Bonus Episode: Reversing Fatty Liver at the UltraWellness Center

0:00Dr. Mark Hyman:Coming up on this episode of the Dr. Hyman Show. So even though we call it non-alcoholic fatty liver, what they're actually doing is they're becoming like a brewery. The bacteria in the gut and the food that the person's eating is actually having a low-grade production of alcohol, which is like sort of like dripping alcohol into the person's liver 24-7.

0:23Dr. Mark Hyman:Before we jump into today's episode, I want to share a few ways you can go deeper on your health journey. While I wish I could work with everyone one-on-one, there just isn't enough time in the day, so I built several tools to help you take control of your health. If you're looking for guidance, education, and community, check out my private membership, The Hyman Hive, for live Q &As, exclusive content, and direct connection. For real-time lab testing and personalized insights into your biology, visit Function Health. You can also explore my curated doctor-trusted supplements and health products at drhyman.com.

0:52Dr. Mark Hyman:And if you prefer to listen without any breaks. Don't forget, you can enjoy every episode of this podcast ad-free with Hyman Plus. Just open Apple Podcasts and tap try free to start your seven-day free trial. Hey everybody, it's Dr. Mark Hyman and welcome to our series about chronic disease where we focus on a functional medicine approach that's quite different and highlights the things that we do with the Ultra Wellness Center in Lenox, Massachusetts. It's a practice I've had for 20 years. We've got five doctors, three physician's assistants, I think five to seven nutritionists. We do deep dives on people to find out root causes of all sorts of issues, stuff that you just don't get when you go to your regular doctor.

1:29Dr. Mark Hyman:And it's stuff that we should be doing because the science is here. It's just not getting into practice. So we've got a great topic today and a great story that we're going to share with you around a common problem, unfortunately way too common, which is fatty liver disease. And joining me today is my friend and colleague, Dr. Todd Lapine. We've been working together since the mid-90s, believe it or not. Still are going at it. We've been doing a long time. A long time. I think we have over probably 120 years of collective experience in functional medicine at our practice. Really incredible group of physicians and providers and helpers and a great team.

2:02Dr. Mark Hyman:And we help people deal with stuff when they've done everything else and tried everything else and they can't get the answers. And we think about things differently. And we use the lens of functional medicine to think about how do we understand the root cause of disease. And today our topic is going to be something all too common, which is fatty liver disease. It used to be called non-alcoholic fatty liver disease. And now it's changed the name because before we used to see this in alcoholics because they drink too much and would mess up their liver. And we see this in about 40 to 50 % of the American population, which is kind of terrifying.

2:37Dr. Mark Hyman:It's 70 to 90 % of people who have prediabetes or type 2 diabetes. It's the most common liver disorder in the United States. And now the new name for it is metabolic associated fatty liver disease. Metabolic meaning your metabolism's busted, meaning you have high blood sugar or high insulin, and you're on that trajectory to prediabetes and type 2 diabetes. And it's scary because it's not affecting just adults. It's affecting kids. And that's what's terrifying to me. I saw this guy once, Todd, at a conference on childhood obesity, and I was there. And there was this guy who was a hepatologist. And I'm like, well, what are you doing here?

3:13Dr. Mark Hyman:You're like a liver specialist, liver surgeon. I'm like, what are you doing here? He's like, well, a lot of kids who are young and drinking soda have fatty liver disease, and we do liver transplants on 15-year-olds. Oh, my God. And I'm like, oh, my God, really? And so this is a real problem. It's mostly undiagnosed, mostly untreated, because there's no, quote, drug for it. But there's a lot of things we can do when we think through the lens of functional medicine. And I personally have seen this so much, and I've seen it reversed so quickly using a really intelligent approach of getting with the root causes.

3:44Dr. Mark Hyman:So Todd, I want you to start by walking us through what are the factors from a root cause perspective that are driving this epidemic, which is affecting probably one in two Americans. I mean, you know, anybody who's overweight probably has this, right? 75 % of Americans are overweight. About two-thirds of people who are skinny also have metabolic issues. So maybe it's like, you know, when you look at how do you define it? Because most people aren't getting liver scans, and we'll talk about the diagnosis of it. And if you have an MRI or you have a fatty liver scan, and I'll tell you, you can actually see the amount of fatty liver.

