February 2, 2025 • 37 mins
Dr. Galati is back in the KTRH studios for the show tonight. He starts with a quick chat about diet soda and why you should avoid it. Dr. Galati also has Dr. Stine join the show to talk about his jourey at Penn State and the role of exercise for your liver in great detail.
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Transcript
Episode Transcript
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Speaker 1 (00:01):
Initial Life Sequence.
Speaker 2 (00:04):
Coming to you live from Houston, Texas, home to the
world's largest medical center.
Speaker 1 (00:08):
In the bunch of bas Day.
Speaker 3 (00:13):
Roger Collie, this.
Speaker 2 (00:20):
Is your Health First, the most beneficial health program on
radio with doctor Joe Galotti. During the next hour you'll
learn about health, wellness and the provention of disease. Now
here's your host, doctor Joe Bellotti.
Speaker 3 (00:43):
Well a good.
Speaker 1 (00:44):
Sunday evening till everybody.
Speaker 4 (00:47):
Doctor Joe Galotti broadcasting from our world headquarters here in Houston,
Texas and broadcasting coast to coast on the I iHeartRadio app.
And it is always a pleasure to be here. And again,
our soul mission is to raise your Health IQ, one
(01:08):
listener at a time, and to make you better consumers
of healthcare.
Speaker 1 (01:12):
That is our.
Speaker 4 (01:13):
Simple mission for the past twenty two years, every Sunday
at seven o'clock. So we have not given up on
our mission. That is what we're passionate about, and we
are so glad everybody is here tonight. The website of
the program doctor Joegalotti dot com, d R J O
E G A L A t I dot com And
(01:37):
when you go there you can sign up for our
weekly newsletter that goes out every Sunday, no, every Saturday.
Speaker 1 (01:42):
Every Saturday in the morning.
Speaker 4 (01:45):
All of our social media is there, and if you
want to send me a message, there is a tab
that says contact us. And we're happy to hear from
from everybody. That is what we want to do. It's
a two way street. It's not just me yaking on
the radio. It is to hear from all of our listeners.
Now on the program tonight, Jonathan Stein from Penn State,
(02:12):
Great University, great academic institution. He is a hepatologist, a
liver specialist like myself, and his area of research and
interest is in fatty liver. And you've heard me talk
a lot about fatty liver because it's ubiquitous and it's
(02:33):
a huge public health problem. But his research, one of
the areas that he's concentrating in is the role of exercise,
which is excellent. I think we need to exercise more.
We need to have our patients and our community more
versed and educated on exercise. So doctor Stein will be
(02:56):
coming up in just a bit. We'll have him on
for a good part of the program, So get your pencils, notepad,
take notes. That is what we want to do a
quick programming note. This coming Tuesday, February fourth, I will
be on Sirius XM channel one twenty nine, the Catholic Channel,
(03:20):
and we do just about a once a month broadcast
on the Catholic Channel. The special treat is that we
have Martha McCallum from the Fox News Channel who will
be joining me, and since it is the Catholic Channel,
we'd be talking about faith, but we'll also be talking
(03:41):
about personal wellness, how she raised her family, some of
her health and wellness attitudes. Maybe we'll squeak in a
little bit of well her thoughts on make America healthy again.
But Martha McCallum Tuesday one a clock East, Serious XM
(04:02):
channel one twenty nine, make sure you tune in for that,
and we follow us along on all the social media platforms.
I will be reposting it there before we get on
my gosh, quick shout out my daughter and her husband,
Elizabeth and Daniel. She wanted to make me alert everybody
that she is cooking at home Sunday night cook in.
Speaker 1 (04:26):
And for.
Speaker 4 (04:29):
The younger generation our children, it is marvelous to see
that they are taking the interest cooking at home and
learning the skills in the kitchen. Both of them are
excellent in the kitchen. Rather than ordering out getting processed food,
they are cooking inside. The apple doesn't fall far from
(04:51):
the tree. So thank you Elizabeth and Daniel for cooking
at home. That's what we like to see, all right.
So I received a message from a longtime listener, Mark,
and his question was he drinks a lot of diet
(05:12):
soda and he's questioning whether or not it's healthy. Now, categorically,
the quick answer is no, it is not healthy. Most
sweetened drinks fall under the ultraprocessed food category. These are
bad news. Ultra process foods are associated with the wide
(05:35):
range of health derangements. But when you look at diet soda,
they are associated with diabetes and metabolic syndrome. Your good cholesterol,
the HDL goes down, blood sugar can go up, increase
in belly fat, high triglycerides, and blood pressure, and of
(05:59):
course all this puts you at for type two diabetes.
There's an association with atrial fibrillation. There is, you know,
one of the problems that these drinks are so sweet,
they really fake out your brain and when they get
this sweet impulse, it creates a trigger for you to
(06:24):
really crave more sweets, more high calorie foods, which will
lead to weight gain and belly fat. They're dental problems,
changes in bone density. But the most interesting thing is that,
and we've talked about this a lot. Maybe doctor Stein
will touch on this as well, the bacteria in your intestine.
We talk about the intestinal microbiome. These artificial sweeteners disrupt.
Speaker 1 (06:50):
The normal.
Speaker 4 (06:53):
Environment of the good bacteria the bad bacteria, and so
much is being learned learned about how if you don't
have the right bacteria.
Speaker 1 (07:04):
In your gut, a whole.
Speaker 4 (07:06):
Host of problems are going to develop, including waking diabete,
is fatty liver. All right, so mark frequent listener, throw
out the diet, soda, drink water.
Speaker 1 (07:22):
All right. I'm doctor Joe Glotti.
Speaker 4 (07:23):
Don't forget doctor Joeglotti dot com is our website. Doctor
Jonathan Stein from Penn State is coming up in just
a few minutes.
Speaker 1 (07:33):
Stay tuned. We will be right back. Welcome back everybody,
doctor Joe Galotti. Every Sunday between seven and eight.
Speaker 4 (07:41):
Pm, we're here trying to make sure you stay out
of the doctor's office, stay out of the er, because
so much, so much of the chronic disease that is
related to lifestyle choices we make. And you don't underestimate
(08:06):
how much influence you have on your own health and wellness.
So never despair, Never think that you're never going to
get well. There's so many things that you could do,
but it all comes with knowledge.
Speaker 1 (08:18):
That is the basis.
Speaker 4 (08:19):
It's knowledge, and that's what we try to do here
every Sunday. So, as I was saying earlier, it's a
great honor to have doctor Jonathan Stein from Penn State,
a terrific institution he is. He's an Associate Professor of
Medicine and Public Health where he serves as the Fatty
(08:40):
Liver Program Director and Liver Center Research Director. A fellow hepatologist, John,
it's always great to talk to another liver person on
the radio.
Speaker 1 (08:49):
How are you tonight?
Speaker 3 (08:51):
Oh, I'm doing so well, Joe. Thank you so much
for having me. It's an absolute delight. Congrats on your
twenty two years. I just have to say I love
the fact that you played YouTube the Beautiful Day that
was actually our theme song for our collegiate recruitment rowing
video when I rode up at Penn State that many
many years ago. So I'm having a moment here and
(09:13):
like I should go get out on the water and
then get some get some strokes in on the boat.
Speaker 4 (09:17):
All right, Well, I'm glad we could generate some goosebumps
with that. Now, talking about going out on the water
on the boat, I neglected to say in Houston today
it eclipsed at eighty degrees and I know my family
and friends back in New York it was in the teens.
How is it in the Penn State Land.
Speaker 3 (09:38):
Yeah, it's kind of kind of low thirties, you know,
a little warmer than it's been, you know, but not
quite as bad as in New York, but still eighty
eighties and sun, I mean, gosh, youa yeah, you're making
me wish I was somewhere else right now. You got
any openings down there? My friend?
Speaker 1 (09:51):
I know, that's that's excellent. All right.
Speaker 4 (09:52):
So why don't you tell everybody a little bit about yourself,
what you're doing now at Penn State and how how
your journey got you into liver disease.
