Latest / The Gastro Truth with Dr. Mel Ona / How to Catch Fatty Liver While It's Still Reversible

Transcript

How to Catch Fatty Liver While It's Still Reversible · The Gastro Truth with Dr. Mel Ona

• 0:00
  SPEAKER_00: One in four adults has this.
• 0:02
  SPEAKER_00: Most have no idea because the early version doesn't hurt at all, and it stays reversible right up until it doesn't.
• 0:08
  SPEAKER_00: There are four numbers on your last blood test that tell you where you stand, and two more checks that need no blood work at all.
• 0:14
  SPEAKER_00: So if your last blood test is on your phone or in a drawer somewhere, go grab it now.
• 0:18
  SPEAKER_00: If you don't have it, stay with me anyway.
• 0:20
  SPEAKER_00: The last two checks you can do sitting right where you are.
• 0:23
  SPEAKER_00: I'm Dr.
• 0:24
  SPEAKER_00: Mel Ona.
• 0:25
  SPEAKER_00: I've been a gastroenterologist here in Hawaii for about nine years.
• 0:28
  SPEAKER_00: And before medical school, I obtained a Master's of Science degree in nutritional biochemistry and metabolism, which is a long way of saying I studied what food does to a body before I ever studied disease.
• 0:40
  SPEAKER_00: Now that turns out to be most of what fatty liver actually is.
• 0:43
  SPEAKER_00: Now back six or seven years ago, I was the first doctor in the state to put a liver scanner into private practice.
• 0:49
  SPEAKER_00: So I've put that probe on a lot of people who'd been told their blood work looked fine.
• 0:54
  SPEAKER_00: Nothing about the early version of this gets flagged on a normal annual physical.
• 0:58
  SPEAKER_00: And I've been on the other side of this myself.
• 1:01
  SPEAKER_00: I gained a significant amount of body weight earlier in my life, and I took more than 60 pounds back off.
• 1:07
  SPEAKER_00: So when I talk about the liver and metabolism, it isn't just theoretical for me.
• 1:11
  SPEAKER_00: Okay, let's do your four numbers first.
• 1:13
  SPEAKER_00: Now, numbers one and two, ALT and AST.
• 1:17
  SPEAKER_00: Find ALT and AST on your report.
• 1:19
  SPEAKER_00: They'll be grouped with your liver panel.
• 1:22
  SPEAKER_00: Now on older reports, they're labeled SGPT and SGOT.
• 1:27
  SPEAKER_00: Now these are enzymes that live inside your liver cells.
• 1:30
  SPEAKER_00: When those cells are under stress and get damaged, the enzymes leak out into your blood.
• 1:35
  SPEAKER_00: So a rising ALT means one thing.
• 1:38
  SPEAKER_00: Your liver cells are taking hits.
• 1:40
  SPEAKER_00: Now, here's the thing about that number.
• 1:42
  SPEAKER_00: A lot of labs set the top of the normal range at 40.
• 1:46
  SPEAKER_00: Some go as high as 56.
• 1:48
  SPEAKER_00: So if your ALT is 38, it prints as within normal limits and it never gets mentioned.
• 1:52
  SPEAKER_00: But that range on the page isn't a health target.
• 1:54
  SPEAKER_00: It's just where most of the people that lab has tested happen to land.
• 1:58
  SPEAKER_00: And a lot of those people already have fatty liver.
• 2:01
  SPEAKER_00: More current research puts the optimal number below 30 for men and below 19 for women.
• 2:06
  SPEAKER_00: So write your ALT down.
• 2:08
  SPEAKER_00: Then compare it to those numbers, not the one the lab printed.
• 2:11
  SPEAKER_00: And do one more thing, because this next part is what actually predicts trouble.
• 2:15
  SPEAKER_00: Go back a year.
• 2:16
  SPEAKER_00: Go back two if you've got them.
• 2:18
  SPEAKER_00: Is your ALT the same?
• 2:20
  SPEAKER_00: Or has it been creeping up?
• 2:22
  SPEAKER_00: I've seen people carry a slightly elevated LT for three, four, five years in a row.