4:19Dr. Mark Hyman:But most people don't have that. And you really want a liver fat less than 2%. And over that, you're starting to get into trouble. So Todd, what are the things that, from a functional medicine perspective, we think about? How do we start to diagnose these problems? What are the clues that you have it? Kind of walk us through that, thinking about it. You actually read my mind mark because basically I was going to bring in two topics, which is basically just sort of wrap your head around what's happening when you get fatty liver disease. I want you to think of soda and the big gold sodas, which are laden with high fructose corn syrup.

4:51And then you also think of foie gras. So the French have a wonderful, delicious, fatty delicacy called foie gras. And the way that they make foie gras is that they force feed ducks, grains, and they literally just shove it down their throat for days at a time. And eventually they overwhelm the liver's ability to process food. So there's a metabolic overload. And what happens is those calories can't be burned. They get stored as fat. And that's what's really happening with people who have fatty liver disease is that it's a metabolic mitochondrial traffic jam, what's happening. And yes, you see this more commonly in people who are overweight.

5:34People are consuming too many calories, but you can also see in people who are not. So there's multiple ways of looking at what is going on in patients who have fatty liver. sometimes it's picked up because somebody does some liver tests or a chem panel and they notice that the liver tests are slightly elevated um one of the tests that is a really sensitive marker uh is a liver test called gamma glutamine transferase or gtt and that is one of the most sensitive markers uh that you can pick up fatty liver disease very early on and again it's

6:11Dr. Mark Hyman:You've got that in your routine panel, right? No, it's actually, it's interesting. You actually bring up a good point because the reason why it's not brought up is because so many people have abnormal GGTs that they don't do it anymore routinely because they say everybody's got elevated GGT. And I know, right, you don't, right. That's good. So, and the other aspect of that is that an elevated GGT is actually a sign of glutathione deficiency. And glutathione, as we've all heard, is one of the major antioxidant systems in the body. So when you have an elevated GTT, it tells you that there's like the check-in lights coming on in the liver saying something's wrong here.

6:49And that can be an early sign to tell you that a person has fatty liver disease. And again, like you were saying, one out of three Americans have metabolic syndrome, which is what you get years before you develop diabetes. So catching this early is really, really critical because, you know, if you let it go long enough, like you're saying, you're going to be doing liver transplants in the teenagers. And that's not where we need to be headed. So it's really one of those conditions that you have to think about. And as a physician, you don't want to be fooled because somebody can have it and not actually be overweight or markedly obese.

7:23So you really have to have your antennas up to try to pick it up early.

7:27Dr. Mark Hyman:You know, there are other diagnostic tests we do, because the GGT and liver function tests are telling you that you have a problem, but they don't really necessarily tell you why. It's a good screening tool, and it should be done for everybody, and we do this at the Ultra Wellness Center. But the other big thing we look at carefully is insulin resistance, and there are some really interesting ways to actually diagnose this phenomena, which can happen, you know, obviously when you have diabetes, type 2 diabetes, when you have pre-diabetes, But even before that, you can have low-grade insulin resistance that can still cause problems.

7:58Dr. Mark Hyman:And so how do we diagnose this problem of insulin resistance? You bring up, we actually just had a topic with one of my colleagues about that. And you typically can, I think the gold standard, in my opinion, for checking for insulin resistance is the glucose tolerance test, which measures both glucose and insulin levels simultaneously. And some people will say, you know, we'll check your hemoglobin A1C. And if it's normal, they say, oh, you don't have insulin resistance, but you actually can have insulin resistance, even with a normal hemoglobin A1C. And I recently had a patient who had a normal fasting glucose and a normal fasting insulin.