Speaker 3 (10:04):
Yeah, so you knows, as you know, I'm a liver
doctor and by training, and you know, when I was
studying medicine at Georgetown University had quite a few really
interesting patients who struggled at the end of their lives
and needed a life saving liver transplant, right, And I
really just thought that was powerful medicine and wanted to
(10:26):
learn more and just you know, had a lot of
really great teachers along the way, and just ended up
ended up where I am in love with the liver.
Speaker 4 (10:33):
Well, that that is great, you know, it's I love
liver disease. And again, so many of us have these
stories of a particular patient or a certain event, and
as you know, we could talk about this another time.
They're just there's such a man power deficit in liver disease,
and the younger physicians coming up are just not finding
(10:56):
it all that exciting.
Speaker 1 (10:57):
I don't know, I don't I don't know what to
do about it.
Speaker 3 (11:02):
Yeah, it's a huge problem, you know. And I know
we're going to talk, you know a little bit about
fatty liver disease, and you talk about that, you know,
quite a bit on your show, and you know, there's
soon to be one liver doctor for every forty thousand
patients to have this condition. So yeah, we really need
to do more to get young folks excited about some
of our liver societies are trying. They have quite a
(11:23):
few programs right to help encourage young investigators. But yeah,
we definitely need more liver docs out there.
Speaker 1 (11:29):
Yeah, we certainly do, all right.
Speaker 4 (11:30):
So you know, we really formally met at the Liver
meetings in San Diego a few months ago where you
were presenting some of your research on exercise, and I
sat there and I said to myself, Hey, this is
fascinating research. B it's very interesting. And see you're a
great communicator, and I said, radio, we have to get
(11:52):
him on the radio. So so why don't you tell
everybody the journey you've had with your research and exercise
and how you've bridged the faudy liver story with exercise.
Speaker 1 (12:03):
It's it's a great story.
Speaker 3 (12:06):
Yeah, it was really fortunate to meet you at the
Liver meeting and thanks again for having me. So, you know,
I really have always just personally loved being active, and
when I was a child that was actually on crutches
for a year and and couldn't couldn't run, couldn't you know,
really do what I love. So I've been just looking
for ways to share that passion in the world of
(12:27):
liver disease and I kind of fell into this, you
know area where not a lot of people were looking at,
you know, how we get people more active to help
their liver, and then how we can prescribe exercise. So,
you know, we've done some work in our group over
the last six or seven years focusing on how exercise
can help patients with fatty liver disease in particular, and
(12:50):
we focused on, you know, a lot of aerobic based
intervention where we have people come, you know, walk with us,
they ride a bike. They do it at a modern intensity,
so meaning they can talk, you know, to the person
next to them, but not the thing. And then after
a very short short time, you know, about three or
four months, we found some incredible results and they're actually
independent of people losing body weight. Okay, we're so focused
(13:13):
in medicine on losing weight, losing weight, losing weight, but
the great thing is with physical activity, you don't have
to lose a single pound, and it's actually a weight
neutral intervention.
Speaker 4 (13:23):
Now, were you surprised at that or were you thinking
exercise equaled weight loss equalled healing of the liver.
Speaker 3 (13:34):
I was not surprised, and I kind of just went
back and said, hey, you know, if I want to
lose weight, what is easier to do? Is it easier
to you know, not drink the can of soda or
pop or is it easier to go walk for twenty minutes?
And it's a lot easier to not make that make
that choice. So I was hoping that science would follow that,
(13:55):
but you are correct. You know, we do counsel our
patients to lose weight if they want to improve they're
fatty liver disease. In particularly the histologies to what we
stand to the microscope if we do a biop.
Speaker 4 (14:05):
Right now, tell us a little bit about the protocols
that you had people do.
Speaker 1 (14:10):
You said ride a bike, you had walk what what
would you say?
Speaker 4 (14:13):
It is so that people at home could say, well, gee,
I ride a stationary bike, or I walk, or I
do weights or I swim.
Speaker 1 (14:20):
Where does it all fit in?
Speaker 3 (14:23):
Yeah, it's nothing fancy. I mean literally, we basically tried
to find, you know, what type of aerobic activity that
people like. We haven't done quite as much with resistance training,
where we have people, you know, lift weights at home
or in person. But it's all just simple activities you
can do at home. Everybody can you know, in theory,
you know, put on a pair of shoes and start
(14:44):
doing some degree of activity. So we had people walk,
we had them, you know, use an elliptical machine at
the gym we were at. We had them use a
rowing machine, we had them you know, ride a bike,
and again it was about five days a week of
thirty minutes of this moderate intensity activity where again, you know,
they could be able to have a conversation with us.
(15:05):
You know, they couldn't you know, belt out the YouTube's
beautiful Day, right, you know, that would be going too hard.
So it's it's a progressive program. You know. We certainly
start people with small tangible goals to be able to
get them up to that, you know, five days a
week of thirty minutes of moderate activity. And the nice
thing too is, you know, our protocols we had people
(15:26):
do the activity you know, all in when sitting. But
there's some really good evidence you don't have to do that,
and you can do what are called exercise snacks where
you break things up and you take that thirty minutes
and you do three different ten minute lengths of activity,
so you know, ten minutes before you go to work
in the morning, ten minutes over a lunch, on your break,
(15:46):
ten minutes when you get home, and then those all
add up provided you get to the correct intensity of activity.
Speaker 4 (15:52):
Right now on on your studies. And this is you know,
I think an important point because of complying. It's in
a sense, were the patients coming to you to your center,
getting on a bike, getting on a rower and you know,
getting hooked up with heart rate and you know, ekg
(16:13):
whatever it was to monitor them or was this at home?
Speaker 1 (16:16):
Were they on their own?
Speaker 3 (16:19):
So the first several studies we did, we had people
come in person, and we realized that if we were
going to help the many many people with this condition,
that having them, you know, take the time to travel
and then being able to do this in a larger
group of people just wasn't going to be possible. Right,
So we actually have been able to adapt our program
to have people do them from the comfort of their
(16:41):
of their home. We do still supervise using telehealth for
using kind of a either like a zoom or web
based platform, and then people have a basically a fitness
track or so a fit bit on their wrist and
from there they can monitor their heart rate at home.
We give them the correct zones to make sure they
are doing, you know, the exact and hensity of activity
we'd like them to complete.
Speaker 1 (17:02):
Yeah.
Speaker 4 (17:02):
Just we're going to be taking a break here just
in a second. But you talked about zone zone. Are
you talking at least getting to zone two?
Speaker 3 (17:12):
Yes, predominantly zoned two and a little bit of zone
three for moderates, perhaps bigger some intensity activity.
Speaker 4 (17:17):
Right, So would you say that, and again this is
under a research trial and patients may have different attitudes
and motivation, but would you say most of those in
the study were compliant they did the exercise as outlined.
Speaker 3 (17:34):
Yeah, absolutely, we had over eighty percent compliance.
Speaker 1 (17:38):
Okay, good study and.
Speaker 3 (17:39):
Over ninety seven percent compliance. It's the second one that's ongoing.
Speaker 4 (17:43):
Excellent, all right, we're going to take a quick break
right now. We're on with Jonathan Stein from Penn State
where it's down in the twenties today, and we're talking
about Famdy liver Roll of exercise and his research.
Speaker 1 (17:59):
A lot more talk about doctor Joe Galotti.
Speaker 4 (18:03):
Well we're right back, stay tuned, Welcome.
Speaker 1 (18:06):
Back everybody, Doctor Joe Galotti.
Speaker 4 (18:08):
As I like to say, we don't have guests on
the program, we have experts, and tonight we've got doctor
Jonathan Stein. He is Associate Professor of Medicine and Public
Health at penn stayed in Hershey, Pennsylvania, where he heads
up the fatty Liver program and the liver research there,
(18:33):
and we're talking tonight about his research and his clinical
interest in exercise and fatty liver. Considering there's roughly eighty
to one hundred million people with fatty liver in the
United States, we're gonna have to get everybody sneakers, John,
what do you think, Yeah.
