Fatty Liver Disease - Diagnosis, Treatment And Prevention

[Music] [Music] hi welcome to another episode of talking with docs i'm dr brad waining and i'm dr paul zalzel i'm dr naveen aryam davine arya thank you very much for being here you're a gastroenterologist we love having you on the show because you got guts guts and also a special interest in the liver so today we are talking about something that's really important unfortunately becoming more and more prevalent particularly within north america something called nafld it's an acronym that stands for non-alcoholic fatty liver disease so can you talk just a little bit about what the liver does and who this group of people are to me so first of all uh the liver is an extremely important organ it's not sexy like cardiology but i love it um so what it does is really it removes a lot of our toxins out of our body uh and it's also helps produce proteins that help us clot you know when we get a bleeding we it helps clot helps with protein production with vitamin vitamins and keeps our body and homostasis but it's actually a pretty resilient organ so you actually have to have a lot of damage before you have any signs or symptoms or actually damage the liver it's like the catalytic converter in the car right removing the toxic substances i like it except everybody's stealing the catalytic converters yes because of the value of monos this is way over my fun fact no it's the uh it's got precious metals in it uh rhodium i think it's called it's worth nine thousand dollars an ounce wow you're really a renaissance man well i like cars so who are the group of people that we're worried about have this type of liver disease so to be honest in north america it's extremely common like one-third of us in a bad term has fatty liver disease if i'm a liver i'm offended by that term but it is a bad term but that is the term and but one third of us have it and we actually don't know we haven't so and wait a minute one third that's like one of one of us it's not it it's me not it it's me um but we shouldn't panic first of all so first of all let's talk about the signs and symptoms okay fatty liver disease 95 of time no symptoms right that's dangerous it doesn't cause pain it doesn't cause jaundice except when it goes progression right it doesn't it's really picked up incidentally right or you by your family doctor or you're a health care provider right so if it doesn't cause symptoms and it doesn't cause any problems what's the big deal of having it so that's the problem right is because people who have it can progress into liver damage okay and once you have liver damage then you can have signs and symptoms then you can have complications and you can also progress to liver transplant and liver failure so so even though people don't have signs and symptoms we have an idea of what the group of people that has this look like so we would say people that have are slightly overweight people have diabetes people have what's called metabolic syndrome so high blood pressure high cholesterol diabetes that's the group of people that typically has this problem is that correct correct and just because you're not your ideal weight doesn't mean you have it people who are also in their ideal weight can have fatty liver disease right and again just because you're not your ideal weight you should not think you have it but you're more likely to have it right if you're above your ideal weight of your ideal weight okay and so how does fat in our liver do damage because we have fat in other areas of our body with fat under skin fat that surrounds some of our vital organs why does fat in our liver actually cause a specific problem so there's it's a spectrum for fatty liver disease so we all can have fat in our liver where the fat deposits into our liver and it does nothing there right it sits there you see you get an ultrasound and it's there happy fat happy fat right doesn't do anything but there are some people then who have fatty liver who can get inflammation of the fat and that inflammation can lead to scarring of the liver and that's called non-alcoholic steato hepatitis or nash we always like the cool acronyms so if you have nash that's kind of the more dangerous or symptomatic version that the fatty liver goes to that one can progress and that's the one that us hepatologists or gastroenterologists start worrying about and that's where we say we want to catch those patients who have nash or even fatty liver disease and get them back to normal how to get them back to normal well first of all that's how we diagnose it okay right so generally we diagnose it with your an ultrasound if you have an ultrasound for another reason or you're having pain or bloating you get a ultrasound abdominal ultrasound and they pick up fatty liver disease right or you have elevated liver enzymes right and they and they can have doing ultrasound pick up fat on that ultrasound mri cat scan but doesn't mean you have liver damage just because you have fatty liver or steady hepatitis right um so the one thing is we then we go on you see a specialist and you have to rule out other things the biggest thing is drink english right so by definition non-alcoholic fatty liver is less than typically two drinks a day for a man is that correct correct yes and the other thing there's other causes autoimmune hepatitis hepatitis b hepatitis c very common in our population one percent of the population has hepatitis c so we have to relap other sources right medications and so um we should not panic when we see fat on the ultrasound or report but we have to reload things right so once you get that sorted out and it is non-alcoholic fatty liver disease so then we say how much damage do we have right don't panic i think most of us have no damage i personally have five liver diseases i'm hoping i have no damage okay so what do we do we need to the biggest thing is it's not about how much inflammation we have it's about how much scar yeah so we can do two tests to diagnose scarring one is a liver biopsy so here you the radiologist pokes you there's risks it never it does hurt a little bit but that's not the test we should be doing right away there is a test called a fibro scan which we can order which can it's a poor person's test to uh determine how much scarring and it's scarring from zero which is none okay for to cirrhosis okay we just can test is it a biopsy testing so what it is is a scan and it touches tissue harmonics to determine and it's it's just you know putting the probe on and seeing how how much scarring there