Dhru Purohit Show - The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick

Episode Date: April 21, 2025

This episode is brought to you by Maui Nui, Levels, and Ollie. When we think about chronic disease and vital organs, the liver isn’t always the first that comes to mind—but it should be. The liver plays a role in nearly every metabolic process in the body, from stabilizing blood sugar levels to converting amino acids into usable fuel. Today’s guest joins the podcast for a deep dive into how optimizing liver health is key to supporting overall health. Today on The Dhru Purohit Show, Dhru sits down with Kristin Kirkpatrick to explore the liver’s vital role in detoxification, the rise of fatty liver disease, and how liver health impacts overall mortality. They break down the connection between diet and liver function, debunk myths about dietary fat, and examine the effects of ultra-processed foods and artificial sweeteners. Kristin shares the benefits of coffee, muscle mass, and blood sugar balance for metabolic health, along with key liver-supportive foods, lifestyle tips, and insights into GLP-1 medications for those with obesity and liver issues. In this episode, Dhru and Kristin dive into: The shocking rates of non-alcoholic fatty liver disease (00:00) Understanding fatty liver disease and its twelve major risk factors (2:51) Why Americans are at greater risk (7:50) The crucial role the liver plays in the body (13:28) The phases of detoxification from environmental toxins (18:18) Research linking fatty liver disease to increased mortality risk (22:28) The earlier onset of fatty liver disease in today’s population (27:15) Why carbohydrates may be more to blame than fat (27:54) The impact of Diet Cola, artificial sweeteners, and foods to avoid (32:01) Twelve liver-friendly foods to prioritize (48:31) The importance of building and maintaining muscle mass (58:01) Lifestyle recommendations for managing fatty liver disease (1:05:31) The role of physical activity in liver health (1:08:31) Understanding GLP-1 medications and their effects (1:11:53) Final thoughts on liver health and nutrition (1:18:31) Also mentioned in this episode: Kristin’s Presentation Slides Regenerative Health Book For more on Kristin, follow her on Facebook, Instagram, X/Twitter, Pinterest, Youtube, LinkedIn, and her Website. This episode is brought to you by Maui Nui, Levels, and Ollie.  Right now, Maui Nui Venison is offering my listeners a limited collection of my favorite cuts and products. Just go to mauinuivenison.com/dhru to secure your access now —but hurry, supply is limited! Right now, Levels is offering my listeners an additional 2 FREE months of the Levels annual Membership when you use my link: levels.link/DHRU. Make moves on your metabolic health with Levels today. Want to give your dog the best in clean eating? Take the online quiz and introduce Ollie to your pet. Right now, Ollie is offering 60% off your first box of meals when you subscribe today! Just head to Ollie.com, use the code DHRU, and you’ll get 60% off your first box of meals in your subscription. Learn more about your ad choices. Visit megaphone.fm/adchoices

Kristen, you're back on the podcast today to talk about protecting one of the most vital organs in our body, our liver. You've even put together a fantastic list of 12 of the top foods that support liver health, which I'm excited to share with our audience today. But before we get into that, you have a pretty mind-blowing stat and fact about our liver. And that fact is that one in four adults in the U.S. is now living with fatty liver, non-alcoholic fatty liver disease. And this is the clincher. Most people have no idea. That's almost 100 million Americans walking around with this as a silent condition that left unaddressed can completely upend our life. What is fatty liver disease?

And let's jump right into it. who's at risk for this condition? Yeah, so Drew, as you know, it's really interesting. This data is actually a little bit older. We don't have the updated data yet. Some assumptions now are that it could be as severe as even one in three. Could be greater than what we think. Definitely one in four.

Fatty liver disease is simply having excess fat in the liver. So the liver is supposed to have some fat. Once you get over about 10% of fat and fat starts to overtake healthy liver cells, Now you have something called fatty liver disease, and that's basically the gist of what it is. But it is what comes because of it that really is the alarming factors, right? And this phrase that I used, once fat overtakes healthy liver tissue, so once we have kind of that hijacking of overtaking, of having healthy liver tissue being replaced by unhealthy, fibroatic, inflamed tissue, the liver no longer works the way it should.

And that causes a whole host of problems. Talk to us about who's at risk, because we talked about this being largely for many people, a silent epidemic. They don't know actually they're on their way to getting this very terrible condition, which has a whole host of problems in their life. So you have a great slide on this, if you could walk us through. You know, the silent nature of this is really what I've seen in my practice and the hepatologist that I've worked with.

Many people don't get diagnosed with this until they see their liver and. are up. And then that's kind of the warning symbol. What's going on here with your liver? So let's just go over some of the risk factors. Insulin resistance is probably one of the greatest risk factors. The reason for that is because the liver plays such a huge role in regulation of blood sugar. You know, when the body senses that blood sugar is too low, the liver were worked towards releasing the stored form of blood sugar. So we don't have that low blood sugar. And so there's a huge connection here. In fact, when we look at that one in four, statistic, we are looking at individuals who have insulin resistance or type 2 diabetes

much greater in the stats, right? So probably 80 to 85% of individuals that are suffering from insulin resistance or type 2 diabetes probably also have fatty liver disease as well. And this just speaks to the dysregulation of what is going on in sugar, in their blood sugar. You and I were talking earlier today about wearing CGMs. I have my CGM on right now as well. It's so interesting to compare my patients and their data with someone who doesn't have insulin resistance and looking at how poor and how less efficient the body is at recognizing how much insulin is necessary, losing what we call that sensitivity. Insulin resistance is not having the sensitivity needed to give you the right amount of insulin to match the right

amount of carbohydrate. So that is a huge risk factor. Obviously that falls within the type to diabetes as well. Obesity, and we're looking at obesity here as waist circumference. So one of the reasons, and we can talk about this later, but one of the reasons that the nomenclature from non-alcoholic fatty liver disease, which was NAFLD, changed to mass old, M-A-S-L-L-D, so that is metabolic dysfunction associated stentotic liver disease, is because of the fact that we needed to recognize the metabolic features of this condition. And so that really speaks to the obesity perspective and waist circumference in general. So when we see waist circumference, the belly fat being larger, we know that then leads down a path of a greater incidence of insulin resistance,

type 2 diabetes. So there's the connection there. Sedentary lifestyle. Again, when we are sedentary, we are more likely to be obese and especially having that belly fat, but we also, we also don't have great regulation of our blood sugar again. So we're not utilizing the fuel that we need for activity. So sedentary lifestyle is another huge factor as well. Tobacco use, we know tobacco use can damage the lining of our vessels, so the endothelial lining. So we know that tobacco use puts us at risk for, of course, lung cancer and things like that. It's also a huge risk factor for things like dementia, right? So if you look at like Lancet's outline of the main risk factors for dementia, of course, tobacco use was in there. And that has to do with the damaging of what happens

with our vessels. And of course, when we think about the liver, we have to remember that the liver is connected to a whole bunch of vessels, just like every organ is as well. Metabolic syndrome, that would again feed to the type 2 diabetes insulin resistance. Metabolic syndrome is essentially a way for physicians to say, okay, let's look at the factors that you have. Do you have hypertension? Do you have sleep apnea? Is your hemoglobin A1C 5.7 or above? You've have enough risk factors here for us to say that you've got metabolic syndrome, which is basically just a cluster of these symptoms that lead to metabolic dysfunction. High lipids can fall into that as well. And we recently had some news coming in from Cleveland Clinic and Dr. Nissen looking at stealth

cholesterol and some of the potential pharmacological approaches that can go towards this. So a lot of lipids in the news, and that's a good thing, makes us think about the fact, maybe I should get my lipids drawn, right? Hypertension again falls into that metabolic syndrome. And unfortunately, age. Age always plays a factor, right? I was coaching a group of menopausal women the other day, and someone had brought up hot flashes and another woman brought up gray hair. And I said, Do you remember, you don't remember, but do you remember when we were a baby? We didn't have any of these. Our skin was great.

