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The Health Pulse
The Silent Liver Epidemic | Episode 68
Your liver could be in serious trouble—and you might not even know it. In this episode of The Health Pulse, we uncover the silent but growing epidemic of non-alcoholic steatohepatitis (NASH), the advanced and inflammatory form of non-alcoholic fatty liver disease (NAFLD) now emerging as a leading cause of liver failure worldwide.
We explore how insulin resistance, high-fructose diets, and modern sedentary lifestyles trigger a metabolic cascade that overloads the liver with fat, drives inflammation, and leads to scarring—even in people who feel perfectly healthy. You’ll learn how fructose metabolism, de novo lipogenesis, and oxidative stress play central roles in this condition, and why NASH is so often found in those with type 2 diabetes, obesity, and high triglycerides.
More importantly, we share hopeful, evidence-based strategies to reverse early-stage liver damage—including the benefits of weight loss, low-carb and Mediterranean diets, and regular physical activity, even without major weight change.
If you haven’t checked your liver enzymes lately, this episode could be the nudge that changes everything.
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Welcome to the Health Pulse, your go-to source for quick, actionable insights on health, wellness and diagnostics. Whether you're looking to optimize your well-being or stay informed about the latest in medical testing, we've got you covered. Join us as we break down key health topics in just minutes. Let's dive in.
Speaker 2:When you hear liver damage, what's the first thing that probably pops into your head? For most of us it's, you know, a longstanding, maybe complicated, relationship with alcohol.
Speaker 3:Right, that's the common association.
Speaker 2:But here's the crucial insight we're diving into today. There's a rapidly growing kind of silent epidemic of liver disease, and it's affecting millions of people who have never touched a drop of alcohol.
Speaker 3:It's really quite staggering when you look at the numbers.
Speaker 2:Yeah, we're talking about non-alcoholic steatohepatitis, or NASH. It's quietly and well shockingly quickly becoming one of the fastest rising pauses of cirrhosis, liver failure and even liver transplants worldwide.
Speaker 3:That's correct, a major public health issue unfolding.
Speaker 2:So our mission today is really to unpack this stealthy condition. Nash is often asymptomatic until it's dangerously advanced, which is why it's so important to understand.
Speaker 3:Absolutely. Awareness is key.
Speaker 2:We're going to explore exactly what NANISH is, why it happens, how you can detect it early and, maybe most importantly, how it can often be reversed, often without medication. This deep dive is about giving you the knowledge to truly take control of your metabolic future.
Speaker 3:And just to really put the scale of this problem into perspective, NASH is actually part of a much broader condition. It's called non-alcoholic fatty liver disease or NAFLD.
Speaker 2:NAFLD.
Speaker 3:And NAFLD affects astonishing maybe one in three adults in the United States and potentially up to 38 percent of adults globally.
Speaker 2:It's huge Wow, one in three.
Speaker 3:Yeah, but the critical difference and this is really important is that while a simple fatty liver can sometimes be relatively harmless, nash involves active inflammation and scarring. That's what truly damages the liver over time.
Speaker 2:Okay, so that inflammation part is the danger zone.
Speaker 3:Precisely.
Speaker 2:So if you're someone who deals with obesity or insulin resistance or type 2 diabetes, this deep diet is going to be particularly crucial for you.
Speaker 3:Definitely pay close attention, if that sounds like you.
Speaker 2:Right, so let's start by clarifying those terms. We just threw out NAFLD and NASH. How do they relate and what's the crucial difference for our listeners?
Speaker 3:Yeah, that's a great place to begin. So NAFLD, or simple steatosis, that's the umbrella term. It just means there's fat present in the liver.
Speaker 2:Okay.
Speaker 3:But crucially, there's no significant inflammation or damage yet.
Speaker 2:Okay, so step one, just fat accumulation.
Speaker 3:Exactly. Think of it as maybe a warning sign. Naish, however, takes that a step further. It means the fat has actually triggered inflammation and liver cell injury, and in many cases this also leads to fibrosis, which is basically scarring of the liver tissue. So, you could say NAFLD is a warning, NASH is the actual damage occurring.
Speaker 2:Got it. Warning versus damage, and if left unchecked, this condition can really spiral into something far more serious, can't it?