8:33And when I did the glucose tolerance test, the person was, you know, maybe 10 pounds overweight. But I just had a sneaking suspicion based upon the history that there was probably some insulin resistance. and when I did the insulin glucose tolerance test, the patient's insulin level maxed out at one. The gold standard is really the glucose tolerance test, which is really like a stress test for your pancreas. So if you want to know what's going on with the heart, you get on the treadmill. This is like a treadmill for your pancreas.

9:04Dr. Mark Hyman:Good, it's a really good test. We've done it for decades, but I don't know if you're aware of it, but there's a newer test that's been developed by Quest that uses mass spectrometry to measure insulin and C-peptide And that is as good as the glucose tolerance sensor, if not better. And it's sort of even equivalent to what they use in research called the euglycemic clamp test. So it's really sensitive. And now we can, with a simple blood test, without drinking the equivalent of two co-colas, which we used to do, actually measure this. And again, it's one of those things that is not getting picked up by your traditional doctor, but there's all this emerging diagnostics available to help us understand this problem.

9:38Dr. Mark Hyman:What are some of the other things we would look at that help us sort of diagnose this and that sort of see there's a problem besides looking at your liver function tests, looking at your blood sugar, insulin, fasting or the insulin resistance score. There was somebody I read once had high levels of blood alcohol, but they didn't drink at all. And it's because they had this auto-brewery syndrome where the sugars were being fermented by the bacteria in their small bowel because they had gut issues. Yeah, and you can actually get the auto-brewery syndrome from both yeast because when we make alcohol, We basically take sugar, grapes or whatever, and then you add in yeast and they ferment it.

10:17And the waste product is actually alcohol. That's why alcohol is a toxin because it's a waste product. And that can happen both from yeast and also from bacteria. So you can get it from both of the organisms, which can produce alcohol. And that is one of the risk factors for developing fatty liver. I did a deep dive on this. I did a series of seminars with a good friend of mine, David Brady, and we did it on diabetes or metabolic syndrome and all the implications thereof. And as you mentioned, we used to call this non-alcoholic fatty liver disease. And, you know, back in the day, I used to work at the VA hospital and you see a lot of patients who were alcohol users and alcoholics.

11:02and it was that was one of the main things that you would see where people would get fatty liver disease now the interesting thing is the gut microbiome and this is in the literature this is really quite fascinating there's specific bacteria uh which and there's probably multiple ones but one of the biggest ones is when you measure the gut microbiome and you see high levels of clbcli is a gram negative bacteria it's found naturally in people but when you have overabundance of Klebsiella. Klebsiella bacteria actually produce alcohol. So even though we call it non-alcoholic fatty liver, what they're actually doing is they're becoming like a brewery.

11:43The bacteria in the gut and the food that the person's eating is actually having a low-grade production of alcohol, which is like sort of like dripping alcohol into the person's liver 24-7 because they're eating highly processed foods, highly glycemic foods. And a lot of times when you see these patients, these are the patients who like, they walk around like, I've got brain fog. Well, they have brain fog because they're having low levels of alcohol 24-7 in their body. So that's another thing that you can have to think about in terms of diagnostics is to look at the gut microbiome and also leaky gut.

12:17Dr. Mark Hyman:I think people in here, fatty liver, they think, oh, I'm going to eat fat and I'm going to get fatty liver. It's actually the opposite. You kind of hinted at it, you know, to get these duck to have, or goose to have a fatty liver. And by the way, frog bra is, means fatty liver in French. basically. And what they do is they force feed them like corn, and that turns into fatty liver. But what we're seeing now is this increase in high fructose corn syrup in our population, which can be anywhere from 55 % to 75 % fructose. Now, people say, oh, it's the same as regular sugar. And in many ways it is.

12:49Dr. Mark Hyman:But the one significant difference is that high fructose is what drives fatty liver. It won't cause your blood sugar to go up or your insulin to go up directly, but indirectly it would lead to fatty liver and insulin resistance over time. So this is a big factor in why these kids who are drinking like big gulps or, you know, two liter bottles of soda today are getting fatty liver. Yep, absolutely. You actually just, that's a nice segue into the next aspect of fatty liver that I want to talk about. And fructose, as you mentioned, is one of the big drivers in high fructose. So we find fructose in plates.