Everything was wonderful. And that's because our cells were wonderful and so young. As cellular damage occurs, so does our risk for chronic conditions, including fatty liver disease. Now, something very controversial, even though that's true here in America, that you've presented in your book, regenerative help, discover your metabolic type, and renew your liver for life. It's fantastic. We have a link in the show notes. is that an important reminder is that we can see that in other parts of the world,

just because people are getting older, doesn't mean that they're going to be getting this disease. In fact, there are a lot of places like Japan and other Asian countries where people who preserve the traditional ways of life are not sedentary, don't eat as much as processed food, have strong social ties. And of course, as a byproduct of that have good metabolic health, they're not getting fatty liver at the same rates that we are getting here in America.

Is that true? Yeah, it's absolutely true, Drew. I mean, we've seen us also with the data looking at dementia and Alzheimer's as well, looking at individuals that have, you know, the same aging cells as other individuals, yet from an epigenetic standpoint. So looking at gene expression and looking at all the associations with that, lifestyle you mentioned social activity which is a huge component they're not getting the diseases that we're seeing individuals get here in the united states or um other areas of the globe so you're

absolutely right age alone is not the risk factor we've seen people beat that based on lifestyle choice um but age definitely contributes to it if your lifestyle is one that doesn't speak to better help you can't have this conversation about fatty liver and how to avoid it without at least giving people some context for why the liver is such a vital organ in the body. And you have a fantastic slide for this. It's slide number three. Can you walk us through all the beautiful things that the liver does for the body when it's healthy? If you know me and you know my content, you heard the experts on this podcast, you know that

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about your metabolic health and tracking all of your metrics in one place, now is the time to get started. Just go to levels. level.com, levels. dot link slash dh-R-U to get two free months of their annual annual membership today. Yeah, absolutely. You know, one of the things that I tell my patients

and that I've, the hepatologist that I've worked with, I hear them say this all the time, if your liver doesn't work, nothing else does, right? But yet we don't give it the attention it deserves. We just focus on the braid and the heart. And of course, they're important, right? But the liver is necessary to allow those organs to work. So number one, looking at the absorption of vitamins, there's so much discussion now on nutrient density, as there should be getting more nutrient density in our diet. But if your liver is not working and you're getting nutrient density, you don't have necessarily all the mechanisms to be able to get the vitamins, the minerals, all of those components from good foods that you might be eating. Hormone production. So we know

there's connections with looking at things like hypothyroid and things like that that we know are directly impacting the liver. So when we think about hormones in general, the liver plays a role in our hormone function. And so again, if we start having the liver breakdown, not have the healthy tissue it needs, then hormone function can be also a huge component as well. Obviously, bile production, we need bile production that works with the gallbladder to be able to break down things like fats, iron storage. So there's a condition called hemachromatosis, which is basically iron overload. It's relatively rare, but we have to make sure we have a good balance of iron within the body. And of course, iron gives us that energy, if you will, to our red blood

cells. It oxygenates those red blood cells. So that's really important. Protein synthesis. We've already talked about glycogen and really kind of that stored form of glucose, being able to recognize, hey, we're a little bit too low here in our tank. We need to release some. And so the liver plays the role of that. Cholesterol synthesis. So the liver plays a huge role in cholesterol. such a big role that when individuals are for the first time prescribed a statin, liver enzymes are typically one of the things that a physician will be monitoring to make sure that the statin is actually going through that detox phase, right? So the statin goes directly to the liver. The liver isn't working or there's some components of the statin that's not jiving

with the body. The liver enzymes will indicate that. Quick question about that, actually, just while on it. If people have, you know, obviously high cholesterol comes from a lot of different things. Yes. And there's different types of cholesterol that's there. But if somebody has high LDL and it's not genetically driven from hyperproducing or hyper absorbing, could the liver not working well play a role in people having high LDL? Absolutely. Absolutely. And we've seen studies, which we talk about in the book as well, that looking at heart attack, stroke, cardiovascular conditions is one of the main causes that we sometimes see of death with individuals that have liver disease. And this, of course, speaks to many different factors, including inflammatory factors, but also looking at the mismanagement of overall

lipids as well. So the liver definitely plays a role in that. And that kind of leads to one of the most important factors, which would be the detoxification qualities that the liver provides. So I think sometimes when I talk to my patients, many of them say, well, you know, I'm just really trying to avoid toxins. So I just have blast. I'm not using plastic anymore. And, you know, they'll name a few things that they think are kind of the keys to not having those toxins. But really, we are exposed to toxins all the time. So it's not just diet. It is walking outside our front door and being near a car that's driving by. It is being in the environment. It is what happens when we're completely stressed. There are toxins everywhere and the liver is the main

organ and it works a little bit, of course, with the kidneys as well, to be able to detoxify. And we could talk about this a little bit later, Drew, but it remains one of the frustrations I have with like kind of detox diets or detox potions that are out. out there because no one does it better than the liver. And all we really need to do is start taking care of our liver to have that detoxification mechanism work well for us. You know, talking about the crucial role of the liver in the detoxification process, I think it's worth diving into a little bit deeper because there are some fantastic images that

you have in slide number four to really help people understand that why is it so important to protect our liver, especially in this model. day and age of air pollution, microplastics, tap water, and all these other things that our body is trying to fend off on a regular basis. Yeah. And it's so, it's, there's so much to change, right? Every day, I feel like there's something else that we're finding is a toxin to the body. So even more reason why we need to take care of this organ and the detoxification process. So it's basically a three phase process. The first process, if we imagine something coming in, let's even look at something like that statin or we can look at, you know, anything, a toxin

coming in from food. So that comes in and the first phase is basically converting it into something that the body can understand to move on to phase two. So it's breaking it down and it is changing it from fat soluble to water soluble. And so making that change makes it able to kind of keep moving. Now there are some byproducts that occur with this that can be. a little bit harmful. Even one would say inflammatory. So once we release kind of the or get ready for the toxin to go to phase two, there is a release of some of those harmful substances. So this is why

phase two is so important. So now we move into that phase two. Phase two is basically the preparation for removal. Removal is phase three. So when we look at phase two, there are many different pathways that occur. Now we have this water soluble substance, and now we have to go through the pathways of just breaking it down so those really harmful components don't stay within the body. This is where diet plays a really huge role. So looking at the role of amino acid metabolism, omega-3s, all of these things, antioxidants in the diet, these all make a difference in that phase two. So getting that pathway to where it should be. And then we go into phase three, which is elimination. So literally looking at, all right, we've done everything that we were supposed to

in phase one and two, now we need to get it out of the body. And this was interesting because this kind of speaks to thinking about how things are excreted. A big chunk of my patients are on Ozenpic or Wagovi or one of those drugs and they suffer from constipation. And I had a patient told me the other day, well, yeah, the constipation is my only symptom, but I'm not worried about it. I don't care about that. And I said, well, I am because phase three can't really occur if it's still stuck in the body, right? If we're if we're constipated and we're not literally getting things out the way we used to be, then phase one and two could have worked, but now it's just kind of stuck there. It's not moving. And so it's still there. So this is where we can look at really, you know,

