302 - Confronting a metabolic epidemic: how to prevent, diagnose, & manage liver disease

Julia Wattacheril is a physician scientist & director of the Metabolic Dysfunction Associated Steatotic Liver Disease (MASLD) program at Columbia University Irving Medical Center. In this episode, Julia delves deep into the complex world of liver health, beginning with a foundational overview of liver physiology. She provides an in-depth look at how alcohol impacts liver function, breaking down the metabolism of ethanol & its detrimental effects. Julia then shifts the focus to understanding liver function tests & optimal enzyme levels, providing a detailed explanation of AST & ALT & elucidating why fluctuations in these levels may or may not be concerning. She provides a primer on the four major stages of liver disease, discussing risk & emphasizing the importance of early diagnosis. Julia highlights the role of liver disease in increasing the risk of cancer & cardiovascular disease & covers in detail the various strategies for diagnosing, treating, & preventing the progression of liver disease. Dr. Wattacheril’s views expressed in this conversation reflect her own, not those of her institution.

We discuss:
0:00:00-Intro
0:01:52-Julia’s training, importance of liver health, & innovations of hepatology
0:08:14-The crucial functionality of the liver & its four most essential functions
0:13:36-Liver injuries: understanding causal factors & the progression to liver diseases & cancer
0:26:03-How the liver metabolizes nutrients & what happens in the presence of excess calories
0:35:39-Methods of diagnosing liver disease
0:43:45-The poisonous nature of ethanol
0:51:19-Varied responses to alcohol, damaging effects of alcohol beyond the liver, & advising patients on their alcohol consumption
1:03:59-Liver enzymes AST & ALT—interpreting levels, lifestyle factors that affect them, & diagnostic approaches
1:20:39-Interpreting liver function tests for fatty liver disease, & diagnosing liver pathologies, particularly in children versus adults
1:26:45-Comprehensive liver health assessments via imaging & various diagnostic tools to prevent overlooking potential liver pathologies
1:35:32-Impact of recreational drugs, statins, & other medications on liver function test results
1:39:49-Shifting nomenclature from NAFLD to MASLD
1:46:40-Pathophysiology of MASLD, the need for proactive screening, & the significance of liver fat percentage
1:53:46-Screening for rare conditions alongside common metabolic diseases associated with fatty liver
1:56:50-Practical strategies for managing MAFLD
2:05:10-Impact of fructose consumption on liver health & the challenges of disentangling its effects from obesity & insulin resistance
2:10:20-The potential of GLP-1 agonists for the treatment of MASLD
2:13:31-4 stages of liver disease
2:18:21-Increased cancer & heart disease risk associated with early-stage MAFLD
2:26:18-Emerging drugs & therapies for addressing fat accumulation & fibrosis related to MAFLD
2:33:33-Takeaways
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About:

The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, & all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, & much more.

Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan & simultaneously improving their healthspan.