August 25, 2025 • 21 mins
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The liver performs vital functions including filtering toxins, producing proteins, storing energy, aiding digestion, and regulating cholesterol and hormones. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has become the most common chronic liver disease globally, affecting up to 38% of the population worldwide.
• The liver filters blood, breaks down alcohol and medications, produces proteins like albumin and clotting factors
• It stores energy as glycogen, vitamins, and minerals including iron
• The liver makes bile for digesting fats and helps regulate cholesterol and support immune function
• Common liver problems include fatty liver disease, alcohol use, viral infections, and medication toxicity
• MASLD (formerly non-alcoholic fatty liver disease) occurs when too much fat builds up in the liver
• MASH is a severe form of MASLD with inflammation and damage that can lead to fibrosis and cirrhosis
• Up to 38% of people worldwide have MASLD, with prevalence rising to 65% in those with type 2 diabetes
• 5-10% total body weight loss can help slow, stop or reverse liver injury from MASLD
• The FDA recently approved semaglutide (Wegovy) as the first specific medication for treating MASH
• Regular check-ups with blood tests can help detect liver problems before symptoms develop
Stay healthy, and if you're concerned about your liver health, speak with your healthcare provider about testing and treatment options.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Edward Delesky, MD (00:08):
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
Nicole Aruffo, RN (00:23):
And I'm Nicola Aruffo.
I'm a nurse.
Edward Delesky, MD (00:26):
And we are so excited you were able to join
us here again today.
Nicole Aruffo, RN (00:30):
Why are you looking at me like that?
Edward Delesky, MD (00:32):
I don't know , you've had the giggles all day
.
You really have.
The Emu Lemu commercial came onand the bass on the sound bar
was like way too high and it waslike and you just go, damn, it
was like a really, it was like abassy man's voice, damn.
I was like, oh my God, youstartled me.
(00:56):
I was startled by thecommercial and then I was
startled by you, damn.
Nicole Aruffo, RN (01:03):
I think I startled myself.
Edward Delesky, MD (01:09):
And you were startled by a sound.
You've had the giggles all dayand then, like you know, I we
woke up in this type of mood.
I mean, if this was a visualpodcast, you see that we're like
wrapped in two blankets.
I have like mother mary goingon with the white blanket over
my head right now.
You have like bali sunglasseson right now.
Nicole Aruffo, RN (01:23):
Yeah, I got CUNY sunglasses for Bali.
Edward Delesky, MD (01:25):
And you're wrapped like a babushka in this,
like teal fluffy blanket.
Gravy is on the excuse me,gravy is on the stovetop.
Got up early to do that.
We're trying to get Jones topoop.
Nicole Aruffo, RN (01:40):
Oh yeah, he's been sick.
We took him to the doctor,though.
Well, eddie did, because someof us had to go to work.
Edward Delesky, MD (01:47):
oh wow, it's really bright in here without
these sunglasses on the blindsare completely closed and they
like, darken the room entirelyno, but maybe the sunglasses are
just that good.
They're cute, right no, they'recute, I like them.
(02:08):
Yeah, I like them, they're cutebring them to bali with us yeah
, we're um doing some like uhresearch on bali by watching
real housewives of orange countyduring those episodes to try to
understand what bali looks like.
It.
It's not helping me at.
Nicole Aruffo, RN (02:24):
No, all they're doing is fighting in the
hotel.
Edward Delesky, MD (02:26):
Yeah, so that's not helpful One bit.
Nicole Aruffo, RN (02:30):
But yeah, Ollie's been sick.
He had a little stomach bug.
Eddie took him to the doctor.
He got little puppy fluids.
He's so cute.
He's improving though he is,he's better.
He's pooping regularly,semi-regularly.
So road to recovery.
Edward Delesky, MD (02:47):
Road to recovery.
I made burgers last night.
You seemed to really like them.
Nicole Aruffo, RN (02:53):
Yeah, that was a good burger You've been
making.
I feel like you've beensleeping on burger making and
have been holding out on me.
Edward Delesky, MD (03:00):
On burger making, let me tell the good
people.
So we used regular beef, likelike ground beef, but you do
ground turkey.
Uh, I didn't actually use theonion that it calls for.
Um a third of a cup ofbreadcrumbs, a tablespoon of
worcestershire, a tablespoon ofdijon mustard, a teaspoon of
paprika, which we didn't have.
Half a teaspoon of garlicpowder, teaspoon of kosher salt
(03:25):
unless you have hypertension umhalf a tea I'm kidding.
Half a teaspoon of fresh groundpepper and an egg.
You mix that up and put it onthe cast iron and you really
liked it yeah, it was reallydelicious yeah, so that was good
.
Um, and then it is fantasyfootball season.
I am am obsessed with fantasyfootball season my drafts and
(03:46):
things like that.
So I'm working on that onovertime.