bald movements and looking at stool testing and all of those things, even looking at the connection with microbiome and those components associated with that. But the detoxification is so important. It is one of the reasons why we absolutely needed this organ at birth. And as I said before, one of my great frustrations when people spend their money on detox potions that, quite frankly, don't always have the science. Well said. So is it also fair to say that when somebody has fatty liver disease, they're

liver cannot detoxify as well. Can you make that connection for us? Yes, you can definitely make that connection. I think the severity of the disease will, of course, speak to how inefficient or efficient the connection actually is. Obviously, individuals that are in cirrhosis, but even looking at individuals in what we would say, kind of the second step, which would be looking at fibrosis, inflammation, you know, they would have some challenges as well. But anyone that has excess fats where that tissue is being replaced could see some issues with detoxification. You know, another mind-blowing fact that you have about fatty liver disease is something that

actually came from a paper that was published this year. And for anybody who wants to live a long, healthy life, this is something they're definitely going to want to pay attention to. can you talk about this paper and what the findings were? Yeah, absolutely. This was such an alarming paper. It just came out a few weeks ago and looking at the fact that individuals with fatty liver disease have twice the mortality rate of individuals that do not.

So quite frankly, speaking on that one, and more simply, you're more likely to die early, right? This is what it means. And the death would come from other associated diseases typically. This is what we've actually seen when we look at the data on fatty liver disease. in general. Looking back at that data at heart disease and heart attack and stroke, more likely to occur in someone who has fatty liver disease. This paper also brought up death from common diseases such as cancers as well. So looking at the cellular changes that could occur based on poor liver health. We haven't seen as many studies looking at cancer in general. Of course, we do know

that fatty liver disease is one of the top causes. of liver cancer. You know, it used to just be that if you drink too much, then you're more likely to get liver cancer. Of course, that is also true. And we could talk two hours about drinking, right? And the data on drinking today. But really, you know, I think this looks at a varying degree of cancers, not just that liver cancer as well, if I remember correctly. So, you know, cancer is another big one. So it's kind of like, it's kind of like the liver is like the hub. I refer to the liver in my first book is like the great and powerful Oz. And he's just kind of like the puppeteer to the other organs. And this study really shows it. So the liver's not working great.

It's probably not the first thing we're thinking of. But it's impacting cancer. It's impacting our thyroid. It's impacting our hearts, our brain. And so we think of those organs that are associated there, not realizing that it was the guy behind the curtain kind of pulling the puppet strings all along. Could you make that connection a little bit more for us for the audience who may not be familiar with this? Why would it be that you would be more likely to get cancer, for example, if your liver is not working well and you find yourself with fatty liver disease? What do you think potentially could be going on? Is it as straightforward as toxins are not getting filtered? And so now you have cellular damage and mutations of cells that then can get out of control?

What are your thoughts on that? You know, I think that it's probably very complex, multifaceted. So it's probably not one thing that we can pinpoint. Once the liver goes bad, here's what happens. But it's probably a combination of things. I think the detoxification process that you brought up and the cellular damage, I think is a huge component. I think inflammation in general, we do know that when you have liver disease and you're at more severe stages of it,

your C-reactive protein, your sedimentation rate, inflammation levels tend to go up. We know that the microbiome is impacted. And so there's also that association between all of the components looking at gut health and the risk of cancer based on some of the components there. So I think we probably need to learn more. We probably need to get more data. It's probably not as simple as we think, but it probably all stems from some component that the liver is not able to do any longer. Detoxing is. is the most recognizable component, but we also know that obesity is an independent risk factor for certain cancers as well. Again, is it because we're having an inflammatory storm occur

within the body? Cytokines are going nuts. We have all of these things going on where the cellular damage is overloaded and cancer could occur. We need to learn more. Basically, the same lifestyle and set of factors, genetics are part of it, but genetics are a very small part of it. You talk about it in your book, but the lifestyle, because it's largely a modern disease at the level that we're having today, the same lifestyle that creates a fatty liver is a same lifestyle that is going to independently, even though the liver relates to it, is going to be a same lifestyle that is more likely to create cancer or heart disease. So you have a natural sort of association or correlation.

So it may not be directly related to the liver, but the liver can play a role. But it's just that same lifestyle as naturally going to create a whole host of diseases. Absolutely. And I think one of the really concerning things here is, you know, just thinking about your audience and who you speak to each and every day, many of which are parents. So we are seeing liver diseases now being diagnosed in children as young as eight years old. So, of course, that is also associated. with insulin resistance, obesity, type 2 diabetes, and the risk factors that we had covered earlier.

So, you know, the liver really, I always say it, man, it takes a punch. It can take a beating and keep going. It's like that energizer bunny. So the good news is that it does take a long time to get to those latter stages. But that's bad news if you're a child and you get this and you can't resolve it because now you have a whole bunch of time to be able to go to those latter stages where we start seeing these more severe consequences. We had you on the podcast previously, and you made a super profound point.

A lot of people here, fatty liver. And yes, fatty liver is actual excess fat in the liver. And so the natural assumption that people feel is that, wow, is this because I'm eating too much fat in my diet? And you have a hot take on this. Can you share it again for our audience? Today's episode is brought to you by Ali, the Cleanness. fresh nutrition, your dog would literally beg for if they could talk.

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Yeah, I would put the blame more on carbohydrates than fat. You know, it's interesting. I was listening to a podcast the other day and saw this debate over red meats. And I just, for my today's show column, I just wrote an article on the carnivore diet. And my thought, once I published it, was like, well, this isn't going to be popular, right? it will be evidence-based, but not necessarily popular. But there's this whole debate, right? Should we just eat meat?

And the debate is, well, look at our ancestors. They didn't have the modern diseases we had. But if we go back to the cavemen, they also didn't live that long, right? So if they lived into their 80s or 90s, would we have seen the development of heart disease? Maybe, maybe not, right? They also didn't have access to carbohydrates as much. So back to this question about fats. you know, really, if you look at fat in general, fat tends to be a very healthy component,

a dietary component for fatty liver disease. Number one, because it doesn't impact our blood sugar levels, right? We don't have an impact to insulin, which is a huge factor in fatty liver disease. But number two, we don't associate fat really, even with things like, you know, elevated obesity. this is a little controversial, but, you know, if you look at kind of how fat was vilified back in the 80s with heart disease, we don't really see that connection. Now we see it with sugar, right? So there's all these components here that would make you really kind of question, gosh, is my low fat diet a really good option here? And it might not be, especially if that low fat diet is paired with a very high carbohydrate level and especially if those carbs are stripped. What do you think are the other top foods?

You know, now that we know that it's contextual about fat, you know, there's plenty of fats that are great for a healthy lifestyle. You know, you talk about many in the book. Olive oil is a fantastic source of fat for the diet, avocado oil, even, you know, saturated fats that largely have been demonized. Yeah. And be a healthy part of a diet, especially when we uncoupled them from high. high caloric ultra-processed foods that are often high in carbohydrates like donuts and pizza and other things.