Speaker 3 (18:51):
That's absolutely or at least you know, some some discounts
here from your local running stores. I think we have
got a step in and help out.
Speaker 1 (18:59):
I yeah, I think so.
Speaker 4 (19:02):
So. Uh, getting back you would you were talking about
the research and the interesting part that the study subjects,
the patients didn't really need to lose a lot of
weight or any weight at all to help theirliver. Now,
what were the things you were looking at to say, uh,
somebody's liver improved and exercise is a good thing.
Speaker 3 (19:25):
Yeah, that's that's a really great question. And you know,
it all went back to how this disease develops, and
you know the first thing we see when somebody has
abnormal metabolism is they get fat stuck on their liver
and then over time the liver gets inflamed and then
and then scarred. So, you know, the first thing we
tried to show was that, you know, with exercise, people
(19:47):
lost fat in their liver right, and we showed that
with MRI scans. We also showed that the inflammation in
the liver gots better also with with MRI scans and
blood work. And then lastly, you know, we've art of
the show that some of the long term changes with
scar tissue can start to be reversed with exercise, even
(20:08):
if you don't lose significant amounts of body weight. So,
you know, for those of you listening tonight, there's definitely
a lot of a lot of promise here, and we're
hoping to get the word out and really just encourage
people to get more active and perhaps Joe and I
can talk about a few strategies that surely worn them
on the way they might help you.
Speaker 4 (20:26):
Sure now, these studies how long of an intervention if
you want to call it?
Speaker 1 (20:30):
That was it?
Speaker 4 (20:32):
I think you mentioned three or four months, But do
you have data on people that have been exercising a year,
eighteen months and really really sticking with it.
Speaker 3 (20:42):
Yeah, most of our intense interventions are more short term
if you brought up, and they're usually on the order
of sixteen or twenty weeks, so four or five months.
Speaker 1 (20:51):
Sure.
Speaker 3 (20:52):
What we typically do is when somebody finishes a study
with us, is we set them up for success. So
we basically take what is working in the study, so
you know, if they enjoy coming to the gym, they
enjoy using the exercise equipment, we make sure they have
a gym membership. When they're done, we make sure they
have access to a personal trainer. And then from there
we actually have data where we've called people three months
(21:14):
after they're done with us, and unfortunately, folks, you know,
are a little less successful. Only about one out of
three people are still you know, completing the same amount
of activity as they were in the clinical trials. So clearly,
I think there's a little more for us to do
to make sure that these incredible changes people making the
short term translate into more long term healthy behaviors.
Speaker 4 (21:38):
Yeah, and I would I would say almost anything we
do as humans, it is having that sense of accountability
that look, during the study, they know doctor Stein and
his team, they're they're going to get on you if
you missed a session of you know, working out or something,
they're going to get you back in line. But it's
(22:00):
very hard. I think for anything we try to do,
any habit that unless somebody is checking in on you.
And that's why having a trainer or a coach or
a workout buddy is good. It might be called out
it's raining, you don't want to work out, I'm going
to call you up and say, John, get your butt outside,
put your sneakers on, let's go for a run. So
(22:22):
I think that if we're going to really tackle this
ginormous problem, we have to within the healthcare sphere in
a sense, set up some kind of accountability for our patients.
Speaker 3 (22:36):
What do you think, Yeah? Absolutely, I mean you're singing
my heart song, you know here for lack of better words.
And you know, luckily, I have a really great collaborator,
doctor Chris Shimana, who's here at Penn State with us,
and he's looked into how to make exercise fun and
how to make people accountable. So he's developed actually some
(22:59):
community based programs where adults go and go to a
local park and essentially he's created new games for people
to play to become more active. We call the playfit
and we're hoping to take this and adapt it to
the many folks you know living with BATTYE libertycy. Yeah,
and this is because we've done some work in patients
(23:19):
awaiting liber transplantation with an exercise program on a smartphone
showing that if there is a game component to the exercise,
so meaning they earn't badges for how much exercise they do,
that they can compete with different people on the application
kind of like Peloton, but only for people waiting transplant.
That people enjoy this more. There's that accountability and it
(23:41):
really encourages more adherents until they get that phone call
for that life saving liber transplant, right.
Speaker 4 (23:47):
Right, And so much has been written, even in all
aspects of business, just gamifying a process, and people really respond.
Speaker 1 (23:56):
We like to play games.
Speaker 3 (23:59):
Yeah, absolutely, I mean I'm no exception to that, you know,
and I get bored easily, you know, I have to
constantly change my exercise routine. I mean what we're all
creatures that have it, like you said, and there's you know,
hedonic adaptation, which essentially just means that you know, eventually
we get used to something that's new, right, you know,
you buy that new car, you se Internet, it smells amazing,
(24:19):
and then three months later you're, right, why did I
get this thing? Can I create it in? I mean,
I think it's that's just kind of how it works.
Hoping not the sneakers were going to get people.
Speaker 4 (24:27):
I know, I know you got to you got to
get at least yeah, you got to get five hundred
miles on the sneakers. But you know, on the on
the patients that were in the study, or even you know,
maybe the non study patients that you're taking care of
and they're exercising and they see that beneficial effect fat
and the liver is down, maybe their liver chemistries go down,
(24:47):
stiffness of the liver improves. What what did they say
to you? Certainly they I'm sure they were very happy
and grateful, But was there a change of heart, something
really something wired in their body feeling differently?
Speaker 3 (25:04):
Yeah, and we actually, you know, both anecdotally with what
people would tell us, but we did formal assessment in
a research you know standpoint where we basically you know,
ask people about their their quality of life before and
after the exercise program. And in addition to the liver
getting much healthier. Blood sugar is improving, cholesterol, improving, blood
(25:27):
pressure going down. We found that people felt better, they
had less pain, they were sleeping better, they felt much
more supported in their in their daily life. And we've
really had some people, you know, have a complete transformation
and they walk in and they look different, they speak different,
they have new confidence, and they feel like they have
(25:49):
this renewed sense of purpose when they take charge of
their health, and it's incredibly powerful. It's such a gift
to be able to see this when it happens for
some of our patients.
Speaker 1 (25:58):
Yeah, it really is. Is is marvelous.
Speaker 4 (26:01):
Before we take the next break, I want to try
to start off on something. There's a bit of a
movement for physicians to write exercise prescriptions or to prescribe exercise.
Speaker 1 (26:14):
What do you think of that?
Speaker 4 (26:16):
And you know, we'll be taking a break here in
a second, we could finish it, But what's your initial
you know, thirty thousand foot idea on that?
Speaker 3 (26:24):
Yeah, I mean I'm completely biased because I work with
the American College of Sports Medicine to promote physicians doing
exercise prescription and have brought that into the Satty Liver
World if you will, and it definitely, you know, needs
a lot of work. There is a lot of buy in,
right and the first thing we need to do is
(26:44):
actually improve position education because currently US medical schools and
zero minutes educating on exercise prescription.
Speaker 1 (26:51):
Absolutely all right.
Speaker 4 (26:52):
Final segment coming out with it johnas thin Stein from
Penn State. He's an expert in Live a Disease re Search,
Fanny Liver and exercise.
Speaker 1 (27:01):
I'm not to Joe Goltti.
Speaker 4 (27:02):
Don't forget doctor Joegalotti dot com is our website.
Speaker 1 (27:06):
Stay tuned. Final segment coming up. Man, that hour goes fast.
We're right back. Welcome back, everybody.
Speaker 4 (27:13):
Final segment, don't forget on Tuesday.
Speaker 1 (27:18):
This coming Tuesday, February. Fourth program.
Speaker 4 (27:22):
Note I'll be on Serious XM Channel one twenty nine
The Catholic Channel with Martha McCallum from Fox News Channel
talking about health and wellness and her approach to raising
her family and health strategy she had along with a
(27:43):
little Catholicism. It is the Catholic Channel, by the way,
and don't forget doctor Joe Galotti dot com is our website.