Nicole Aruffo, RN (03:50):
You're such a good fake football coach.
Edward Delesky, MD (03:53):
Thank you.
Yeah, the boy, I listen topodcasts about this, do
relentless research.
The boys in the locker roomwere assembling our team
multiple teams and it's going tobe fun.
We're going to see where itgoes and I think we're gonna put
together a good squad this year.
Make a good stretch run that'swhat football coaches say, I
think.
Nicole Aruffo, RN (04:11):
get the boys riled up in the locker room, you
know.
Edward Delesky, MD (04:14):
Yeah yeah, it's gonna be good.
Um, I bought these shorts withyeah, underwear built in.
Is that underwear?
Nicole Aruffo, RN (04:26):
I mean, I don't know if that's like.
I think it's just supposed tobe like a compression short, but
that's basically your underwear, Not to be weird.
Edward Delesky, MD (04:35):
Yeah, well, it really brings it to a single
use then, Not that, like, I mean, if you're wearing underwear,
maybe you can like reuse a shortif you're wearing it like
lightly right.
Yeah, I think so yeah, so thatwas fun.
And then a handheld waterbottle, because I'm seeing
people run around and they'reholding water and I will go like
(04:56):
not far, far distances, butlike reasonably far distances,
and not have water, and I'mthirsty when I'm doing that
stuff.
Nicole Aruffo, RN (05:05):
How did your run feel today with your water?
Edward Delesky, MD (05:07):
thank you.
Um, you know it felt good today.
I felt nice to be able to justrun with it.
It kind of just slides right onyour hand so you don't have to
change anything and it was good.
I um probably ran about thesame length, um exerted myself
about the same amount, but itfelt nice to have the water with
me so I didn't have to beparched.
Nicole Aruffo, RN (05:27):
Hydration.
Edward Delesky, MD (05:29):
Yeah, hydration is key, a major key,
if you will.
Nicole Aruffo, RN (05:32):
And we got a new monitor.
We had ourselves a little dayyesterday.
Edward Delesky, MD (05:37):
We did Well.
I'm starting work soon and Iwanted to be able to multitask
and have two things up at onceor just have a better display.
And I am very pleased becausepreviously I just used like do
you have it up right now?
Oh, yeah, yeah, I have the shownotes right up on the oh,
really the screen right now,yeah, wait, let me come look
yeah, ohthis looks great yeah, we got to
(05:59):
get you one of these.
Yeah, it's good, it's a goodmonitor and the guy helped us
out.
Um, they're making laptopsthese days that look pretty nice
.
Nicole Aruffo, RN (06:08):
Yeah, I think we should get some.
I want one too.
Edward Delesky, MD (06:11):
I have a lot of laptops.
What are you going?
Nicole Aruffo, RN (06:13):
to do with a laptop.
I don't know what do people dowith laptops?
Edward Delesky, MD (06:18):
What you're going to do on your phone.
Nicole Aruffo, RN (06:19):
Surf the web.
I'll book our next vacation.
That'll be nice, we've got torack up the credit card points.
Got to buy two laptops.
We use all our points for ourhoneymoon.
Edward Delesky, MD (06:32):
Got to rack them back up, as economical as
it makes it sound.
That's how that works, and thenany other thoughts before we
dive in here.
I don't think so, okay, well,what are we going to talk about
today, nick?
Nicole Aruffo, RN (06:47):
Today we're talking about the liver, some
metabolic liver disease and thenew FDA approval for Wagovi, and
all of that.
Edward Delesky, MD (06:58):
Yeah, and today's information is grounded
in consensus guidelines from theAmerican Diabetes Association,
systematic reviews and majorclinical trials, putting all of
this stuff together for you inwhat seems like three segments
today.
So before we dive into all ofthat, I really wanted to
introduce the idea about whatthe liver does.
(07:18):
I went out on threads the daywe're recording this and I was
like do you know what the liverdoes?
And a sassy biology teacher of30 years was like yes, comma,
look it up.
I taught biology for 30 years,which wasn't the intent of the
post.
It was to invite.
Nicole Aruffo, RN (07:34):
It was a little literal.
Edward Delesky, MD (07:35):
It was a little literal, it was to invite
that it does a lot.
The liver is very important.
It is a large organ located inthe upper right part of the
abdomen, just below the ribsright there, and it has a ton of
important jobs.
Nick, why don't we go back andforth kind of reviewing what
these important jobs are?
(07:56):
I will kick us off.
Okay, it mainly, or one majorfeature it has, is filtering and
cleaning the blood, and by thatI mean thinking of toxins.
Certain medicines and drugs andother waste products from the
blood get processed through theliver.
It also helps break downalcohol and, like I mentioned,
other medicines, before movingit to other parts of the body
(08:19):
where it's easier to handle.
What else does the liver do?
