The Dr. Hyman Show - How To Support Your Liver With Food, Household Products, And Supplements

Episode Date: March 6, 2023

This episode is brought to you by Paleovalley, InsideTracker, Athletic Greens, and Nordic Naturals. A healthy liver helps your body clean your blood, combat toxic junk and chemicals in your environment, and much more. It is instrumental in keeping you from getting sick and helping you maintain plenty of energy. Unfortunately, however, 90 million Americans—and a growing number of individuals worldwide—have what is called “fatty liver disease,” which literally means your liver fills with fat.  In today’s episode, I answer a question from a listener about how to take care of your liver. I also speak with Dr. Robert Lustig and Dr. Elizabeth Boham about why fatty liver is so prevalent, how to test for it, and how to reverse it. Dr. Robert Lustig is a neuroendocrinologist with expertise in metabolism, obesity, and nutrition. He’s the Emeritus Professor of Pediatrics in the Division of Endocrinology and a member of the Institute for Health Policy Studies at UCSF. He is also one of the leaders of the current “anti-sugar” movement that is changing the food industry, in part through his game-changing books. His latest work is Metabolical: The Lure and the Lies of Processed Food, Nutrition, and Modern Medicine. Dr. Elizabeth Boham is a physician and nutritionist who practices Functional Medicine at The UltraWellness Center in Lenox, MA. Through her practice and lecturing she has helped thousands of people achieve their goals of optimum health and wellness. She witnesses the power of nutrition every day in her practice and is committed to training other physicians to utilize nutrition in healing. This episode is brought to you by Paleovalley, InsideTracker, Athletic Greens, and Nordic Naturals. Paleovalley is offering my listeners 15% off their entire first order. Just go to paleovalley.com/hyman to check out all their clean Paleo products and take advantage of this deal. InsideTracker is a personalized health and wellness platform like no other. Right now they’re offering my community 20% off at insidetracker.com/drhyman. AG1 contains 75 high-quality vitamins, minerals, whole-food sourced superfoods, probiotics, and adaptogens to support your entire body. Right now when you purchase AG1 from Athletic Greens, you will receive 10 FREE travel packs with your first purchase by visiting athleticgreens.com/hyman. Nordic Naturals omegas are pure concentrated omega-3 fish oil made from 100% wild-caught fish. Shop today at nordic.com and save 20% using code FARMACY. Full-length episodes of these interviews can be found here: Dr. Mark Hyman Dr. Robert Lustig Dr. Elizabeth Boham

Hi, Doctors Pharmacy listeners, it's Dr. Mark here. If you've been following me, you know that I'm obsessed with understanding the latest research on longevity and how we can apply it to our daily lives. So I wrote a book about it. Think of it as a roadmap to optimal aging. It's called Young Forever. It's never too early or too late to take control of your health, and this book will show you how.

Visit youngforeverbook.com to learn more and order now. Coming up on this episode of The Doctor's Pharmacy. Problems with the liver impact our immune system, how we can digest food, metabolize food. There's so many reasons why we really want to look deeper. Hey everyone, it's Dr. Mark here. If you've been following me for a while, you know that I often talk about how eating organ meats is so good for your health. Now, I know it can be hard to work them into your diet, but when we don't eat things like liver, kidney, and heart regularly, we're missing out on wonderful sources of essential

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dot com slash Dr. Hyman. That's me, Dr. Hyman. And you'll see the discount quote in your cart. Now let's get back to this week's episode of The Doctor's Pharmacy. Hi, this is Lauren Feehan, one of the producers of The Doctor's Pharmacy. The health of our liver is directly tied to the overall health of our body. Unfortunately, it is also the site of disease for a growing number of people. 90 million Americans and a growing number of individuals worldwide have what is called fatty liver disease, which literally means that your liver fills with fat. In today's episode, we feature three conversations from the doctor's pharmacy on how to support our livers, why fatty liver is so prevalent, and how to prevent and reverse it.

