The Dr. Hyman Show - Fatty Liver Is the New Smoking—And 90 Million Americans Have It

Episode Date: April 7, 2025

What if your fatigue, weight gain, hormone imbalances, and brain fog all traced back to a silent disease that affects 1 in 3 people—and you didn’t even know you had it? In today’s episode, I’m joined by Dr. Elizabeth Boham and Dr. Yousef Elyaman to talk about a condition that’s quietly becoming one of the biggest threats to our health: fatty liver disease—now renamed Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). It’s not just a liver issue. It’s deeply connected to heart disease, cancer, infertility, type 2 diabetes, dementia, and even hormone dysfunction. The most alarming part is it’s often missed in traditional medicine because there’s no easy drug to prescribe. We break down: The real root causes—from sugar and starch overload to gut imbalances, toxins, alcohol, and chronic inflammation The surprising early warning signs your body might be giving you Why standard labs often miss it, and the tests you actually need The step-by-step functional medicine approach to reverse fatty liver naturally—using targeted nutrition, lifestyle upgrades, and proven supplements I also share the latest science on inflammation, why it’s the common thread between fatty liver and nearly every chronic disease, and how to calm it down at the root. This is the episode I wish every patient (and doctor) could hear—because fatty liver is reversible when you catch it early, and the ripple effects of healing it are massive. If you care about your energy, hormones, brain health, or longevity… this one’s for you. Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. Dr. Yousef Elyaman is the founder and Medical Director of Absolute Health, a primary care functional medicine practice in Ocala, Florida. He is the 100th President of the Marion County Medical Society and the Functional Medicine Director at The Guest House Ocala, a trauma and substance abuse center. Dr. Elyaman also serves as the Medical Director for HumanN, a leading nutraceutical company, and is a Consultant for Quest Diagnostics Laboratory in their Wellness Division. He is teaching Faculty for the Institute for Functional Medicine on their Cardiometabolic module. Dr. Elyaman belongs to the first graduating class of the Institute for Functional Medicine. He is Board-certified in Internal Medicine and holds certifications in functional and integrative medicine as well. His leadership and expertise are reflected in his diverse roles, demonstrating his commitment to advancing medical knowledge and improving patient care. When not at work, Dr. Elyaman loves spending time with his wife and seven children where they live on a cattle and horse ranch. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN10 to save 10%. Full-length episodes can be found here: How To Prevent And Reverse Fatty Liver Disease with Functional Medicine The Best Diet to Reverse Fatty Liver Disease with Dr. Yousef Elyaman Why Fatty Liver Is So Common And How To Heal It

Coming up on this episode of the Dr. Hyman show. 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, all are putting stress on our liver. What if I told you there's a mineral that acts like a spark plug for your body, powering your brain, heart, muscles, and even your mood, and most of us are running on empty? That mineral is magnesium and it's involved in over 600 biochemical reactions, from regulating stress to boosting energy, sleep, and digestion.

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Try Magnesium Breakthrough today and feel the difference. Go to BioPtimizers.com slash Hymen and use code HYMAN10 for 10% off your order. 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. And if you're in need of deepening your knowledge around your health journey, check out my membership community, the Hymen Hive. And if you're looking for curated and trusted supplements and health products for your health journey, visit my website at drhymen.com, or my website store for a summary of my favorite and thoroughly tested products. 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 and metabolize chemicals from the environment, metabolize our own hormones, you know, metabolize and get rid of toxins. And so 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 90 million people in the US have fatty liver disease. And so it's increasing in this country, it's increasing worldwide in the US have fatty liver disease. And so that's... Wow. And it's increasing in this country, it's increasing worldwide, the amount of fatty liver we are seeing. So Liz, tell me more about a patient that we've had, because I think some of the patient

stories are really helpful and instructive and give us a sense of how we do things differently at the El Tribano Center here in Massachusetts and Lennox and what you found and what you were able to sort of help him with and how it all worked. 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 25 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 gonna 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 his diet was like and what his alcohol consumption was like.

Because that's one of the first things, of course, we think about with 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 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. That altogether was really impacting these liver functions for him. And so we noticed with his diet, it was not rich enough in vegetables, that's for sure. And really, that was probably the biggest thing I would say with his diet. It was just devoid of a lot of vegetables. And you were talking about some of the things, supplements we use for helping the liver. 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, really to help support the liver and help it heal, essentially. We also had him take a break from alcohol. We said, 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 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 gall bladder work better, lots of green leafy vegetables.