Nicole Aruffo, RN (08:25):
The liver helps with making important
proteins.
It produces an important onelike albumin, which keeps fluid
in the bloodstream, helps withclotting factors and helps to
stop you bleeding.
Stop you bleeding.
Stops your bleeding after aninjury.
Edward Delesky, MD (08:41):
Yeah, all extremely important stuff.
Very easy for those things togo awry One simple organ doing
all those complex things.
What it also does is it helpsstore energy.
Actually, the liver storessugar, which can be broken up
into smaller particles of usableenergy, and releases them to
the body when the body needsenergy.
(09:01):
It also stores other vitaminsand minerals.
Like it has a lot of stores ofiron in there as well.
What else is it good for?
Nicole Aruffo, RN (09:10):
It helps us with digesting food.
The liver makes bile, which isa yellow-green fluid that helps
digest the fats in our food, andit's stored in the gallbladder
and then released into theintestine when we need it.
Edward Delesky, MD (09:25):
Yep, and the liver also helps regulate
cholesterol and other hormones,so it's involved in managing the
level.
It's also involved in creatingcertain types of cholesterol.
Cholesterol is like much morecomplicated we have episode 43,
which discusses the other typesof cholesterol to think about.
(09:47):
But the liver also has animportant job as it relates to
cholesterol, and I'll just jumpin here and finish out that it
also helps support the immunesystem, so it also the liver
itself can help remove bacteriaand other germs from the blood
in some smaller role than it has.
So the way that variousclinicians can help and check
and see if the liver is okay isthey have certain liver
(10:09):
chemistries that they can lookat to detect liver injury or
disease, and these are ones thatyou may see on your own labs
looking like ALT, ast, alkalinephosphatase, bilirubin and
albumin, and so abnormalities inthese may tip off that there's
something to think about.
But honestly that's like such aniche thing with you and your
(10:32):
doctor to think about.
But those are the labs thatpeople most of the time look at.
Nikki, can you take us throughwhen things go awry, when these
liver enzymes may be abnormal orthey may not be?
What are some common causes ofliver problems?
Nicole Aruffo, RN (10:52):
Some common causes of liver problems include
fatty liver disease, alcoholuse, viral infections such as
hepatitis, some medicines andsometimes you can inherit
different kind of liverconditions.
Edward Delesky, MD (11:09):
Totally, and there's a lot of things that
can obviously, as you mentioned,common and uncommon that can
tickle the liver or really sendit to go haywire.
The liver is resilient, butsometimes people fly too close
to the sun and the liver gets,you know, beat up a little bit
too much.
Many liver diseases don't causesymptoms at first, and so
(11:30):
that's why getting your checkupsand getting some blood tests
can be important for people whoare at higher risk.
To highlight on your list rightthere fatty liver disease or
otherwise, in medical language,metabolic dysfunction,
associated steatotic liverdisease.
This is the thing that you maysee as Masl-D is the thing that
(11:50):
we talk about in the secondsegment today, becoming one of
the most common causes of liverinjury in our society today.
So, so, unlike the end of theextreme, if the liver isn't
working well, people can noticesymptoms like yellowing of the
eyes or skin, swelling in thebelly or the legs, easy bruising
(12:12):
and bleeding and overallfeeling an intense set of
fatigue, and so if you noticethese, don't pass go, make sure
you connect with your doctor.
So, now that we have a broadoverview of what the healthy
liver does and general concepts,what we really wanted to dive
(12:37):
into is MASLD, or the thingcalled metabolic dysfunction
associated steatotic liverdisease.
It used to be callednon-alcoholic fatty liver
disease, but this new name hasmore of a patient first type of
denotation when you're talkingabout it.
So it's not so much like theperson is the disease, it's that
the person has this, and that'swhy the name is so long.
(12:59):
It was a recent change in thelast couple of years, so I'll
kick us off here.
The question remains is what isthis?
Well, masl-d is a or M-A-S-L-Dis a common liver condition that
occurs when too much fat buildsup in the liver.
(13:19):
This falls squarely in thebucket of visceral fat that fat
that we're talking about.
That builds up in the abdomenand it ends up usually being
linked to things like beingoverweight or having obesity,
type two diabetes, high bloodpressure and high cholesterol.
Nikki, can you key us in aboutwhy Masl-D is so important?
Nicole Aruffo, RN (13:46):
Yes, it's actually the fastest growing
cause of cirrhosis and livercancer, which is not good.
It's also linked to higherrisks of heart disease and
kidney problems.
Edward Delesky, MD (14:00):
Yeah, it's extremely common and has been
frustrating to treat untilrecently, when there are new
medications available, bothGLP-related and non-GLP-related.
So the question comes in oflike, how do you know if you
have it?
How do you know if you shouldget checked out?
It is diagnosed by blood testsnoticing those abnormal liver
(14:20):
enzymes.