Soner for our newsletter goes out every Saturday morning.
Speaker 1 (27:57):
Across the country.
Speaker 4 (27:59):
You want to stay in touch with all that we do,
sign up for the newsletter.
Speaker 1 (28:05):
Well, it's been a great pleasure.
Speaker 4 (28:06):
We have doctor Jonathan Stein from Penn State where he
heads up the Fatty Liver Unit and the research and exercise.
It really is quite fascinating John, and thanks very much
for coming on tonight. We were talking about exercise as
(28:27):
a prescription patient walking out with not only well I
hate to say, you know, a medication prescription, but a
prescription for exercise. I look at that as it's very
much needed, but the barriers are huge. What do you
(28:48):
think realistically we can do here?
Speaker 3 (28:53):
Yeah, I completely agree, and I think some of this
goes back to, again the education of the the healthcare
workforce about, you know, how to deliver an exercise prescription.
So you know, we are doing some work now where
we're developing something called the Physical Activity Playbook, which is
meant to package everything together for a very busy healthcare provider,
(29:17):
and this will allow people to use free tools to
screen patients to see how active they are. It'll ask
them questions about, you know, the barriers preventing them from
being more active, and then it'll assess their capability of
doing a certain type of activity, and then from there
a prescription pad will be provided to the healthcare provider
and then under thirty seconds, they can circle how many
(29:39):
days a week they want somebody to do it. Activity,
they can circle, how long, they can circle, the intensity
of the activity, they can circle you know what the
activity is, and then they can rip it off the
pad and give it to a patient. And you know,
we've really found now in a digital age where every
prescription seemingly is electronic these days, that when people leave
(29:59):
the office with a piece of paper, they really like that. Yeah,
and I think this is a very nice compliment to medications.
It's really hard for many of our patients with batty
liver disease to do one without the other. And you know,
a healthy lifestyle and medication in the right context, you
(30:20):
need to be willing to partner.
Speaker 1 (30:21):
Right, Yeah, exactly.
Speaker 4 (30:22):
And I would say it's the triad of the exercise
and lifestyle. It's the nutrition and cooking, and then of
course the traditional medical therapies that and surgical therapies that
we need. So we can't we can't sort of gang
up on just the as I like to say, the
pill mentality. The pills are just the answer. You have
(30:43):
to look at all the other components that are equally important.
So from your perspective, both from yourself.
Speaker 1 (30:52):
Somebody that.
Speaker 4 (30:54):
Has or is an athlete and exercises and understands is
very very well for those listening tonight and you know
everybody in those I should walk more and I should
go to the gym and the treadmill. What would you
say and that you know, this is a quick answer
to a complicated problem, the best exercise with the lowest
(31:16):
bar to entry that will get somebody to exercise.
Speaker 1 (31:20):
What what do you think and what have you learned?
Speaker 3 (31:24):
Yeah? I mean, you know, my easy answer would be
a one size fits all approach that it would endorse,
you know. Walking With that said, I think if we're
looking at, you know, making sure that people started and
stick with it, it gets back to what you enjoy, right,
you know? Were you an athlete in high school? Did
you have a favorite sport? Have you liked running in
(31:45):
the past but you're no longer running? Do you enjoy hiking?
Do you like, you know, talking with the neighbors? You know,
do you enjoy solace in nature?
Speaker 1 (31:53):
Right?
Speaker 3 (31:53):
And these are things I asked my patients. And then
from there, you know, we really focus on you know,
this individualized exercise prescription. If we do it one size
fits all approach, we are never going to be successful. Yeah,
and you know right now, unfortunately, I'd say that that
happens more often than.
Speaker 4 (32:10):
Not, right, And I think that's a good question for
any healthcare providers listening tonight. Ask don't just say, Bob,
you have to exercise more. Really spend a little while
and say what do you like to do? Do you
like to swim? Do you like to go on the
treadmill and just listen to you know, the Grateful Dead
or is it alpine walking or something like that. So
(32:31):
I think that's very good there. You know, early in
the program, I spoke for a minute or two about
diet drinks and how it disrupts the intestinal micro biome.
I believe there's been some research that shows that exercise
(32:52):
improves the intestinal microbiome.
Speaker 1 (32:55):
True or false? And where are we heading with that?
Speaker 3 (32:59):
Yeah? That is true, and luckily our group has actually
started to explore some of that. So, you know, in
terms of fatty liver, the microbiome or the the bacteria
you know, living inside our intestines are abnormal, there's a
larger amount of ones that cause problems with fatty liver worsening. So,
(33:20):
you know, we have actually shown that with a short
exercise program of four months that we can increase the
number of bacteria. We can change the composition where we
have more favorable bacteria that produce less of the byproducts
that worse in fatty liver disease. And then we're also
exploring kind of some of the functional changes where if
(33:41):
we restore bacterial health, the gut will be less leaky,
they'll be less inflammation, and perhaps this will feed back
to the liver and ultimately be one of the reasons
why fat gets out of the liver and inflammation gets
better even without weight loss with regular exercise.
Speaker 4 (33:58):
Yeah, and and I talk all the time about the
importance of the microbiome and for people to really start
paying attention to what they're eating and they're exercise in
their sleep, it really is important. A little bit slightly
off topic, what is your take on the GLP one agents,
(34:19):
the ozepics of the world that are out there, and
the sort of the discussion we've had for many many
months is should the barrier to getting these drugs be
low in that basically, hey, if you want it and
you want to lose weight, it's available, or should it
(34:41):
be reserved for the more extreme cases of obesity where
people have severe diabetes, they have heart disease.
Speaker 1 (34:49):
Advanced liver disease.
Speaker 4 (34:51):
Of course, what is your take and what do you
think the public wants to hear?
Speaker 3 (34:57):
Yeah, I mean, I think gop ones are one of
the most important scientific discoveries you know, of the last
ten twenty thirty plus years. They are an incredible class
of medications with many widespread benefits, even beyond the livers.
So I think, you know, if we're going to improve
population health that you know, having access to these you know,
(35:21):
really highly effective medicine is going to be very important.
They certainly come with a price tag, so you know,
we have to figure out the health economic side. But
when you look at purely just you know, access and equity,
I think that you know, the data is there for
not only treatments but also disease prevention, and right certainly
(35:42):
the medications has f gay approval for some of those
some of their things.
Speaker 4 (35:48):
Yeah, no, no, no, no exactly, And I think we're
still trying to figure out the best way to use them,
because it seems like every week there is another positive effect.
There was I was just looking at an article I
don't know if it's the New York Times about how
dementia and Alzheimer's is improving with the use of ozembic.
(36:08):
So again, tip of the iceberg. We just have to
figure out how to really harness this for the millions
out there. So, Jonathan, we got a minute left. You're
talking to America tonight. What's your message to everybody about
not only fatty liver, but the role of exercise and
(36:29):
how should they think tomorrow morning, Monday when they wake
up and they see their sneakers sitting in the closet, what.
Speaker 1 (36:36):
Do you think?
Speaker 3 (36:38):
Yeah, I would hope that our time together tonight has
been inspirational and you look at the sneakers and you say,
you know, I can do it, and as today is
the day, and I would love just for you to
be five minutes more active tomorrow and ten minutes to
the next day and then you figure out a way
to sustain this. And I hope tonight's program was helpful.
(36:58):
I know that you know, Joe, You're you've been fighting
this fight for a long time and really just trying
to help everybody be as healthy as possible. And you know,
we all want to lead the life we want lives
we want to lead right right, and if we don't
have our health, we can't do the things who wants
to do, We can't accomplish our purpose, we can't make
the impact who wants to make. So you know, if
(37:19):
you look at those sneakers, you remember that it's about impact,
it's about legacy, it's about being the person you want
to be, and perhaps that maybe a motivational strategy at it.
Speaker 4 (37:28):
All, Right, Jonathan Stein, we will be in touch with
you soon. For everybody else, Doctor Joe Glotti, we'll see
you next Sunday evening.
