302 - Confronting a metabolic epidemic: how to prevent, diagnose, & manage liver disease

In this episode, we discuss: 0:01:52-Julia’s training, importance of liver health, & innovations of hepatology 0:08:14-The crucial functionality of the liver & its four most essential functions 0:13:36-Liver injuries: understanding causal factors & the progression to liver diseases & cancer 0:26:03-How the liver metabolizes nutrients & what happens in the presence of excess calories 0:35:39-Methods of diagnosing liver disease 0:43:45-The poisonous nature of ethanol 0:51:19-Varied responses to alcohol, damaging effects of alcohol beyond the liver, & advising patients on their alcohol consumption 1:03:59-Liver enzymes AST & ALT—interpreting levels, lifestyle factors that affect them, & diagnostic approaches 1:20:39-Interpreting liver function tests for fatty liver disease, & diagnosing liver pathologies, particularly in children versus adults 1:26:45-Comprehensive liver health assessments via imaging & various diagnostic tools to prevent overlooking potential liver pathologies 1:35:32-Impact of recreational drugs, statins, & other medications on liver function test results 1:39:49-Shifting nomenclature from NAFLD to MASLD 1:46:40-Pathophysiology of MASLD, the need for proactive screening, & the significance of liver fat percentage 1:53:46-Screening for rare conditions alongside common metabolic diseases associated with fatty liver 1:56:50-Practical strategies for managing MAFLD 2:05:10-Impact of fructose consumption on liver health & the challenges of disentangling its effects from obesity & insulin resistance 2:10:20-The potential of GLP-1 agonists for the treatment of MASLD 2:13:31-4 stages of liver disease 2:18:21-Increased cancer & heart disease risk associated with early-stage MAFLD 2:26:18-Emerging drugs & therapies for addressing fat accumulation & fibrosis related to MAFLD 2:33:33-Takeaways

It's incredible that we can get all this information for free , thank you both.

Amazingly brilliant hepatologist and still able to share her vast valuable knowledge in a humble way with the public . Thank-you!

An INVALUABLE public service, delivered clearly and professionally. THANK YOU to both Julia & Peter for adding immensely to my understanding of the liver and its role in human biology.

It's very difficult to be knowledgeable, articulate, beautiful and humble at the same time. Well done Julia, thank you Peter

Great interview. I started watching “liver disease” a guy on YouTube who’s got massive liver and pancreas damage to convince me to start caring for myself better.

70ish female, non drinker, type 1 diabetic with non diabetic A1C, 22 BMI. Did major pressure washing (literally tons of real stone on our house) to rid mold/mildew from the mortar joints. Also used a long extension part of the time and was holding it above my head. Had scheduled bloodwork the following Monday and my AST was 3 points over normal. My ALT was also increased but still in normal range. I explained to my doctor what I had been doing and why I thought the increases were there. To be on the safe side, had a fibro scan done and results were normal. Three months later, retested and AST was 19 (10-35 QUEST, FL) and ALT was 14 (6-29). Following two tests results were the same. I believe the muscle strain and mildew caused both my liver enzymes to increase. Next time I will wear a mask. The muscle strain is just part of the job.

I find Julia as impressive and fascinating as the liver's vital role is in sustaining life. She is articulate and incredibly knowledgeable. Thank you, Peter, for sharing her insights with your audience.

So...the "teaser", I guess it's called. The first opening part, she talks about involving endocrinologist, and other doctors on the care of this one patient. What kind of practice does this? I can't imagine ANY insurance covering that kind of expense. One patient, with cardiologist, endocrinologist and hepatology expert and however many other experts...for one patient? This just doesn't exist for most people. Does it? The out of pocket cost has to be in the thousands, if it does.

this is one of the best discussions. our poor livers. the damage most kids(high school/college) do drinking is scary. myself included.

Thank you, Doctors...to be able to listen to dedicated professionals talk about such intense health issues is invaluable.

Most interesting episode I have seen in a while. I hope Peter has guests that cover other organs

The amount of times that I needed to go back to rehear the info. So valuable Thank you for such a great content!

Wow, fantastic interview, very interesting, great information, thank you both!

Wow, she is incredibly knowledgeable.

The amount of liver disease that I and my docs and fellow NP in GI clinic is mind blowing. It’s overtaking IBS.

This is a fantastic interview. I learned a lot about the liver, thank you!

Actually kind of surprised at the total alcohol intake being that high for Peter. Obviously labs aren't that bad but given carcinogenic effects seems like a lot. I mostly stopped drinking and really don't miss it much at all. Counter being that the liver is soooo resilient.

It is amazing how much I learned today. Thank you so much.

My god I wish she were my Dr. So knowledgeable and genuinely concerned with healing