Perhaps Someone may get animaging study like an ultrasound
or an MRI or some other imagingstudy, and it may, incidentally
, come up and be noticed and inmore rare cases, these days the
gold standard is a liver biopsy,which sounds dramatic.
It's not the easiest thing inthe world and it's a little
annoying, but less commonly used, but really, really, that's a
(14:43):
really common thing to use todiagnose this.
And in truth, when putting allof that together, to capture
this diagnosis it requires liverfat, metabolic risk factors,
like we talked about before, andruling out other causes of
liver injury, some of the mostcommon ones being alcohol or
hepatitis.
You know what, since you alwaysget this, I'll take this one,
(15:09):
because you always end uptalking about how things are
treated and what I will say hereis that lifestyle changes end
up being the first thing to do.
I kind of want to kick us offwith a 5% to 10% total body
weight loss can help.
There is a lot of evidence thatsuggests that weight loss helps
(15:30):
slow down, stop or even reduceand reverse the liver injury
because of this, and so reallysincerely take it into account
that if you're thinking aboutyour weight and your doctors
mention, hey, you have some fatin your liver, that's a solution
.
I'm not proposing that it'seasy, but that's something that
could be done.
And then you think aboutmanaging the other health
(15:52):
problems like control bloodsugar, control your cholesterol
better and make sure that yourblood pressure is under
excellent control.
So an interesting piece is that, specifically, there are no
medications available for MASLDor the fatty liver, and that's
specific because, while that'san umbrella term, underneath
(16:14):
that umbrella there is a laterstage, something called
metabolic dysfunction associatedsteatohepatitis, which means
that there's inflammation anddamage and that there also can
be scarring in the liver andpotentially downstream cirrhosis
, which is excess scarring inthe liver, and liver cancer,
(16:37):
potentially Soon.
In our next segment we're goingto talk about that delineation
is important because there is arecent FDA approval for a GLP-1
medication, wagovi, to beapproved to treat MASH or that
long name that I said earlier.
I am glad that we're spendingso much time talking about this
(16:58):
because this is so incrediblycommon.
There is a recent New EnglandJournal of Medicine review that
came out August of 2025, whichsuggests that up to 38% of the
population worldwide is affectedby Masl-D, and that proportion
of people is even higher incertain subgroups, like people
(17:19):
who have type 2 diabetes, andthat suggests that the
prevalence of that, which is thenumber of people that have that
in a population at any giventime, could be about 65%.
So this review suggests thatnow this is the most common
chronic liver disease globallyand is continuing to happen here
(17:41):
more and more frequently.
Okay, so can you, since we tooka little step away from what
mash is there, can you tell usand remind us what mash is?
Nicole Aruffo, RN (17:57):
Mash is a severe form of the mass oldie,
but with inflammation and actualdamage to your liver, and this
can lead to fibrosis, cirrhosisor cancer.
Edward Delesky, MD (18:08):
So enter GLP-1 receptor agonists, and
this is a brief summary review.
These medicines were originallydeveloped for type 2 diabetes
and the management of thechronic disease of obesity, and
they help people support bloodsugar control and weight loss,
and recently, in a trial, theywere shown to improve liver
health as well in MASH.
(18:29):
All of this in totality beingrelated to metabolic health and
the management of metabolicdysfunction.
And so the FDA approval comeson the back of semaglutide, a
GLP-1 agonist for patients withMASH in a moderate or advanced
fibrosis category.
What that means for anyone outthere is that certain tests done
(18:52):
, or imaging studies done, topoint you in the direction that
it's a moderate to severescarring in the liver and, of
note, it's the first medicationspecifically approved for this
condition.
There is another medicationapproved for helping liver
fibrosis is resmetiron.
We won't be talking about thattoday, but that is another
medication.
(19:12):
The idea behind how they workis essentially to improve liver
health and resolve inflammation.
There is an evidence that itreduces the actual scarring in
some patients, which is amazing.
In addition, it helps supportweight loss and improve blood
sugar, cholesterol and heartrisk factors, all in all being
(19:33):
very helpful and approved.
Here.
Basically, what we're seeing isthat they're going down the
line, finding anyobesity-related complication and
trying to get FDA approval forthese.
Last year, we saw them approveZepBound for sleep apnea and
that's been very helpful, andnow we're seeing Wagovi or
(19:55):
semaglutide be approved fortreatment of MASH.
So, all in all, it's a reallycool development that there is
an extra tool in the toolbox tobe more proactive and help
people with this condition.
This is something that'sincredibly common, like we
talked about earlier, and itshould be taken so seriously.
It's something to be proactivewith and get checked out for.
(20:18):
So hopefully this was helpfulfor anyone listening.
Well, thank you for coming backto another episode of your
Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
Check out our website.
Come visit us on threads.
I'm literally on there all thetime.
You can email us atyourcheckuppod at gmailcom.