Speaker 2 (37:37):
You've been listening to Your Health First with doctor Joe Glotti.
For more information on this program or the content of
this program, go to your Health First dot com
Initial Life Sequence.
Speaker 2 (00:04):
Coming to you live from Houston, Texas, home to the
world's largest medical center.
Speaker 1 (00:08):
In the bunch of bas Day.
Speaker 3 (00:13):
Roger Collie, this.
Speaker 2 (00:20):
Is your Health First, the most beneficial health program on
radio with doctor Joe Galotti. During the next hour you'll
learn about health, wellness and the provention of disease. Now
here's your host, doctor Joe Bellotti.
Speaker 3 (00:43):
Well a good.
Speaker 1 (00:44):
Sunday evening till everybody.
Speaker 4 (00:47):
Doctor Joe Galotti broadcasting from our world headquarters here in Houston,
Texas and broadcasting coast to coast on the I iHeartRadio app.
And it is always a pleasure to be here. And again,
our soul mission is to raise your Health IQ, one
(01:08):
listener at a time, and to make you better consumers
of healthcare.
Speaker 1 (01:12):
That is our.
Speaker 4 (01:13):
Simple mission for the past twenty two years, every Sunday
at seven o'clock. So we have not given up on
our mission. That is what we're passionate about, and we
are so glad everybody is here tonight. The website of
the program doctor Joegalotti dot com, d R J O
E G A L A t I dot com And
(01:37):
when you go there you can sign up for our
weekly newsletter that goes out every Sunday, no, every Saturday.
Speaker 1 (01:42):
Every Saturday in the morning.
Speaker 4 (01:45):
All of our social media is there, and if you
want to send me a message, there is a tab
that says contact us. And we're happy to hear from
from everybody. That is what we want to do. It's
a two way street. It's not just me yaking on
the radio. It is to hear from all of our listeners.
Now on the program tonight, Jonathan Stein from Penn State,
(02:12):
Great University, great academic institution. He is a hepatologist, a
liver specialist like myself, and his area of research and
interest is in fatty liver. And you've heard me talk
a lot about fatty liver because it's ubiquitous and it's
(02:33):
a huge public health problem. But his research, one of
the areas that he's concentrating in is the role of exercise,
which is excellent. I think we need to exercise more.
We need to have our patients and our community more
versed and educated on exercise. So doctor Stein will be
(02:56):
coming up in just a bit. We'll have him on
for a good part of the program, So get your pencils, notepad,
take notes. That is what we want to do a
quick programming note. This coming Tuesday, February fourth, I will
be on Sirius XM channel one twenty nine, the Catholic Channel,
(03:20):
and we do just about a once a month broadcast
on the Catholic Channel. The special treat is that we
have Martha McCallum from the Fox News Channel who will
be joining me, and since it is the Catholic Channel,
we'd be talking about faith, but we'll also be talking
(03:41):
about personal wellness, how she raised her family, some of
her health and wellness attitudes. Maybe we'll squeak in a
little bit of well her thoughts on make America healthy again.
But Martha McCallum Tuesday one a clock East, Serious XM
(04:02):
channel one twenty nine, make sure you tune in for that,
and we follow us along on all the social media platforms.
I will be reposting it there before we get on
my gosh, quick shout out my daughter and her husband,
Elizabeth and Daniel. She wanted to make me alert everybody
that she is cooking at home Sunday night cook in.
Speaker 1 (04:26):
And for.
Speaker 4 (04:29):
The younger generation our children, it is marvelous to see
that they are taking the interest cooking at home and
learning the skills in the kitchen. Both of them are
excellent in the kitchen. Rather than ordering out getting processed food,
they are cooking inside. The apple doesn't fall far from
(04:51):
the tree. So thank you Elizabeth and Daniel for cooking
at home. That's what we like to see, all right.
So I received a message from a longtime listener, Mark,
and his question was he drinks a lot of diet
(05:12):
soda and he's questioning whether or not it's healthy. Now, categorically,
the quick answer is no, it is not healthy. Most
sweetened drinks fall under the ultraprocessed food category. These are
bad news. Ultra process foods are associated with the wide
(05:35):
range of health derangements. But when you look at diet soda,
they are associated with diabetes and metabolic syndrome. Your good cholesterol,
the HDL goes down, blood sugar can go up, increase
in belly fat, high triglycerides, and blood pressure, and of
(05:59):
course all this puts you at for type two diabetes.
There's an association with atrial fibrillation. There is, you know,
one of the problems that these drinks are so sweet,
they really fake out your brain and when they get
this sweet impulse, it creates a trigger for you to
(06:24):
really crave more sweets, more high calorie foods, which will
lead to weight gain and belly fat. They're dental problems,
changes in bone density. But the most interesting thing is that,
and we've talked about this a lot. Maybe doctor Stein
will touch on this as well, the bacteria in your intestine.
We talk about the intestinal microbiome. These artificial sweeteners disrupt.
Speaker 1 (06:50):
The normal.
Speaker 4 (06:53):
Environment of the good bacteria the bad bacteria, and so
much is being learned learned about how if you don't
have the right bacteria.
Speaker 1 (07:04):
In your gut, a whole.
Speaker 4 (07:06):
Host of problems are going to develop, including waking diabete,
is fatty liver. All right, so mark frequent listener, throw
out the diet, soda, drink water.
Speaker 1 (07:22):
All right. I'm doctor Joe Glotti.
Speaker 4 (07:23):
Don't forget doctor Joeglotti dot com is our website. Doctor
Jonathan Stein from Penn State is coming up in just
a few minutes.
Speaker 1 (07:33):
Stay tuned. We will be right back. Welcome back everybody,
doctor Joe Galotti. Every Sunday between seven and eight.
Speaker 4 (07:41):
Pm, we're here trying to make sure you stay out
of the doctor's office, stay out of the er, because
so much, so much of the chronic disease that is
related to lifestyle choices we make. And you don't underestimate
(08:06):
how much influence you have on your own health and wellness.
So never despair, Never think that you're never going to
get well. There's so many things that you could do,
but it all comes with knowledge.
Speaker 1 (08:18):
That is the basis.
Speaker 4 (08:19):
It's knowledge, and that's what we try to do here
every Sunday. So, as I was saying earlier, it's a
great honor to have doctor Jonathan Stein from Penn State,
a terrific institution he is. He's an Associate Professor of
Medicine and Public Health where he serves as the Fatty
(08:40):
Liver Program Director and Liver Center Research Director. A fellow hepatologist, John,
it's always great to talk to another liver person on
the radio.
Speaker 1 (08:49):
How are you tonight?
Speaker 3 (08:51):
Oh, I'm doing so well, Joe. Thank you so much
for having me. It's an absolute delight. Congrats on your
twenty two years. I just have to say I love
the fact that you played YouTube the Beautiful Day that
was actually our theme song for our collegiate recruitment rowing
video when I rode up at Penn State that many
many years ago. So I'm having a moment here and
(09:13):
like I should go get out on the water and
then get some get some strokes in on the boat.
Speaker 4 (09:17):
All right, Well, I'm glad we could generate some goosebumps
with that. Now, talking about going out on the water
on the boat, I neglected to say in Houston today
it eclipsed at eighty degrees and I know my family
and friends back in New York it was in the teens.
How is it in the Penn State Land.
Speaker 3 (09:38):
Yeah, it's kind of kind of low thirties, you know,
a little warmer than it's been, you know, but not
quite as bad as in New York, but still eighty
eighties and sun, I mean, gosh, youa yeah, you're making
me wish I was somewhere else right now. You got
any openings down there? My friend?
Speaker 1 (09:51):
I know, that's that's excellent. All right.
Speaker 4 (09:52):
So why don't you tell everybody a little bit about yourself,
what you're doing now at Penn State and how how
your journey got you into liver disease.