Dr. Hyman takes a question from a listener on how to care for our liver. He speaks with Dr. Robert Lustig on how liver fat is created by high sugar diets and with Dr. Elizabeth Boehm on testing and treating fatty liver disease. Let's jump in. Hi, Dr. Hyman. My name is Camille and your podcast has helped me immeasurably. Can you please advise the best liver cleanse to use on a daily basis? Thank you. Thank you so much for that question, Camille. It's really important because we all need to learn how to love our livers. They do a lot of work for us. They clean our blood. They keep us healthy. And when they don't work, we get sick. And people think that, you know, unless you have liver failure, it's fine, which is not true. The liver

needs a lot of support to do its work. And I know this personally because I had mercury poisoning and I had to take care of my liver if I wanted to get better. The liver requires a lot of support to do its job of detoxification. And also, unfortunately, we are in a sea of toxins. So what is the worst toxin now affecting the liver? You might say pesticides. You might say industrial chemicals. You might say heavy metals. And you'd be wrong. The biggest problem affecting the liver is sugar.

It's the number one cause of liver disease today in America. In fact, it's the number one cause of liver disease today in America. In fact, it's the number one cause of liver transplants. Drew, I don't know if I ever told you this story, but I went to a conference on childhood obesity. It was maybe eight years ago. And there was a doctor there who was chatting with in the hall. I'm like, hey, what do you do? He says, well, I'm a pediatric gastroenterological surgeon. I'm like, what are you doing here? He said, oh, well, we do liver transplants. I'm like, what do you mean? Liver transplants for what? He said, we're now seeing teenagers with cirrhosis of the liver from fatty liver from eating sugar and soda. And I'm like, you're kidding. This is just

horrific. We see kids as little as five years old with what we call non-alcoholic steatohepatosis and fatty, which just basically means fatty liver. And eventually ends up with scarring the liver and cirrhosis. We think it's alcoholism. It's not. It's sugar and starch. So this is the biggest driver of a toxic liver. So the first thing you need to take care of your liver is really dramatically cut down or cut out starch and sugar. Obviously, alcohol is a problem. You next want to make sure you're avoiding as many toxins as possible. So get rid of the toxins in your food. Obviously, processed food for sure, additives, preservatives, but also pesticides and chemicals in food. I am on the board of the Environmental Working Group, and it's important to check which

vegetables you're eating that are contaminated. For example, strawberries, which I love. The worst, I would never eat a non-organic strawberry. It's number one on the Environmental Working Group's list of most contaminated fruits and vegetables. You can Google it, it's ewg.org. You can find the Dirty Dozen list, stay away from those. And then there's a ewg.org. You can find the dirty dozen list, stay away from those. And then there's a clean 15. So if you don't eat organic avocados or bananas, it's okay, right? Save some money there. But for sure, if you're having celery, if you're having nectarines or having strawberries, you do not want to eat those if they're not organic. Next is clean up your house. Your house is one of the biggest sources

of toxins, both indoor air pollution from off-gassing of VOCs and chemicals, whether it's paint or furniture, carpets. I mean, there's so much plastics and chemicals out there. So try to use natural materials in your house. And also household cleaning products. And if you can't make sure you redo everything in your house, get an air filter and clean your air with a HEPA filter. We use one called Air Doctor, which is really great. Next, I would say you want to make sure you are using household cleaning products that are not making you sick. I mean, think about it. When you read these products, if ingested, go immediately to the hospital.

You don't want those in your house. So the Environmental Working Group has, what do they say, household cleaning products, skin care products they have a wonderful uh database called skin deep where you can see what are you putting on your face your lipstick has got lead in it well don't use it if your topical creams have parabens and plastics in them don't use it you're absorbing it if you wouldn't eat it you shouldn't put it on your skin and next and next you want to make sure obviously the fish and the meat you're eating has low mercury and toxins. And there's, again, guides on the ewg.org. So it's a great resource to lower your exposures.

