How To Prevent And Reverse Fatty Liver Disease with Functional Medicine with Dr. Elizabeth Boham

Coming up on this episode of the Doctor's Pharmacy.

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.

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Episode of the Doctor's Pharmacy. Welcome to the Doctor's Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy and F, a place for conversations that matter. And if you've ever heard about this weird thing called fatty liver, you better listen up. This is not something you should ignore and it's something that affects almost one out of every two Americans. So, we are going to go deep into fatty liver today, otherwise known as foie gras in French. And we're going to talk with, not other than our own Dr. Elizabeth Bowen from the Ultra Wellness Center. She's been my colleague and friend for decades now. She's the medical director of the Ultra Wellness Center. She's one of the leading physicians in the functional medicine movement, training doctors all over the world. And she's, you know, what every doctor should be. She's trained as a family doctor. She's at a fellowship in nutrition and has also studied as an exercise physiologist and trainer.

She's the real deal. Welcome back, Liz.

Oh, Mark, it's great to be with you. Thanks for having me. Okay, so let's talk about fatty liver.

First of all, what is fatty liver? Why should we care? And who has it? Oh my goodness. So 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 that the liver does.

Right?

So the liver really helps our body detoxify, metabolize chemicals from the environment, metabolize our own hormones, you know, metabolize and get rid of toxins. And so, you know, we are, 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, the amount of fatty liver we are seeing.

So, why are we seeing so much fatty liver? People think, oh, it's alcohol. You know, alcoholics have big livers, they have liver failure, it's hepatitis. But, you know, what is the most prevalent cause by far of fatty liver in America?

I mean, so, right, so you can have, alcoholic fatty liver disease. So you can get fatty liver because of drinking too much alcohol, and we'll talk about that and what is too much. But really what we're seeing, why we're seeing such a skyrocketing of the amount of fatty liver is because of the non-alcoholic fatty liver disease, which is the major reason is this drive and this increase in insulin resistance metabolic syndrome, which is connected with everything as we always talk about, but also fatty liver disease. And it's prevalent, right? So we know with non-alcoholic fatty liver disease, it's about, there's studies saying 10 to 46% of the people in the United States have it or even 6 to 30% of people worldwide. So somewhere in that quarter to half of people are dealing with fatty liver disease and it's increasing. It's increasing worldwide and we're seeing it with our children too. as we know, how does that really impact their overall health and development and risk of death as they get older? Significant.

That's huge. So what is the biology here? Who gets it? I mean, we talk about 90 million Americans who have this problem. It's almost one out of two Americans. It's something when we went to medical school was like, what? That's not a thing. And then all of a sudden it became a thing. Used to be old fatty liver from alcoholics. you know, we got that. But we never saw real problems with this when I was in medical school. And now it's 90 million Americans and maybe even one out of two Americans overall have some level of dysfunction of the liver.

Right. So what happens first is that the fat cells replace the liver cells and that's called fatty liver or steatosis. And then what can happen over time if there's inflammation with that fat dust deposition in the liver, that's called fibrosis. So that's fatty liver with inflammation. And if that continues to progress, we can get scar tissue in the liver. And that is called cirrhosis, which is this, that's the non-reversible stage. So fatty liver, the great news is it's very reversible. Even the fibrosis, when there's inflammation, is reversible. Once it becomes cirrhosis or scarred, then it's not reversible. so the damage to the liver is non-reversible and definitely increases risk of cancer and lots of problems as we spoke about. And why somebody progresses from the fatty liver to cirrhosis really depends on your genetics, the rest of your diet, of course, the microbiome probably has this huge impact. It's not really all understood, but it's so fascinating some of the research looking at that. as well. So, yeah, it's.