• 2:27
  SPEAKER_00: Every chart note says mildly elevated, will monitor.
• 2:30
  SPEAKER_00: And that's a completely reasonable note to write on any single visit.
• 2:33
  SPEAKER_00: It's the fifth one in a row that's the problem.
• 2:36
  SPEAKER_00: The number wasn't wrong, it just never turned into anything.
• 2:39
  SPEAKER_00: So numbers three and four, triglycerides and HDL.
• 2:43
  SPEAKER_00: Now scroll to your lipid panel and find two more things, triglycerides and HDL.
• 2:47
  SPEAKER_00: Triglycerides above 150, HDL below 40 if you're a man, or below 50 if you're a woman.
• 2:52
  SPEAKER_00: Either one on its own can mean a few different things.
• 2:55
  SPEAKER_00: But when they show up together, triglycerides climbing while HDL drops, they're describing one thing.
• 3:02
  SPEAKER_00: Your body is having trouble handling fuel.
• 3:04
  SPEAKER_00: And that's why a liver problem often shows up on a cholesterol panel before it shows up anywhere else.
• 3:09
  SPEAKER_00: Now the honest limit of this check.
• 3:11
  SPEAKER_00: Now I've got to be straight with you about something before we go further.
• 3:15
  SPEAKER_00: Plenty of people with fatty liver have enzymes that come back completely normal, not borderline, normal.
• 3:21
  SPEAKER_00: So treat these four numbers as a screen, not a verdict.
• 3:25
  SPEAKER_00: If they come back clean, and the two things I'm about to describe still sound like you, you check anyway.
• 3:31
  SPEAKER_00: So the two things a lab report can't tell you, two more things to check, and these aren't on any piece of paper.
• 3:37
  SPEAKER_00: First one, put your hand just under your right rib cage, not on your stomach, higher and to the right.
• 3:43
  SPEAKER_00: Your liver sits right there.
• 3:45
  SPEAKER_00: Now, if you get a fullness or a dull pressure in that specific spot after you eat, pay attention to that.
• 3:50
  SPEAKER_00: When the liver is swollen with fat, it pushes on everything around it.
• 3:54
  SPEAKER_00: That pressure may be what you're feeling.
• 3:56
  SPEAKER_00: So most people with that symptom spend years blaming their stomach for it, because the liver sits a few inches from where they think it does.
• 4:03
  SPEAKER_00: Now, second one, where do you carry your weight?
• 4:05
  SPEAKER_00: If the weight goes to your middle and stays there, even when the scale has moved, that's the same thing your lipid panel was pointing at.
• 4:13
  SPEAKER_00: So that's your check.
• 4:14
  SPEAKER_00: Four numbers and two questions.
• 4:16
  SPEAKER_00: If two or more of those came back concerning, you've got a reason to look at the liver directly.
• 4:22
  SPEAKER_00: So why I don't drink doesn't rule it out.
• 4:25
  SPEAKER_00: Now I want to be clear about this next part because it's the single most common reason people skip all of it.
• 4:31
  SPEAKER_00: You don't have to drink to get fatty liver.
• 4:33
  SPEAKER_00: And most people I diagnose aren't heavy drinkers.
• 4:36
  SPEAKER_00: A lot of them barely drink at all.
• 4:38
  SPEAKER_00: So you also don't have to be visibly overweight.
• 4:41
  SPEAKER_00: There are people who look completely fine and have it.
• 4:43
  SPEAKER_00: The name of the condition actually changed for this reason.
• 4:46
  SPEAKER_00: It used to be called non-alcoholic fatty liver disease.
• 4:49
  SPEAKER_00: Now it's called metabolic dysfunction associated steatotic or fatty liver disease, because alcohol was never the main cause.
• 4:57
  SPEAKER_00: So if it isn't the drinking, what is it?
• 4:59
  SPEAKER_00: One of your liver's jobs is handling the sugar and the refined carbohydrate coming through it.