The next thing I would do is make sure you're eating foods that upregulate all your detox pathways. So the most important categories of foods are the brassica or cruciferous vegetable family, which is broccoli, collards, kale, cabbage, Brussels sprouts, that whole family, and the garlic and onions and family. And so I would eat those on a regular basis. For tonight, I'm having broccolini with garlic. So I do it pretty much every day. I make sure I have these foods. Next, you can actually start to do kind of more fancy stuff. You can have green juices, celery juice, watercress juice, cilantro juice. I had a guy who had heavy metals and he just

juiced cilantro and had a cup of cilantro juice every day.. I had a guy who had heavy metals and he just juiced cilantro and had a cup of cilantro juice every day. And cilantro is a great detoxifier that helped his liver flush out the metals and he got rid of his metals. You also want to eat herbs and spices like rosemary, curcumin, which is like turmeric for curries. You want to make sure you have things like rosemary, lemon peel. We throw away the the lemon peel but if you get organic lemons you can you can kind of i like to to kind of grate the lemon peel and put it in salads it's great with like my kale pine nuts a lemon peel lemon juice olive oil salt and pepper it's delicious uh that's why i like summer because we grow fresh kale it's really good with the fresh kale

and then once you've kind of upgraded your diet include all the phytochemicals and i'm literally just like touching the surface. There's whole books written about this. I just got picked from Ikaria, which is in Greece, one of the blue zones. And every morning, and all day actually, they had this stuff called wild sage tea. And I'm like, wow, what is this stuff? Why do they live to be 100 years old? Why do they have the longest lived population in the world?

I'm like, does it have anything to do with the tea? Well, I think it does because when I looked up the tea and the phytochemical content, it was full of something called epiglottic catechins, which are these incredible compounds that are detoxifying, that are anti-inflammatory, that help your immune system, that activate longevity switches. In fact, there's some theory that, and in fact, there's data on this, that these catechins in green tea and also in this wild sage tea upregulate glutathione and help your body detoxify which is the main detoxifier then after you've done all that obviously exercise is important making sure your gut's healthy is important making sure you're

sweating i call it the three p's poop uh pee poop and perspire you want to make sure you're flushing your system lots of water lots of sweatingas. I mean, I did hot yoga. I was just in New York. I love hot yoga. Kind of flush your system out, moves your lymphatic circulation. All that's great for detox. And then lastly, you want to kind of beef up your supplement measurement. So a good multivitamin.

And the reason is, before I go to the supplements, I just want to kind of loop back to the food. You know, a lot of people don't realize how important amino acids are from protein. So protein is so important for detoxification because a lot of the pathways, and I'm not going to bore you with all the fancy chemical names, but a lot of the pathways in the liver to get rid of toxins require amino acids. So you have to have a good complement of amino acids. And if you're just eating plant foods, you might not get those. So important to make sure you're getting enough of the right amino acids. And then

supplements. So what should you be taking? A good multi is important. But then there's a number of ones that are really key. Methylation, B12, folate, B6, very critical. Zinc, very critical. Selenium, important for the liver detoxification and boosting glutathione. Magnesium. So you want to make sure you have adequate levels of these nutrients. Then there's all the herbs like milk thistle and other compounds that can really be helpful. Curcumin, artichoke. There's a lot of these compounds, ellagic acid and pomegranate. So there's all these things that we can use as part of our diet to upregulate these pathways that are phytochemicals. And then there's the supercharged ones like glutathione boosting supplements, like N-acetylcysteine, which works

so well the government wants to ban it, which makes me laugh. You know, anything works too good, they want to turn it into a drug. I'm like, no, it's just a supplement. And then lipoic acid also is very important. And there's a host of other things. But those are the main things I focus on. And I've learned to incorporate these. It sounds like a lot, but I learned to incorporate these into my life every day. This morning I had a green juice. I make sure I took a sauna today. I have one in my house, a steam. I'm having broccolini and garlic tonight for dinner. I'm taking my supplements with N-acetylcysteine, lipoic acid, and my methylating supplements. So I just sort of work it into my life. It sounds like a lot, but once you kind of learn how your

body works, you kind of just do it automatically. Hey everyone, it's Dr. Mark. Now the basis of any healing protocol should be whole real food. But with all the GMO foods and lung transportation, storage times, and monoculture farming methods, depletion of our soils, food's not as nutritionally dense as it once was, even good stuff. And that's why I recommend supplementing a whole foods diet with a high-quality multivitamin as a basis for any health-oriented program. And the product I personally use comes from Athletic Greens. Their AG1 supplement has 75 different nutrients that work together to fill out the gaps in our diet. I take AG1 every day and I've noticed that I consistently feel better and