That's where most people are getting their saturated fat from, not these healthy sources that you talk about in the book. So what are the other big offenders that you talk about with your patients that you say, listen, with fatty liver disease largely being driven by our lifestyle, food being a big part of it, not the only part. These are other foods that we really want to significantly pull back from in the diet. So we'll talk about what we want to pull back from. And then you have a fantastic slide of foods that we want to actually prioritize. But let's talk about things that we want people to pull back from if they want to either lower their risk or, God forbid, they're in this category of

one in three that already has some version of fatty liver disease. Yeah. So you know what's the big one that I've noticed that I've been talking about a lot with my patients lately is diet cola. And you brought up kind of the donut, right? And the donut is an obvious ultra-processed food. It raises blood sugar, raises insulin. And it's obvious. It's obvious. But diet cola is also ultra-processed.

And I have so many patients that will kind of show up to my office and say, like, I'm really limiting my ultra-process foods. And they've got, like, you know, some sort of drink mixture in their water or they got the diet cola. And I was like, well, that's ultra-processed. And the same mechanisms would occur with some of these foods. So I would really caution to my patients and to your audience, just because something doesn't necessarily raise blood sugar or insulin, doesn't necessarily mean it's not harmful in terms of the liver. Because we're making this big connection.

Hey, if your blood sugar or insulin are dysregulated to begin with and then you have something that makes it really go up high, that's really. really, that's overwhelming. That's overwhelming for the liver. So when we have things that maybe aren't impacting, Diet Cola is a great example. We just saw another study on looking at artificial sweeteners, I think two or three days ago, looking at how there was a huge increase of hunger that typically followed when you have a Diet Cola or another diet product. So that's kind of the first caution. If you're someone who's saying, gosh, I'm really trying to get out these refined carbohydrates. I'm trying not to have a donut, don't, don't switch it to a fake donut that might have a whole bunch of artificial sweeteners, right? I'd love to ask you a follow-up question on that if you're open to it.

You know, diacola is that sort of, that thing, you know, for a lot of people, even a lot of people that are healthy or like, I need my diet cola. Now, one thing that I want to, you know, bring up is that there's been individuals that have said, okay, you might have one study showing. that Diet Cola and like aspartame or whatever version of, you know, non-sugar sweetener they use, you know, it has changes in the gut microbiome. And okay, we don't know if those changes are necessarily good or bad. We just know that there's a change that's there. But on par, largely when people replace sugary beverages for Diet Cola, and I'm not a Diet Cola drinker, so I'm not here to like defend it in any kind of way, but more sort of bringing up your thoughts,

that the total body of studies show that people end up losing weight. And when you ask people to make a lot of changes in their life, if there's too many things that they're changing, they sometimes can drop off the program. This is what you'll hear from individuals, some that have had on my podcast, because I like learning from everybody. I want to hear everybody's side of the equation,

and I always want to have that discussion. You'll hear from individuals that are more in the sort of, traditional weight loss camps that are out there. You have any thoughts on that? Yeah, absolutely. I mean, we have seen that, right? If you look at studies, looking at diabetics, consuming a diet cola over a regular cola makes a very big difference. We don't see the impact to blood sugar and things of that nature. So I do agree with that, but I think it's a gateway. And that's where my challenge is, is that once you have the diet cola, you're you might be more prone to have other foods that are also processed.

The way that I look at this and you said you're not a Diet Cola drinker, I used to love Diet Cola, okay? So you're talking as a former drinker. I am like, well, let me, let me, not just former, okay? I probably have one Diet Cola a month and I look at it as my dessert. Like, it is dessert. It is my thing that I'm going to have once a month and I'm not going to feel shame or guilt or any of those words. that kind of take us out of intuitive eating, I enjoy it. I really, really enjoy it. And it's a once a month thing. So I tell my patients, like, there's really nothing you have to give up completely,

but we need to change the proportion of where it falls in the diet. That diacola for me is 10%, probably less of what I'm having in general. Yeah, probably less because if you're having it once a month, it's a very small part of your diet. And it just, you know, it's funny because My kid was talking to me the other day, and we went someplace, and he's like, mom, you should have your diacola. And I was like, it's like, it's early April. This is way too early. I have to go as far long as I came on. And then I get to the end of the month and I enjoy it, right? I'll only think about it if I just have it at the beginning of the month. But my point here is this. I think, you know, having a diacola is fine. But if that is your drink of choice, it is number one, replacing space. literal space in your body for other good nutrients that you could have, right? So it's like, I'm having a diacola. I'm not getting that. And it also provides zero bang for your nutritional buck. So 80 to 90% of the time, I want my patients having something that has some sort of benefit to their health span. So let's just not even look at liver, but let's go much more higher level

and look at this concept of health span. When you have something, if I'm going to have a diet cola, does it contribute to my health span? No. Is it neutral? It's probably neutral if I'm going to have, you know, once a week or once a month. Is it going to be negative? Maybe now we're in the negative factor if I'm going to have it three times a day. So it just depends on kind of what the frequency is.

But I do think, and I see this in myself as well, and this is my job, right? I talk to people about this all day long. When I have my Diet Cola, I'm more likely wanting. to have something else like fries. It's just something that popped into my head, right? I'm just like, oh, this diacola is great. I'm like, I'm going to have it with a burger. Right?

So I'm never like, I can't wait to have my diacola with my kale salad. No, that's not the connection. So I do think there's an association with that. And of course, it's greater than diet cola. There's a million, if you look at protein bars, if you look at even protein powders today, you know, for the most part, the less ingredients something has, the better it's going to be for you. Diet Cola, it doesn't

matter the brand. There's a lot of ingredients, right? There's a lot of ingredients. So, and then the third thing I would say is, in some ways, it hijacks our taste buds. So if we think about our taste buds and we think, and we might define ourselves, as many as my patients, many of my patients define themselves as a sugar addict. Okay. And so they'll do a nutrigenomics test. They'll find out that there's some epigenetics going on or genetics going on where they're more likely to have sugar and they'll say, you see, I told you I'm a sugar addict. When we have that great amount of sweet coming in from sucralose or aspartame, you know, we're not giving our taste buds the opportunity to not want it. We're going to want it because we're giving it to it in such high intensity, right? So again,

if sugar is your thing and you're really trying to get off of it, this is why I suggest against getting off a regular cola with a regular with a diet cola. A diabetic population is a little bit different. You know, if it's a stepping stone towards better choices and drinks, then I could see that. That could be beneficial. But if it's the drink of choice all day, it might not be the best choice. So what did you replace your diet cola, quote unquote, addiction? Yeah.

What did you replace it with? So I can't stand water. It's just so boring for me. So I had to figure out like, okay, I, I really wanted to get away from seltzer waters with natural flavors. And some people would say, well, gosh, that's so aggressive. Like having a lemon seltzer water, that can't be so bad for you. But natural flavors don't have to be disclosed what they are, right?

They're proprietary. So we're not quite sure what they're doing to the body. So that's number one. And so I actually just move towards a plain mineral water, and I constantly have this bowl of lemons and limes in my house. It takes more effort. The bowl actually looks very beautiful. So I think that that can speak to like, you know, if you have flowers in your house or you've got a nice bowl with colorful fruits, then, you know, there could be something related to stress and lowering stress with that definitely does for me.