13:27So if you have an orange or an apple and it's in season, there's a small amount of fructose. And the liver can only process so much fructose. What happens is when you overwhelm the liver's ability to metabolize fructose, you deplete ATP. So ATP is the fuel that our mitochondria use to generate energy. That's how we power our cells in our body. And what happens is you actually get mitochondrial dysfunction when you overwhelm the liver with too much fructose because the incidence of fatty liver rises to two to three times when you have a high fructose diet. So, yeah, mitochondria is another aspect.

14:09And the way I also remember that is that when we burn our calories, where do we burn our calories? We burn our calories in the mitochondria, on the fireplace of the cell. So you want to put the log in your fireplace and burn it. Well, my analogy to patients is that when you have dysfunctional mitochondria, it's like having a log that doesn't fit into the fireplace. So you start stacking the wood on the side. And that's essentially the buildup of adipose tissue throughout the body, especially in the liver and the visceral fat, et cetera. And that's where it's coming from.

14:44Dr. Mark Hyman:And I think we'll get back to the causes, but in terms of just diagnosis, you can look at your liver tests and it could be a lot of things. You could be taking too much Tylenol, you could be doing other things, or drinking too much. So there's other factors that we now know that we can look at, like C-reactive protein, which measures inflammation, not specific, or ferritin. But there's some really cool kind of diagnostic tests that are derivative from your regular blood work. And for example, there's something called the Fib4 test, which is a Fib4 index. and it basically can help you identify issues without biopsy.

15:17Dr. Mark Hyman:So it looks at platelets as well as your liver function test, AST, ALT. And there's another test called NAFLD, or maybe it's such a NAFLD, fibrosis score. And that fibrosis score takes into six variables that are easy to measure, your age, your body mass index, your blood sugar, right? If you have impaired fasting glucose, your AST, ALT, which is your liver test, your platelets, and your albumin. and that gives you an idea through not a lot of invasive testing what's going on and so there's another way you can screen for it and that can be done through regular lab work and then there's imaging tests which can be very helpful.

15:52Dr. Mark Hyman:I mentioned the MRI but there's ultrasound and there's also called the fiber scan which sort of checks this pulse wave into the liver and sees how the wave goes and the elasticity of the liver and if it's fatty you can tell, if there's some fatty liver you can tell, if there's more serious various versions of this. You can tell if there's like more scarring. So it's a really, it's a really interesting way to kind of measure problems. It only takes a few minutes. And of course there's the MRI. So there's a lot of ways to sort of figure this out. And it's important people understand that, you know, most traditional doctors don't really measure this, don't look at these things, don't send people for these tests.

16:29Dr. Mark Hyman:And if you're a hepatologist, you do, but otherwise in your most primary care, internal medicine doctors just don't have a clue about how to really diagnosis. And then they're like, what are you going to do about it? Right? So let's talk about some of the causes of fatty liver. We kind of hinted about fructose and diet. One other thing, Mark, I just wanted to, you're talking about the diagnostic test. One test that I've been using a lot of my patients, which measures six biomarkers is a test called FibroSure. And that's available by mainstream labs. And that's another way of, they have an algorithm where they're checking the various biomarkers and they put it into the algorithm after the blood draw, and that can help you to risk stratify how bad the fatty liver disease is.

17:09That's another one.

17:10Dr. Mark Hyman:Yeah. So, you know, there's other reasons to have liver damage, like environmental toxins, you know, deficiency of certain nutrients like choline, but, and obviously you can look indirectly at lipids because, you know, see lipid abnormalities when you have a fatty liver, like small particles or high triglycerides because liver can't process all the less triglycerides. And so, you know, we can kind of start to measure something, stool testing, looking at the gut, and kind of get a pretty good sense of like what's causing it. I think, you know, when you look at our current diet, I mean, 60 % of it's ultra processed food.