have more energy throughout the day. Plus, it works with any diet, keto, paleo, vegan, dairy-free, even gluten-free. AG1 is a simple, easy way to optimize your health. Right now, Athletic Greens is giving away 10 free travel packs with your first purchase. All you have to do is visit athleticgreens.com forward slash hymen have to do is visit athleticgreens.com forward slash hyman. Again, that's athleticgreens.com forward slash hyman. Did you know that 80% of people are deficient in omega-3 fats? Omega-3s impact every cell in your body and help support your brain, your skin, your heart, your immune system, and lots more. And that's why I recommend eating at least two servings of wild or sustainably raised cold water fish per week to get sufficient

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or prevent any disease. And now let's get back to this week's episode of The Doctor's Pharmacy. So the question is, why is it that we had never heard of fatty liver disease before 1980, and now 45% of adults and 25% of children not obese adults not obese children all adults all children now have a disease that didn't even exist 50 years ago yeah I mean except for alcoholics they'd get fatty liver right and that's the point only alcoholics had this and now everyone has this and children don't drink alcohol. But children consume something that is just like alcohol. And that is sugar. Sugar and alcohol are virtually

identical as far as the liver is concerned. The big difference between sugar and alcohol is that for alcohol, the yeast does the first step of metabolism, which we call glycolysis, anaerobic glycolysis. For sugar, for fructose, the sweet molecule in sugar, we do our own first step of metabolism. But after that, they're exactly the same. And so it makes sense that children would get the diseases of alcohol without alcohol. So until we fix this problem, and by the way, this is just one of several problems with the Western diet. Until we fix this problem, nothing else is going to work. And I actually proved this in our own clinic here at UCSF.

Because what we did was we took 43 children from our clinic who had metabolic syndrome. So this was in the movie Fed Up, right? No, we had not gotten the results on this study back when Fed Up was recorded. This is actually newer. So no, it's not in there. So there was something like that in the study where you put the kids in a metabolic ward and you fed them different diets and you saw what happened very quickly, right? Right, right. So 10 days, 10 days. What we did was we figured out what they were consuming on their home diet. We studied them on their home diet. Then for the next nine days, we catered their meals, no added sugar. So we took the percent of calories from sugar from 28%, which is a lot, down to 10%. Okay. Now, if you do that-

10% is still a lot. Well, that was when we gave them fruit. So we gave them fruit. That was pretty much the only sweet thing we gave them. Now, if you do that, you're going to take 350 to 400 calories a day out of kids' diets. And if you do that, number one, they're going to be hungry. And number two, they're going to lose weight. We didn't want them to lose weight because, hey, if they lost weight and they got better, people say, well, of course they got better. They lost weight. We didn't want them to lose weight.

We actually wanted them to gain weight. So we had to substitute the sugar with something else that was equicoloric. We gave them refined starch. So in the vernacular, we took the pastries out. We put the bagels in. We took the sweetened yogurt out. We put the baked potato chips in. We took the chicken teriyaki out. We put the turkey hot dogs in. Okay. So we didn't give them good food. We gave them crappy food. We gave them processed food. We gave them Safeway food. We gave them kid food. Food kids would eat. Okay. But it was no added sugar food. And we also gave them a scale. And every day we'd call them up on the phone what's your way and if

they were losing weight eat more in order to keep their weight constant through the 10 days and then we studied them 10 days later and lo and behold no change in weight but the fat in their liver went down 22 percent wow their conversion of sugar to fat went down 46%. Their triglycerides went down 49%, just 10 days. Their visceral fat, the belly fat went down 7%. And most importantly, their insulin in their pancreas started being released and working properly. In other words, we reversed their metabolic syndrome with no change in calories and no change in weight. And what this told us was that it's not the weight. It's not the fat.

It's the liver fat. And that's the fat you can't see. That's the fat you can't measure when you stand on a scale. And that's why we have metabolically healthy obese people who don't have liver fat, and we have very thin, sick people who do. In my understanding, you know, this is, David Ludwig says this, you know, below the neck, your body can't tell the difference between, you know, cornflakes and a soda, right? Or between a bowl of sugar and a bagel. And I think, you know, refined starches are also a problem.