Speaker 3 (10:04):
Yeah, so you knows, as you know, I'm a liver
doctor and by training, and you know, when I was
studying medicine at Georgetown University had quite a few really
interesting patients who struggled at the end of their lives
and needed a life saving liver transplant, right, And I
really just thought that was powerful medicine and wanted to
(10:26):
learn more and just you know, had a lot of
really great teachers along the way, and just ended up
ended up where I am in love with the liver.
Speaker 4 (10:33):
Well, that that is great, you know, it's I love
liver disease. And again, so many of us have these
stories of a particular patient or a certain event, and
as you know, we could talk about this another time.
They're just there's such a man power deficit in liver disease,
and the younger physicians coming up are just not finding
(10:56):
it all that exciting.
Speaker 1 (10:57):
I don't know, I don't I don't know what to
do about it.
Speaker 3 (11:02):
Yeah, it's a huge problem, you know. And I know
we're going to talk, you know a little bit about
fatty liver disease, and you talk about that, you know,
quite a bit on your show, and you know, there's
soon to be one liver doctor for every forty thousand
patients to have this condition. So yeah, we really need
to do more to get young folks excited about some
of our liver societies are trying. They have quite a
(11:23):
few programs right to help encourage young investigators. But yeah,
we definitely need more liver docs out there.
Speaker 1 (11:29):
Yeah, we certainly do, all right.
Speaker 4 (11:30):
So you know, we really formally met at the Liver
meetings in San Diego a few months ago where you
were presenting some of your research on exercise, and I
sat there and I said to myself, Hey, this is
fascinating research. B it's very interesting. And see you're a
great communicator, and I said, radio, we have to get
(11:52):
him on the radio. So so why don't you tell
everybody the journey you've had with your research and exercise
and how you've bridged the faudy liver story with exercise.
Speaker 1 (12:03):
It's it's a great story.
Speaker 3 (12:06):
Yeah, it was really fortunate to meet you at the
Liver meeting and thanks again for having me. So, you know,
I really have always just personally loved being active, and
when I was a child that was actually on crutches
for a year and and couldn't couldn't run, couldn't you know,
really do what I love. So I've been just looking
for ways to share that passion in the world of
(12:27):
liver disease and I kind of fell into this, you
know area where not a lot of people were looking at,
you know, how we get people more active to help
their liver, and then how we can prescribe exercise. So,
you know, we've done some work in our group over
the last six or seven years focusing on how exercise
can help patients with fatty liver disease in particular, and
(12:50):
we focused on, you know, a lot of aerobic based
intervention where we have people come, you know, walk with us,
they ride a bike. They do it at a modern intensity,
so meaning they can talk, you know, to the person
next to them, but not the thing. And then after
a very short short time, you know, about three or
four months, we found some incredible results and they're actually
independent of people losing body weight. Okay, we're so focused
(13:13):
in medicine on losing weight, losing weight, losing weight, but
the great thing is with physical activity, you don't have
to lose a single pound, and it's actually a weight
neutral intervention.
Speaker 4 (13:23):
Now, were you surprised at that or were you thinking
exercise equaled weight loss equalled healing of the liver.
Speaker 3 (13:34):
I was not surprised, and I kind of just went
back and said, hey, you know, if I want to
lose weight, what is easier to do? Is it easier
to you know, not drink the can of soda or
pop or is it easier to go walk for twenty minutes?
And it's a lot easier to not make that make
that choice. So I was hoping that science would follow that,
(13:55):
but you are correct. You know, we do counsel our
patients to lose weight if they want to improve they're
fatty liver disease. In particularly the histologies to what we
stand to the microscope if we do a biop.
Speaker 4 (14:05):
Right now, tell us a little bit about the protocols
that you had people do.
Speaker 1 (14:10):
You said ride a bike, you had walk what what
would you say?
Speaker 4 (14:13):
It is so that people at home could say, well, gee,
I ride a stationary bike, or I walk, or I
do weights or I swim.
Speaker 1 (14:20):
Where does it all fit in?
Speaker 3 (14:23):
Yeah, it's nothing fancy. I mean literally, we basically tried
to find, you know, what type of aerobic activity that
people like. We haven't done quite as much with resistance training,
where we have people, you know, lift weights at home
or in person. But it's all just simple activities you
can do at home. Everybody can you know, in theory,
you know, put on a pair of shoes and start
(14:44):
doing some degree of activity. So we had people walk,
we had them, you know, use an elliptical machine at
the gym we were at. We had them use a
rowing machine, we had them you know, ride a bike,
and again it was about five days a week of
thirty minutes of this moderate intensity activity where again, you know,
they could be able to have a conversation with us.
(15:05):
You know, they couldn't you know, belt out the YouTube's
beautiful Day, right, you know, that would be going too hard.
So it's it's a progressive program. You know. We certainly
start people with small tangible goals to be able to
get them up to that, you know, five days a
week of thirty minutes of moderate activity. And the nice
thing too is, you know, our protocols we had people
(15:26):
do the activity you know, all in when sitting. But
there's some really good evidence you don't have to do that,
and you can do what are called exercise snacks where
you break things up and you take that thirty minutes
and you do three different ten minute lengths of activity,
so you know, ten minutes before you go to work
in the morning, ten minutes over a lunch, on your break,
(15:46):
ten minutes when you get home, and then those all
add up provided you get to the correct intensity of activity.
Speaker 4 (15:52):
Right now on on your studies. And this is you know,
I think an important point because of complying. It's in
a sense, were the patients coming to you to your center,
getting on a bike, getting on a rower and you know,
getting hooked up with heart rate and you know, ekg
(16:13):
whatever it was to monitor them or was this at home?
Speaker 1 (16:16):
Were they on their own?
Speaker 3 (16:19):
So the first several studies we did, we had people
come in person, and we realized that if we were
going to help the many many people with this condition,
that having them, you know, take the time to travel
and then being able to do this in a larger
group of people just wasn't going to be possible. Right,
So we actually have been able to adapt our program
to have people do them from the comfort of their
(16:41):
of their home. We do still supervise using telehealth for
using kind of a either like a zoom or web
based platform, and then people have a basically a fitness
track or so a fit bit on their wrist and
from there they can monitor their heart rate at home.
We give them the correct zones to make sure they
are doing, you know, the exact and hensity of activity
we'd like them to complete.
Speaker 1 (17:02):
Yeah.
Speaker 4 (17:02):
Just we're going to be taking a break here just
in a second. But you talked about zone zone. Are
you talking at least getting to zone two?
Speaker 3 (17:12):
Yes, predominantly zoned two and a little bit of zone
three for moderates, perhaps bigger some intensity activity.
Speaker 4 (17:17):
Right, So would you say that, and again this is
under a research trial and patients may have different attitudes
and motivation, but would you say most of those in
the study were compliant they did the exercise as outlined.
Speaker 3 (17:34):
Yeah, absolutely, we had over eighty percent compliance.
Speaker 1 (17:38):
Okay, good study and.
Speaker 3 (17:39):
Over ninety seven percent compliance. It's the second one that's ongoing.
Speaker 4 (17:43):
Excellent, all right, we're going to take a quick break
right now. We're on with Jonathan Stein from Penn State
where it's down in the twenties today, and we're talking
about Famdy liver Roll of exercise and his research.
Speaker 1 (17:59):
A lot more talk about doctor Joe Galotti.
Speaker 4 (18:03):
Well we're right back, stay tuned, Welcome.
Speaker 1 (18:06):
Back everybody, Doctor Joe Galotti.
Speaker 4 (18:08):
As I like to say, we don't have guests on
the program, we have experts, and tonight we've got doctor
Jonathan Stein. He is Associate Professor of Medicine and Public
Health at penn stayed in Hershey, Pennsylvania, where he heads
up the fatty Liver program and the liver research there,
(18:33):
and we're talking tonight about his research and his clinical
interest in exercise and fatty liver. Considering there's roughly eighty
to one hundred million people with fatty liver in the
United States, we're gonna have to get everybody sneakers, John,
what do you think, Yeah.
Speaker 3 (18:51):
That's absolutely or at least you know, some some discounts
here from your local running stores. I think we have
got a step in and help out.
