Liver Health

Mark Hyman, MD

Dr. Mark Hyman is leading a health revolution—one focused on using food as medicine to support longevity, energy, mental clarity, happiness, and so much more. Mark Hyman, MD is a practicing family physician and an internationally recognized leader, speaker, educator, and advocate in the field of Functional Medicine. He is the founder and director of The UltraWellness Center, Founder and Senior Advisor for the Cleveland Clinic Center for Functional Medicine, a fifteen-time New York Times best-selling author, and Board President for Clinical Affairs for The Institute for Functional Medicine. He is the founder and chairman of the Food Fix Campaign, dedicated to transforming our food and agriculture system through policy.

He is a co-founder and the Chief Medical Officer of Function Health. He is the host of one of the leading health podcasts, The Dr. Hyman Show with 150+ million downloads. Dr. Hyman is a regular medical contributor to several television shows and networks, including CBS This Morning, Today, Good Morning America, The View, Fox, and CNN.

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Full Transcript

Automatically generated. Please forgive any typos or errors in the following transcript. It was generated by a third party and has not been subsequently reviewed by our team.

Dr. Mark Hyman
Coming up on this episode of The Doctor Hyman Show.

Dr. Elizabeth Boham
We're seeing this huge rise in fatty liver, not only because of alcohol, but because of how high blood sugar, high levels of insulin, toxins like glyphosate and all the other toxins you mentioned, medications that people are taking, are putting stress on our liver.

Dr. Mark Hyman
Now before we jump into today's episode, I'd like to note that while I wish I could help everyone by my personal practice, there's simply not enough time for me to do this at scale. And that's why I've been busy building several passion projects to help you better understand, well, you. If you're looking for data about your biology, check out Function Health for real time lab insights. If you're in need of deepening your knowledge around your health journey, check out my membership community, the Hyman Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at DrHyman.com for my website store for a summary of my favorite and thoroughly test products.

Dr. Elizabeth Boham
Fatty liver is when the liver cells, the cells in your liver, are, replaced with fat cells. So fatty liver just means that some of the cells in your liver have been replaced with fat cells. And so there's fat deposited within your liver. Why do we care? Because then that means your liver can't work as well because it doesn't have all those liver cells doing the job with it.

The liver does, right? So the liver really helps our body detoxify, metabolize chemicals from the environment, metabolize our own hormones, you know, metabolize and get rid of toxins. And so, you know, we definitely don't want to have an under functioning liver, that's for sure. And this is, the prevalence of fatty liver disease is really, really high. And unfortunately, it's increasing.

But about ninety million people in The US have fatty liver disease. So-

Dr. Mark Hyman
that's, and

Dr. Elizabeth Boham
it's increasing in this country, it's increasing worldwide, the amount of fatty liver we are seeing.

Dr. Mark Hyman
So Liz, tell me more about a patient that we've had, because I think, you know, some of the patient stories are really helpful and instructive and give us a sense of how we do things differently at the El Giorgio Bono Center here in Massachusetts and Lenox and what you found and what you were able to sort of help him with and how it all worked.

Dr. Elizabeth Boham
Yeah, so I had a 50 year old gentleman who came in to see me and he was told by his primary doctor that his liver function tests, his ALT and AST were mildly elevated. And so he came in because he was frustrated with his weight. He wanted to lose some weight. He was about twenty five pounds overweight. And he just mentioned to me that his doctor had said his liver function tests were a little elevated and that they were going to be rechecking them in a few months.

And so, you know, we really got a good detailed history from him and we got a sense of what he was, what his diet was like, you know, what his alcohol consumption was like. Because, you know, that's one of the first things, of course, we think about with, you know, fatty liver or these elevated liver function tests is we're like, okay, how much alcohol is this person consuming? And what was interesting to me about him was, you know, he was pretty moderate in his alcohol consumption. He was having about two glasses of wine a night. And so not for a man, you know, that kind of almost falls within what's considered moderation.

So I was, you know, he was not a binge drinker. He was not overusing alcohol from the criteria we were talking about earlier. But I think the amount of alcohol he was consuming in connection with his diet and probably his genetics and many other things like his microbiome that we've spoken about, you know, that altogether was really impacting these liver functions for him. And so, you know, we noticed with his diet, it was, you know, not rich enough in vegetables, that's for sure. And, you know, really, that was probably the biggest thing I would say with his diet.

It was just, you know, devoid of a lot of vegetables. And you were talking about some of the things, supplements we use for helping the liver. You know, one of the things we think a lot about is sulforaphane, right? Which comes from your cruciferous vegetables that helps and encourages the production of glutathione in the body. And so one of the things we really worked on with him is making sure he got some cruciferous vegetables every day, broccoli, cauliflower, cabbage, kale, brussels sprouts, you know, really to help support, support, the, liver and help it heal essentially.