But, most importantly, stayhealthy, my friends.
(20:40):
Until next time.
I'm Ed Dolesky.
I'm Nicole Rufo.
Thank you, goodbye, bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
(21:00):
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcare provider for personalized
(21:27):
guidance based Thank you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
Hi, welcome to your checkup.
We are the patient educationpodcast, where we bring
conversations from the doctor'soffice to your ears.
On this podcast, we try tobring medicine closer to its
patients.
I'm Ed Delesky, a familymedicine doctor in the
Philadelphia area.
Nicole Aruffo, RN (00:23):
And I'm Nicola Aruffo.
I'm a nurse.
Edward Delesky, MD (00:26):
And we are so excited you were able to join
us here again today.
Nicole Aruffo, RN (00:30):
Why are you looking at me like that?
Edward Delesky, MD (00:32):
I don't know , you've had the giggles all day
.
You really have.
The Emu Lemu commercial came onand the bass on the sound bar
was like way too high and it waslike and you just go, damn, it
was like a really, it was like abassy man's voice, damn.
I was like, oh my God, youstartled me.
(00:56):
I was startled by thecommercial and then I was
startled by you, damn.
Nicole Aruffo, RN (01:03):
I think I startled myself.
Edward Delesky, MD (01:09):
And you were startled by a sound.
You've had the giggles all dayand then, like you know, I we
woke up in this type of mood.
I mean, if this was a visualpodcast, you see that we're like
wrapped in two blankets.
I have like mother mary goingon with the white blanket over
my head right now.
You have like bali sunglasseson right now.
Nicole Aruffo, RN (01:23):
Yeah, I got CUNY sunglasses for Bali.
Edward Delesky, MD (01:25):
And you're wrapped like a babushka in this,
like teal fluffy blanket.
Gravy is on the excuse me,gravy is on the stovetop.
Got up early to do that.
We're trying to get Jones topoop.
Nicole Aruffo, RN (01:40):
Oh yeah, he's been sick.
We took him to the doctor,though.
Well, eddie did, because someof us had to go to work.
Edward Delesky, MD (01:47):
oh wow, it's really bright in here without
these sunglasses on the blindsare completely closed and they
like, darken the room entirelyno, but maybe the sunglasses are
just that good.
They're cute, right no, they'recute, I like them.
(02:08):
Yeah, I like them, they're cutebring them to bali with us yeah
, we're um doing some like uhresearch on bali by watching
real housewives of orange countyduring those episodes to try to
understand what bali looks like.
It.
It's not helping me at.
Nicole Aruffo, RN (02:24):
No, all they're doing is fighting in the
hotel.
Edward Delesky, MD (02:26):
Yeah, so that's not helpful One bit.
Nicole Aruffo, RN (02:30):
But yeah, Ollie's been sick.
He had a little stomach bug.
Eddie took him to the doctor.
He got little puppy fluids.
He's so cute.
He's improving though he is,he's better.
He's pooping regularly,semi-regularly.
So road to recovery.
Edward Delesky, MD (02:47):
Road to recovery.
I made burgers last night.
You seemed to really like them.
Nicole Aruffo, RN (02:53):
Yeah, that was a good burger You've been
making.
I feel like you've beensleeping on burger making and
have been holding out on me.
Edward Delesky, MD (03:00):
On burger making, let me tell the good
people.
So we used regular beef, likelike ground beef, but you do
ground turkey.
Uh, I didn't actually use theonion that it calls for.
Um a third of a cup ofbreadcrumbs, a tablespoon of
worcestershire, a tablespoon ofdijon mustard, a teaspoon of
paprika, which we didn't have.
Half a teaspoon of garlicpowder, teaspoon of kosher salt
(03:25):
unless you have hypertension umhalf a tea I'm kidding.
Half a teaspoon of fresh groundpepper and an egg.
You mix that up and put it onthe cast iron and you really
liked it yeah, it was reallydelicious yeah, so that was good
.
Um, and then it is fantasyfootball season.
I am am obsessed with fantasyfootball season my drafts and
(03:46):
things like that.
So I'm working on that onovertime.
Nicole Aruffo, RN (03:50):
You're such a good fake football coach.
Edward Delesky, MD (03:53):
Thank you.
Yeah, the boy, I listen topodcasts about this, do
relentless research.
The boys in the locker roomwere assembling our team
multiple teams and it's going tobe fun.
We're going to see where itgoes and I think we're gonna put
together a good squad this year.
Make a good stretch run that'swhat football coaches say, I
think.
Nicole Aruffo, RN (04:11):
get the boys riled up in the locker room, you
know.
Edward Delesky, MD (04:14):
Yeah yeah, it's gonna be good.
Um, I bought these shorts withyeah, underwear built in.
Is that underwear?
Nicole Aruffo, RN (04:26):
I mean, I don't know if that's like.