We made sure he was eating enough protein. 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 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 flaxseed. 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 because he was 25 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. So you know, things 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. Yeah, so incredible, so incredible.

So I feel like we, you know, 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 have 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. And I don't think we are equipped in heart rate 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 evaluated the liver differently. We have 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, healthy 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. Yeah, I mean, within four months on the plan, his liver functions came down to totally normal. You know, after he lost, he lost 10 of those pounds and then within a few more months, he lost another 10 pounds. Um, and, and, and his fasting insulin came down to normal. His, his liver function tests, his,

his, um, 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 he 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.

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 failure. That's not a common thing. Other than that. 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.

Right. I mean, they can happen quickly. Fatty liver can happen quickly. Fatty liver can develop quickly. They know 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, it can 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. So it 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, all 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 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 it becomes a 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 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 want to take care of our bodies 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 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? So there was also an interesting study came out recently looking at cancer and alcohol and showing

that there's a dramatic increase in 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 it was a concern but but that aside there besides just the the overload on your liver besides just the the stress on your liver stability 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. With that said, how do we know if we have fatty liver? You know, 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 the 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, is this fatty liver? Is this, 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. Yeah, absolutely.

And so there's other tests you can use, which I've had personally, just because I've got we start to see it most frequently with our patients. Yeah, absolutely. And so there's other tests you can use, which I've had personally, just because I've got sort of biohacking, kind of like to check everything, but you can do an MRI and look at liver fat. You know, and it should be less than 2%. And many people have very, very high liver fat. I thankfully have less than 2%.

You can also, they're actually also doing fiber scans, which look at the fibers content, the 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, you know, 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, in addition to the testing we talked about, we're looking at some resistance, we're looking at particle size, we're looking at inflammation, we're looking 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? 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 some 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 wanna 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 we know that problems with the liver and fatty liver impact our immune system and how well we fight off infections. It impacts 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. 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 75% of the population is overweight, 42% are obese, 93.2% are metabolically unhealthy, which is essentially what this is, a metabolic associated fatty liver disease, right? So

93% of us have some metabolic dysfunction. What's driving that? 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, fructose. High fructose corn syrup in all our foods.

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 the 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. So there's a- That's when you're bloated and you get a food baby after eating. Bloating is because there's bacteria in your small intestine, which should not be there. Then ferment the food that you eat, particularly starches and carbohydrates, to then give off all kinds of toxic metabolites that can then poison your liver.

That's what you're saying, right? Absolutely. Right. Right. Yeah. What did you say? A food baby? Yeah. Yeah. Yeah. Loading food pregnancy. Right. Yeah. So so if you one alarming statistic they 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 young men in their 20s,

not overweight, normal ideal weight. So I think that kind of brings us to one of the first drivers, which is this insulin resistance concept. Now, just to kind of back up on that, that's a stunning statistics. 50% of healthy normal weight 20 year old men have pre-diabetes or some degree of insulin resistance,

which is on the way to pre-diabetes. Yeah, they're blood sugar normal. And now they're measuring this by the new mass spec test from Quest, which is a really new test. So just to back up on that, the way we used to measure insulin resistance in the lab was a euglycemic clamp test, super fatty liver, correct? 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, due 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 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.

And they call it triglycerides, triglyceride rich VLDL versus triglyceride poor and VLDL becomes, there's another enzyme found in the lining of our blood vessel 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. Okay, I'm gonna, this is so, you see right here, I'm just gonna 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 foie gras, whatever. And that means in French, fatty liver. 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. And 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 wanna serve it on toast unless you're maybe a Hannibal Lecter. 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 did a whole podcast on cardiovascular risk and lipid analysis. So the small dense cholesterol particles, which by the way, everybody listening, your doctor's not measuring when you go to get your cholesterol test. Less than 1% of cholesterol tests in America are for the right cholesterol test,

which is called lipoprotein fractionation. And it's looking at the particle size, the particle number, the VLDL numbers. And you can get all that, by the way, through functionhealth.com.com. It's a company I co-founded. It's a lot of people that get access to the right amount of information and data.