But having access to that and just kind of putting that in my drink, I get to the point sometimes where I forget about the Diet Coke and it just doesn't taste as good anymore. So we kind of, as much as we can learn a habit, we can unlearn a habit, but that takes time, effort, and alternative. Yeah, that's great. Well, I appreciate you sharing your perspective for our audience. I think it's good to have people here from all different, you know, perspectives. And you're also sharing from your personal experience, but also your clinical experience. And if I would synthesize it, you know, we do have data as a population that when people get most of their calories from ultra-processed foods, they spontaneously eat 500 to a thousand more calories in the day. So even controlled for calories, if you get your calories from ultra-processed food, you crave more other foods. And so what I'm hearing is that based on a little bit of that data that's out there, we may not have it on Diet Coke exactly, but that your clinical experience with your patients is that they tend to crave other sweet things. They tend to crave more things, and that can create a cycle that if you're having that and you're already struggling with so many of the risk factors that you talked about in your first

slide, you could put yourself in a situation where you're just craving more ultra-prose. Ross's food if you're on the Diet Cola train. Yes. And, you know, we, and basically we've seen this more in animal studies, but human studies, there could be some incidents, especially if you're insulin resistant, where the body is confused by the sweetness, right? So we've seen this in animal studies where an animal will have a, let's say, a diet cola or just pure, you know, aspartame, sucralose, or some sort of artificial sweetener. And the body is not given any calories. but yet the pancreas is like, no, no, there's some sweet here.

So I need to release insulin because we have sweet. So if we have sweet, you need insulin. I don't know how much, but I'm going to release it. And then we have insulin circulating around with no job to do, which is a really bad situation for insulin. So there is, again, we need more human studies there. And the other thing that I hear a lot in my practice as well is people just killing themselves if they have any kind of processing at all.

Right? So we've got like, I'm sure you've seen this, the Nova classification out of Brazil that classifies how processed food actually are kind of, you know, what bucket they go into. So we've got like culinary ingredients, processed, non-processed, right? Ultra-processed. And so a lot of times I'll tell my patients, you know, it's almost impossible to eat a completely unprocessed diet. Right? That means if you want to carry it, you're going in your backyard, you're pulling it from the earth and you're having to eat. And you're having the carrot. It's like it's almost impossible. So we we can't like slap ourselves, you know, on the back and say, gosh, you know, you're so bad for doing this. If we have something that has some processing, because it's very hard, not impossible, but it's hard for all Americans to eat a completely unprocessed diet. You have a piece of cheese. There's processing there. So again, like I think defining ultra-process from process is also important as well. Well, let's zoom back out. You know, we got on this tangent, which was actually a great tangent to go on.

You know, that's what the audience is here for on these long-format podcast. And the question was, we're about to get into the foods that you want people to prioritize, that you want people to use and consume on a regular basis to protect their liver, their 12 of these liver-friendly foods. And I was saying before you get into that, are there foods you like to? to see your patients pull back from, start to limit. You know, it's not about being perfect, as you said. It's about starting to be aware. So you mentioned too, you mentioned Diet Cola, right, as a beverage of choice for a lot of people and the reasons why. And then naturally as an extension

of that, we talked about ultra-process foods as a category. Any other foods that deserve an honorable mention in terms of pulling back from that you talk about with your patients? One of the things I talk about, and again, this might seem a little aggressive because you made a great point that when we're asking patients to change so many things. It's like, here, change everything and also take away the Diet Cola. It's like, what? Right. But the other thing, too, to look at is when we consume something, and it's a grain, are we consuming an intact grain or are we consuming a whole grain? Both are good? One might be a little bit better. So I'll give you an example. If you have whole wheat bread, that is whole grain, if it's whole wheat, right? It has all three components of.

of the wheat kernel, the brand, the germ, the endosperm, right? So whole, an actual word. But it had to go from that grain to the plants to create bread versus just wheat berries or things like that. So that is another place where, again, it goes above and beyond the obvious of diet things. And I mentioned Diet Cola, but I will also say there's a huge emergence now of diet sweets. They can get diet licorice diets, peach rings. I know them all. Okay. I know them all because my patients ask me about them, right? Like, what about these, like, what about this brand or this brand? So there's this huge opportunity for consumers now to eat the foods they used to love, but now without any of the consequence. But unfortunately, there's probably some consequence there. So this is a little more

aggressive than that. But again, like instead of whole wheat pasta, could we just have something that's intact, wasn't created into another product. So this really gets into kind of eating closer to the farm, closer to the ground, to the bush, to the tree. You know, can we eat more foods that haven't been turned into other foods? I would almost argue I'd rather you make your own sourdough bread at home, even though it might be made with refined grains, than getting a whole wheat bread that comes in a bag, right? And it's not the bag that I have the issue with. It's just the fact that, you know, your hands weren't in it. You didn't create it yourself. It's going to last pretty long. You put it in the fridge probably last two weeks. So there could be something to be said about that, too.

So, you know, I would say anything that has a huge amount of ingredients would be a place where I would say, let's rethink this. Could we have a better alternative here? That's great. Well, we've teased it a bunch, but let's get into your slide that you have prepared for us, which is 12 liver-friendly foods that you want to highlight. Talk about this list big picture. And then let's go through some of the foods that you've highlighted. Yeah. So I think number one big picture is they're all real foods. And so that would be kind of like my high level advice to people.

If we just eat more real food, you know, Michael Pollan defined food is something that comes from nature, is fed from nature, and will eventually rot. And I think that's one of the best definitions of food that I have ever heard. You know, if you look at food from that perspective, it's very easy on how you choose things like plants. And it becomes easier on how you choose things like animal proteins. So comes from nature, fed from nature, for example, you want to go with a cow that is eating from grass versus grain, okay? Because that's not feeding from nature if they're eating grain. So just an example of that one. So this is all real food.

And the other thing I would say is it also has foods that I don't know if I'm, I'd go into the detail of saying are controversial, but foods that I think patients say to me, well, gosh, I can never have chocolate again. I can never have coffee again, right, without really having the data associated with it. So I think that's kind of, that's kind of big picture, right? If these 12 foods don't speak to you, choose 12 foods that are real and you'll probably be in just as good of a scenario. Fantastic. All right. Well, your first one on the list is actually coffee. So talk to us about that. I cannot tell you, Drew, how many studies are out there looking at specifically fatty liver disease and coffee consumption? Coffee consumption has been associated with a lower

risk of fibrosis, reversal of fibrosis. Fibrosis is the inflammatory inflammation that occurs when we get into those latter stages of liver disease. And coffee is probably good for a few reasons. You know, when you look at the studies, there is some assumption that, It has a lot to do with a bean, but it could have something to do with the caffeine as well. So the studies are positive, both in caffeinated coffee and decath, number one. We know that there's a lot of bioactive compounds within the coffee bean. I always tell my patients, if you do one thing today to improve your dietary pattern, choose the deepest-hued plants. right? So the plants that have the most color have the most benefit. So in theory, a red delicious

apple will be slightly better for you than a yellow delicious apple, okay? Because it's got much deeper hue. It's why we see all these great studies on berries, things like that. It's hard to get deeper hue than a coffee bean. And it's controversial because I always get people saying, well, coffee will increase your cortisol and that increases glucose and all these bad things about coffee. You know, we have a gene called the SIP 1A2. So CYP 1A2, and we know that that gene really kind of puts people into one of two camps. You're a fast metabolizer of caffeine or your slow metabolizer. Slow metabolizers of caffeine should not have that much caffeinated coffee.

The data is very clear, okay, increases the risk of high blood pressure, heart attack, etc. But if you tolerate caffeine, then, you know, the studies are pretty, pretty clear that having four or more cups a day can be very beneficial specifically to overall liver health. It's what we put in coffee that really ruins it. So that's the traditional Starbucks Rappuccino with gobbles and gobbles of artificial flavors, sugars, and everything else in between. Yeah. Yeah. I mean, and even if like you're going to your coffee house, just ask for a black coffee with half and half. Right. So that's like a very, it's actually cheaper. So number one, it will be so much cheaper than the specialty drink.