So I don't want people to take away from this is that you can eat refined starches and that's okay. And I think it's still a problem. Let me delve into that a little bit. Let me unpack that. Okay, sugar, dietary sugar, the sweet stuff you put in your coffee, you know, the crystals,

is two molecules in one. Okay. It's called sucrose, but it is two molecules. One is called glucose. One is called fructose. Now, glucose is the energy of life. Every cell on the planet burns glucose for energy. Glucose is so important that if you don't consume it, your body makes it. Okay. Makes it out of proteins. It makes it out of fats. So you will always have a serum glucose level. The Inuit who basically didn't have any carbohydrate because they didn't have any fields to grow any carbohydrate. They ate whale blubber. They still had a serum glucose level because glucose is that important, but it's not important to eat because you can make it. Now, fructose, that sweet molecule in sugar, is a different animal entirely.

There is no biochemical reaction in any vertebrate that requires dietary fructose. It is completely vestibular to all animal life. Now, it just so happens it's sweet. It just so happens we like it a lot. It just so happens it's addictive, but it is actually metabolized like fat, but it is completely unnecessary. Now, glucose will stimulate insulin release, and that's not good because insulin release will drive energy into fat cells and increase weight gain and that's what dave ludwig is talking about and he's right and he's right i'm not saying he's

wrong he's right but fructose because it gets stuck in the liver and causes that liver fat you get insulin resistance two different phenomena two, two different things. One's called insulin secretion, insulin release. The other one's called insulin resistance. They are not the same. Insulin release will cause weight gain. Insulin resistance will cause heart disease, diabetes, Alzheimer's, cancer, and virtually all of the other chronic metabolic diseases that are chewing through our entire healthcare system. Insulin resistance is the bad guy. Insulin secretion is basically what we're talking about when we're talking about the scale. Insulin resistance is what we're talking about in the doctor's office. But eventually, though, if you have enough of the restoring starches, even if you don't have refined sugars, you will see an increase in insulin resistance because you have to use more and more insulin and the cells become resistant.

So it's sort of related, but I get your point. Fructose really has a unique effect on the body. We had Richard Johnson on the podcast who talked a lot about the dangers of fructose. And David Perlmutter talked about what he called drop acid, meaning uric acid in this role as a real accelerator of insulin resistance and chronic illness. So I agree with you, Robert. I think, you know, it's so amazing to me that the single biggest driver of our exorbitant healthcare costs, of our declining health globally, of all of our chronic diseases, heart disease, cancer, diabetes, dementia, even depression, and more, are driven by insulin resistance. And yet it's something we learn almost nothing about

in medical school. My daughter now is in second year medical school. I think she had like an hour on it. And it wasn't really in the context of what's really driving it. And it's like, if you treat that, you treat so many of these chronic illnesses. And it's one of the drivers of all aging. I just finished my book on longevity called Young Forever. And it basically, if you look at the science of this, the science of insulin resistance is really the science of chronic disease and the science of aging and the science of death. Couldn't agree more. In fact, insulin resistance is the sentinel problem in all of these chronic metabolic diseases because insulin resistance is a manifestation of mitochondrial dysfunction. Mitochondria are the little energy burning factories inside each of our cells.

And when our mitochondria work efficiently, we are healthy and our blood glucoses do not vary very much and our weight stays stable and we feel good and we can sleep well and all is right with the world. And as soon as our mitochondria don't work well, all hell breaks loose and we get all of these chronic diseases and we feel like crap, et cetera, et cetera. And we end up starting to having to take medicines in order to try to make our mitochondria work

better, except guess what? We don't have a medicine to make our mitochondria work better. Because no medicine can actually get to where the problem is. Okay. But it's foodable, not druggable, right? Right. So that's the whole point is, what's wrong with the mitochondria and how do you fix it? That's basically what this whole story is about.