We also had him take a break from alcohol. You know, we said, you know, let's just pull away alcohol for a period of time, really help that liver calm down and let it give us some time to heal. And as I was mentioning earlier, we really can see the liver function tests go down pretty quickly for some patients. We can see if somebody did have fatty liver, you can watch it improve within a few weeks of cleaning up the diet and decreasing alcohol intake. So it can be, especially if it's not too far progressed, we can see changes pretty darn quickly.

And, you know, so with him, we really focused on cruciferous vegetables, lots of the, sulfurous vegetables like onions and garlic. We gave him turmeric. We gave him dandelion root to help his liver and gallbladder work better. Lots of green leafy vegetables. We made sure he was eating enough protein.

You know, we know that protein is really important for the detoxification process in the body. We need to be eating enough protein to do that. And so, you know, we made sure he was getting enough and, you know, foods that were rich in fiber to bind toxins, things like the beans and legumes and nuts and seeds, ground flax seed. And I did, I gave him some N acetylcysteine, some NAC. I gave him some liposomal glutathione and, milk thistle.

We put him on a really good multi that had methylated B vitamins in it. I gave him a little bit of an extra methylated B vitamin and really focused on those nutrient dense foods, so that he wasn't wasting his calories. Cause he was twenty five pounds overweight and we needed to cut back on his, on that weight. So we really needed to pull away those foods that were not nutrient dense. That are just people are eating way too much of that are getting into our diet that are not giving us all of the nutrients the body needs to work properly.

Dr. Mark Hyman
Yeah, so incredible. So incredible. So I feel like we see this so prevalently, it's so misdiagnosed or underdiagnosed. It's such a huge impact on your long term risk factors for all sorts of chronic illnesses, from heart disease to cancer, to diabetes and more. And it's something that traditional medicine doesn't really deal with very well.

And you might've been told your liver function tests are elevated or don't worry about them or they're not that bad or whatever, we'll watch it. That is just not a good idea. I don't think we are equipped in our traditional training with understanding how to actually figure out what to do for these patients with abnormal liver function tests. And I certainly was never trained. But the beautiful thing about functional medicine is that we have a way of evaluating the liver differently.

We have a different diagnostic tests we use. We have different therapy options and we see tremendous improvements in liver function and quality of health. And it's not just about the liver. It's like, when you treat what's going on with your patient, it's like everything gets better. His hormones get better, his liver gets better.

He loses weight, his sex drive improves, you know, like everything gets better. Blood pressure goes down and all of a sudden you've got a person who's instead of going on a trajectory towards increased risk of disease and death to actually having more vibrant, healthier life. So it's super encouraging when you see these kinds of patients because they're really relatively easy to diagnose and treat and yet traditional care just doesn't cut it for the most part.

Dr. Elizabeth Boham
Yeah, I mean, four months on the plan, his liver functions came down to totally normal. You know, after he lost 10 of those pounds. And then within a few more months, lost another 10 pounds. And his fasting insulin came down to normal. His liver function tests, his markers of inflammation in the body improved.

And then eventually, you know, I've been seeing him for a while. So, at this point, he does have one or two glasses of wine a few days a week. Like, does drink some alcohol at this point. He never, as I said, he never had a problem with alcohol abuse or alcohol overuse disorder. It just was he was drinking too much for his body.

And so, at this point in time, he's having a little bit of alcohol and doing doing okay with that. And it's not causing a bump in those liver function tests or some problem with his weight or insulin resistance anymore. So he, he did really well.

Dr. Mark Hyman
So why, why is fatty liver a problem? I mean, so my liver is a little fatty. Who cares? Like, why is it an issue for people? Why do we care to fix it?

Other than the fact that you can get cirrhosis and die from liver That's not a

Dr. Elizabeth Boham
common thing. Think other than that.

Dr. Mark Hyman
But that's a late stage thing. The other problems are not late stage and they happen to a lot of people and they're unrecognized as related to fatty liver.

Dr. Elizabeth Boham
Right. I mean, happen, they can happen quickly. Fatty liver can develop, quickly. They know that, that within two weeks of heavy drinking, having one and a half to two ounces of hard alcohol every day for two weeks, you can start to see signs of fatty liver. Which is, you know, that it develop very quickly.

What's great to also understand within a lot of this research is that it can resolve quickly. So when somebody has fatty liver because of alcohol and you take them off of alcohol, that you can see resolution of fatty liver within four to six weeks. You know, that is, can progress unfortunately, quickly if we're not taking care of ourselves. And then it also regresses when we start to make some shifts. And, you know, as you were mentioning, we're seeing this huge rise in fatty liver, not only because of alcohol, but because of how high blood sugar, high levels of insulin, toxins like glyphosate and all the other toxins you mentioned, medications that people are taking, are putting stress on our liver and making it so that our liver can't do what it needs to do to detoxify.

So it becomes this vicious cycle of we're we're we're inundated with toxins that are impacting our liver, but then the liver can't work as well, and so then we can't get rid of the toxins that we're inundated with. So because of this vicious cycle of having issues with our detoxification system in our body. And as we've spoken about before, the liver is such a critical organ within the body's natural ability to detoxify and handle all the toxins we're exposed to. You know, maybe we weren't, weren't, put together to handle all of these toxins, unfortunately, that we're exposed to. But we do have this ability to handle toxins.