is now that's not a 100 test so if it tells you you have f3 disease which is three close to cirrhosis or four then you really need to do you know a liver biopsy to confirm that right if if there's no other signs of cirrhosis so for people to understand you have the fatty liver at least inflammation then your liver is trying to heal itself and that's what leads to the scarring and then the more scarring that happens the more of a problem inflammation that's right right that leads on to more scarring and the scarring is irreversible is that fair to say no so we that is not true so this is where we say if i have two two out of four scarring yep i can get it back to normal our liver again they're real robust a liver is an amazing organ it's not like joints you break your joints you gotta get it fixed right you can fix your liver yeah for yourself so or hair i got a problem with that so the fact is that we don't panic right we you can do the right thing to get now if you have cirrhosis that is irreversible okay but and once you have sclerosis then we have to go down this path of monitoring for complications you know monitor and then you still shouldn't panic because there's a certain people who don't will progress to liver failure needing liver transplant and it is the third most common cause of liver transplant in north america wow so they're not common they're because so many people have it one third of the population has it alcohol is number one alcohol hep c yeah perhaps he's going down now because we have a treatment for everything that's right we have a colleague actually that donated a significant portion of his liver yeah for his mother i don't know what the diagnosis was but yeah just recently somebody who worked it's amazing i know it's a great donation i mean i gave 20 bucks to the children's youth thing i couldn't let go of that bill i can't imagine trying to let go of a live river wide red i think more men require liver transplants for alcohol and more women for non-alcoholic fatty liver disease well that's not a it's also but it's not just about man women issue we all have it so the fact is that um we really need to first of all get a diagnosis yep and see where you're at now let's not panic we're treatment right they have all these things about vitamins and probiotics this will help your liver these toxins will help your liver that is not true not true fun fact we're gonna we're gonna myth bust here so we're talking about vitamin d vitamin e and then probiotics so vitamin d is great if you're vitamin d that's right so if you're deficient right but it does not improve your liver milk thistle does not improve your liver plus it hurts your tongue really no no no just say it milk thistle like you like whistle like a spiky oh right i thought you were just saying it's hard to be with orthopedic surgeons but that's okay carry on okay but to be honest so the key is not a pill is to lose weight and it's not and it's the weight that is around here right it's our weight that we put around our bellies that is very important i don't care if you're 250 pounds and you have guns like hulk hogan right but this is the weight yeah i'm looking at it but this is the weight here that we and it's very difficult right and the key is diet eighty percent of its diet no fad diets it's portion sizes and if you think about it just removing 500 calories per day out of your diet that's 3500 calories a week which is one pound right and really do it slow and i think i read that that actually takes it more from your organ so if you lose weight really quickly on a fad diet where you lose 20 pounds in a week you lose it from different areas where if you lose it slowly and steadily it has a higher chance of coming off of your organs and the key is to do when you lose weight slowly the more likely you won't get it back right right and if you lose too much weight too quickly there are risks you can get gallstones there's lots of other risks health risks our viewers are have heard us talk about weight loss quite often but here's another reason i think it's the i think it's the most important reason of course because you're a gastroenterologist right but yeah be honest because you can reverse scarring yeah right yeah you can heal your liver and you'll feel better and then you can have cardiac you know cardiac again but to be honest the liver can heal and regenerate itself now when it doesn't and it and these people everyone who has tigers should be monitored right for progression whether you do a fiber scan every two to three years check your liver enzymes but if your weight doesn't go down then and or you start adding alcohol into the mix or other things then then i got then you got to come and see me or there's a problem um and we may have to do a liver biopsy and then we'll have to monitor you for complications okay would you say that second recommendation so definitely a low sustainable weight loss would you also say abstinence from alcohol i know that's hard to say and hard to hear we've we've talked about even joked about non-alcoholic beer and stuff but yeah would you not say that now it's time to panic no no i think the fact is it depends on where you're at sure right but i mean if you have symptoms and you have eleven enzymes and you generally have no symptoms so right so the fact is it depends on the scar so if you're at three right and you don't want to progress to four which is cirrhosis 100 yeah even too but remember alcohol is calories sure why would you actually drink it calories it's not you're actually not benefiting yourself to get back to zero there you go so there you go fatty liver yep uh a reversible lisa cirrhosis cirrhosis is not reversible got to monitor the cirrhosis but the key thing is don't panic like really do not panic 30 30 the population has it very very common but i think it needs to be at least to tell the patients or your physicians where you're at and where what we can do and there's no pill there's no magic mushroom i wish there was but there's no but there's nothing except slow progressive weight loss right thank you thank you that's amazing so this is a topic that i think a lot of people aren't even aware of so we wanted to let you guys know so you can make some informed decisions for yourself and if you like this video please like it subscribe to our channel and remember you are in charge of your own health see you next time

Channel: Talking With Docs

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Id: SLliudaGE_8

Length: 13min 39sec (819 seconds)

Published: Wed May 25 2022