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
Great discussion I learned a lot Possibly explore more in the future the injury part due to hard training in not onlyvthe liver levels but other changes
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.
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.
I am delighted that she did most of the talking, which was very informative and I learned a lot of new things from her. It easily beats out Peter’s rumbling monologue 😂
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.
Great interview. I started watching “liver disease” a guy on RUclips who’s got massive liver and pancreas damage to convince me to start caring for myself better.
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.
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.
I am wondering how often there are cases of fatty liver in people with APOB mutations, specifically when the mutatuon results in a disfuncional APOB, where the protein is not able to form VLDL and LDL particles so fat ends up accumulating in the liver. Because APOB is such a large protein, with over 4500 amino acids , I would think the mutations are rather common. Very little testing is done, as almost every physician is only concerned with high LDL and TG and low levels are oddly ignored. I am heterozygous for APOB-32 mutation ( LDL of 25 and TG 30) . I hope you find my question interesting .
It is common apparently. 5x liver fat for the same bmi/glucose tolerance curves. Why do I know this? I have fhbl.. 👋. I was in an nih study... they ultrasounded my liver due to risk. My father who I inherited this from went from fatty liver to late fibrosis with normal blood enzymes. I'm really concerned.... and most doctors know almost nothing My ldl normally hovers around 25 as well. We are low even for fhbl. Sigh.
Is there any mention of "meds" and the liver? If not, could anyone provide information on bodily systems and the impact of antidepressants, anti-anxiety medications, stress, gut microbiome and the liver? In teens?
Interesting podcast. I wish we elaborated more on fructose. Like how much is too much? Can eating fruit be dangerous for people already having liver disease etc
I would check out Dr Jason Fung who is amazing explaining about fructose. He is a Nephroologist (Kidney Specialist in Canada). He also has a RUclips channel as well. ruclips.net/video/_oBkdmsRu0Y/видео.htmlsi=Lk5O9G14ytTTdID5 He has written a few books, which I have all of them. The Complete Guide to Fasting The Obesity Code The Diabetes Code The Cancer Code I wish you good health!
I would check out Dr Jason Fung who is amazing explaining about fructose. He is a Nephroologist (Kidney Specialist in Canada). He also has a RUclips channel as well. ruclips.net/video/_oBkdmsRu0Y/видео.htmlsi=Lk5O9G14ytTTdID5 He has written a few books, which I have all of them. The Complete Guide to Fasting The Obesity Code The Diabetes Code The Cancer Code I wish you good health!
I would check out Dr Jason Fung who is amazing explaining about fructose. He is a Nephroologist (Kidney Specialist in Canada). He also has a RUclips channel as well. ruclips.net/video/_oBkdmsRu0Y/видео.htmlsi=Lk5O9G14ytTTdID5 He has written a few books, which I have all of them. The Complete Guide to Fasting The Obesity Code The Diabetes Code The Cancer Code I wish you good health!
Fruit is usually not a problem because of the fiber, but still if you already have a problem, then I would stay away from certain high fructose fruits (eg. Figs) or only consume them in very small portions (eg. Half a fig). And of course no juice whatsoever. Maybe reverse juice if you really feel like you are missing out on fruit.
Hmm. I asked my doctor about my fatty liver. She said not to worry too much: only in a small percent of individuals, does it go on to later stages. My ALT was 28, and has been around this for decades. She said it was common nowadays.
I visited an old friend last summer and somehow the topic of prediabetes came up. She said her doctor said oh everybody has that. She said it in such a cavalier way. As if the doctor was saying, it’s not really a problem. I honestly think that doctors get to the point where they kind of throw up their hands because they keep telling patients to do preventative things and the patients don’t do them. Even when they give them medication a lot of times the patients don’t take the medication. I’m sure it’s frustrating on both sides.
Would like to know Dr. Wattacheril’s thoughts about the Ayurvedic supplement bhringraj sans the concern about process contamination. That is, a pure, organically produced form of bhringraj.
I am a 21 year old male and have had consistently heightened liver enzymes, though my AST has come into “normal range” at 37. However, ALT is 76. Ive never drank alcohol, exercise and maintain a good diet as well. Did a liver MRI, Wilson’s disease test, autoimmune test, Hep E test, amongst many others and docs are still unable to figure out what’s going on. Everything else has come back normal. Is it possible that individuals can have a higher number level at baseline and still function normally?