Speaker 3:Absolutely. It typically progresses from that initial fatty liver, the steatosis, to NASH, with that ongoing inflammation and damage. From there it can lead to fibrosis, the scarring we mentioned, which then can progress to cirrhosis and that's advanced, often irreversible, liver damage.
Speaker 2:Irreversible.
Speaker 3:Yeah, and potentially even liver cancer or outright liver failure. It's a progressive disease. If you don't intervene.
Speaker 2:And the numbers on that progression, I mean they're pretty sobering.
Speaker 3:They really are. According to the NIH, up to 30% of people with just simple fatty liver will go on to develop nanosh 30%. Wow, and among those who get nanosh up to maybe 20% may progress all the way to cirrhosis. What's truly fascinating, and frankly a bit terrifying, is that, unlike alcohol-related liver disease, where the cause is often pretty obvious, nash is driven primarily by metabolic dysfunction.
Speaker 1:Right, not alcohol.
Speaker 3:Exactly. This isn't about what you put in your glass, necessarily, but how your body processes food energy, and that makes it incredibly stealthy often missed until it's quite advanced.
Speaker 2:That's the crucial distinction here. But there's a vital piece of good news amidst those numbers, isn't there?
Speaker 3:Yeah.
Speaker 2:That nananosh, unlike advanced cirrhosis, is potentially reversible, especially if you catch it early.
Speaker 3:Precisely that's the hope. If we intervene before fibrosis becomes too severe, the liver has this remarkable capacity to heal itself. The inflammation can go down, the fat can reduce can reduce.
Speaker 2:Okay, that's really encouraging. So we've talked about how widespread natash is and how it's not alcohol related, but you mentioned it's driven by metabolic dysfunction. Can you help us connect the dots? How does something like insulin resistance, which many of us associate with blood sugar directly, cause liver damage?
Speaker 3:Yeah, it's a very direct connection. So when your body becomes resistant to insulin, meaning your cells aren't responding effectively to insulin signals anymore, your liver, it, tries to compensate.
Speaker 2:Okay.
Speaker 3:It starts producing more glucose, even when your blood sugar is already high, which isn't helpful, right? It also begins converting excess sugar into fat. There's a specific process called de novo lipogenesis, which literally means new fat creation right there in the liver.
Speaker 2:Making fat from sugar.
Speaker 3:Exactly and crucially, your liver also starts retaining fat within its cells. It doesn't export it as well. So over time this buildup of fat becomes well toxic to those liver cells. It triggers oxidative stress, inflammation and ultimately that fibrosis or scarring we talked about.
Speaker 2:So this is why NASH is so often found alongside conditions like type 2 diabetes and obesity. It's all linked.
Speaker 3:Exactly. This is precisely why NASH is so strongly associated with things like high fasting insulin, elevated triglycerides, abdominal obesity and prediabetes or type 2 diabetes. They're all classic hallmarks of what we call metabolic syndrome. It indicates your body isn't processing energy efficiently.
Speaker 2:And when we talk about what actually causes this metabolic dysfunction in the first place? Diet and lifestyle factors are huge, aren't they?
Speaker 3:Oh, they are absolutely central. We're looking at diets high in refined sugars, especially fructose, sodas, fruit juices, lots of processed sweeteners.
Speaker 2:Fructose okay.
Speaker 3:Also a high intake of processed foods in general, unhealthy industrial seed oils, a sedentary lifestyle and just chronic overconsumption of calories, particularly for individuals who are already insulin resistant. Their bodies just can't handle the load.
Speaker 2:I want to really emphasize your point about fructose. You singled that one out. How is it different from other sugars, like glucose, in terms of its impact on the liver?
Speaker 3:Yeah, that's a critical distinction. So, unlike glucose, which pretty much every cell in your body can use for energy, fructose is metabolized almost exclusively by the liver.
Speaker 2:Ah okay, Primarily the liver's job.
Speaker 3:Right and once it gets to the liver it's very rapidly converted to fat. It kind of pushes that de novo lipogenesis pathway hard. This makes it a direct and frankly potent driver of fatty liver and NASH, bypassing some of the normal metabolic controls that glucose goes through.
Speaker 2:So it's not just a liver problem, then, is it? It's almost like fatty liver, and NASH especially, is the canary in the coal mine for your entire metabolic system.