I think it's just supposed tobe like a compression short, but
that's basically your underwear, Not to be weird.
Edward Delesky, MD (04:35):
Yeah, well, it really brings it to a single
use then, Not that, like, I mean, if you're wearing underwear,
maybe you can like reuse a shortif you're wearing it like
lightly right.
Yeah, I think so yeah, so thatwas fun.
And then a handheld waterbottle, because I'm seeing
people run around and they'reholding water and I will go like
(04:56):
not far, far distances, butlike reasonably far distances,
and not have water, and I'mthirsty when I'm doing that
stuff.
Nicole Aruffo, RN (05:05):
How did your run feel today with your water?
Edward Delesky, MD (05:07):
thank you.
Um, you know it felt good today.
I felt nice to be able to justrun with it.
It kind of just slides right onyour hand so you don't have to
change anything and it was good.
I um probably ran about thesame length, um exerted myself
about the same amount, but itfelt nice to have the water with
me so I didn't have to beparched.
Nicole Aruffo, RN (05:27):
Hydration.
Edward Delesky, MD (05:29):
Yeah, hydration is key, a major key,
if you will.
Nicole Aruffo, RN (05:32):
And we got a new monitor.
We had ourselves a little dayyesterday.
Edward Delesky, MD (05:37):
We did Well.
I'm starting work soon and Iwanted to be able to multitask
and have two things up at onceor just have a better display.
And I am very pleased becausepreviously I just used like do
you have it up right now?
Oh, yeah, yeah, I have the shownotes right up on the oh,
really the screen right now,yeah, wait, let me come look
yeah, ohthis looks great yeah, we got to
(05:59):
get you one of these.
Yeah, it's good, it's a goodmonitor and the guy helped us
out.
Um, they're making laptopsthese days that look pretty nice
.
Nicole Aruffo, RN (06:08):
Yeah, I think we should get some.
I want one too.
Edward Delesky, MD (06:11):
I have a lot of laptops.
What are you going?
Nicole Aruffo, RN (06:13):
to do with a laptop.
I don't know what do people dowith laptops?
Edward Delesky, MD (06:18):
What you're going to do on your phone.
Nicole Aruffo, RN (06:19):
Surf the web.
I'll book our next vacation.
That'll be nice, we've got torack up the credit card points.
Got to buy two laptops.
We use all our points for ourhoneymoon.
Edward Delesky, MD (06:32):
Got to rack them back up, as economical as
it makes it sound.
That's how that works, and thenany other thoughts before we
dive in here.
I don't think so, okay, well,what are we going to talk about
today, nick?
Nicole Aruffo, RN (06:47):
Today we're talking about the liver, some
metabolic liver disease and thenew FDA approval for Wagovi, and
all of that.
Edward Delesky, MD (06:58):
Yeah, and today's information is grounded
in consensus guidelines from theAmerican Diabetes Association,
systematic reviews and majorclinical trials, putting all of
this stuff together for you inwhat seems like three segments
today.
So before we dive into all ofthat, I really wanted to
introduce the idea about whatthe liver does.
(07:18):
I went out on threads the daywe're recording this and I was
like do you know what the liverdoes?
And a sassy biology teacher of30 years was like yes, comma,
look it up.
I taught biology for 30 years,which wasn't the intent of the
post.
It was to invite.
Nicole Aruffo, RN (07:34):
It was a little literal.
Edward Delesky, MD (07:35):
It was a little literal, it was to invite
that it does a lot.
The liver is very important.
It is a large organ located inthe upper right part of the
abdomen, just below the ribsright there, and it has a ton of
important jobs.
Nick, why don't we go back andforth kind of reviewing what
these important jobs are?
(07:56):
I will kick us off.
Okay, it mainly, or one majorfeature it has, is filtering and
cleaning the blood, and by thatI mean thinking of toxins.
Certain medicines and drugs andother waste products from the
blood get processed through theliver.
It also helps break downalcohol and, like I mentioned,
other medicines, before movingit to other parts of the body
(08:19):
where it's easier to handle.
What else does the liver do?
Nicole Aruffo, RN (08:25):
The liver helps with making important
proteins.
It produces an important onelike albumin, which keeps fluid
in the bloodstream, helps withclotting factors and helps to
stop you bleeding.
Stop you bleeding.
Stops your bleeding after aninjury.
Edward Delesky, MD (08:41):
Yeah, all extremely important stuff.
Very easy for those things togo awry One simple organ doing
all those complex things.
What it also does is it helpsstore energy.
Actually, the liver storessugar, which can be broken up
into smaller particles of usableenergy, and releases them to
the body when the body needsenergy.
(09:01):
It also stores other vitaminsand minerals.
Like it has a lot of stores ofiron in there as well.
What else is it good for?
Nicole Aruffo, RN (09:10):
It helps us with digesting food.