Not mentioned here but alcohol at high doses is eliminated via zero-order kinetics. Small increase in dose leads to a big increase in toxicity with zero-order kinetics, because a constant amount of alcohol is eliminated per unit time (1 standard drink per hour) the half life and time it takes to eliminate all the alcohol is massively increased. In other words because alcohol is eliminated by zero-order/ saturation kinetics, it stays in your system longer able to cause damage to liver cells. That’s not the case with caffeine where the amount eliminated depends on the dose, i.e the half life is constant. Make sense?
Sad the amount of people commenting on Peters alcohol intake- if anything, this makes him more relateable and normal. I’m sure he has a great quality of life and enjoys socializing with friends. I guess some listeners would rather he was a total freak- plenty of other people you can listen to who don’t drink, and enjoy crazy diets like only eating red meat 😊
Debatable, depending on your health and metabolic status. In other words, if you need the caffeine then the cream is sort of irrelevant. If you are looking for other health benefits then yes, you are better off without the sugar and other proteins.
As Winston Churchill once said: I have taken more out of alcohol than alcohol, has taken out of me. Not sure what Julia would’ve said as Churchills doctor.
Why should an innocent healthy baboon suffer due to a human's dietary choices? Praying against the barbaric psychopaths who commit these ungodly atrocities.
I am a bit surprised and disappointed to hear in this episode that Peter is a moderate alcohol drinker. For someone who is usually evidence-based in his decision-making, this is surprising as nearly all the recent high quality data on alcohol is negative in terms of heart disease, cancer, liver disease, neurodegenerative diseases, etc.
@@user-ou8pe9it8j Attia has in the many years I have been listening to him, thought that alcohol has no safe lower limit. He has argued that he trades off the low level physical harm at low doses against the social benefits he derives from low level consumption. I see no evidence of hypocrisy.
We all make trade-offs in terms of our enjoyment of life vs. our lifespan. You can optimize your health regimen to the point that you hate your life and then what is even the point of living?
Sorry to bust the comment section echo chamber of praise and accolades, but one question this jawchlenginly complicated conversation high in abstract medical nomenclature fails to consider: is this clearly sophisticated and intelligent organ purposefully and selflessly going beyond it's own 5% fat storing capacity to protect the body, specifically it's sister, the heart?
Absolutely not. Rather, it might be for you. It certainly isn't for me. I drink that much. I also have multiple week gaps when I travel and have zero desire to have a drink. I start again when I'm curious about some flavor combination I want to try. (I mix my own cocktails.)
@@allencrider Nor is it determined by how much you do or don't drink. You're confusing cause and effect. The propensity to suffer from alcoholism can lead to drinking more. That's an entirely different scenario. (And, btw, alcoholism is very much an "instant-on" phenomenon)
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
Great discussion I learned a lot
Possibly explore more in the future the injury part due to hard training in not onlyvthe liver levels but other changes
Thanks alot both!
It's incredible that we can get all this information for free , thank you both.
It's free o Medical and physiopathology, pathology BOOKS
@@user-ou8pe9it8j are you implying that people should be willing to read those books on their own and just skip RUclips?
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
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.
She is marvellous!
Ya, she makes Petter sound like an average dude. I think this woman might be the most eloquent speaker I've heard in English.
I am delighted that she did most of the talking, which was very informative and I learned a lot of new things from her. It easily beats out Peter’s rumbling monologue 😂
The amount of times that I needed to go back to rehear the info.
So valuable
Thank you for such a great content!
Most interesting episode I have seen in a while. I hope Peter has guests that cover other organs
Wow, fantastic interview, very interesting, great information, thank you both!
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.
this is one of the best discussions. our poor livers. the damage most kids(high school/college) do drinking is scary. myself included.
I know right? Now my kids high school is selling Starbucks style coffee with load of sugars 😢 it’s scary.
Great interview. I started watching “liver disease” a guy on RUclips who’s got massive liver and pancreas damage to convince me to start caring for myself better.
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.
Wow, she is incredibly knowledgeable.
It is amazing how much I learned today. Thank you so much.
Name one thing you learned.
@@mannyP7227 To a moron troll?
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.
I am wondering how often there are cases of fatty liver in people with APOB mutations, specifically when the mutatuon results in a disfuncional APOB, where the protein is not able to form VLDL and LDL particles so fat ends up accumulating in the liver. Because APOB is such a large protein, with over 4500 amino acids , I would think the mutations are rather common. Very little testing is done, as almost every physician is only concerned with high LDL and TG and low levels are oddly ignored. I am heterozygous for APOB-32 mutation ( LDL of 25 and TG 30) . I hope you find my question interesting .