Speaker 3:That's a perfect analogy, yeah.
Speaker 2:If your liver is struggling, it's a huge signal that something bigger is going on systemically.
Speaker 3:Absolutely. Many experts now consider fatty liver a clear warning sign that your entire metabolic system is under stress. This affects everything you know, from your cardiovascular health to your risk of diabetes, dementia, other issues. The key message here for you listening, is this If you have insulin resistance, maybe high triglycerides or central obesity the belly fat you may already be at risk for NADH, even if you feel perfectly healthy right now.
Speaker 2:Which leads us to the symptoms or lack thereof. One of the most dangerous things about NADatch is how quietly it progresses. I mean, someone could have it for years and feel completely normal, right.
Speaker 3:You're absolutely right. Most patients feel completely normal in the early stages, which is why it's so often discovered, frankly, by accident, maybe during routine tests. For something else entirely If symptoms do occur early on, they tend to be very, very vague.
Speaker 2:So someone could experience, say, chronic fatigue, maybe a bit of vague discomfort, maybe even unexplained weight gain, and just kind of attribute it to getting older or being busy, right?
Speaker 3:Yeah.
Speaker 2:How often do you see patients surprised by this diagnosis because they felt fine?
Speaker 3:It happens all the time. Yeah, early symptoms, if they exist, can be things like just mild discomfort or a feeling of fullness in the upper right abdomen, where the liver is, or sometimes you see those darkened skin patches known as acanthosis nigricans, often on the neck or underarms. Those are actually related to the underlying insulin resistance.
Speaker 2:Okay, a skin sign.
Speaker 3:Yeah, but it really raises this important question If symptoms are so vague or even non-existent early on, how do you even begin to know you might have it?
Speaker 2:And here's the truly alarming part right by the time, more serious, obvious symptoms appear like fluid buildup in the abdomen, jaundice yellowing skin or even confusion. The disease has often progressed to advanced fibrosis or full-blown cirrhosis.
Speaker 3:Exactly At that point, options become much more limited. That's where lab clues become absolutely vital for early detection.
Speaker 2:OK, labs are key.
Speaker 3:Key findings often include elevated ALT and AST. Those are liver enzymes. In fact, NASH is now the most common cause of abnormal liver enzymes in the US.
Speaker 2:Most common cause, more than alcohol or viruses.
Speaker 3:Currently yes for unexplained elevations in the US. Most common cause More than alcohol or viruses. Currently yes for unexplained elevations in many populations. Other important clues we look for are high fasting insulin and triglycerides, often low HDL cholesterol the good cholesterol and maybe elevated GGT or levels as well. And then imaging tools like ultrasound FibroScan, which measures liver stiffness, or MRI elastography can also help detect fatty liver or fibrosis non-invasively.
Speaker 2:So how does this translate to your personal health picture? What it means is you can have progressive liver damage happening silently and feel completely fine.
Speaker 3:That's the takeaway.
Speaker 2:Which is why proactive lab testing is so essential, especially if you have those risk factors like insulin resistance or metabolic syndrome.
Speaker 3:Absolutely crucial. Don't wait for symptoms.
Speaker 2:Since symptoms are so unreliable in the early stages, what specific lab tests should our listeners maybe be asking their doctors about for detection?
Speaker 3:Yeah, absolutely so. The core blood tests we often start with for suspected NASH include ALT, that's alanine aminotransferase, and AST, aspartate aminotransferase.
Speaker 2:The liver enzymes.
Speaker 3:Those are the main liver enzymes. Yeah, elevated levels are often the first sign of fatty liver and ALT is usually considered a bit more liver-specific than AST.
Speaker 2:Okay.
Speaker 3:Then there's GGT or gamma-glutamyl transferase. That's also important. It can be elevated in many liver conditions and often reflects oxidative stress happening in the liver.
Speaker 2:GGT got it.
Speaker 3:High ferritin levels can sometimes signal inflammation or iron overload, both of which can be related to.
Speaker 2:NASH.
Speaker 3:Okay, and of course, fasting. Insulin and glucose are absolutely crucial. We use those to calculate something called OPAIR.
Speaker 2:Homeir yeah.
Speaker 3:It stands for homeostatic model assessment for insulin resistance. It's a really good early marker of that underlying insulin resistance which, as we said, drives the fat accumulation in the liver.