The liver makes bile, which isa yellow-green fluid that helps
digest the fats in our food, andit's stored in the gallbladder
and then released into theintestine when we need it.
Edward Delesky, MD (09:25):
Yep, and the liver also helps regulate
cholesterol and other hormones,so it's involved in managing the
level.
It's also involved in creatingcertain types of cholesterol.
Cholesterol is like much morecomplicated we have episode 43,
which discusses the other typesof cholesterol to think about.
(09:47):
But the liver also has animportant job as it relates to
cholesterol, and I'll just jumpin here and finish out that it
also helps support the immunesystem, so it also the liver
itself can help remove bacteriaand other germs from the blood
in some smaller role than it has.
So the way that variousclinicians can help and check
and see if the liver is okay isthey have certain liver
(10:09):
chemistries that they can lookat to detect liver injury or
disease, and these are ones thatyou may see on your own labs
looking like ALT, ast, alkalinephosphatase, bilirubin and
albumin, and so abnormalities inthese may tip off that there's
something to think about.
But honestly that's like such aniche thing with you and your
(10:32):
doctor to think about.
But those are the labs thatpeople most of the time look at.
Nikki, can you take us throughwhen things go awry, when these
liver enzymes may be abnormal orthey may not be?
What are some common causes ofliver problems?
Nicole Aruffo, RN (10:52):
Some common causes of liver problems include
fatty liver disease, alcoholuse, viral infections such as
hepatitis, some medicines andsometimes you can inherit
different kind of liverconditions.
Edward Delesky, MD (11:09):
Totally, and there's a lot of things that
can obviously, as you mentioned,common and uncommon that can
tickle the liver or really sendit to go haywire.
The liver is resilient, butsometimes people fly too close
to the sun and the liver gets,you know, beat up a little bit
too much.
Many liver diseases don't causesymptoms at first, and so
(11:30):
that's why getting your checkupsand getting some blood tests
can be important for people whoare at higher risk.
To highlight on your list rightthere fatty liver disease or
otherwise, in medical language,metabolic dysfunction,
associated steatotic liverdisease.
This is the thing that you maysee as Masl-D is the thing that
(11:50):
we talk about in the secondsegment today, becoming one of
the most common causes of liverinjury in our society today.
So, so, unlike the end of theextreme, if the liver isn't
working well, people can noticesymptoms like yellowing of the
eyes or skin, swelling in thebelly or the legs, easy bruising
(12:12):
and bleeding and overallfeeling an intense set of
fatigue, and so if you noticethese, don't pass go, make sure
you connect with your doctor.
So, now that we have a broadoverview of what the healthy
liver does and general concepts,what we really wanted to dive
(12:37):
into is MASLD, or the thingcalled metabolic dysfunction
associated steatotic liverdisease.
It used to be callednon-alcoholic fatty liver
disease, but this new name hasmore of a patient first type of
denotation when you're talkingabout it.
So it's not so much like theperson is the disease, it's that
the person has this, and that'swhy the name is so long.
(12:59):
It was a recent change in thelast couple of years, so I'll
kick us off here.
The question remains is what isthis?
Well, masl-d is a or M-A-S-L-Dis a common liver condition that
occurs when too much fat buildsup in the liver.
(13:19):
This falls squarely in thebucket of visceral fat that fat
that we're talking about.
That builds up in the abdomenand it ends up usually being
linked to things like beingoverweight or having obesity,
type two diabetes, high bloodpressure and high cholesterol.
Nikki, can you key us in aboutwhy Masl-D is so important?
Nicole Aruffo, RN (13:46):
Yes, it's actually the fastest growing
cause of cirrhosis and livercancer, which is not good.
It's also linked to higherrisks of heart disease and
kidney problems.
Edward Delesky, MD (14:00):
Yeah, it's extremely common and has been
frustrating to treat untilrecently, when there are new
medications available, bothGLP-related and non-GLP-related.
So the question comes in oflike, how do you know if you
have it?
How do you know if you shouldget checked out?
It is diagnosed by blood testsnoticing those abnormal liver
(14:20):
enzymes.
Perhaps Someone may get animaging study like an ultrasound
or an MRI or some other imagingstudy, and it may, incidentally
, come up and be noticed and inmore rare cases, these days the
gold standard is a liver biopsy,which sounds dramatic.
It's not the easiest thing inthe world and it's a little
annoying, but less commonly used, but really, really, that's a
(14:43):
really common thing to use todiagnose this.
And in truth, when putting allof that together, to capture
this diagnosis it requires liverfat, metabolic risk factors,
like we talked about before, andruling out other causes of
liver injury, some of the mostcommon ones being alcohol or
hepatitis.
You know what, since you alwaysget this, I'll take this one,
(15:09):
because you always end uptalking about how things are
treated and what I will say hereis that lifestyle changes end
up being the first thing to do.