And we wanna take care of our body so we can handle, the toxins that we are exposed to. And so, it's really important that we take care of our liver. And so what is considered, you know, what's considered normal for alcohol intake? You know, for for, men it's less than 10 drinks a week and for women it's less than five drinks a week. And so we know that that problems with the liver can occur when we're drinking too much.

So, we see problems when, when people are binge drinking or consuming more than 14 drinks a week for men or more than seven drinks a week for women. So I think it's important we also talk to our patients about what is moderation with alcohol? How do we take care of our liver, both from all aspects of nutrition and lifestyle?

Dr. Mark Hyman
So there was also an interesting, study came out recently looking at cancer and alcohol and showing that there's a dramatic increased prevalence of cancer, even a little bit of alcohol may actually increase the risk of cancer. So it's not just fatty liver, but it was a Japanese study with 63,000 adults where they looked at people who were drinking alcohol and it was a concern. But that aside, just the overload on your liver, besides just the stress on your liver's ability to deal with all the normal toxins we have to deal with, What happens when you have a fatty liver is it drives inflammation in the body and it's linked to heart disease, to cancer, to diabetes, to even dementia, and all sorts of things that we don't think necessarily related to a fatty liver. So fatty liver is sort of an early warning sign and clue that there's something wrong in your body and it's causing a risk, an increased dramatically increased risk of all these other problems. But that said, how do we know if we have fatty liver?

Dr. Elizabeth Boham
One of the first ways we find out is with general blood work. So if you do a metabolic panel, comprehensive metabolic panel on a patient, and we look at these markers like the AST and ALT, and if they're elevated, either high end of normal or elevated above the normal range, that's something we really have to be thinking about is this fatty liver? Should we go on and do an ultrasound of the liver to see if we are seeing some fat deposition in the liver? And so that's one of the ways we start to see it, most frequently with our patients.

Dr. Mark Hyman
Yeah, absolutely. So there's other tests you can use, which I've had personally just because sort of biohacking kind of like to check everything, but you can do an MRI and look at liver fat. And it should be less than 2%. And many people have very, very high liver fat. I thankfully have less than 2%.

They're actually also doing fiber scans, which look at the fibrous content, fiber, sorry, the scar tissue from the fatty liver, and they can use ultrasound scans. And those are good for measuring the degree. They can do liver biopsies. And I think what we see is really in functional medicine, a roadmap for healing the liver in ways that just doesn't exist with a traditional medicine or conventional medicine. So talk about what are the ways that, you know, in addition to the testing we talked about, we're looking at insulin resistance, looking at lipid particle size, we're looking at inflammation, we'll look at a lot of things that a traditional doctor wouldn't look at.

What are the beginning things we do from a dietary lifestyle and supplement perspective to reverse fatty liver?

Dr. Elizabeth Boham
I mean, one of the first things we do, right, is of course we get a good detailed history from our patients and try to get a sense of what's going on for them. Get an understanding of their timeline of their health. And that can help us find out what may be driving health problems in that person. So if there is concerns about fatty liver, you want to get a sense of what their toxic load has been in their lifetime. What is their weight?

What is their nutrition? What are they eating? And what is their microbiome like? And so we can really evaluate all of that and get a sense of how best to help this patient, that individual patient improve. Because we know that for some people it may be more focusing on toxic load.

For somebody else, it may be focusing more on alcohol intake. For somebody else, it may be more they're eating way too many carbohydrates, refined sugars, soda, coffee drinks, muffins, and not exercising enough in that whole metabolic syndrome process. So we want to really help focus the treatment plan on that individual patient. And I think that's what's so special about functional medicine is it's really looking for that underlying root cause for that underlying patient so that they can reach their optimal health. And, you know, we know that problems with the liver and fatty liver impact our immune system and how well we fight off infections.

It impacts our, how we can, how we can digest food, metabolize food. It impacts our nutritional, state in our body. So there's so many reasons why we really wanna look deeper here.

Dr. Mark Hyman
Why do you think this is increasing? I mean, it clearly was there obviously when we were in training, but it's just exploded. You know, we see seventy five percent of the population is overweight, forty two percent are obese, ninety three point two percent are metabolically unhealthy, which is essentially what this is, a metabolic associated fatty liver disease, right? So ninety three percent of us have some metabolic dysfunction. What's driving that?

Dr. Yousef Elyaman
So one of the major things is food, right? So food and insulin resistance is kind of at the top of the list. So our food, there's more sugar being added to our foods. There's higher carbohydrates. But when you look a little bit deeper into it, high uric acid as well.