Speaker 2:Makes sense. So you need insulin and glucose together.
Speaker 3:Correct. And finally, your standard lipid panel. Specifically, triglycerides and HDL are often abnormal in people with NASH or metabolic syndrome. High triglycerides, low HDL are common patterns. Right, the classic metabolic syndrome High triglycerides low HDL are common patterns.
Speaker 2:Right, the classic metabolic syndrome pattern.
Speaker 3:Exactly, and beyond those basic blood tests, there are also some specialized non-invasive fibrosis scores that can help us assess risk a bit deeper without needing a biopsy right away.
Speaker 2:Oh, interesting Like what.
Speaker 3:Well, there's the FA4 index. It uses your age, ast, alt and your platelet count to estimate fibrosis risk.
Speaker 2:Okay.
Speaker 3:And another one is the NAFLD fibrosis score, or NFS. That combines multiple markers like BMI, glucose levels, liver enzymes, age, platelet count and albumin. Both of these are calculations. They're non-invasive and they can help guide decisions like determining if maybe more advanced imaging or rarely a biopsy might be needed.
Speaker 2:And speaking of advanced testing, are there situations where more in-depth imaging is necessary?
Speaker 3:Yes, sometimes, while not always needed up front, some patients might benefit from, say, an ultrasound or a FibroScan to get a better look at the liver texture and check for stiffness, which indicates fibrosis.
Speaker 2:FibroScan measures stiffness.
Speaker 3:Yes, it's a type of ultrasound technology that does that, and ostography MRI can also provide even more precise fibrosis staging if needed, and look in very rare, uncertain cases, a liver biopsy might still be performed for a definitive diagnosis. But honestly, with these newer non-invasive tools, it's becoming less common than it used to be.
Speaker 2:That's good news. Fewer biopsies Definitely. So the crucial implication here is really clear the earlier you catch NARASH, the easier it is to potentially reverse. And those first signs are often hiding in your lab work, not in how you feel day to day.
Speaker 3:That's exactly right, which leads us to, I think, the most hopeful part of our deep dive. Yeah, narash is, unlike advanced cirrhosis, which often involves permanent scarring, the inflammation and the fat accumulation that define nanorash can improve significantly.
Speaker 2:Yeah.
Speaker 3:And the way to do that is by targeting the root cause, that metabolic dysfunction we've been talking about.
Speaker 2:Okay, so targeting the root cause. What's truly empowering about all of this is the idea that the path to healing your liver might not start with a prescription pad at all. Where do you begin when tackling Menesh?
Speaker 3:naturally, you almost always begin with weight loss. Assuming weight is an issue, which it often is. Clinical studies are very clear on this Losing just 5 to 10 percent of your body weight can significantly reduce liver fat, improve the inflammation and even reverse early fibrosis.
Speaker 2:Just 5 to 10 percent. That sounds achievable for many people.
Speaker 3:It is, and the data supports specific targets. For example, losing just 5 percent or more of body weight can noticeably reduce liver fat. Getting to 7 percent or more often improves the actual NASH histology, the inflammation and cell injury, and achieving 10 percent weight loss or more may even lead to reversal of fibrosis in some cases.
Speaker 2:That sounds incredibly promising that NASH is irreversible with these lifestyle changes. But you know, for someone who's maybe struggled with weight loss before, what are some of the biggest hurdles they might face and how can they overcome them.
Speaker 3:Yeah, that's a vital question, because knowing what to do is different from doing it consistently. The biggest hurdles are often, well, consistency itself and breaking ingrained habits. It's really not about crash dieting or extreme measures those rarely last. It's about finding sustainable, nutrient-dense ways of eating and incorporating consistent physical activity into your daily life.
Speaker 2:Sustainability is key.
Speaker 3:Absolutely Focusing on whole foods, really minimizing or eliminating those ultra-processed items and prioritizing daily movement, even just walking. It's those small, consistent changes that add up to profound results over time.
Speaker 2:And when it comes to the best diets for liver health, are there specific approaches that show particularly strong evidence?