I kind of want to kick us offwith a 5% to 10% total body
weight loss can help.
There is a lot of evidence thatsuggests that weight loss helps
(15:30):
slow down, stop or even reduceand reverse the liver injury
because of this, and so reallysincerely take it into account
that if you're thinking aboutyour weight and your doctors
mention, hey, you have some fatin your liver, that's a solution
.
I'm not proposing that it'seasy, but that's something that
could be done.
And then you think aboutmanaging the other health
(15:52):
problems like control bloodsugar, control your cholesterol
better and make sure that yourblood pressure is under
excellent control.
So an interesting piece is that, specifically, there are no
medications available for MASLDor the fatty liver, and that's
specific because, while that'san umbrella term, underneath
(16:14):
that umbrella there is a laterstage, something called
metabolic dysfunction associatedsteatohepatitis, which means
that there's inflammation anddamage and that there also can
be scarring in the liver andpotentially downstream cirrhosis
, which is excess scarring inthe liver, and liver cancer,
(16:37):
potentially Soon.
In our next segment we're goingto talk about that delineation
is important because there is arecent FDA approval for a GLP-1
medication, wagovi, to beapproved to treat MASH or that
long name that I said earlier.
I am glad that we're spendingso much time talking about this
(16:58):
because this is so incrediblycommon.
There is a recent New EnglandJournal of Medicine review that
came out August of 2025, whichsuggests that up to 38% of the
population worldwide is affectedby Masl-D, and that proportion
of people is even higher incertain subgroups, like people
(17:19):
who have type 2 diabetes, andthat suggests that the
prevalence of that, which is thenumber of people that have that
in a population at any giventime, could be about 65%.
So this review suggests thatnow this is the most common
chronic liver disease globallyand is continuing to happen here
(17:41):
more and more frequently.
Okay, so can you, since we tooka little step away from what
mash is there, can you tell usand remind us what mash is?
Nicole Aruffo, RN (17:57):
Mash is a severe form of the mass oldie,
but with inflammation and actualdamage to your liver, and this
can lead to fibrosis, cirrhosisor cancer.
Edward Delesky, MD (18:08):
So enter GLP-1 receptor agonists, and
this is a brief summary review.
These medicines were originallydeveloped for type 2 diabetes
and the management of thechronic disease of obesity, and
they help people support bloodsugar control and weight loss,
and recently, in a trial, theywere shown to improve liver
health as well in MASH.
(18:29):
All of this in totality beingrelated to metabolic health and
the management of metabolicdysfunction.
And so the FDA approval comeson the back of semaglutide, a
GLP-1 agonist for patients withMASH in a moderate or advanced
fibrosis category.
What that means for anyone outthere is that certain tests done
(18:52):
, or imaging studies done, topoint you in the direction that
it's a moderate to severescarring in the liver and, of
note, it's the first medicationspecifically approved for this
condition.
There is another medicationapproved for helping liver
fibrosis is resmetiron.
We won't be talking about thattoday, but that is another
medication.
(19:12):
The idea behind how they workis essentially to improve liver
health and resolve inflammation.
There is an evidence that itreduces the actual scarring in
some patients, which is amazing.
In addition, it helps supportweight loss and improve blood
sugar, cholesterol and heartrisk factors, all in all being
(19:33):
very helpful and approved.
Here.
Basically, what we're seeing isthat they're going down the
line, finding anyobesity-related complication and
trying to get FDA approval forthese.
Last year, we saw them approveZepBound for sleep apnea and
that's been very helpful, andnow we're seeing Wagovi or
(19:55):
semaglutide be approved fortreatment of MASH.
So, all in all, it's a reallycool development that there is
an extra tool in the toolbox tobe more proactive and help
people with this condition.
This is something that'sincredibly common, like we
talked about earlier, and itshould be taken so seriously.
It's something to be proactivewith and get checked out for.
(20:18):
So hopefully this was helpfulfor anyone listening.
Well, thank you for coming backto another episode of your
Checkup.
Hopefully you were able tolearn something for yourself, a
loved one or a neighbor.
Check out our website.
Come visit us on threads.
I'm literally on there all thetime.
You can email us atyourcheckuppod at gmailcom.
But, most importantly, stayhealthy, my friends.
(20:40):
Until next time.
I'm Ed Dolesky.
I'm Nicole Rufo.
Thank you, goodbye, bye.
This information may provide abrief overview of diagnosis,
treatment and medications.
It's not exhaustive and is atool to help you understand
potential options about yourhealth.
It doesn't cover all detailsabout conditions, treatments or
medications for a specificperson.
(21:00):
This is not medical advice oran attempt to substitute medical
advice.
You should contact a healthcare provider for personalized
(21:27):
guidance based Thank you.
In short, I'm not your doctor,I am not your nurse, and make
sure you go get your own checkupwith your own personal doctor.
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