So that comes from eating too much fructose. Yes, high fructose corn

Dr. Mark Hyman
syrup in all our

Dr. Yousef Elyaman
food. So we have high fructose corn syrup, alcohol, alcoholism is on the rise. So alcohol is a toxin. So that also affects is going to affect the liver along with small intestinal bacterial overgrowth. So bad bacteria in gut.

The gut can be as metabolically active as the cytochrome P450. And because of our current lifestyles, the bacteria in our gut or in our intestines are changing and they're changing for the worst. And there is an association between small intestinal bacterial overgrowth, which is one of the major causes of irritable bowel syndrome and having fatty liver disease. There's a

Dr. Mark Hyman
That's when you're bloated and you get a food baby after eating. Right? That bloating is because there's bacteria in your small intestine, which should not be there, that then ferment the food that you eat, particularly starches and carbohydrates, that then give off all kinds of toxic metabolites. Right. They can then poison your liver.

That's what you're saying, right?

Dr. Yousef Elyaman
Absolutely. Right, right. Yeah. Yeah. You can, what did you say?

A food baby?

Dr. Mark Hyman
Food baby. Bloating

Dr. Yousef Elyaman
thing

Dr. Mark Hyman
in That food

Dr. Yousef Elyaman
pregnancy. Right. Yeah. So if you, one alarming statistic, they looked at young men that were not overweight, and they found that they did something called a insulin resistance score test on them. And they found that more than half of them had insulin resistance.

And these are non these are young men in their 20s, not overweight, normal ideal weight. So I think that kind of brings us to the one of the first drivers, which is this insulin resistance concept.

Dr. Mark Hyman
Now, to to kind of back up on that, that's a stunning statistics. Fifty percent of healthy, normal weight, 20 year old men have prediabetes or some degree of insulin resistance, which is on the way to pre diabetes.

Dr. Yousef Elyaman
Yeah. Their blood sugar normal.

Dr. Mark Hyman
And now they're measuring this by the new mass spec test from Quest, which is a really new test.

Dr. Yousef Elyaman
So, right.

Dr. Mark Hyman
So just to back up on that, way we used to measure insulin resistance in the lab was a euglycemic clamp test, super fatty liver, correct?

Dr. Yousef Elyaman
It's the huge driver of fatty liver disease. It's I would say it's the number one driver but there are eight or nine drivers. But I so what happens is is that due to inflammation, to toxicity, due to too much sugar, like too much of a sugar overload or a carbohydrate overload. When those receptors on our fat cells, we have these insulin receptors that are supposed to take sugar and put sugar into the cells. When they start to not work well, when they start to get resistant, there is an enzyme called hormone sensitive lipase.

And what that enzyme does is it starts tearing up the fat in the fat cell and it sends the fat to the liver and it overloads the liver. So now you have this liver that gets overloaded. So the liver ends up with a whole bunch of triglycerides which is one of the one of the tests that we look on the lipid panel. Now here's the interesting thing so you could check a triglyceride level and their level would look okay and that's because some people genetically will tear those will decrease triglycerides in the blood but what the triglycerides do when you end up sending a whole bunch of triglycerides to the liver they turn into something called VLDL they call it triglyceride rich VLDL versus triglyceride poor. And VLDL becomes there's another enzyme found in the lining of our blood vessel that is that is called lipoprotein lipase.

And it turns it into the tiny dense LDL, which causes clogging of the blood vessel and heart disease, strokes and heart attacks.

Dr. Mark Hyman
Okay, I'm going I'm this is so you see right here, I'm just going unpack a little bit because basically, you know, just to kind of put things in context, in France, there's a delicacy called foie gras. Oh, yeah. Which I probably didn't pronounce right, but whatever. That means in French, fatty liver.

Dr. Yousef Elyaman
Yep.

Dr. Mark Hyman
Now, most people think that if you eat fat, you get fat and that fatty liver must be coming from all the fat we eat. But what you just said was that, in fact, it's not true that it's actually the sugar and refined starches and carbohydrates, the flour and the sugar that we're eating in pharmacologic doses is overloading our biology and causing that carbohydrates to turn into triglycerides, which then turns into fatty liver.

Dr. Yousef Elyaman
And

Dr. Mark Hyman
then you're in this vicious cycle where the fatty liver then creates all sorts of other problems. So let's kind of unpack what happens biologically when you have a fatty liver. You get a fatty liver, and so your liver is looking like a fat goose or duck liver, and you don't want to serve it on toast unless you're maybe a handful of lector. And then and then, you know, you've got a process going on in that liver that's just more than the accumulation of fat. So what are the things are happening in the liver that end up causing harm?

You mentioned that the type of cholesterol we get because of that fatty liver is the dangerous, small, dense cholesterol we talked about in the podcast. We do a whole podcast on on cardiovascular risk and lipid analysis. So the small, dense cholesterol particles, which by the way, everybody listening, your doctor is not measuring when you go to get your cholesterol test. Less than one percent of cholesterol tests in America are for the right cholesterol test, which is called lipoprotein fractionation. And it's looking at the particle size, particle number, the VLDL numbers.

