A Doctor's guide to FATTY LIVER: Causes, Diagnosis, and How to Reverse it through Diet!

[Music] hello and welcome i'm dr raj sharina budrypod i'm board certified in internal medicine and today's video is all about fatty liver disease [Music] one of the most common abnormalities i see on patients blood work is an elevation in their liver enzymes here we have my patient kevin and his alt and ast which are his liver enzymes are elevated on his blood work so his alt is 57 and his ast is 45 normal liver enzymes should be in the teens or 20s another term for the alt and asd is transaminases so if you have elevated transaminases your liver is saying help it's a sign of liver dysfunction and the number one cause is fatty liver disease it's a metabolic disease where fat gets stored and produced in liver cells the problem is this triggers a cascade of inflammation in the liver so let's take a look under the microscope so this is what a healthy liver looks like on a liver biopsy now let's compare it to a fatty liver see a difference these giant white globules are fat which are accumulating inside the liver cells called hepatocytes this is a problem because the fat triggers inflammation which can cause some of the hepatocytes to burst and when they burst they release their liver enzymes into the bloodstream that's why we see elevated levels of liver enzymes on your blood work the reason i decided to make a video on fatty liver is it's become a global epidemic about a quarter of the u.s population suffers from fatty liver it's especially prevalent in those who are obese overweight or diabetic and sadly we're even seeing fatty liver now in children so what causes fatty liver well genetics do play a role but the number one cause is the diet the standard american diet or the sad diet is the main cause of fatty liver disease another main root cause of fatty liver disease is insulin resistance insulin is the hormone your pancreas makes which tells your body cells to take up blood sugar the problem in insulin resistance is the body's cells and receptors are ignoring the insulin so the pancreas has to produce higher levels of insulin the bad news is insulin triggers fat storage throughout your body including your liver cells so that's why i typically see a metabolic trifecta in my patients with fatty liver disease so in addition to having the elevated liver enzymes they'll have elevated fasting insulin they may also have an elevated blood glucose and hemoglobin a1c which is the average of the blood sugars for three months so this could suggest pre-diabetes or diabetes finally these patients have high cholesterol especially triglycerides when it comes to fatty liver disease carbs are not your friend carbs and vegetables are not a problem at all but what i mean is processed carbs as well as grains which are present in bread pasta cereals and rice if you have a sweet tooth this is a big problem because sugar is a huge trigger for fatty liver high fructose corn syrup is like the worst thing imaginable for your liver and i'll explain why it's present in a lot of sodas and even in ketchup let me explain the crucial difference between glucose and fructose glucose can be used by any cell in your body like your muscles your heart or your brain in contrast fructose can only be used by your liver cells and it triggers a process called de novo lipogenesis which is the creation of fat and triglycerides inside the liver cells be aware that refined sugar also known as table sugar has one molecule of glucose bound to one molecule of fructose [Music] alcohol can also contribute to fatty liver because it breaks down into sugar some of you may be familiar with foie gras which is a french delicacy made from the fatty liver of a goose the sad and controversial part of this food is that they actually force tubes down the throats of these geese and force feed them large amounts of corn boiled with fat and this makes their liver fatty so you don't want your liver to turn into human foie gras now back to my patient kevin i diagnosed him with fatty liver but he was surprised because he had no symptoms well that's because most of the time fatty liver is a silent disease or it can cause vague symptoms like fatigue or malaise but the great news is fatty liver is a treatable and reversible condition the official term for fatty liver disease is non-alcoholic fatty liver disease this just implies that the patient was not an alcoholic but remember alcohol still contributes to fatty liver disease because it turns into sugar the next stage is non-alcoholic steatohepatitis this is a more serious level of inflammation that we can see on a liver biopsy the good news is both non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are reversible it's important we reverse this inflammation while we can because five to 12 percent of patients with fatty liver disease progress to fibrosis and scarring of the liver which is irreversible and known as cirrhosis you definitely want to avoid cirrhosis which is end-stage liver disease where your liver can't perform its normal functions this causes symptoms like ascites which is fluid buildup in the abdomen and edema which is fluid accumulation in the legs the liver becomes unable to clear out bilirubin which causes jaundice which is yellowing of the skin and the eyes the back pressure from the serratic liver leads to the development of esophageal varices which are basically veins in the esophagus and these can pop open and cause life-threatening upper gi bleeds [Music] in cirrhosis ammonia levels rise and this can affect your thinking causing hepatic encephalopathy cirrhosis can also affect your kidneys leading to kidney failure because of these complications many patients with cirrhosis end up needing a liver transplant it's really important