It is common apparently. 5x liver fat for the same bmi/glucose tolerance curves. Why do I know this? I have fhbl.. 👋. I was in an nih study... they ultrasounded my liver due to risk. My father who I inherited this from went from fatty liver to late fibrosis with normal blood enzymes.
I'm really concerned.... and most doctors know almost nothing
My ldl normally hovers around 25 as well. We are low even for fhbl. Sigh.
Is there any mention of "meds" and the liver? If not, could anyone provide information on bodily systems and the impact of antidepressants, anti-anxiety medications, stress, gut microbiome and the liver? In teens?
I don't think they'll be much research on it now because we're still in the process of using them* youngins as guinea pigs.
Interesting podcast. I wish we elaborated more on fructose. Like how much is too much? Can eating fruit be dangerous for people already having liver disease etc
Check the "bittersweet truth " by Dr. Pradip
I would check out Dr Jason Fung who is amazing explaining about fructose. He is a Nephroologist (Kidney Specialist in Canada).
He also has a RUclips channel as well.
ruclips.net/video/_oBkdmsRu0Y/видео.htmlsi=Lk5O9G14ytTTdID5
He has written a few books, which I have all of them.
The Complete Guide to Fasting
The Obesity Code
The Diabetes Code
The Cancer Code
I wish you good health!
I would check out Dr Jason Fung who is amazing explaining about fructose. He is a Nephroologist (Kidney Specialist in Canada).
He also has a RUclips channel as well.
ruclips.net/video/_oBkdmsRu0Y/видео.htmlsi=Lk5O9G14ytTTdID5
He has written a few books, which I have all of them.
The Complete Guide to Fasting
The Obesity Code
The Diabetes Code
The Cancer Code
I wish you good health!
I would check out Dr Jason Fung who is amazing explaining about fructose. He is a Nephroologist (Kidney Specialist in Canada).
He also has a RUclips channel as well.
ruclips.net/video/_oBkdmsRu0Y/видео.htmlsi=Lk5O9G14ytTTdID5
He has written a few books, which I have all of them.
The Complete Guide to Fasting
The Obesity Code
The Diabetes Code
The Cancer Code
I wish you good health!
Fruit is usually not a problem because of the fiber, but still if you already have a problem, then I would stay away from certain high fructose fruits (eg. Figs) or only consume them in very small portions (eg. Half a fig). And of course no juice whatsoever. Maybe reverse juice if you really feel like you are missing out on fruit.
The amount of liver disease that I and my docs and fellow NP in GI clinic is mind blowing. It’s overtaking IBS.
Do you ever recommend a prolonged water fast, and going into ketosis?
Hmm. I asked my doctor about my fatty liver. She said not to worry too much: only in a small percent of individuals, does it go on to later stages. My ALT was 28, and has been around this for decades. She said it was common nowadays.
I visited an old friend last summer and somehow the topic of prediabetes came up. She said her doctor said oh everybody has that. She said it in such a cavalier way. As if the doctor was saying, it’s not really a problem. I honestly think that doctors get to the point where they kind of throw up their hands because they keep telling patients to do preventative things and the patients don’t do them. Even when they give them medication a lot of times the patients don’t take the medication. I’m sure it’s frustrating on both sides.
Are elevated liver enzymes from prescribed colestipol or statins , indicative of disease ?
Can you link liver fat to visceral fat? If visceral fat is elevated does that indicate a need for further testing of the potential for fatty liver?
My god I wish she were my Dr. So knowledgeable and genuinely concerned with healing
Would like to know Dr. Wattacheril’s thoughts about the Ayurvedic supplement bhringraj sans the concern about process contamination. That is, a pure, organically produced form of bhringraj.
Choline ever discussed? If so anyone know when? Ty
I had a lacerated liver from a car accident in 1986.. emergency surgery...lucky to be alive..should I be concerned today of any liver damage?
How about statin usage?
I am a 21 year old male and have had consistently heightened liver enzymes, though my AST has come into “normal range” at 37. However, ALT is 76. Ive never drank alcohol, exercise and maintain a good diet as well. Did a liver MRI, Wilson’s disease test, autoimmune test, Hep E test, amongst many others and docs are still unable to figure out what’s going on. Everything else has come back normal. Is it possible that individuals can have a higher number level at baseline and still function normally?
Do you have a high protein diet?
Those are some scary labs. Peter recommends alt and ast to be under 20.
Please can you comment on coenzyme q10?