And you can get all that, by the way, through functionhealth.com/mark. It's a company I co founded to allow people to get access to the right amount of information and data. So functionhealth.com/mark, you can get the right panel so you can see what's going on. And we also measure insulin, although I assume we're going be measuring this insulin resistance score, which is very exciting.

Dr. Yousef Elyaman
Right. Yeah. What's

Dr. Mark Hyman
happening in the liver?

Dr. Yousef Elyaman
So what's happening in the liver? So we can go back to what's happening in the fats and then go right back to the liver. So number one, the fat starts to send these triglycerides to the liver and start overloading the liver. When that process is overloaded, then then fat, then your fat cells, which actually your fat is, I don't know if you've done a podcast on this, but your fat is like an endocrine organ. It makes things like adiponectin.

You're When the process is bad, adiponectin levels can go down, which causes more insulin resistance and more inflammation. And then there are other hormones that can go up in the liver that can cause inflammation like tumor necrosis factor, like leptin. So those go up and now that inflammation and worsening insulin resistance and all that fat make its way throughout the body and they go in the liver and the liver starts to accumulate and accumulate and accumulate and it just can't keep up with it. The liver packages it and sends it back to the fat. The fat takes it up but then because of the insulin resistance it shoots it right back to the liver and you end up with this vicious cycle.

In the meantime the liver is not supposed to be storing fat. The liver is supposed to be making all these metabolic processes. It's supposed to repackage the fat and now when it gets overloaded and jam packed, now the liver starts to get inflamed. It starts to rust oxidative stress. Sugar starts to get worse and it kind of creates this this this metabolic nightmare.

Dr. Mark Hyman
It's like a vicious cycle.

Dr. Yousef Elyaman
It's a vicious cycle.

Dr. Mark Hyman
And what you're saying essentially is it's both an endocrine and an immune organ. So all the hormones that regulate weight, appetite, insulin resistance like leptin, adiponectin, these are hormones of the body produced to regulate your your your eating behavior and your your way you process sugars and and regulate inflammation. Like like you said, tumor necrosis factor alpha or IL-six. And these are these are cytokines. We heard about the cytokines storm.

So with the fatty liver, you're not just getting fat in there. You're getting this cytokine kind of increase that's driving systemic inflammation throughout the body, which it can explain a lot of things we see with the increased rate of death and heart attacks and cancers and all these things that seem to be related to inflammation.

Dr. Yousef Elyaman
Right. And see, and the thing is, I mean, we could just go, we could probably do a whole podcast on when you have fatty liver, all of the other imbalances or all of the other things that are thrown off in the human body. Unfortunately, too many providers, too many doctors take a look at say, oh, you have fatty liver, lose weight, and they move on. And they don't really talk to them about it again. When really that is driving heart disease, it's driving Alzheimer's disease, it's driving cancer.

The liver is supposed to be metabolizing our toxins. So now your liver is not working. It causes hormone imbalances. The liver is supposed to metabolize estrogen so now you can't metabolize estrogen. Estrogen goes up, progesterone goes down.

Women start to have Infertility issues? Infertility is big they start to have they start to have mood issues they start to have they start storing more weight like they and men men start to get start to have that that estrogen effect it blocks their testosterone and it's kind of this just, it affects everything.

Dr. Mark Hyman
It doesn't sound like fun.

Dr. Yousef Elyaman
No, it's not. Well, I'll tell you now that we have technology, the non invasive, easily accessible technology to take a look at the liver. When we tell people that their liver is has fat in it or there's an issue with their liver, I have not seen a more motivating driver of change. As a matter of fact, when I see liver enzymes being up, I had a patient who I talked to her about she had elevated liver enzymes I said I want to take a look at your liver. I sent her to do this test it's called a FibroScan.

Before she came back, had lost she stopped drinking alcohol and she had lost 20 pounds yeah, came back her liver was fine. But but what happened when people hear that their liver there's a problem with their liver for some reason, it creates that motivation. Yeah. Which I can tell them, Hey, you're going die of a heart attack. And it doesn't Yeah.

Dr. Mark Hyman
Yeah. It's interesting. But you know, I think, you know, what you just point to is something really important, which is that this is a condition that's so prevalent, affects at least a third of Americans that is underdiagnosed. And that is a biggest risk factor for having a heart attack as anything else. Like the level of magnitude of the risk of having a fatty liver for death, heart attacks, cancer is extremely high.

Right. Do you have some of the data on that?

Dr. Yousef Elyaman
Right. Yeah. We could put them in, we can post them in the show notes. The attack. Yeah.

Yeah. We could put them in the, in the show notes, the percentages. Yeah. It's really

Dr. Mark Hyman
significant. And I, and when I started reading about fatty liver years ago, was like, wow, this is in and of itself a huge problem because it's driving all these other diseases that we're treating separately, but we should actually be treating the liver. Right.