And to be honest with you, Mark, that's what functional medicine is about. Okay. Whether they taught you that or not, that's where we are. No, it's for sure. Frigging mitochondria. All right. So what's poisoning them? That's the big question in all of medicine. Before we get into the – I want to get deep into mitochondria and all this. I just want to kind of back up a little bit because we said a lot of stuff, and I want to make sure people get it. So I want to talk about how we diagnose insulin resistance,

and you have in your book a way to self-diagnose because it's really important because your doctors are missing 90 of it they don't get taught how to diagnose it they don't because there's no simple drug for it so there's no drug for it why test for it right and and you talk about you just talked about a few major things that are a little bit confusing one is you can be metabolically normal obese meaning you're overweight but metabolically normal obese, meaning you're overweight, but metabolically normal. And I think that's a small number of people. You can be metabolically obese and normal weight, like the people from India and China, they can be on their BMI, their body mass index normal, but they're still diabetic, right? And that's dangerous. In fact, I've seen some studies that that may be more dangerous than being overweight and metabolically unhealthy. And then there's the,

and then there's the, obviously the overweight, the metabolically obese and obese, obese patients. So there's these different categories. Some of it's genetic, some of it's, you know, had a lot of variations, but you kind of can't know until you test. So explain to us how we can understand what's going on in our bodies. How do we test for this phenomenon that's driving all these diseases for which we're taking so many medications that aren't really working? They're just managing the disease and they're not actually treating the problem, they're treating the symptoms. Totally. The problem, of course, is that your doctor has access to all of this and you don't. And you need to, and they need to, but they don't

understand it, which, you know, maybe you can teach your doctor what to do. How would that be, all you audience out there? I love that. All right. Sometimes doctors are a little, you know, shall we say provincial and they don't necessarily, you know, listen to their patients, but they really should. If they listen to their patients, they'd be much better doctors. All right. Number one, you look at your waist. Now your waist is a conglomeration of many things, but primarily visceral fat and liver fat. That's what determines

your waist circumference. If you are a male and your waist is 40 inches or greater, the chances are you have visceral and or liver fat, and that probably means you have insulin resistance and you have mitochondrial dysfunction. If you are a female and your waist is 35 inches or greater, same thing. Now that's the cheap way. Unfortunately, it's sensitive, but not specific. So there are other things that can, you know, cause you problems as well, like ascites and other things,

but you know, we're not going to- Pregnancy. Pregnancy, yeah, pregnancy. Thank you, yes. Okay, so, which of course is insulin resistance also, you know, but're not going to. Pregnancy. Yeah. Pregnancy. Thank you. Yes. Okay. So, which of course is insulin resistance also, you know, but that's for another day. Um, then you start getting into the lab tests. Okay. What lab tests do you need to get? The most important lab tests for determining insulin resistance is a fasting insulin. Now doctors don't draw fasting insulins.

I think it's the single most important lab test to draw, but they don't draw it. Why don't they draw it? Because the American diabetes association told them not to draw it. Now, why is it that I'm saying that this is the most important test that you have to run? And the diabetes association is saying, don't bother. How come we are so completely diametrically opposite? The answer is because I'm right and they're wrong. Now, here's why. Now, here's why. I agree. Actually, by the way, I've been measuring this test for 30 years. Me too. And it's just astounding to me how important it is and how nobody tests for it who's in the conventional medicine.

That's right. So here's why the ADA says don't draw it. Two reasons, and they're both wrong and specious. Number one, they say, well, lab tests around the country for fasting insulin are not standardized. Yeah. Now, that is true. That is true. I don't argue that.

And the reason is because cheap tests, cheap insulin tests do not distinguish between the insulin molecule and its precursor, the pro-insulin molecule. Now, pro-insulin is a pro-hormone, meaning it's before you get the active hormone, it's bigger. And the pancreas, the beta cells in the pancreas make this thing called pro-insulin. And then there's an enzyme that cleaves the C-peptide piece off, and then you release the insulin. Now, when you're sick, when you're insulin resistant, your pancreas doesn't have time. Okay. And that may actually

even be a problem that you have a problem with that enzyme. And that enzyme is called PC1 or prohormone convertase one. Now you may, if you're sick, release both. You may release both pro-insulin and insulin. And so pro-insulin gets picked up in the insulin assay. So indeed, insulin assays around the country are not standardized. So the American Diabetes Association is right about that. But so what? If it's high, you got a problem.