Can low carbs/keto increase your ALT?
So good When was this recorded, curious due to the references to the pandemic which sounds to be ongoing?
Not mentioned here but alcohol at high doses is eliminated via zero-order kinetics. Small increase in dose leads to a big increase in toxicity with zero-order kinetics, because a constant amount of alcohol is eliminated per unit time (1 standard drink per hour) the half life and time it takes to eliminate all the alcohol is massively increased. In other words because alcohol is eliminated by zero-order/ saturation kinetics, it stays in your system longer able to cause damage to liver cells. That’s not the case with caffeine where the amount eliminated depends on the dose, i.e the half life is constant. Make sense?
Sad the amount of people commenting on Peters alcohol intake- if anything, this makes him more relateable and normal. I’m sure he has a great quality of life and enjoys socializing with friends. I guess some listeners would rather he was a total freak- plenty of other people you can listen to who don’t drink, and enjoy crazy diets like only eating red meat 😊
Peter Attia ROCKS!
Suplements can cause liver injury? How can we make sure our suplements are safe even from famous brands?
Frequent lab would be my guess- with supplements and without is what I do . Not expensive at all . Good luck
That's why I don't take suplements.
Take only what a doctor recommends and not what people on internet recommend.
Read up on anything you take.
We need a bit of clarity about coffee please. Does drinking it with light cream negate the benefits?
Debatable, depending on your health and metabolic status. In other words, if you need the caffeine then the cream is sort of irrelevant. If you are looking for other health benefits then yes, you are better off without the sugar and other proteins.
Peter parties 🤘🏼
As Winston Churchill once said: I have taken more out of alcohol than alcohol, has taken out of me. Not sure what Julia would’ve said as Churchills doctor.
2:02:15
What is your opinion of CHEERS RESTORE ?
fantastic YT .. I learned a lot. Completely demonstrates Julia knows her s**t.
❤❤❤
Peter's most favorite organ: Liver.
If you take SARMs or steroids.....elevated liver enzymes, yes?
Metabolic Derangement is the name of my next punk band.
Why should an innocent healthy baboon suffer due to a human's dietary choices? Praying against the barbaric psychopaths who commit these ungodly atrocities.
*Bas Rutten has entered the chat...*
Get people to stop drinking alcohol.
And juice
Added sugar is a bigger culprit. Sugar addiction is more accepted and joked about. Kids are getting fatty liver disease.
I am a bit surprised and disappointed to hear in this episode that Peter is a moderate alcohol drinker. For someone who is usually evidence-based in his decision-making, this is surprising as nearly all the recent high quality data on alcohol is negative in terms of heart disease, cancer, liver disease, neurodegenerative diseases, etc.
He said it's occasional in social gathering settings.
Everything is for *image* and sell something, an ideal, a book, a suplements.
No blame to making money.
I think it's great that Peter is transparent with his alcohol usage.
@@user-ou8pe9it8j Attia has in the many years I have been listening to him, thought that alcohol has no safe lower limit. He has argued that he trades off the low level physical harm at low doses against the social benefits he derives from low level consumption. I see no evidence of hypocrisy.
We all make trade-offs in terms of our enjoyment of life vs. our lifespan. You can optimize your health regimen to the point that you hate your life and then what is even the point of living?
Sorry to bust the comment section echo chamber of praise and accolades, but one question this jawchlenginly complicated conversation high in abstract medical nomenclature fails to consider: is this clearly sophisticated and intelligent organ purposefully and selflessly going beyond it's own 5% fat storing capacity to protect the body, specifically it's sister, the heart?
Damn took my comment down… lol
I cannot understand a darn thing that woman says!!
I think that hasving 6 to 8 drinks per week is a pathway to addiction.
No, it's not.
@@Lolipop59 Just try and stop. Get a serious, open look at your own situation.
Absolutely not. Rather, it might be for you. It certainly isn't for me. I drink that much. I also have multiple week gaps when I travel and have zero desire to have a drink. I start again when I'm curious about some flavor combination I want to try. (I mix my own cocktails.)
@@mattmathai Just give it more time. Alcoholism isn't an instant-on phenomenon.
@@allencrider Nor is it determined by how much you do or don't drink. You're confusing cause and effect. The propensity to suffer from alcoholism can lead to drinking more. That's an entirely different scenario. (And, btw, alcoholism is very much an "instant-on" phenomenon)
That’s why stay away from meme coins - it’s just noise
extracorporeal. word of the day. what a great word.