Dr. Yousef Elyaman
And going so, so unfortunate and in the conventional realm, unfortunately, we look at we look try to look at the disease kind of in a vacuum, right? Okay, so you have fatty liver. So what can fatty liver do? Well, the liver can start getting inflamed, and then it can start to turn into fibrosis or hardening, and then you can get cirrhosis, right? And nobody wants liver cirrhosis, right?

Most people know that liver cirrhosis is a bad thing and then you can also get liver cancer. But like you just mentioned, they have more of a chance of dying of a heart attack than of the liver cirrhosis when they have fatty liver. So I think that's what you were alluding to.

Dr. Mark Hyman
Yeah, yeah, yeah.

Dr. Yousef Elyaman
Yeah, so it's so, but I think the beautiful thing and I'm so fortunate or grateful to that I found functional medicine because we don't look at fatty liver as a disease in itself. We say there is a process that is happening.

Dr. Mark Hyman
Part of a syndrome that's happening.

Dr. Yousef Elyaman
Part of a syndrome now and everybody is unique on what's causing it because some people it's insulin resistance. Some people are eating lots of the way that their body deals with fructose. They start to increase uric acid and it's the uric acid that is driving it. Where other people can have thyroid dysfunction that's causing it and others could have an issue with can have an issue with bad bacteria in the So other people have a iron overload that is causing it. And others were exposed to different toxins.

And it's probably a combination of a

Dr. Mark Hyman
lot Yeah, mean, think this is really important. I just want to pause there because from a traditional medicine point of view, it's like, okay, you know, we do a blood test, we do a fiber scan or MRI. We look at your liver, we do a biopsy. Okay, you have fatty liver disease. But the why is very much neglect And there is some understanding that it's due to a high refined carbohydrate diet.

But these other and yes, people understand hemochromatosis and iron overload. But the fact that, you know, the microbiome is involved, environmental toxins are involved, that it may be thyroid dysfunction, that there's a whole list of causes. And that's really where functional medicine is different than traditional medicine. It's root cause medicine that is ruthless around investigating the causes of a condition so that you can treat that person as an individual rather than treating everybody who's got this condition the same. Right?

If someone was a thing I read about years ago, was a scientific paper about a guy who had liver failure, but he was a golfer. Know, usually golfers, I'm not a golfer, but apparently they have to clean their balls and use this ball cleaning thing on the golf course to get the dirt off. But he used to lick the balls to clean them. But there's pesticides all over the golf course. So he was getting toxic pesticide load in his liver and caused him to have liver failure.

So we had to think about all the root causes and that's where functional medicine helps us to navigate. And then the gut role plays a huge thing too. Mean, we don't really think about addressing the gut, but we know how big a role the gut plays in affecting our metabolic health and our load of toxins. And I mean, in medical school, we used to treat liver failure, which resulted, you know, in the inability to metabolize the toxins from the gut by which caused basically delirium, something called hepatic encephalopathy. We treat it with antibiotic and a laxative.

So basically to sterilize the gut, get rid of the bacteria that were poisoning the body, which is interesting. Don't, because now we understand the microbiome has a huge role in mental health, but that was something we learned and it didn't really kind of connect with us in terms of a thing about the microbiome in medical school. Right,

Dr. Yousef Elyaman
right. It's a prebiotic. Lactulose is a prebiotic. So you're feeding the good bacteria. So we were manipulating the microbiome and we thought we were just making them poop.

And it was amazing. It would take them out of that hepatic encephalopathy phase.

Dr. Mark Hyman
So basically what's going on in the liver is you've got a number of different things that are happening in our society, which is no overload of toxins, which is obviously our diet, which, you know, other factors that you mentioned, gut microbiome changing dramatically, all driving this epidemic of fatty liver disease. And now there's sort of an interest in kind of addressing this more directly in the medical field. We renamed the disease from nonalcoholic fatty liver disease to metabolic associated fatty liver disease.

Dr. Yousef Elyaman
And actually it changed that. So they first went to metabolic associated liver disease. Then they changed it again because they, so they're, yeah, whoever they are, the big panels, actually multiple panels got together and they talked to patients, but I think we should talk about that story a little bit, right? So non alcoholic fatty liver disease was basically your naming a condition by saying what it was not. It's not alcoholic.

Like it was kind of weird anyway. Even though that it was called non alcoholic fatty liver disease, people associated with alcohol Because alcohol was in the

Dr. Mark Hyman
name, have

Dr. Yousef Elyaman
to explain it to their family. And no, I'm telling you it's non alcoholic. So you had that negative. And then the fatty had a stigma. So they changed it to metabolic associated or metabolic dysfunction associated fatty liver disease.

But then they changed it again because they're like, fatty is stigmatizing. So we want fat out of it. So now it's metabolic dysfunction associated steatic, which means fat, liver disease. So no, steatic liver disease. So now you took everything out that anybody could understand.

Dr. Mark Hyman
So you put a medical term in which means fat, steatosis, which means fatty.

Dr. Yousef Elyaman
Right, right. But now they don't get shamed.