Well, that's right, Liz. I mean, you know, the, the microbiome is such a key part because it drives inflammation and fatty liver is an inflammatory disease of the liver. Yes. And, and, and the microbiome can release toxins and can cause leaky gut and can cause all sorts of problems. But it seems as though prevalent of fatty liver is really because of our high starch sugar diet. I mean, the average American eats about a pound of sugar and flour every single day. you know, 152 pounds of sugar, 133 pounds of flour a year, that's an enormous amount of flour and sugar every single day. And what that does is it drives the pathology of fatty liver. And when you think of fatty liver, people are like, oh, if I eat fat, I'm gonna get a fatty liver. Well, it's actually not true. It's the opposite. Fat actually can heal a fatty liver, such as a ketogenic diet or even high levels of MCT oil. but with fatty liver, the real cause is the carbohydrates and the sugar. So it's the starch and the sugar that drive insulin that lead to fatty liver and cause high triglycerides and cause low HDL and cause inflammation and more insulin resistance. And you end up with this vicious cycle. And the problem is, you know, from a nutritional point of view, we're good at diagnosing it, but not great at, well, we're not even that good at diagnosing it, but we're not really skilled at treating it or reversing it, which is kind of stunning because it's like, oh, well, just, you know, take these drugs or, you know, have, have better control of your blood sugar, or let's lose weight. That's another one. I'll just lose weight. It'll get better. Well, that's an easy thing to say to people. It's a hard thing to get people to do. And a lot of people who have fatty liver are pre-diabetic insulin resistant or diabetic. And, and again, 88 of Americans are metabolically unhealthy, which means that 88 of Americans are at risk for fatty liver because they have some degree of metabolic dysfunction and that metabolic dysfunction is caused by sugar and starch and processed foods and it's driving the insulin resistance that causes the metabolic dysfunction which is defined as high blood sugar, high cholesterol, high blood pressure. So, this is such a common issue and then when you add on alcohol on top of that and you add on medication on top of that, let's say people are taking Tylenol, which is damaging to the liver, you end up with not a very fun environment for the liver. And on top of that, you have all the environmental toxins that we're all exposed to, the pesticides, in our household cleaning products, in our skincare products, in our food, in our water, we're constantly inundated with compounds that are putting a stress on our liver and making it work harder to detoxify. So you add all that together and then you go, wow, we're in a big problem. So why is fatty liver a problem? I mean, so my liver is a little fatty, who cares? 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 concern.

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 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, you know, that is, 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 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 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 body so we can handle the toxins that we are exposed to. And so it's really important that we take care of our liver. And so what is considered, you know, what's considered normal for alcohol intake? You know, for 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, 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 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 are drinking alcohol and it was a concern. But that aside, besides just the overload in your liver, besides just the stress on your liver's ability to deal with all the normal toxins we have to deal with, what happens when you have a fatty liver is it drives inflammation in the body and it's linked to heart disease, to cancer, to diabetes, to even dementia and all sorts of things that we don't think necessarily related to a fatty liver. So fatty liver, is sort of an early warning sign and clue that there's something wrong in your body and it's causing a risk, an increased, dramatically increased risk of all these other problems. But that said, how do we know if we have fatty liver?

You know, one of the first ways we find out is with general blood work. So if you do a metabolic panel, comprehensive metabolic, a 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? 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 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 two percent. And many people have very, very high liver fat. I, I thankfully have less than two percent. You can also, they're actually also doing fiber scans, which look at the fibrous content, the fiber, sorry, the, the scar tissue from the fatty liver. And they can use ultrasound scans, and those are good for measuring the degree. You can deliver biopsies. And I think, you know, what we see is is really in functional medicine a roadmap for healing the liver in ways that just doesn't exist with 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 particle size, we'll look at inflammation, we'll look at a lot of things the 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, one of the first things we do, right, is of course we get a good a good detailed history from our patients and try to get a sense of what's going on for them. Get an understanding of their timeline of their health and that can help us find out what may be driving health problems in that person. So if there is concerns about fatty liver, you want to get a sense of what their toxic load has been in their lifetime. What is their weight? What is their nutrition? What are they eating? And 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, you know, 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 our 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 here.