Okay. And they basically don't understand that and that's so that's that's specious issue number one yeah specious issue number two they say insulin levels don't correlate with obesity That is also true. They correlate with metabolic health. Yes, and heart disease and cancer and dementia. Exactly. And we just told you that there are thin, sick people. So they're not registering on the scale, but then they don't know that they're sick. Yeah. So this is exactly why we need to be drawing fasting insulins, is to figure that out. Yeah. So fasting insulin.

And by the way, you know, the other thing I do, I would just say it's going to add my two cents because I've been doing this for a long time too. And I started measuring not just fasting insulin, but I measured a glucose tolerance test with insulin. Almost on every patient who I thought even smelled that they could have had metabolic syndrome. And it was fascinating to see the data on this. You'd see people with like blood sugars that were perfect.

Like I had this one woman, like a big apple. Her fasting blood sugar was like 90 after the 75 75 gram glucose, which is like, you know, two Coca-Cola worth of sugar. Her blood sugar went to like 110, never even went into glucose intolerance, but her fasting insulin was like 50 and it went to like 200 at one in two hours. So I found that very helpful. And fasting insulin is probably the second stage. The first stage is a post preamble insulin that goes up, right? Yes, exactly. Right. So in fact, we did oral glucose tolerance tests with simultaneous insulin levels on kids published this back in the early two thousands, where we, this is where we realized where we had these two problems. One's called insulin hypersecretion,

and those kids are fat, but healthy. And this's called insulin hypersecretion, and those kids are fat but healthy. And this thing called insulin resistance, and those kids were fat and sick. And so even though they are both insulin problems, they are for different reasons and different things in our diet cause each of them. Insulin hypersecretion can be genetic. Insulin resistance usually is not, but it's very, very liver fat specific and very much dietary fixable. So we learned quite a bit by doing that. I don't need to do that anymore. And I actually retired anyway. So I'm not seeing patients, but, um, but the point is I can figure out from the other lab tests, what's going on. So I don't have to exactly. Exactly. I, me too. It's a, I, it's actually, when I was in residency training, I had a, I had a, uh, a pulmonologist

who was one of my preceptors and he, you know, he taught us to read x-rays and he goes, well, you know, this is a, this is that, and then he goes, and this is the Aunt Millie sign. I'm like, well, what do you mean? What's the Aunt Millie sign? Well, it walks like Aunt Millie. It talks like Aunt Millie. It looks like Aunt Millie. So it must be Aunt Millie.

Basically, if you look at the pattern, it's a pattern recognition. And if you look at the types of cholesterol, if you look at uric acid, if you look at all these other phenomena, hormones, you can tell so much about what's going on. So besides the insulin fasting level, what else should people be measuring besides their waste and their fasting insulin? Right. So the next thing down the list is their ALT, alanine aminotransferase. Now, the problem with ALT is not- It's a liver test. It's a liver test.

It's a test that tests for fatty liver. Okay. It's again, sensitive, not specific. But the problem with ALT is not the test. The problem with ALT is the interpretation. Yeah. Now, in 1976, when I entered medical school, the upper limit for ALT was 25.

Today, you look at the lab slip, it's 50 or 50, sometimes 50. Yeah. So same test, but, you know, now double the upper limit of normal. How'd that happen? The answer is because everyone has fatty liver disease. That's right. Okay. The entire curve shifted to the right. And the way the lab determines normality is they do a whole bunch of tests on, you know, 10,000 or a hundred thousand people. Okay. And they get the mean and they get two standard deviations and they draw a line at those and say, okay, that's the upper limit of normal. Well, if the entire curve shifted, guess what? The upper limit shifts, but that doesn't mean it's normal. It just means that the patient didn't know they had a problem.