Dr. Mark Hyman
Now it's in Latin, so it's okay.

Dr. Yousef Elyaman
Yeah, yeah, it's fancy. It's fancy.

Dr. Mark Hyman
Whatever. So that's the problem. And you know, in medicine, we call it the naming and blaming game. We name the disease and we blame the name for the problem. Well, I know why you have

Dr. Yousef Elyaman
Now it's called Mazeld.

Dr. Mark Hyman
Mazeld. Mazeld. Okay. Then there's, okay, forget about what it was called. We know this is a bad thing.

We know it's increasing and we know that traditional medicine, you know, doesn't have a great approach. So let's, I want to walk through how traditional medicine approaches this and then how we're going to approach this with a new perspective of root cause medicine and functional medicine. And then how we go about looking at the diagnostic tools we have to assess it. And what are the therapeutic tools? So just sort of high level, what if you want to see a traditional hepatologist, you have fatty liver, what are they going to tell you?

What are they going to tell you to do?

Dr. Yousef Elyaman
Okay, so you go to a traditional hepatologist, they take

Dr. Mark Hyman
a liver specialist.

Dr. Yousef Elyaman
A liver specialist. They see the patient, they tell the patient you have fatty liver disease, go ahead and try to lose weight, right? They may give them vitamin E, probably you're going to give them the wrong kind of vitamin E because we know that there's different forms of vitamin E. And then if you're lucky, will say, no, don't stay away from vitamin E. And then they see if you're bad enough to be enrolled in a study.

And if you are, then they'll put you on a drug, right? If not-

Dr. Mark Hyman
Because there's no FDA approved drugs for fatty liver disease.

Dr. Yousef Elyaman
There is one now. In March, we have one called ResMediram and we should probably unpackage that later because there's some protection. But yes, so there's finally one drug. It costs only $4,000 a month. Is that it?

That's it. And it can cause all kinds of side effects as well. Great. That being-

Dr. Mark Hyman
Sounds like fun.

Dr. Yousef Elyaman
Being said, it's all about getting them, okay, we have a disease, we named it, right? We need to tame it with a particular drug.

Dr. Mark Hyman
So, I'll be told March before that, what would they be telling you?

Dr. Yousef Elyaman
They would, some would say, take it, ask your doctor if he would prescribe semaglutide for you. Ozempic. Ozempic. That's currently what they're, what they'll tell For weight

Dr. Mark Hyman
loss because when you lose weight, fatty liver gets Right.

Dr. Yousef Elyaman
So what would we do? We would take a look at the FibroScore. And I do want to talk about this FibroScore because this is the FibroScan because this is extremely-

Dr. Mark Hyman
But it's back to the traditional medicine. Are they thinking that, you know, this is really diet related? Are they thinking that we should cut back on carbohydrates and starches and sugars? No particular diet. Do they really talk about a keto diet or anything like that to help?

Dr. Yousef Elyaman
Traditional medicine is like lose weight.

Dr. Mark Hyman
Lose weight. Just lose weight, eat less, exercise more, come back in three months. And if it doesn't work, we'll put you on drugs except oops, there's no drug for this.

Dr. Yousef Elyaman
Yes. Unfortunately we don't. So semaglutide.

Dr. Mark Hyman
So okay, was gonna pick, all right. Yeah. And then, and then.

Dr. Yousef Elyaman
Yeah. So, and that's it. And then they just kind of leave you there. Yeah. And they, and most of them are not getting a FibroScan.

Most of them don't know how bad it is. They don't know if they're, they have fibrosis, which is hardening or not. And they, and they just, they just kind of wait till things get really

Dr. Mark Hyman
And they might, if you're diabetic, which is associated a lot with diabetes, right? Because it's sort of the same condition, but earlier on. They might give you metformin or they'll give you the Ozempic or maybe some of the

Dr. Yousef Elyaman
Although metformin hasn't been found to decrease fatty liver disease. It's kind of, but they may give you that. They definitely will say you have a high risk of heart disease, so make sure you're on a statin drug. So they will put you on a statin drug. And the problem is it's a double edged sword.

The statin drug can cause liver toxicity, but also it can change the way the lipid metabolism. So you know you may be hurting the liver, but you may be helping the heart. Right, So it's not one of those.

Dr. Mark Hyman
And then and then if you're overweight enough, they'll say, why don't you have bariatric surgery? They're perfect bypass. So. Yeah. Clearly, you know, traditional medicine has has not developed a good approach to this yet.

What food should we particularly be concerned about? Well, there's been a lot of research lately about fructose and fatty liver, And fructose is absorbed differently than regular sugar. It just goes right in. And in high fructose corn syrup, the difference with high fructose corn syrup, unlike for example, fruit, which has fructose and glucose, but it's all packed in a fiber matrix with lots of vitamins and minerals and lots of phytochemicals and lots of antioxidants, doesn't get absorbed super quickly. That's okay.