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 toxins in food and household 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 boost with the thion, 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 know, you and I were both trained in traditional medicine, and we worked in the emergency rooms. And, you know, people come with total overdose. We give them this, quote, drug called mucamist, right? Which. Yeah. Which is actually n-acetyl cysteine. It's a supplement. You can go over the counter. What it does is it boosts glutathione and helps the liver to regenerate glutathione, which is what's depleted often with fatty liver and in total. liberal damage from overdose. And, and so there's a lot of things you can do to boost glutathione. You can take glutathione, you can take inositol 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, when you use this cocktail of substances, things like milk thistle, lipoic acid, you know, inositol cysteine, 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, which is a lot of what we do in functional medicine, and then make sure you're on the right supplements to help reverse the problem. So Liz, tell me more about a patient that we've had. Because I think, you know, some of those patient stories are really helpful and instructive and give us a sense of how we do things differently at the Ulcerano Center here in Massachusetts and Linux and what you found and what you were able to 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 going to be rechecking them in a few months. And so, you know, we really got a good detailed history from him and we got a sense of what he was, what his diet was like and, and, and, you know, what his, what his alcohol consumption was like because, you know, it's one of the first things, of course, we think about with, you know, fatty liver or, or these elevated liver function tests were like, okay, how much alcohol is this person consuming? And what was interesting to me about him was, you know, he was, he was, he was pretty moderate in his alcohol consumption. He was having about two glasses of wine a night. And so, not for a man, that kind of almost falls within what's considered moderation. So, I was, 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, which comes from your cruciferous vegetables that helps and encourages the production of glutathione in the body. And so one of the things we really worked on with him is making sure he got some cruciferous vegetables every day, broccoli, cauliflower, cabbage, kale, brussels sprouts, you know, really to help support the liver and help it heal, essentially. We also had him take a break from alcohol, you know, we said, you know, let's just pull away alcohol for a period of time, really help that liver calm down and let it give it some time to heal. And as I was mentioning earlier, we really can see the liver function tests go down pretty quickly for some patients. We can see if somebody did have fatty liver, you can watch it improve within a few weeks of cleaning up the diet and decreasing alcohol intake. So it can be, especially if it's not too far progressed, we can see changes pretty darn quickly. And, you know, so with him we really focused on cruciferous vegetables, lots of the sulfur-rich vegetables like onions and garlic. We gave him turmeric, we gave him dandelion root to help his liver and gallbladder work better, lots of green leafy vegetables. We made sure he was eating enough protein. You know, we know that protein is really important for the detoxification process in the body. We need to be eating enough protein to do that. And so, you know, we made sure he was getting enough and, you know, foods that were rich in fiber to bind toxins, things like the beans and legumes and nuts and seeds, ground flaxseed. And I did, I gave him some n-acetyl cysteine, some NAC. I gave him some liposomal glutathione and milk thistle. we put them on a really good multi that had methylated B vitamins in it. I gave them 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 were eating way too much of that are getting into our 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 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, you know, whatever, you know, we'll watch it. That is just not a good idea. And I don't think we are equipped in our traditional training with understanding how to actually figure out what to do for these patients with abnormal liver function tests. And I certainly was never trained. But the beautiful thing about functional medicine is that we have a way of evaluating the liver differently. We have a different diagnostic test 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. His 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, it's super, it's, it's super encouraging when you see these kinds of patients because they 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 10 of those pounds and then within a few more months he lost another 10 pounds and his fasting insulin came down to normal, his liver function tests, his 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 did really well. Well, that's so great.

And, I think for those listening, if you had issues with liver function, abnormalities, if you have fatty liver, if you think you have it, or if you know someone who has it, please tell them about this podcast. Go listen to it. Come see us at the Ultra Wellness Center. We take people from all over the world. We have virtual consults. We do now. We can accommodate you all there. We're pretty booked up, so you might have to wait a while. But, the beautiful thing is there's lots free content. We're doing groups on online too now which will be able to help sort through your problem even without getting an immediate appointment. And, we'd love to see you. So, come to visit us and also share your experiences with maybe what you've had with fatty liver. Have you struggled? What have you done? Have you fixed it? Leave a comment. We'd love to hear from you. Subscribe to Every Year of your podcasts and share this with your family and friends on social media. And, we'd really be excited to get this out there this is a big problem and everybody needs to know about it. And we'll see you next week on the Doctor's Pharmacy.

Hey, everybody, it's Dr. Hyman.

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