Scott Webb (Host): Metaphorically speaking, our livers wear many hats. In other words, they do a lot in our bodies and are essential to good health. Today, I'm joined by Dr. Robert Vincent. He's a board certified gastroenterologist and an independent physician who chooses to practice at Franciscan Health, and he's here to tell us about fatty liver disease, who's at risk, and how we can help ourselves by keeping our hearts and bodies healthy.

 This is the Franciscan Health Doc Pod. I'm Scott Webb. Doctor, it's nice to have you here today. We're going to talk about fatty liver disease and what that is and who's at risk, but I want to give you maybe the easiest, hopefully the easiest question here up front. What does the liver do?  

Dr. Robert Vincent: An awful lot. It does a little bit of everything. the liver filters the toxins and processes the first wave of all the nutrition you absorb from your gut and GI tract. And in that process, it makes the things that make your blood coagulate. It makes backup energy on demand. It stores your vitamins, and it keeps proteins in your blood to help things be in the right place. It does an awful lot, and helps you digest fats, which is where some of the issues come from.

Host: Yeah. As you say, it wears many hats, if you will, inside our bodies. So then, what is fatty liver disease?

Dr. Robert Vincent: Well, fatty liver disease, which they've kind of changed the name to metabolic-associated steatotic liver disease, or metabolic-associated steatohepatitis, if it's an advanced form, is where too much cholesterol is kind of absorbed and contained within the liver, in particular triglycerides, and that is the fat that becomes excess in the liver.

And because of that, the cells can't function normally, and we start having problems with function, and sometimes, in some patients, inflammation and scarring, and that's where we worry the most.

Host: Yeah. As you say, we're trying to get away from referring to it as fatty liver disease. And I definitely don't know all those big words that you used, but who's at risk for MASLD or MASH?

Dr. Robert Vincent: An awful lot of Americans. High cholesterol, diabetes, hypertension, having extra weight, all these things are known as risk factors that can cause fatty liver disease in patients. There is a genetic component, and we're still trying to figure that out, because some patients-- heck, a lot of Americans-- up to 50% of us, 40-50% of us, develop this condition, but not everybody has a problem. They don't develop the inflammation and scarring.

Host: Okay. Yeah. Are there signs and symptoms of liver disease? In other words, like does one know, or does it really need to be diagnosed?

Dr. Robert Vincent: It does need to be diagnosed. It can really go under the radar. Even general labs that your primary doctor perform may not detect it, because you may not have enough inflammation to kind of spark a concern, and patients who are at risk may need to have a screening test that looks for fat in the liver. And heck, a lot of our patients are diagnosed by accident when they have a CT scan or an ultrasound, and they're told that they may have steatosis, or fat in the liver, and then they're referred to us.

Host: Yeah. And in putting my notes together for our conversation today, doctor, I came across FibroScan and wondered what that is.

Dr. Robert Vincent: Well, that's a test we use to kind of risk stratify patients. If somebody has fatty liver disease, we can use the FibroScan to see if there is a lot of steatosis in the liver. That's the cholesterol and, at the same time, get a judgment whether there's any scar because the FibroScan will see if the liver is stiff. And if the liver's not stiff, then we have less to worry about. There's definitely not scar, but if it is stiff, we need to work it up more.

Host: Yeah. And you said that, you believe anyway, that there's a family history, a genetic component to fatty liver disease. Is there anything we can do though, behavior, lifestyle, otherwise, exercise, diet, whatever it might be to prevent liver diseases?

Dr. Robert Vincent: Yes. For this one in particular, exercise, diet, and weight loss is the best and initial treatment. And doing that and bringing that as part of your life can help prevent it. And when it does occur, it can help remove this steatosis, so then the condition kind of resolves and the inflammation starts to go away. There may be scar that's still present and we may have to look out for that. But yes, healthy lifestyle is the best treatment we know, even though there's some newer options that are becoming available.

Host: Okay. So then, once a diagnosis has been made, let's talk about the stages of the disease and what the progression of the disease is like and is there anything that can be done to reverse or slow down the disease or do folks just basically live with liver disease?

Dr. Robert Vincent: A lot of liver diseases can be affected by what we do, like we were discussing before, but how we stage it is done either with a FibroScan that I mentioned. But some patients may need to have a liver biopsy if there's concerns of another process also affecting the liver. So with either the FibroScan or the liver biopsy, we stage it by how much scar is there. And the lowest level is F0, or essentially no fibrosis or scarring. And we go to F1, F2, F3. And if we reach F4, that's considered cirrhosis. And that's when we start having other problems that we really need to look out for. And that's really what we're trying to prevent when we're working with these patients. Those patients, we may need to do periodic testing and also imaging and even endoscopy to make sure we're not developing a complication that we're not aware of until it's really profound.

Host: Yeah.

Dr. Robert Vincent: Now, as if we can reverse it, the scarring doesn't reverse, but we can get rid of the steatosis. So, no scarring occurs. And there is some research looking into whether we can reverse the scar, but that's still in process. It's kind of early stages for that work.

Host: Yeah, still down the road. So, let's talk treatment options. It sounds to me like things have come a long way in my conversations with other Franciscan health experts. Doctor, it just seems like there's a lot of room for optimism. Is that the same? Would you express the same thoughts when it comes to liver diseases and the treatment options?

Dr. Robert Vincent: Yeah. Definitely things are getting better with liver diseases, and survival is improving. We can reverse a lot of things and we do have new medication treatments for fatty liver disease and also a lot of other liver diseases. You just need to, you know, work with your primary doctor and then sometimes with us to try and work on those options

Host: Yeah. And then specifically, maybe just broadly here, when we think about the treatment options, maybe you could take us through that a little bit. Is there sort of steps, you know, starting one place and ending up perhaps with surgery? How does that work in terms of treatment?

Dr. Robert Vincent: Well, initially, if we find out there's just simple steatotic liver disease, we work with the exercise, diet, and weight loss, and then kind of track that with FibroScan or other tests to see if the cholesterol or the steatosis goes away. We also follow liver enzymes to see if the inflammation goes away too. That's our first step. Now, if there's scar and it's progressed to a certain stage, we then watch out for liver problems or reduction in liver performance. And if we develop cirrhosis, we sometimes refer the patient to a transplant center. But that is rare and farther along in the process.

Host: Yeah. So, it sounds more like a sort of monitoring and surveillance, if you will, just, you know, keeping track of the liver, how it's doing, how folks are doing. I just want to finish up here today and just give you a chance. We think about keeping our livers healthy and how important that is, because as you mentioned at the start of the podcast, liver does a lot, right? It wears a lot of hats. So, how do we keep our livers healthy?

Dr. Robert Vincent: Healthy life in general. Trying to avoid too much alcohol, everything in moderation is the simple answer for everything. And with a lot of liver disease too, your heart is actually more important. So if you do something healthy for your heart, it's healthy for your liver. And that's kind of the best way to try and live and prevent things from this condition.

Host: Yeah, that's great advice from an expert today, right? We keep our hearts healthy, keep our bodies healthy, it extends to the liver, of course, hopefully. So, really appreciate your time today. Thank you so much.

Dr. Robert Vincent: Thank you.

Host: And to learn more, visit franciscanhealth.org and search fatty liver. And if you found this podcast helpful, please share it on your social channels, and be sure to check out the full podcast library for additional topics of interest. This is the Franciscan Health Doc Pod. I'm Scott Webb. Stay well, and we'll talk again next time.