we take care of our liver because our liver is one of our biggest detox organs thanks to your liver you're able to clear out toxins from your food and environment and it also helps to metabolize estrogens so in patients with fatty liver who are drinking alcohol i'll typically see higher levels of estradiol on their blood work because their liver is not able to do a good job of clearing out the estrogens [Music] before i can diagnose fatty liver i have to rule out other possible causes so i review the patient's medications and supplements for example i've seen several patients who had elevated liver enzymes from taking a supplement called chlorella from contaminated sources after they stop the supplement their liver enzymes return to normal i also like to rule out viral hepatitis by checking antibodies for hepatitis b and c i rule out autoimmune hepatitis by checking a smooth muscle antibody i check the ferritin level which is a marker of iron storage to rule out a genetic condition called hemochromatosis i like to order a liver ultrasound to confirm the diagnosis of fatty liver so fat makes the liver look more echogenic or bright on ultrasound and sometimes it causes the liver to be enlarged so here's the great news if we diagnose you with fatty liver it's a treatable and reversible condition the treatment involves one primary thing can you guess what that is the main treatment for fatty liver disease is the diet i recommend a paleo diet which is a diet of our paleolithic ancestors so it's like a stone age or caveman diet [Music] the paleo diet is similar to a whole30 diet and it eliminates grains which are a huge trigger for insulin resistance and fat storage in the liver the most important part of the diet is vegetables so you want vegetables to be the bottom of your food pyramid so make sure that half to three quarters of your plate is always vegetables exercise is also tremendously helpful in reversing insulin resistance but believe it or not diet is the number one thing in reversing fatty liver disease so you want to avoid sugar alcohol grains dairy products vegetable oils as well as processed foods so you may be wondering why is dairy products a problem well it's because dairy has the milk sugar called lactose lactose is made out of glucose and galactose and as you remember glucose is not good for fatty liver disease the whey protein that's present in dairy products also increases your pancreatic insulin production so it feeds into the cycle of insulin resistance so what about good fats like avocados olive oil and nuts these are nutrient dense foods that i encourage as part of the paleo diet because they enhance satiety meaning they keep you full and help to reduce your hunger and insulin levels a lot of people are confused about eggs so pasteurized eggs are actually a really nutritious source of protein omega-3s and vitamin d in the diet most american breakfasts are loaded in carbs and sugars so i recommend eating eggs and vegetables for breakfast because this keeps you full and keeps your insulin levels low another option is not to eat breakfast we call this intermittent fasting to learn more about fasting check out my video on autophagy autophagy means self-eating and it happens when you're fasting autophagy is excellent for fatty liver disease did you know that the bacteria in your gut microbiome can affect your liver we call this the gut liver axis research suggests there's a bi-directional relationship between the gut microbiome and the health of your liver cells depending on the food you're eating the bacteria in your gut will create certain metabolites or postbiotics and this can influence inflammation in your liver this is why a stool microbiome test can be really helpful and allows me to give you specific guidance on what kind of probiotic would be best for your health here are some key supplements that are great for your liver glutathione is the master antioxidant or detoxifier for all the cells in your body but especially your liver cells berberine is my favorite supplement for activating insulin receptors so berberine comes from bright red berries and the capsules from berberine are bright yellow in color they're also really anti-inflammatory alpha-lipoic acid is another antioxidant that's great for insulin recognition in the body finally coenzyme q10 or coq10 is great for the mitochondria of your cells which are the energy powerhouses of your cells if you're on a cholesterol-lowering medication like a statin or a supplement like red yeast rice i definitely recommend coq10 because these could potentially deplete coq10 from your body now getting back to my patient kevin he did a great job of following the paleo diet and when i saw him three months later his liver enzymes were normal so his alt came down to 22 and his ast came down to 24. he also lost 15 pounds and felt so much better and had more energy in summary fatty liver disease is an inflammatory condition of the liver driven by carbs and insulin resistance the good news is it's reversible through diet thanks so much for watching this video if you liked the video please give it a thumbs up and subscribe to my channel i love to hear from you so please leave your questions and comments below thank you again and have a wonderful day [Music]

Channel: Rajsree Nambudripad, MD

Views: 174,569

Keywords: Fatty liver, NAFLD, NASH, Cirrhosis, Fatty liver disease, insulin-resistance, glutathione, liver ultrasound, liver disease, gut-liver axis, liver biopsy, fructose, glucose, fois grois, high fructose corn syrup, lactose sugar, alcohol, carbs and sugars, carbs, sugar, paleo diet, intermittent fasting, autophagy, high cholesterol, high blood sugar, prediabetes, diabetes, fasting

Id: 8v8C7iAJrXU

Length: 13min 44sec (824 seconds)

Published: Mon Jul 19 2021