So functionhealth.com.com. You can get the right panels. You can see what's going on. And we also measure insulin. Although I assume we're gonna be measuring this insulin resistance score, which is very exciting. Right, yeah, so- What's happening in the liver? So what's going on. And we also measure insulin, although I assume we're gonna be measuring this insulin resistance score, which is very exciting. Right, yeah, so- What's happening in the liver?

So what's happening in the liver? So we can go back to what's happening in the fat and then go right back to the liver. So number one, the fat starts to send the triglycerides to the liver and start overloading the liver. If when that process is overloaded, 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. 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 resistant 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 metabolic nightmare. It's like a vicious cycle. It's a vicious cycle. 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 that the body produces to regulate your eating behavior and your way you process sugars and regulate inflammation. Like you said, tumor necrosis factor alpha or IL-6. These are cytokines. We heard about the cytokine 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. 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, 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 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's not working. It causes hormone imbalances. The liver is supposed to be metabolizing our toxins. So now your liver's not working. It causes hormone imbalances. The liver's 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 mood issues. They start to have, they start storing more weight. like they, and men, men start to get, start to have that estrogen effect, it blocks their testosterone, and it's kind of this, it just, it affects everything. There's- It doesn't sound like fun.

No, it's not. Well, I'll tell you, now that we have technology, that non-invasive, easily accessible technology to take a look at the liver, when we tell people that their liver 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 wanna take a look at your liver. I sent her to do this test, it's called a Fibra Scan. Before she came back, she had lost, she stopped drinking alcohol and she had lost 20 pounds. And yeah, it came back, her liver was fine. But what happened when people hear that their liver,

there's a problem with their liver for some reason, it creates that motivation. Which I can tell them, hey, you're gonna die of a heart attack and it doesn't, yeah. Yeah, that's interesting. But you know, I think what you're just pointing to is something really important, which is that this is a condition that's so prevalent,

it affects at least a third of Americans that is under diagnosed, and that is the biggest risk factor for having a heart attack as anything else. Right? 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? Right. Yeah, we could put them in, we can post them in the, the heart attack. Yeah. Yeah. We could put them in the, in the show notes. Yeah. The percentages. Yeah, it's really significant. And when I started reading about fatty liver years ago,

I 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, and going, so unfortunately, in the conventional realm, unfortunately, we 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. Yeah, so it's so, but I think the beautiful thing, and I'm so fortunate or grateful 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. Part of a syndrome that's happening. 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 gut. Yeah, 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 both. Yeah, I mean, I think this is really important. I just wanna pause there because from a traditional medicine point of view, it's like, okay, 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 neglected. 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 the microbiome's 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, there was a thing I read about years ago, it was a scientific paper about a guy who had liver failure but he was a golfer and usually golfers, I'm not a golfer but apparently they have to clean their balls and there's 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 cause him to have liver failure. So we have 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. And 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 in the inability to metabolize the toxins from the gut by, which caused basically delirium, something called the hepatic encephalopathy. We treated with the antibiotic and a laxative. So basically to sterilize the gut, get rid of the bacteria that were poisoning the body.

And which is interesting, 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, 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. But it was amazing, it would take them out of that hepatic encephalopathy. 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 reload of toxins,

which is obviously our diet, which other factors that you mentioned, the 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 non-alcoholic

fatty liver disease to metabolic associated fatty liver disease. 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 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, they, people associated with alcohol. Because alcohol was in the name,

they have to explain it to their family. You know, 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 don't, we want fat out of it. So now it's metabolic dysfunction associated statis, the static static, which means fat liver disease. So that no static liver disease. So now you took everything out that anybody could understand. So you put a medical term in which means fat, which is steatic liver disease. So now you took everything out that anybody could understand. So you put a medical term in which means fat, which is steatosis, which means fatty.

Right, right, but now they don't get shamed. Now it's in Latin, so it's okay. Yeah, yeah, that's fancy. That's fancy. Whatever. So, that's the problem. 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 that... But mazl, now it's called mazl.

Mazl, mazl, okay. Then there's... Okay, forget about why you have that. But Maslod, now it's called Maslod. Maslod, Maslod, 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 wanna walk through how traditional medicine approaches this

and then how we're gonna 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 I wonder the therapeutic goals. So just sort of high level, what if you want to see a traditional hepatologist, you have fatty liver, what are they gonna tell you?