• 5:03
  SPEAKER_00: When more of that shows up than your body has a use for, the liver turns the extra into fat and it stores that fat right there in the liver.
• 5:11
  SPEAKER_00: So that's it, that's the mechanism.
• 5:12
  SPEAKER_00: It isn't exotic and it isn't rare.
• 5:15
  SPEAKER_00: It's just that nobody looks at a glass of orange juice and thinks about their liver.
• 5:19
  SPEAKER_00: What the real test actually finds.
• 5:21
  SPEAKER_00: So let's say your self-check came back concerning.
• 5:24
  SPEAKER_00: What happens next?
• 5:25
  SPEAKER_00: The scan is called a fibroscan.
• 5:27
  SPEAKER_00: Takes about five minutes, you lie down, we put a probe on your right side, and it sends a small pulse through the liver.
• 5:34
  SPEAKER_00: Two numbers come back.
• 5:36
  SPEAKER_00: One is how much fat is in there, and the other is how stiff the liver has become, which tells us whether there's scarring or fibrosis starting.
• 5:44
  SPEAKER_00: No needles, nothing to drink, nothing to really recover from, and you're back in your car in 10 to 15 minutes.
• 5:50
  SPEAKER_00: So a regular liver ultrasound picks up fat too, and it's more widely available.
• 5:54
  SPEAKER_00: And either one tells you far more than another year of not knowing.
• 5:58
  SPEAKER_00: So what to ask for and how to know it's working.
• 6:01
  SPEAKER_00: Take your numbers to your primary care doctor first.
• 6:03
  SPEAKER_00: That's the right starting point, and it's a short conversation.
• 6:06
  SPEAKER_00: A sentence to use is this my ALT has been sitting at this level for a couple of years and my triglycerides are up.
• 6:14
  SPEAKER_00: Can we image my liver?
• 6:15
  SPEAKER_00: Now if they order an ultrasound, good.
• 6:18
  SPEAKER_00: If they send you to a gastroenterologist, also good.
• 6:20
  SPEAKER_00: Now every practice has a fiber scan and you don't need one to get started.
• 6:25
  SPEAKER_00: Now here's the part that usually doesn't come up.
• 6:27
  SPEAKER_00: Early fatty liver reverses.
• 6:30
  SPEAKER_00: And I'm not being optimistic with you, that's just what happens.
• 6:32
  SPEAKER_00: Fat comes back out of the liver when the rest of your metabolism changes.
• 6:45
  SPEAKER_00: So if you're finding this on a lab report, instead of because something hurts, you're almost certainly still early enough for it to matter.
• 6:53
  SPEAKER_00: So how do you know it's working?
• 6:54
  SPEAKER_00: You recheck.
• 6:56
  SPEAKER_00: Get the enzymes redone in three to six months.
• 6:58
  SPEAKER_00: After you've actually changed something.
• 7:00
  SPEAKER_00: If the number is coming down, keep going.
• 7:03
  SPEAKER_00: And if you've made real changes and it hasn't moved at all, that's when you push for the scan and a closer look, because something else may be going on.
• 7:10
  SPEAKER_00: So if your numbers came back ugly today, there's a second half to this.
• 7:14
  SPEAKER_00: Early fatty liver has warning signs some patients can feel, and patients spend years blaming them on their stomach.
• 7:21
  SPEAKER_00: There's a video on this channel that walks through all of them.
• 7:23
  SPEAKER_00: This one gave you the numbers.
• 7:25
  SPEAKER_00: That one gives you the symptoms that go with them.
• 7:28
  SPEAKER_00: Go watch it next.
• 7:29
  SPEAKER_00: So your liver isn't a lost cause, and neither are those numbers.
• 7:32
  SPEAKER_00: The liver is the one organ that genuinely rebuilds itself when you give it a chance.
• 7:37
  SPEAKER_00: And now you know how to read whether it needs that.
• 7:39
  SPEAKER_00: Subscribe, and the next one of these will find you.
• 7:42
  SPEAKER_00: Every week I put out videos like this so you can take care of your health from the inside out.
• 7:46
  SPEAKER_00: See you on the next one.