Yeah. Well, it's sort of like if you were a Martian landing an American today, it would be normal to be overweight and obese because that's what Americans are. It doesn't mean it's optimal. That's right. And so, in fact, an ALT upper limit is 25. If you're African American, an ALT upper limit is 20. So if you see an ALT above that, you got a problem and you don't necessarily know why. And your doctor's looking at it and saying, well, you know, your ALT is 30, you know, it's below 40 or 50, you know, then no problem. And

so your doctor's missing it. So that's, that's the second test. And those are cheap. These are cheap tests. These are cheap tests. These are tests that are normally done on standard chem panels. 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 then 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, of, of having issues with our detoxification system in our body. And as, 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. 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 body so we can handle the toxins that we are exposed to. And so

it's really important that we take care of our liver. And so what's considered normal for alcohol intake? 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 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 increased prevalence of cancer, even a little bit of alcohol may actually increase the risk of cancer. So it's not just fatty liver, but it was a Japanese study with 63,000 adults where they looked at people who were drinking alcohol and it was a concern. But that aside, besides just the overload on your liver, besides just the stress on your liver's ability to deal with all the normal toxins we have to deal with, what happens when you have a fatty liver is it drives inflammation in the body. And it's linked to heart disease, to cancer, to diabetes, to even dementia and all sorts of things

that we don't think necessarily related to a fatty liver. So fatty liver is sort of an early warning sign and clue that there's something wrong in your body and it's causing a risk, an increased, dramatically increased risk of all these other problems. 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, you know, that's something we really have to be thinking about is, is this fatty liver? Should we go on and do an ultrasound of the liver to see if we are seeing some fat deposition in the liver? And so that's one of the ways we start to see it most frequently with our patients. Yeah, absolutely. And so there's other tests you can use, which I've had personally, just because I've started biohacking, kind of like to check everything.

But you can do an MRI and look at liver fat. And it should be less than 2%. And many people have very, very high liver fat. I thankfully have less than 2%. You can also, they're actually also doing fiber scans, which look at the fibrous 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, you know, in addition to the testing we talked about, we'll look at insulin resistance, we'll look at the particle size, we'll look at inflammation, we'll look at a lot of things that traditional doctor wouldn't look at. What, what are the, 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 want to really help focus the treatment plan on that individual patient. And I think that's what's so special about functional medicine is it's really looking for that underlying root cause for that underlying patient so that they can reach their optimal health. And 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 want to look deeper. Absolutely. And I think in addition to the dietary stuff and getting rid of the environmental toxins that we can sort of decreasing our overall toxic load. And we've talked about this in other podcasts, like the Environmental Working Group's Guide to How to Reduce Your Exposure to Toxins in Food and House cleaning products and personal care products. But there's also a lot we can do from a dietary perspective to upregulate those pathways in the liver that boosts glutathione, all the brassica family, the onions and garlic, all the spices that we can use, and even herbs that can be very helpful, like milk thistle and others to help improve the liver function. And then there's a whole bunch of nutrients that the liver needs to function. And in fact, you and i were both trained in

traditional medicine and we work in the emergency rooms and you know people come with tunnel overdose um we give them this quote drug called mucamist right which uh which is actually n-acetylcysteine it's a supplement you can go over the counter. What it does is it boosts lutefione, and it helps the liver to regenerate lutefione, which is what's depleted often with fatty liver and intangible liver damage from overdose. And so there's a lot of things you can do to boost lutefione. You can take lutefione, you can take initial cysteine, lipoic acid, milk thistle, curcumin.

We use a lot of herbs. We use also the B vitamins, zinc, selenium, amino acids. And we do a lot of things to help the liver heal. And what's amazing is when you use this cocktail of substances, things like milk thistle, lipoic acid, N-acetylcysteine, glutathione, and so forth, livers will come back. And it's striking to see the drop in liver function tests, the improvement in fatty liver content. And I encourage people to really think about, one, checking to see if they have it. Two, thinking about how to actually upregulate your lifestyle so that you can protect your liver and live a liver-healthy lifestyle.

I hope you enjoyed today's episode. One of the best ways you can support this podcast is by leaving us a rating and review below. Until next time, thanks for tuning in. If you like this conversation, I know you'll love my new book, Young Forever. If you pre-order this book now, you'll get access to my discount bundle with deals from all my favorite health and wellness brands. Visit youngforeverbook.com to order my book and get access to these deals. I hope you're loving this podcast. It's one of my favorite things to do and introducing you all the experts that I know and I love

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