Speaker 3:Yeah, there are a couple of dietary patterns that consistently show strong evidence for improving liver health. In the context of NFLD and NASH, low-carb or ketogenic diets have been shown quite effectively to reduce insulin resistance and also decrease that fat production. The de novo lipogenesis in the liver Studies show they can improve ALT, triglycerides and liver fat, sometimes within just a few weeks.
Speaker 2:Wow Weeks.
Speaker 3:Yeah, can be quite rapid. The other well-studied approach is the Mediterranean diet.
Speaker 2:Ah, the Mediterranean, Exactly.
Speaker 3:Rich in monounsaturated fats from olive oil, lots of fiber from vegetables, fruits, legumes, nuts and plenty of antioxidants. It's consistently linked to lower liver fat, better glucose control and reduced inflammation markers.
Speaker 2:So different approaches, but is there a common thread?
Speaker 3:Absolutely. The common thread between both successful approaches is clear they are naturally low in added sugars, especially fructose, low in refined grains and ultra-processed foods, and high in nutrient density from whole foods. That seems to be the magic combination.
Speaker 2:Makes sense. Are there any supplements that might offer support? Always with the caveat, of course, to consult a health care provider first before starting anything new.
Speaker 3:Yes, definitely consult your provider, but there are some supplements with emerging and, in some cases, decent evidence. We're talking about things like omega-3 fatty acids, particularly EPA and DHA, which can help reduce liver fat and triglycerides.
Speaker 2:Okay, omega-3s.
Speaker 3:Vitamin E, which is a potent antioxidant, has shown benefit, particularly in non-diabetic patients with NASH, though there are some safety considerations at high doses. Berberine is another interesting one. It's a plant compound that seems to improve insulin sensitivity and lipid metabolism, and also NAC, or N-acetylcysteine NAC yeah, it's a precursor to glutathione, a major antioxidant in the body, and it supports liver detox pathways. So these can be supportive elements within a broader lifestyle approach, but they aren't magic bullets on their own. Lifestyle is foundational.
Speaker 2:Right Lifestyle first, and let's not forget exercise. You mentioned it earlier. Independent of weight loss, what kind of impact can just physical activity have on its own?
Speaker 3:It's significant. Even without moving the scale, much exercise has independent benefits. Just 20 to 30 minutes a day of moderate activity like brisk walking, or adding in some strength training or interval training, can make a measurable impact on reducing liver fat and improving insulin sensitivity.
Speaker 2:So you don't have to become like an elite athlete.
Speaker 3:Not at all. Consistency is really the key Finding something you enjoy and can stick with. It really boils down to these well, seemingly simple choices, doesn't it? Cutting down on sugar, eating real food, getting active it almost sounds too simple for such a serious condition. Is that part of the challenge that people underestimate the power of these fundamental changes?
Speaker 2:I think you're right Sometimes the simplest solutions are actually the hardest to stick with consistently. But what you're saying is, with that consistency, with those lifestyle changes and maybe using lab testing to guide the way, many patients can see really dramatic improvements in their Nahash markers within months.
Speaker 3:Absolutely. It's incredibly empowering. So just to kind of connect this all back to the bigger picture Nashash really is a silent threat.
Speaker 1:Yes.
Speaker 3:But it's also a very clear warning sign that your body's entire metabolic system is under significant pressure.
Speaker 2:But the truly good news, the hopeful message here, is that it is treatable and often reversible, especially when you catch it early through that proactive lab testing and make those consistent lifestyle changes. You don't necessarily need a prescription medication to start healing your liver. What you need is good data, clear direction and, most importantly, that, day-in day-out consistency.
Speaker 3:Couldn't agree more. And if you're listening and wondering how to get started with getting that crucial data, maybe consider exploring options like at-home lab testing for those key markers liver enzymes, insulin resistance markers like HOMA, ir inflammation markers. It can give you those crucial insights into your current metabolic health.
Speaker 2:Right. Knowledge is power here. Ultimately, when you spot NASH early and you take action, you don't just save your liver, you really save your entire metabolic future. So the question for you is what stands out to you most about this silent threat and what will be your first step toward protecting your metabolic future?
Speaker 1:Thanks for tuning into the Health Pulse. If you found this episode helpful, don't forget to subscribe and share it with someone who might benefit. For more health insights and diagnostics, visit us online at wwwquicklabmobilecom. Stay informed, stay healthy and we'll catch you in the next episode.