And it's probably a lot better for you. If you have to have the sweetness, then I would usually add in a stevia. Most coffee houses don't have alulose. Otherwise, I would go with alulose over stevia in terms of how to Sweden. So, you know, even raw honey can be another great example as well. But, you know, that's kind of like changing our coffee order to your point makes a huge difference. like you go to these coffee houses, you're just ordering dessert. Like if you're craving cake, you should get the cake that you're looking at because there's really not going to be a

huge difference between the amount of sugar and what you're getting in the coffee. So just a lot of benefit, a lot of benefit on that one. Mention, let me just back up and say that I've made connections to the heart, to the brain, to the liver. All of these are kind of interconnected in a lot of ways because they're all going on the same circuits, right? So blood flow. So if we have poor blood flow to the brain, risk factor for dementia, obviously to the heart, risk factor for heart attack and stroke. And poor blood flow, looking at even like the hepatic artery and portal vein and all of these things connected to the liver, you know, that makes a big impact as well.

So the association with berries has really been in the data that it really does help with overall blood flow. It helps with endothelio function. And it's got that very deep hue. So again, you know, what does that look like in terms of how you fit that into your diets, right? I know with my CGM, I love blackberries. I'm like, love blackberries. But if I have blackberries alone, my CGM will go pretty high.

It would probably be the highest point that I see during the day. If I add in, if I have like a tablespoon of extra virgin olive oil before those berries, I don't see as much of a spike. So again, there's little tricks of the trade that you can do to kind of impact it if your worry is, well, gosh, Kristen, I'm a diabetic. I can't have too many berries because I get that from my patients, right? Well, these are great. Not good for my blood sugar, though, right? So, you know, working with an expert to figure out, okay, what are some of the things that I can do to kind of limit that spike? So essentially, competition for digestion.

And generally speaking, you know, because we might have some people that are listening that are pre-diabetic, diabetic. Maybe some people are dealing with fatty liver disease. And I'm sure also there's a lot of people that are just healthy that are just fascinated by this conversation because they're thinking about how do they protect their loved ones who might be struggling with this. My opinion on this has sort of evolved over the years is that generally, as long as my metabolic health is super in the optimal zone, I've written about this before, we have some newsletters that are there. And that my fasting insulin is in a good place, right? Generally, people say less than five. I'm usually around like three, you know, three and a half, some around there.

I'm not too worried about individual spikes on my glucose. As long as my entire day doesn't look like a roller coaster up and down. And usually I don't even need my CGM then to tell me that I've had a four day of eating. I just feel like crap. I feel unfocused. I don't have energy, et cetera. But, you know, I'll have like sometimes an entire bowl of cherries when cherry seasons first, you know, comes out. And I'm like, great, I'm indulging a little bit.

And, you know, it's fine. And I know my blood sugar will spike up a little bit. And if I want to mitigate it, I might go for a walk anyway, which I traditionally do after meals, especially dinner that's there. But I'm not too worried about it as a healthy individual. Would you say that's generally how you feel as well? Yeah, I agree with you 100%. And I also think, especially if you're monitoring a CGM, what's the recovery?

Right. So the spike is not as worrisome as the fact that it's not coming down. Right? So that's the other thing as well to look at if you're really tracking that is my spiking and then just kind of hanging out there. That could be an indicator that like, okay, maybe my metabolic health can have some improvement. But if I'm spiking, I refer it to, you know, you really want kind of more valleys than roller coasters. So I'm going to go up a little bit and then I'm going to slowly come down versus this huge spike and then I'm going to hang out there at the very top and then I'm going to nosedive to the bottom, right? So, you know, that is another place where we can look at a little bit more intricate detail as far as how something's impacting us. But absolutely, there's a few things that are as frustrating by someone saying, I can't have fruit anymore.

Someone told me there's too much sugar because there's a very big difference between fruit and a piece of licorice, right? And like all of the antioxidants that come. And so I think I agree with you. I would never want someone to give up fruit. But if you are someone who's hemoglobin A1C is, and I hear this, especially my postmenopausal women, they're like, I was normal my whole life. Now I'm 5.7.

Can't move the needle. I don't know why. So if that is you, then, you know, some of these things where maybe you have a little bit more fats with something, even as healthy as fruit. If you have an apple, maybe you have it with some almond butter. Those are things that could kind of help with, you know, the blood sugar management.

Last item on that, because we've done so many episodes on this, and I'd love to get your perspective for our audience, food is, of course, one part of the equation. But if we really want to put that glucose to use, men and women, especially as we age, especially in this category of perimenopausal, menopausal, and even men who are aging, I got a dexas scan done right before I turned 40.

And I saw that even though I'm healthy, I eat really well. I am significantly under muscleed. So it became my mission to add more muscle mass, work with the trainer, up my protein. And then I saw something fascinating. I saw that I even could increase the carbohydrates in my diet, which largely would be coming from like fruit or white rice. I can have more carbs and my metabolic health, my insulin, they improved simply because

I had more muscle mass. in my body that was actually putting all that glucose in the body that's free flowing to work. So that's just another good reminder that, yes, food is important. And if we get a little bit stronger in our lives and add some muscle at any age, that's also going to take a little bit of the pressure off of having to get the benefits only from food itself. Do you have any thoughts on that? Oh, yeah, absolutely. I could not agree more.

And I think this conversation, and I know you've had guests talking about this as well, has only been exemplified by, you know, the popularity of GLP1 drugs, right? Because we do see the propensity of individuals to lose muscle and sometimes a tremendous amount of muscle. Not in all cases. If people are working with an expert, then we can kind of offset that in some ways. But when we lose muscle as we age, of course we have the risk of sarcopenia. so just kind of muscle wasting. But it also, there's a direct impact to our overall mortality. So going back to this mortality conversation, the less muscle you have, the more likely

you are to fall, to break a hip, you know, all of those things associated. But yes, from the glucose perspective, it's why our glucose goes up when we are exercising, right? We would think our glucose is automatically just going to go down. That's not always the case. If you don't have enough, the glucose sometimes goes up. to give the muscles what it needs to utilize to get energy and able to get through that workout. So again, it's different for everyone, but having more muscle is huge.

And I love that you had the dexacan, the dexascan because, you know, I always tell my patients, like if you've got a scale at home that you're getting on every day, throw it out. Because all it tells you is your stuff. Fat, muscle, water, that's it. It's just here's all the stuff that makes you. That's it. there is no breakdown of your fat to muscle ratio. And so that's a much more important perspective than just some magic number. And a lot of my patients have a magic number. If I'm just 125 pounds again,

I'll be happy. Right. So, well, 120 pounds, 120 pounds of fat is very different from 120 pounds of muscle. That's well said. That's well said. Well, coming back to these list of foods, let's run through these really quickly. And, you know, you can chat a little bit out some of the ones that you feel are special that you really want to highlight for the audience. Yeah. So I think, you know, let's like obviously like kiwi, any kind of on the other fruits are going to be really important in terms of antioxidants. Atomame, we can kind of clump with a legume since it is a legume.