Speaker 1 (18:59):
I yeah, I think so.
Speaker 4 (19:02):
So. Uh, getting back you would you were talking about
the research and the interesting part that the study subjects,
the patients didn't really need to lose a lot of
weight or any weight at all to help theirliver. Now,
what were the things you were looking at to say, uh,
somebody's liver improved and exercise is a good thing.
Speaker 3 (19:25):
Yeah, that's that's a really great question. And you know,
it all went back to how this disease develops, and
you know the first thing we see when somebody has
abnormal metabolism is they get fat stuck on their liver
and then over time the liver gets inflamed and then
and then scarred. So, you know, the first thing we
tried to show was that, you know, with exercise, people
(19:47):
lost fat in their liver right, and we showed that
with MRI scans. We also showed that the inflammation in
the liver gots better also with with MRI scans and
blood work. And then lastly, you know, we've art of
the show that some of the long term changes with
scar tissue can start to be reversed with exercise, even
(20:08):
if you don't lose significant amounts of body weight. So,
you know, for those of you listening tonight, there's definitely
a lot of a lot of promise here, and we're
hoping to get the word out and really just encourage
people to get more active and perhaps Joe and I
can talk about a few strategies that surely worn them
on the way they might help you.
Speaker 4 (20:26):
Sure now, these studies how long of an intervention if
you want to call it?
Speaker 1 (20:30):
That was it?
Speaker 4 (20:32):
I think you mentioned three or four months, But do
you have data on people that have been exercising a year,
eighteen months and really really sticking with it.
Speaker 3 (20:42):
Yeah, most of our intense interventions are more short term
if you brought up, and they're usually on the order
of sixteen or twenty weeks, so four or five months.
Speaker 1 (20:51):
Sure.
Speaker 3 (20:52):
What we typically do is when somebody finishes a study
with us, is we set them up for success. So
we basically take what is working in the study, so
you know, if they enjoy coming to the gym, they
enjoy using the exercise equipment, we make sure they have
a gym membership. When they're done, we make sure they
have access to a personal trainer. And then from there
we actually have data where we've called people three months
(21:14):
after they're done with us, and unfortunately, folks, you know,
are a little less successful. Only about one out of
three people are still you know, completing the same amount
of activity as they were in the clinical trials. So clearly,
I think there's a little more for us to do
to make sure that these incredible changes people making the
short term translate into more long term healthy behaviors.
Speaker 4 (21:38):
Yeah, and I would I would say almost anything we
do as humans, it is having that sense of accountability
that look, during the study, they know doctor Stein and
his team, they're they're going to get on you if
you missed a session of you know, working out or something,
they're going to get you back in line. But it's
(22:00):
very hard. I think for anything we try to do,
any habit that unless somebody is checking in on you.
And that's why having a trainer or a coach or
a workout buddy is good. It might be called out
it's raining, you don't want to work out, I'm going
to call you up and say, John, get your butt outside,
put your sneakers on, let's go for a run. So
(22:22):
I think that if we're going to really tackle this
ginormous problem, we have to within the healthcare sphere in
a sense, set up some kind of accountability for our patients.
Speaker 3 (22:36):
What do you think, Yeah? Absolutely, I mean you're singing
my heart song, you know here for lack of better words.
And you know, luckily, I have a really great collaborator,
doctor Chris Shimana, who's here at Penn State with us,
and he's looked into how to make exercise fun and
how to make people accountable. So he's developed actually some
(22:59):
community based programs where adults go and go to a
local park and essentially he's created new games for people
to play to become more active. We call the playfit
and we're hoping to take this and adapt it to
the many folks you know living with BATTYE libertycy. Yeah,
and this is because we've done some work in patients
(23:19):
awaiting liber transplantation with an exercise program on a smartphone
showing that if there is a game component to the exercise,
so meaning they earn't badges for how much exercise they do,
that they can compete with different people on the application
kind of like Peloton, but only for people waiting transplant.
That people enjoy this more. There's that accountability and it
(23:41):
really encourages more adherents until they get that phone call
for that life saving liber transplant, right.
Speaker 4 (23:47):
Right, And so much has been written, even in all
aspects of business, just gamifying a process, and people really respond.
Speaker 1 (23:56):
We like to play games.
Speaker 3 (23:59):
Yeah, absolutely, I mean I'm no exception to that, you know,
and I get bored easily, you know, I have to
constantly change my exercise routine. I mean what we're all
creatures that have it, like you said, and there's you know,
hedonic adaptation, which essentially just means that you know, eventually
we get used to something that's new, right, you know,
you buy that new car, you se Internet, it smells amazing,
(24:19):
and then three months later you're, right, why did I
get this thing? Can I create it in? I mean,
I think it's that's just kind of how it works.
Hoping not the sneakers were going to get people.
Speaker 4 (24:27):
I know, I know you got to you got to
get at least yeah, you got to get five hundred
miles on the sneakers. But you know, on the on
the patients that were in the study, or even you know,
maybe the non study patients that you're taking care of
and they're exercising and they see that beneficial effect fat
and the liver is down, maybe their liver chemistries go down,
(24:47):
stiffness of the liver improves. What what did they say
to you? Certainly they I'm sure they were very happy
and grateful, But was there a change of heart, something
really something wired in their body feeling differently?
Speaker 3 (25:04):
Yeah, and we actually, you know, both anecdotally with what
people would tell us, but we did formal assessment in
a research you know standpoint where we basically you know,
ask people about their their quality of life before and
after the exercise program. And in addition to the liver
getting much healthier. Blood sugar is improving, cholesterol, improving, blood
(25:27):
pressure going down. We found that people felt better, they
had less pain, they were sleeping better, they felt much
more supported in their in their daily life. And we've
really had some people, you know, have a complete transformation
and they walk in and they look different, they speak different,
they have new confidence, and they feel like they have
(25:49):
this renewed sense of purpose when they take charge of
their health, and it's incredibly powerful. It's such a gift
to be able to see this when it happens for
some of our patients.
Speaker 1 (25:58):
Yeah, it really is. Is is marvelous.
Speaker 4 (26:01):
Before we take the next break, I want to try
to start off on something. There's a bit of a
movement for physicians to write exercise prescriptions or to prescribe exercise.
Speaker 1 (26:14):
What do you think of that?
Speaker 4 (26:16):
And you know, we'll be taking a break here in
a second, we could finish it, But what's your initial
you know, thirty thousand foot idea on that?
Speaker 3 (26:24):
Yeah, I mean I'm completely biased because I work with
the American College of Sports Medicine to promote physicians doing
exercise prescription and have brought that into the Satty Liver
World if you will, and it definitely, you know, needs
a lot of work. There is a lot of buy in,
right and the first thing we need to do is
(26:44):
actually improve position education because currently US medical schools and
zero minutes educating on exercise prescription.
Speaker 1 (26:51):
Absolutely all right.
Speaker 4 (26:52):
Final segment coming out with it johnas thin Stein from
Penn State. He's an expert in Live a Disease re Search,
Fanny Liver and exercise.
Speaker 1 (27:01):
I'm not to Joe Goltti.
Speaker 4 (27:02):
Don't forget doctor Joegalotti dot com is our website.
Speaker 1 (27:06):
Stay tuned. Final segment coming up. Man, that hour goes fast.
We're right back. Welcome back, everybody.
Speaker 4 (27:13):
Final segment, don't forget on Tuesday.
Speaker 1 (27:18):
This coming Tuesday, February. Fourth program.
Speaker 4 (27:22):
Note I'll be on Serious XM Channel one twenty nine
The Catholic Channel with Martha McCallum from Fox News Channel
talking about health and wellness and her approach to raising
her family and health strategy she had along with a
(27:43):
little Catholicism. It is the Catholic Channel, by the way,
and don't forget doctor Joe Galotti dot com is our website.
Soner for our newsletter goes out every Saturday morning.
Speaker 1 (27:57):
Across the country.