Eat fruit. But when you have a high fructose corn syrup, it's free fructose. It's not bound to the glucose molecule because sucrose basically is sucrose plus is glucose plus fructose. That that's what sucrose or table sugar is. But when you actually separate out the fructose and the sucrose, you end up with this free fructose.

And it's often not just a fifty fifty with sugar, with, for example, glucose. It's maybe 75% fructose. And that's what you see often in sodas or anything with high fructose corn syrup. So if you want to get rid of fatty liver or avoid it, do not eat anything with high fructose corn syrup. In fact, there's one thing you can do to radically change your life is avoid every single food product with high fructose corn syrup.

Just get rid of it. There's no need for it. It's super toxic, and it has no health benefits. In fact, it has a lot of harms. And it's just a sign of poor quality food.

So make sure you get rid of all of that. And it's in everything. It's in salad dressing. It's in tomato sauce. I mean, there may be more servings of high fructose corn syrup in your tomato sauce for your pasta than there is in two Oreo cookies.

So get rid of it. No exceptions, %. If you make one rule about diet, no one's gonna argue with that, like nobody. Whether you're a vegan or paleo or raw food or low fat, high fat, low carb, high carb, nobody's gonna say high fructose corn if it's good for you. Second is starch.

So kinda doesn't matter what it is. If it's starchy or sugary, it's gonna be also a problem. Remember the ducks who were forced fed corn, foie gras? Well, that is a form of starch. And it sounds like, oh, corn's good.

What's wrong with corn? But, actually, even whole grain corn is a problem. Whole wheat or whole grain flour is a problem. It's just starch. And when it's broken down like that, it's a problem.

Now if it's in whole kernel bread, like whole kernel rye or whether it's in, you know, whole beans or whole grains, not as much of a problem, especially if you eat it with a matrix of food of protein and fat, it's mostly absorbed, has fiber in it, very different. But but if you eat any of that floury, starchy foods, it's drive fatty liver. And that's what's really what's really driving this. I've written a lot about this. I've written in all my books, The Blood Sugar Solution, The Detox Diet, Food What The Heck Should I Eat, The Peking Diet.

I go a lot into all this. But it's basically, you know, below the neck, your body can't tell the difference between a bagel and a soda. So when you're eating a bagel or having a slice of bread you think you're doing okay, you're not. And you just, you need to think of it like a treat or a drug. I mean, do I have alcohol?

Yeah, rarely. I'll have a drink. But I don't have it every day at every meal, which is what we do in America. Also, you wanna do things that really help to heal your liver. Now, first is getting rid of the bad stuff, obviously, get a starred sugar, processed foods.

Next is up the good fats. Fat heals your liver, particularly MCT oil, which is a derivative of coconut oil, that can be very helpful. With avocados, olive oil, nuts and seeds. I mean, even saturated fat from, from meat, not a bad problem. Chicken, fish, lots of good oils like macadamia oil.

And obviously the omega three fats are so important. And they're anti inflammatory and they they help heal the liver. Exercise also. Exercise will help your body fix its metabolism, fix the insulin resistance and reduce inflammation. Supplements also super important, and I really recommend people do the right supplements for their liver.

And there's a bunch of them, if you have a fatty liver you wanna focus on these. One is N acetylcysteine. This is one that helps you make glutathione in the body. Glutathione is one of the most important detox fires and antioxidants in the body. Sadly, there are government, agencies that are looking at, quote, turning N acetylcysteine into a drug and only available by prescription, which would be a tragedy, because it's very safe, it's a supplement, but it works so well they're considering a drug, which doesn't make any sense to me.

But anyway, that's what's happening. But N acetylcysteine super important. Lipoic acid, another important antioxidant that helps liver. Milk thistle also it's a great herb that you can use to help heal your liver. And there are other ones like dandelion greens and, artichoke hearts and rosemary spices, curcumin, lots of things you can use to help, boost your detox system.

And of course, you also need all the B vitamins, B12, folate, B6 to help, zinc, selenium, magnesium, all help your liver heal and repair. So make sure you get those nutrients, make sure you get the superfoods. The other family of foods I really love are the brassica family. These are the broccoli, collards, kale, arugula, daikon radish, all help. Garlic and onions, another great family of foods that contain sulfur, cilantro, parsley, all these are super detoxifying.

So make sure that one, you check for fatty liver. If you have a little bit of belly fat or you diet as high in sugar, starch, or high fructose corn syrup, there's a pretty high chance you have it. So go get some liver function tests, check a liver scan, see what's going on, and then cut out this high fructose corn syrup, cut out the starch and sugar, dramatically reduce it, eat all the healthful detoxifying foods, and make sure you take the right supplements to boost your pathways for detoxification and heal your liver. Things like lipoic acid, N acetylcysteine, milk thistle, of course, magnesium, B vitamins, selenium, zinc, and also you can eat all these other superfoods like the cruciferous vegetables, the garlic and onion family, they're super liver supporters. So just remember this is affecting so many people, probably a third of America, almost never diagnosed, but killing millions and millions of people a year.

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