We know that plant-based proteins make a big difference. And we also know that edamame in particular has isoflavones, which may play a role in reducing fatty liver disease. The dark chocolate, I think, is a big one. So for my patients, I'm going with either like a raw cacao that they can put in smoothies or things like that. Or just going with something like a 74% or greater. It's hard to get a good tasting chocolate that doesn't have some sugar in it. So again, getting ones that have a little less sugar, better quality, that always can make a big difference.

Green tea has components in green tea, like looking at the actual compounds that we have, green tea that we know reduces inflammation levels. So there's an association there. Extra virgin olive oil, there's been independent studies looking at extra virgin olive oil and again, reducing fibrosis so that inflammatory markers that occur within the liver. Poultry and wild fish as just two great options. Again, in terms of lean sources of protein, not everyone wants to go completely plant-based. So I would say those are wonderful sources. And we've got the data. All of this. is backed by evidence. And then nuts and seeds, you know, really just an option as another way to get more mono-unsaturated and healthy polyunsaturated foods into your diet as well. So again,

studies with all of these, they're all real food, but they're all things that can kind of help us from a multi-organ capacity, which ultimately helps the liver as well. Some people might be looking at this and saying, okay, great, poultry and wild fish, those are fantastic, you know, lean sources of protein. Does that mean that Kristen is telling her patients that she might want them to be avoiding in some situations, red meat or cuts of meat that are higher in saturated fat? What are your thoughts on that? Yeah, so it depends on the patient, really. I mean, you and I were talking a little earlier today, and I think, I can't remember if you use this word or not, but we were talking a lot about finding a person's why. And that's

where I start every single appointment. Someone will come in and say, well, I'm here because I want to lose 40 pounds. Okay, great. Let's table that for a moment. What I want to hear is what's your why beyond weight loss? What are you talking about? Like, what's your why? What do you not want to become? And unfortunately, sometimes we look at those that came before us. Oh, okay, I don't want to get dementia like my mom had. I don't want to get the heart attack like my brother had at the age of 40. Okay? That is a why. And so I always start with those wise to look at what dietary pattern makes sense. For someone who has extreme genetic lipid abnormalities, everyone's having heart attacks in their 40s, I am probably not going to include red meat as an option. So that's a great example of where I might look at that.

Another example where red meat might not be an option could be with an individual who says, I'm on a really limited income. I can't get wild meat. I can't get bison or elk. I just am getting like the ground beef that is like just the cheapest option at my store. I probably am not going to recommend it. We're going to go for a different option there. Or we're going to look at different alternatives.

But those would be some of the things, right? Like what I would recommend or don't recommend oftentimes will take multiple visits and hours to really kind of peel back the layers. of what works for someone, right? And that's really kind of, I'm not against red meat, but I'm very specific into how much and what kind. Well said. Well, you know, putting some of these things together,

for people that are in this category of dealing with fatty liver, right, non-alcoholic fatty liver disease, which has the updated acronym that you mentioned, which is a mouthful, so I'll have you mention it again. Let's combine all those things, and you have these lifestyle recommendations on the next slide that you presented for us. So I think like what's really important to look at is the fact that mindful eating is really at the top of this. I mean, we know that weight loss is going to make a huge difference in improving fatty liver disease.

So looking at the weight loss goal, of course, is big. But right under that in the blue boxes is this mindful eating. So tapping into intuitive eating, you know, how often are we sitting down to eat a meal and our cell phone is right there? and we're just kind of scrolling or we have the nightly news on. We don't recognize, like, is that causing me to eat more? Because I'm just not recognizing how much stress that's providing to me, right? So I think mindful eating is really quite difficult. You know, like I probably meditate for five minutes every day and people would say,

well, gosh, you should do more, but many people don't do any. So if I can fit five minutes in, and maybe because, combine it when I'm in the sauna to kill two birds with one stone. So kind of look what what makes things easy for you in order to incorporate some of these more mindful approaches? Intermittent fasting, I think, is another big one. We just had a study coming out, I think, yesterday or the day prior, looking at time restricted eating in combination with weight loss efforts to really help with weight loss maintenance. So we are surrounded by food 24-7. And it is ingrained. in every aspect of our life.

I mean, you can't go to a party without a spread, right? And if you do go to a party and there's no food, you're like, what's wrong with these people? Right? So it's like food is always associated in every single thing that we do. So I think, like, that's really important to look at, you know, our frequency of eating. Intermitt fasting has been shown to be very beneficial.

If we just look at at AFLD and Nash, so non-alcoholic steo hepatitis, that's getting into the fibrosis. the inflammation. And then the last one is really once you're in the non-reversal phase. So cirrhosis, much different properties on that one. But obviously we've talked a lot about this reducing sugar, all of this. You know, and then finally looking at alcohol. You know, should you have any alcohol if you've got fatty liver disease? My argument is no. Now, this was an actual study. And so their recommendations were perhaps moderate amounts are allowable. But

I would never use the word beneficial. So that's kind of, it's the nomenclature here where I would look at this. Like, if you're going to have alcohol, put it in the same camp as that diacola and that donut. Once a month. Once a month. So it's not that you can't have it or like, let's say twice a month. And having it not at all will be a huge step in the right direction. All right. We just don't know if there's any safe amount of alcohol now. So I think those are our big ones. And then of course, based on, this study looking at the dash diet, the mind diet, the Mediterranean diet. Dash and mind are derivatives of Mediterranean diet. It's very hard to beat the structure of the Mediterranean diet. Where I alter the diet is basically looking at what are the numbers for insulin resistance or type 2 diabetes. Based on the severity of those numbers, I am going to alter the carbohydrates within the Mediterranean diet, but that's going to be on a case-by-case basis. Yeah. Well, another huge important aspect. of this is physical activity. And as we wind down over here, I think it's so important to talk about

the role in this hyper sedentary lifestyle that we live, that lack of physical activity plays when it comes to non-alcoholic fatty liver disease. So what are your recommendations based on some studies that you came across of where people should be shooting for with their physical activity? Well, I think doing something is 500 times better than doing nothing. All right. And so we've seen some studies come out about this, even just getting a half hour a week, which to people that exercise, they're like, what? I mean, come on, who just does a half hour a week? A lot of people do zero hours a week.

So I think if you're right now doing nothing, going for a walk for 10 minutes will be a huge step in the right direction. So I think getting out of this mind frame that, well, I don't have an hour to be able to do this. you know, just getting out of that, any kind of activity is going to be good. I also think looking at the actual data, getting a certain amount of steps in. So I equate that to walking. If you don't have time to do a formal walk, then all of those cliche recommendations we've seen in the past do work, parking further away from where you're going to. My kids didn't have sports one day. And so we needed to go to the mall and I parked at the opposite end.