Speaker 4 (27:59):
You want to stay in touch with all that we do,
sign up for the newsletter.
Speaker 1 (28:05):
Well, it's been a great pleasure.
Speaker 4 (28:06):
We have doctor Jonathan Stein from Penn State where he
heads up the Fatty Liver Unit and the research and exercise.
It really is quite fascinating John, and thanks very much
for coming on tonight. We were talking about exercise as
(28:27):
a prescription patient walking out with not only well I
hate to say, you know, a medication prescription, but a
prescription for exercise. I look at that as it's very
much needed, but the barriers are huge. What do you
(28:48):
think realistically we can do here?
Speaker 3 (28:53):
Yeah, I completely agree, and I think some of this
goes back to, again the education of the the healthcare
workforce about, you know, how to deliver an exercise prescription.
So you know, we are doing some work now where
we're developing something called the Physical Activity Playbook, which is
meant to package everything together for a very busy healthcare provider,
(29:17):
and this will allow people to use free tools to
screen patients to see how active they are. It'll ask
them questions about, you know, the barriers preventing them from
being more active, and then it'll assess their capability of
doing a certain type of activity, and then from there
a prescription pad will be provided to the healthcare provider
and then under thirty seconds, they can circle how many
(29:39):
days a week they want somebody to do it. Activity,
they can circle, how long, they can circle, the intensity
of the activity, they can circle you know what the
activity is, and then they can rip it off the
pad and give it to a patient. And you know,
we've really found now in a digital age where every
prescription seemingly is electronic these days, that when people leave
(29:59):
the office with a piece of paper, they really like that. Yeah,
and I think this is a very nice compliment to medications.
It's really hard for many of our patients with batty
liver disease to do one without the other. And you know,
a healthy lifestyle and medication in the right context, you
(30:20):
need to be willing to partner.
Speaker 1 (30:21):
Right, Yeah, exactly.
Speaker 4 (30:22):
And I would say it's the triad of the exercise
and lifestyle. It's the nutrition and cooking, and then of
course the traditional medical therapies that and surgical therapies that
we need. So we can't we can't sort of gang
up on just the as I like to say, the
pill mentality. The pills are just the answer. You have
(30:43):
to look at all the other components that are equally important.
So from your perspective, both from yourself.
Speaker 1 (30:52):
Somebody that.
Speaker 4 (30:54):
Has or is an athlete and exercises and understands is
very very well for those listening tonight and you know
everybody in those I should walk more and I should
go to the gym and the treadmill. What would you
say and that you know, this is a quick answer
to a complicated problem, the best exercise with the lowest
(31:16):
bar to entry that will get somebody to exercise.
Speaker 1 (31:20):
What what do you think and what have you learned?
Speaker 3 (31:24):
Yeah? I mean, you know, my easy answer would be
a one size fits all approach that it would endorse,
you know. Walking With that said, I think if we're
looking at, you know, making sure that people started and
stick with it, it gets back to what you enjoy, right,
you know? Were you an athlete in high school? Did
you have a favorite sport? Have you liked running in
(31:45):
the past but you're no longer running? Do you enjoy hiking?
Do you like, you know, talking with the neighbors? You know,
do you enjoy solace in nature?
Speaker 1 (31:53):
Right?
Speaker 3 (31:53):
And these are things I asked my patients. And then
from there, you know, we really focus on you know,
this individualized exercise prescription. If we do it one size
fits all approach, we are never going to be successful. Yeah,
and you know right now, unfortunately, I'd say that that
happens more often than.
Speaker 4 (32:10):
Not, right, And I think that's a good question for
any healthcare providers listening tonight. Ask don't just say, Bob,
you have to exercise more. Really spend a little while
and say what do you like to do? Do you
like to swim? Do you like to go on the
treadmill and just listen to you know, the Grateful Dead
or is it alpine walking or something like that. So
(32:31):
I think that's very good there. You know, early in
the program, I spoke for a minute or two about
diet drinks and how it disrupts the intestinal micro biome.
I believe there's been some research that shows that exercise
(32:52):
improves the intestinal microbiome.
Speaker 1 (32:55):
True or false? And where are we heading with that?
Speaker 3 (32:59):
Yeah? That is true, and luckily our group has actually
started to explore some of that. So, you know, in
terms of fatty liver, the microbiome or the the bacteria
you know, living inside our intestines are abnormal, there's a
larger amount of ones that cause problems with fatty liver worsening. So,
(33:20):
you know, we have actually shown that with a short
exercise program of four months that we can increase the
number of bacteria. We can change the composition where we
have more favorable bacteria that produce less of the byproducts
that worse in fatty liver disease. And then we're also
exploring kind of some of the functional changes where if
(33:41):
we restore bacterial health, the gut will be less leaky,
they'll be less inflammation, and perhaps this will feed back
to the liver and ultimately be one of the reasons
why fat gets out of the liver and inflammation gets
better even without weight loss with regular exercise.
Speaker 4 (33:58):
Yeah, and and I talk all the time about the
importance of the microbiome and for people to really start
paying attention to what they're eating and they're exercise in
their sleep, it really is important. A little bit slightly
off topic, what is your take on the GLP one agents,
(34:19):
the ozepics of the world that are out there, and
the sort of the discussion we've had for many many
months is should the barrier to getting these drugs be
low in that basically, hey, if you want it and
you want to lose weight, it's available, or should it
(34:41):
be reserved for the more extreme cases of obesity where
people have severe diabetes, they have heart disease.
Speaker 1 (34:49):
Advanced liver disease.
Speaker 4 (34:51):
Of course, what is your take and what do you
think the public wants to hear?
Speaker 3 (34:57):
Yeah, I mean, I think gop ones are one of
the most important scientific discoveries you know, of the last
ten twenty thirty plus years. They are an incredible class
of medications with many widespread benefits, even beyond the livers.
So I think, you know, if we're going to improve
population health that you know, having access to these you know,
(35:21):
really highly effective medicine is going to be very important.
They certainly come with a price tag, so you know,
we have to figure out the health economic side. But
when you look at purely just you know, access and equity,
I think that you know, the data is there for
not only treatments but also disease prevention, and right certainly
(35:42):
the medications has f gay approval for some of those
some of their things.
Speaker 4 (35:48):
Yeah, no, no, no, no exactly, And I think we're
still trying to figure out the best way to use them,
because it seems like every week there is another positive effect.
There was I was just looking at an article I
don't know if it's the New York Times about how
dementia and Alzheimer's is improving with the use of ozembic.
(36:08):
So again, tip of the iceberg. We just have to
figure out how to really harness this for the millions
out there. So, Jonathan, we got a minute left. You're
talking to America tonight. What's your message to everybody about
not only fatty liver, but the role of exercise and
(36:29):
how should they think tomorrow morning, Monday when they wake
up and they see their sneakers sitting in the closet, what.
Speaker 1 (36:36):
Do you think?
Speaker 3 (36:38):
Yeah, I would hope that our time together tonight has
been inspirational and you look at the sneakers and you say,
you know, I can do it, and as today is
the day, and I would love just for you to
be five minutes more active tomorrow and ten minutes to
the next day and then you figure out a way
to sustain this. And I hope tonight's program was helpful.
(36:58):
I know that you know, Joe, You're you've been fighting
this fight for a long time and really just trying
to help everybody be as healthy as possible. And you know,
we all want to lead the life we want lives
we want to lead right right, and if we don't
have our health, we can't do the things who wants
to do, We can't accomplish our purpose, we can't make
the impact who wants to make. So you know, if
(37:19):
you look at those sneakers, you remember that it's about impact,
it's about legacy, it's about being the person you want
to be, and perhaps that maybe a motivational strategy at it.
Speaker 4 (37:28):
All, Right, Jonathan Stein, we will be in touch with
you soon. For everybody else, Doctor Joe Glotti, we'll see
you next Sunday evening.
Speaker 2 (37:37):
You've been listening to Your Health First with doctor Joe Glotti.
For more information on this program or the content of
this program, go to your Health First dot com
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