17:42Dr. Mark Hyman:There's a lot of fructose in that through high fructose corn syrup in most of them. There's starches in those. And there's also things that damage that got lining like emulsifiers. And so you have a whole perfect storm. Plus we live in a toxic stew of chemicals and pesticides and herbicides and plastic, microplastics, you name it, heavy metals, all that stuff puts a load on the liver. So it's no surprise that we have this. And I wonder, you know, when you're seeing a patient with this, how do you start to think about, you know, what to do with this person? What's the sort of recommended treatment?

18:12Dr. Mark Hyman:Because like I said, there's no drug for treating this. If there was, you know, it would be a multi-billion dollar drug. I'd buy stock in it. We don't have one. So you have to use a functional medicine approach to really heal a fatty liver, which by the way, is really reversible unless you've already gotten to the point of cirrhosis and scarring, which is the end stage of this. This is why kids need liver transplants. They get cirrhosis just like an alcoholic from the sugar. And that's why like anything, like any condition, the earlier you can catch it, the better. And you're exactly, you're hitting the nail right on the head because this is something that you want to be preemptive.

18:45You don't want to wait till there's fibrosis and scarring and there's going to be irreversible damage. You want to catch this way before it happens. And, you know, obviously the first thing you're going to do is dietary changes. And like we're saying, there's a lot of different things that can contribute to disruption of the gut microbiome and disruption of the gut barrier. And we call that leaky gut. There's different tests that you can do that can determine if you have leaky gut. Always remember, this is another thing that I like to emphasize to my patients, is the connection between the gut and the liver.

19:20So all of the blood from the gut, guess where it goes? It doesn't go into the circulation. It actually goes from the gut into the portal system up to the liver to be filtered out before it goes into the systemic system. And that's where patients who have clinically used to see patients with patoconcephalopathy because their blood wouldn't be able to get filtered to the blood. And that causes all kinds of mental conditions. So having a healthy gut so that the blood that's then flowing into the liver is not going to be pro-inflammatory with all of these lipopolysaccharides, the coding of the gram-negative gut bacteria, which provoke inflammation and then aggravate like adding gasoline to the fire.

20:12Dr. Mark Hyman:so so basically diet would be starting with you know a low uh or no ultra processed food right getting rid of high fructose corn syrup in your diet i think if people listening can do one thing and this is you know again we focus on food as medicine at the ultra wellness center we focus on how to treat many chronic conditions with food and and you can dump huge amounts of liver fat by simply cutting out the starch and the sugar, particularly the high fructose corn syrup, which is in almost every package processed food there is. I mean, it's not something you have in your cupboard, right? It's an industrial food product.

20:45Dr. Mark Hyman:And you want to get away from it. Yeah, it's added to many foods. I mean, if you start reading labels, and again, we always talk about that, like the best food is food that doesn't have a label, right? It's not manufactured, it's not frankenfood, it's not processed food, it's real food. And, you know, in addition to the, you know, the fructose content, process carbs so that, you know, when we want to fatten up cattle, what do we do? We feed them grains. And highly processed grains is another thing which is basically acting just like sugar in the diet. It increases insulin and glucose levels, which in turn drive the whole dysfunctional metabolic pathways.

21:25Dr. Mark Hyman:I mean, it's interesting. Also, I remember reading a study where they did this in mice, but there's also done human trials where they gave the mice alcohol to cause fatty liver. But at the same time, they gave something called MCT oil, which is medium chain triglycerides. It's a special kind of fat that's absorbed directly, not through your lymph like most of your fat is, but actually directly into the liver. And it has a lot of benefits to the liver. It helps get rid of liver fat. It helps use inflammation. It helps mitochondrial function. It helps improve insulin sensitivity. It's sort of all your organ fat.

22:02Dr. Mark Hyman:But here you are treating a fatty liver with a fat. And it works pretty darn well. Pretty interesting to see those studies. I thought, I was like, wow, this is basically, even though they're giving a liver toxin, it still works. I was like, wow. And the interesting thing is that I use MCT quite a bit in my patients. And MCT is basically readily available to mitochondria for metabolism. So it's like a clean fuel. It's very, very clean. And it's also been shown to improve cognitive function in patients with dementia or early Alzheimer's. Because it's a cleaner fuel. It just burned through the mitochondria much cleaner than other foods.