What are they gonna tell you to do? Okay, so you go to a traditional hepatologist, they take 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 are 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, many 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. if you and if you are then they'll put you on a drug

Right if not because there's no FDA approved drugs for fatty liver. There is what one now we just in in in March we have one called res meta ROM and We could probably we should probably unpackage that later like because there's implication Yeah, but yes, so there's finally one drug it costs only $4,000 a month. Yeah, that's it. And it can cause all kinds of side effects as well. But that being that being that being said, it's it's all about getting them okay, we have a disease, we named it, right, we need to tame it with a particular drug. So but I'll be till March before that, what would they be telling you? They would say that some say, take, ask your doctor if he would prescribe

semiglutide for you. Ozempic. Ozempic. That's currently what they're, what they'll tell you. For weight loss, because when you lose weight fatty liver gets better. Right. Right. So, what would we do? We would take a look at the FibroScore. I do want to talk about this FibroScore because this is the FibroScan because this is extremely important. But back to the traditional medicine, are they thinking that 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? Traditional medicine is like lose weight. 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 drugs for this. Yes, yes, unfortunately we don't, so semi-glutide. So, okay, that was epic, all right. Yeah. And then? Yeah, so, and that's it, and then they just kind of leave you there. 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 have fibrosis, which is hardening or not, and they just kind of wait till't know how bad it is. They don't know if they have fibrosis, which is hardening or not. And they just kind of wait till things get really bad. 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. And, you know, they might give you metformin or they'll give you the Ozempic or maybe some of the... 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 lipid metabolism. So you know you may be hurting the liver,

but you may be helping the heart. Right. Right, right, right. So it's not one of those. And then if you're overweight enough, they'll say, why don't you have bariatric surgery? Very perfect. Gastric bypass. So clearly, you know, traditional medicine 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 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 high fructose corn syrup, it's free fructose. It's not bound to the glucose molecule because sucrose basically is glucose plus fructose. 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.

It's often not just a 50-50 with sugar, with for example glucose. It's maybe 75% fructose. 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 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 it. It's in everything. It's in salad dressing. 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, 100%. If you make one rule about diet, no one's going to 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 going to say high fructose corn if it's good for you. Second is starch. So it kind of doesn't matter what it is. If it's starchy or sugary, it's going to be also a problem. Remember the ducks who were force-fed corn, foie gras? Well that is a form of starch and it sounds like, oh'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 curl 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 if you eat any of that floury, starchy foods, it's going to drive fatty liver. And that's what's really driving this. I've written a lot about this.

I've written in all my books, the blood sugar solution and 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 want to do things that really help to heal your liver. Well, 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 want to do things that really help to heal your liver. Now, first is getting rid of the bad stuff. Obviously, you got to start 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. Avocados, olive oil, nuts and seeds. I mean, even saturated fat from meat, not a bad problem. Chicken, fish, lots of good oils like macadamia oil. And obviously the omega-3 fats are so important. And they're anti-inflammatory and 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 want to 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 detoxifiers and antioxidants in the body. Glutathione is one of the most important detoxifiers and antioxidants in the body. Sadly, there are government agencies that are looking at 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 is 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 gandalion 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 super foods. 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. 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 helpful 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 super foods 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. If you love this podcast, please share it with someone else you think would also enjoy it. You can find me on all social media channels

at Dr. Mark Hyman. Please reach out, I'd love to hear your comments and questions. Don't forget to rate, review, and subscribe to the Dr. Hyman Show wherever you get your podcasts. And don't forget to check out my YouTube channel at Dr. Mark Hyman for video versions of this podcast and more. Thank you so much again for tuning in.

We'll see you next time on The Dr. Hyman Show. This podcast is separate from my clinical practice at the Ultra Wellness Center, my work at Cleveland Clinic, and Function Health where I am Chief Medical Officer. This podcast represents my opinions and my guests' opinions. Neither myself nor the podcast endorses the views or statements of my guests. This podcast is for educational purposes only and is not a substitute for professional care by a doctor or other qualified medical professional. This podcast is provided with the understanding that it does not

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