And we have a huge mall. And they're like, why aren't you parking at the? And I was like, no, because you guys need to walk today. So we're going to, if the mall is it, we're going to walk as far as we can to get to this store. So looking for those opportunities, I think hit training has a lot of data related to fatty liver disease. So what that could look like is I'm taking a walk and every 10 minutes, I'm going to spend 30 seconds in an all-out sprint. Right. So doing something that gets, you know, obviously making sure everything is.

safe with your position, but doing something that gets the heart rate up significantly. And then finally, you know, not just aerobic but anaerobic, there is just as much benefit as we can see with resistance training and you don't have to have a set of weights. You can use your own body weights. You know, anything that makes your muscles get torn and then rebuilt is going to help to build that muscle mass and that's going to help with longevity as well. That's fantastic. You know, we can't have a conversation about this important topic and protecting the liver

without diving into at least some of the nuances that are there regarding GLP ones. And you kind of already talked about some aspects earlier. But let's zoom out a little big picture. Tell us a little bit more about the role of GLP ones. You have so many patients that are on them. Yeah. We've had many people on this podcast. talk about the pros of them in especially a hyper-abase society that has so much food noise

that making any momentum is so tough because their brain and nervous system and body is completely hijacked by our ultra-processed. So they definitely could use a boost and that there's been many physicians that have been on this podcast that have talked about how they will use it with those patients. We've had other people talk about some of what they see as the potential downsides that are there and the things of the long-term consequences, which some people feel like we're not sure of. Other people would argue while we've been using this with patients for a long time, especially diabetic patients. Give us your practical experience as a clinician who's working with a lot of these patients who have fatty liver disease. And that usually

comes along with the fact that they're often struggling with obesity and have been given these drugs to tackle some of the chronic issues that they're dealing with. Yeah. Well, you know, there's been a lot of studies looking at GLP-1s and fatty liver disease. And if you just go and visit clinical trials.gov and you put in semaglutide or lyruglytide and fatty liver disease, you will see that there are so many trials underway right now. So we're going to see new data coming out. And obviously data coming out about mental health, alcoholism, addiction, all of these things with GLP-1s that we are discovering. Yes, semi-glutide has been used for decades with diabetics, and it seems to be relatively safe. And the studies do tend to also show the safeties in fatty liver disease patients as well.

I think they are potential game changers, for sure, and I've seen it in my patients. where the challenge lies is what is the off ramp? What is the exit strategy? And so very few people think about the exit strategy when they are going into it. And so that is really the key. When you get on these drugs, let's say you were a type 2 diabetic, you had fatty liver disease, you had all these risk factors. And you went on Ozempic. All of your numbers improved.

Your weight is improved. Your inflammation levels are down. Amazing, just absolutely amazing. But are you now on it for life? That's what we're still trying to figure out. Or do you have the capacity to wean off, get off of it, and not have your numbers be impacted? So we had a huge study, I believe it was out of JAMA, about two or three years ago, once the popularity started increasing, looking at the fact that about a third of these patients do put back on a significant amount of weight and more concerning when the weight comes on, numbers go up. So all of these things that improved come back. So it's not to say that the drugs aren't effective. They are very effective. But the question is, are you on them for life? And what are the long-term consequences? And we just don't know the answer to that. So that's kind of number one. And the second thing is, if you're going to do these drugs, you have to do it alongside your practitioner. And the challenge that I see, you know, I'm a mom of two boys, which means

I have access to all these moms at the school who are getting their drugs, who don't have blood sugar problems, they're getting their drugs from med spas, things like that. So it's not meant to at all criticize these places. But if you are getting your drug from this place, is it just, hey, here's your three months, pay us and then like good luck to you. Or are you being followed? Are your dietary patterns being followed? Are you working with a personal trainer? Are you working with someone if you're, you're, you're, or are you working with someone if you're, you're having constipation. We talked about those risk factors with constipation. So those are the things we don't have conversation about. It's just so I don't think the drugs are bad. In fact, I've seen the opposite. They've been so highly effective. But I've seen people improve so much that when we even start the conversation of,

okay, let's start thinking about weaning down. They'll be like, I'm not getting off these drugs. Are you out of your mind? Like, I'm not. I'm going to stay on these for the rest of my life. If I get off these drugs, cravings come back. And unfortunately, they're right. So it's really a get on to get off for those that need it with the right supervision that's there.

You know, the constipation example is perfect that you were sharing earlier. How is your liver going to be able to do the things that it needs to do if you're struggling with constipation? And that's a top side effect that comes with a lot of these drugs, especially when people are at higher doses. So having that proper monitoring and not relying on these often these prescription meal, these prescription mills, and they could be med spas, they could be, you know, well-intentioned, but they don't have the level of service, these telemedicine groups online that people are using, that don't have the lifestyle piece brought into the equation or don't have the monitoring on a regular basis from a doctor, a PA, an NP who really actually can help you put that plan

together to get off eventually. And I think some are able to do that. I've known many different kind of med spa, different services that have physician oversight that are wonderful. You have to meet with the physician every other week to talk about your dietary pattern and talk about things like constipation. But I think this is a term I used earlier in the podcast is, you know, you really want to get bang for your nutritional buck 80 to 90% of the time. But if you're on a GLP, it's got to be 100% of the time. You have no capacity. You have no capacity. you have no extra room to say like, I'm going to have this handful of gummy bears and I'm not going to gain a pound because I'm on a gLP. You have such a limited capacity to get enough calories in, which is ultimately what leads to weight loss, that you can't take anything outside of anything that's nutrient dense. You have to have nutrient density for your microbiome, for inflammation levels, just in general. But to get that nutrient density, right? So that's the other thing that I see with patients is that they're on the drug. So they're like, well, man,

I still have my McDonald's every day, but I only have it once a day and that's my meal. And this is great. Right. So it's kind of like you have to get bang for your buck in every bite. Every bite has got to have meaning. That's well said. Kristen, this has been fantastic. You know, you put together an incredible presentation and walked us through this important thing that, as you mentioned at the beginning of the episode, this impacts now. We think one in three, three people that are out there. So if individuals are not aware of the potential of ending up with a fatty liver, which nobody wants, we wouldn't wish that for our worst enemy that's out there, if we're not aware of that, we could end up finding ourselves in the situation, which unfortunately

a lot of people have where they silently are on their way in that direction. If they have poor metabolic health, if their obesity and their hip-to-waste ratio is heading in the wrong direction, if their insulin is up and all these risk factors that are there. So this is a conversation. You know, the kidney doesn't, sorry, this is a conversation that needs more attention. The liver, unfortunately, doesn't often get a lot of love. It doesn't. But it needs more love, which is funny, actually, because there are certain traditions.

My wife, she's from the Persian, Iranian tradition. And the way that you say that somebody is your deepest sweetheart, the way that you say that somebody is like the love of your life is actually you call them my liver, right, in that, in that culture. So I thought, okay, maybe there's some traditions that know the importance about the liver that's there. But for those of us that don't, this presentation and this conversation has been so important. Any final words that you want to leave our audience with?

Yeah, I think, I know we talked about this a million times, but I think just try and make an effort to eat more real food and to move more. those two simple things can play a huge role, right? Maybe even a greater role, to your point about aging and not getting chronic diseases, maybe even a greater role than what we have previously been relying on, which could have been pharmaceutical drugs or pills, potions, any kind, right? Eat more food, walk more. That's a huge key.

Well, if anybody wants to learn more about how to do that, the best ways to go about it, the amazing regenerative aspects, of the liver, which is one of the only organs, or not the only organ that actually can grow back, which you go into inside of the book. Your book is there. We have a link in the show notes. Regenerative Health, discover your metabolic type and renew your liver for life. It's a fantastic read, and I highly recommend everybody check it out. Kristen, can you also mention, because you're pretty good about putting out content on social media that continues this conversation. Where can people follow you. Yeah, absolutely. So Instagram and Facebook, it's Fuel Well with Chrissy. So exactly as it

sounds, KRI, SSY. And, you know, if you feel well, you feel well. So that's the connection with that one. So we just need to fuel well in better in general. And, you know, hopefully our health span will be enhanced. Well, thanks for helping to teach our audience on how to do exactly that. It was a pleasure to have you back on the podcast. Thank you, Drew. Such a pleasure and an honor to be with you.