolutely Focusing on whole foods, really
minimizing or eliminating thoseultra-processed items and
prioritizing daily movement,even just walking.
It's those small, consistentchanges that add up to profound
results over time.
Speaker 2 (15:16):
And when it comes to the best diets for liver health,
are there specific approachesthat show particularly strong
evidence?
Speaker 3 (15:23):
Yeah, there are a couple of dietary patterns that
consistently show strongevidence for improving liver
health.
In the context of NFLD and NASH, low-carb or ketogenic diets
have been shown quiteeffectively to reduce insulin
resistance and also decreasethat fat production.
The de novo lipogenesis in theliver Studies show they can
improve ALT, triglycerides andliver fat, sometimes within just
(15:43):
a few weeks.
Speaker 2 (15:44):
Wow Weeks.
Speaker 3 (15:46):
Yeah, can be quite rapid.
The other well-studied approachis the Mediterranean diet.
Speaker 2 (15:50):
Ah, the Mediterranean , Exactly.
Speaker 3 (15:52):
Rich in monounsaturated fats from olive
oil, lots of fiber fromvegetables, fruits, legumes,
nuts and plenty of antioxidants.
It's consistently linked tolower liver fat, better glucose
control and reduced inflammationmarkers.
Speaker 2 (16:08):
So different approaches, but is there a
common thread?
Speaker 3 (16:10):
Absolutely.
The common thread between bothsuccessful approaches is clear
they are naturally low in addedsugars, especially fructose, low
in refined grains andultra-processed foods, and high
in nutrient density from wholefoods.
That seems to be the magiccombination.
Speaker 2 (16:24):
Makes sense.
Are there any supplements thatmight offer support?
Always with the caveat, ofcourse, to consult a health care
provider first before startinganything new.
Speaker 3 (16:32):
Yes, definitely consult your provider, but there
are some supplements withemerging and, in some cases,
decent evidence.
We're talking about things likeomega-3 fatty acids,
particularly EPA and DHA, whichcan help reduce liver fat and
triglycerides.
Speaker 2 (16:46):
Okay, omega-3s.
Speaker 3 (16:47):
Vitamin E, which is a potent antioxidant, has shown
benefit, particularly innon-diabetic patients with NASH,
though there are some safetyconsiderations at high doses.
Berberine is anotherinteresting one.
It's a plant compound thatseems to improve insulin
sensitivity and lipid metabolism, and also NAC, or
N-acetylcysteine NAC yeah, it'sa precursor to glutathione, a
(17:09):
major antioxidant in the body,and it supports liver detox
pathways.
So these can be supportiveelements within a broader
lifestyle approach, but theyaren't magic bullets on their
own.
Lifestyle is foundational.
Speaker 2 (17:19):
Right Lifestyle first , and let's not forget exercise.
You mentioned it earlier.
Independent of weight loss,what kind of impact can just
physical activity have on itsown?
Speaker 3 (17:29):
It's significant.
Even without moving the scale,much exercise has independent
benefits.
Just 20 to 30 minutes a day ofmoderate activity like brisk
walking, or adding in somestrength training or interval
training, can make a measurableimpact on reducing liver fat and
improving insulin sensitivity.
Speaker 2 (17:45):
So you don't have to become like an elite athlete.
Speaker 3 (17:48):
Not at all.
Consistency is really the keyFinding something you enjoy and
can stick with.
It really boils down to thesewell, seemingly simple choices,
doesn't it?
Cutting down on sugar, eatingreal food, getting active it
almost sounds too simple forsuch a serious condition.
Is that part of the challengethat people underestimate the
(18:09):
power of these fundamentalchanges?
Speaker 2 (18:11):
I think you're right Sometimes the simplest solutions
are actually the hardest tostick with consistently.
But what you're saying is, withthat consistency, with those
lifestyle changes and maybeusing lab testing to guide the
way, many patients can seereally dramatic improvements in
their Nahash markers withinmonths.
Speaker 3 (18:27):
Absolutely.
It's incredibly empowering.
So just to kind of connect thisall back to the bigger picture
Nashash really is a silentthreat.
Speaker 1 (18:33):
Yes.
Speaker 3 (18:33):
But it's also a very clear warning sign that your
body's entire metabolic systemis under significant pressure.
Speaker 2 (18:39):
But the truly good news, the hopeful message here,
is that it is treatable andoften reversible, especially
when you catch it early throughthat proactive lab testing and
make those consistent lifestylechanges.
You don't necessarily need aprescription medication to start
healing your liver.
What you need is good data,clear direction and, most
importantly, that, day-inday-out consistency.
Speaker 3 (19:02):
Couldn't agree more.
And if you're listening andwondering how to get started
with getting that crucial data,maybe consider exploring options
like at-home lab testing forthose key markers liver enzymes,
insulin resistance markers likeHOMA, ir inflammation markers.
It can give you those crucialinsights into your current
metabolic health.
Speaker 2 (19:19):
Right.
Knowledge is power here.
Ultimately, when you spot NASHearly and you take action, you
don't just save your liver, youreally save your entire
metabolic future.
So the question for you is whatstands out to you most about
this silent threat and what willbe your first step toward
protecting your metabolic future?
Speaker 1 (19:37):
Thanks for tuning into the Health Pulse.
If you found this episodehelpful, don't forget to
subscribe and share it withsomeone who might benefit.
For more health insights anddiagnostics, visit us online at
wwwquicklabmobilecom.
Stay informed, stay healthy andwe'll catch you in the next
episode.
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