Scott Webb (Host): Fatty liver disease is fairly common and reversible, but if it's left untreated, it can lead to cirrhosis of the liver. And joining me today to tell us more about fatty liver disease, including diagnosis and treatment, is Dr. Vikram Patel. He's a Gastroenterologist with Salinas Valley Health. 

This is Ask the Experts, the podcast from Salinas Valley Health. I'm Scott Webb. Doctor, it's great to have you here today. We're going to talk fatty liver disease, and I don't do that very often, but I'm guessing you probably spend a fair amount of time talking about fatty liver disease, explaining it to folks, helping them to slow it down or reverse it.

But before we get to that, I just want to let everyone know, you know, you're from Salinas and you're back there now, and that's probably pretty cool. So tell us about it. Tell us about your journey a little bit and getting back to Salinas.

Vikram Patel, MD: You know, I was born and raised in Salinas. I went through the public school system here in Salinas, California. Went to high school at Salinas High, graduated 2004, go Cowboys. Went to college at UC Berkeley, Medical School Ross University School of Medicine, and did my medicine residency and fellowship on the East coast.

And then when I finished all of that training, I decided to move back to my hometown to serve the community of Salinas, California.

Host: Brings a big smile to my face and as I teased there at the beginning, we're talking fatty liver disease. So let's do that. What is fatty liver disease? 

Vikram Patel, MD: Fatty liver disease, it's a condition where there's an accumulation of fat in the liver. And normally the liver is responsible for processing nutrients and detoxifying harmful substances in our body. But when too much fat builds up, it can start to affect the liver's ability to function properly.

Now, the official name of fatty liver disease belongs to a group called Steatotic Liver Disease, in which there are categories or subcategories called metabolic dysfunction, associated steatotic liver disease and alcohol associated liver disease. And for the purpose of this talk, and to make it easy for our listeners, I'll refer to both as fatty liver.

Host: Yeah, so it makes me wonder, Doctor, what are the main causes of fatty liver disease and is it different than cirrhosis?

Vikram Patel, MD: Yeah. So, fatty liver, it's associated with conditions like obesity, diabetes, high cholesterol, high blood pressure. There is another type of fatty liver, which I kind of referred to earlier, which is specific to excess alcohol consumption, which can damage liver cells, leading to fat buildup. And as this disease process, fatty liver progresses, it can lead to cirrhosis.

Now, as far as fatty liver disease and cirrhosis, they are related in a sense, that, you know, fatty liver can lead to cirrhosis. Some people have simple fatty liver where just the fat accumulates in the liver without significant damage, but at some point there is a chance of the fat to build up leading to inflammation of the liver cells or damage to the liver cells.

And this chronic inflammation can lead to fibrosis or scarring of the liver. And when there's advancement of this type of scarring, that's when this can lead to cirrhosis. And fatty liver can be reversible and generally cirrhosis is not. So I want everybody to think of cirrhosis as a form of end stage liver disease.

Host: Yeah, so like a lot of things in medicine, doctor, it sounds like, early diagnosis, right? Early treatment, as you say, because fatty liver can be reversed, but cirrhosis really can't. So let's talk about that then. Let's talk about the symptoms. What should we be on the lookout for if we think that we might have fatty liver disease or cirrhosis?

Vikram Patel, MD: So symptoms of fatty liver disease are often mild or even absent. Some patients may experience fatigue or even discomfort in the right upper quadrant of the abdomen. Symptoms of cirrhosis can be absent to even severe in terms of buildup of fluid around the abdomen and even life-threatening gastrointestinal bleeding.

 It is important to note that the most common cause of cirrhosis in the United States used to be from hepatitis C, and then it became alcohol related, and now fatty liver is starting to emerge as the most common cause of cirrhosis in the United States, and this is why it's so important to get screened.

And if you do have fatty liver, then you know to make necessary changes now to prevent progression to that end stage liver disease or cirrhosis.

Host: Yeah. Well, and this is why we have experts on Doctor, because in my mind I'm still locked into, you know, alcohol leads to cirrhosis. And it may still, but as you say, fatty liver is sort of gaining or in the lead now, so important to recognize the signs, symptoms, perhaps of fatty liver disease and certainly to be diagnosed.

So let's talk about that. Like how do you diagnose fatty liver disease? What tests are typically involved?

Vikram Patel, MD: Fatty liver, it's usually incidentally found on imaging such as an ultrasound, which a doctor may order for a patient who was found to have elevated liver numbers in their routine blood work. However, an ultrasound does not really tell you how much fat has built up or how much scarring is present on the liver.

It either tells you, yes, there's fatty liver, or yes, you know, there may be scarring. It doesn't really tell you how much. And one test that we do use to help better characterize and diagnose fatty liver is a test called the fibro scan, and this is a special type of ultrasound that measures the amount of scarring and the amount of fat using high frequency sound waves to estimate the stiffness of the liver. In general, it sort of helps us keep tabs on the overall liver health.

Host: Yeah, I was just thinking, you know, you mentioned that it can be reversed, right? So we, we've sort of established that we, if we get early diagnosis, perhaps early treatment, uh, that's a good thing for us. Let's talk about the lifestyle changes. What can we do to reverse this, to get this under control?

Vikram Patel, MD: Yeah, Scott, so you're, yeah, absolutely right. Fatty liver, especially in its early stages, can be reversed with appropriate lifestyle changes. So this typically involves addressing root causes such as controlling obesity, diabetes, cholesterol. For weight loss, typically we would recommend working on losing about five to 10% of body weight, eating a healthy diet, including fruits, vegetables, and healthy fats like those found in olive oil, nuts, or avocados.

Another big thing is limiting sugar and refined carbohydrates like processed foods and sugary drinks. Increasing fiber intake and avoiding alcohol is very important and exercise, about 150 minutes per week or 30 minutes per day is a pretty good amount to help reverse, fatty liver and you know, effectively managing it.

Host: Yeah. And you mentioned that, we should really think of cirrhosis as sort of end stage and not a place we want to get. Right? We don't want to get to the finish line there. So what are the potential complications of cirrhosis and how does it affect our overall health?

Vikram Patel, MD: The liver has several different functions including detoxifying harmful substances, metabolizing and storing nutrients, producing bile for digestion. It helps make proteins and clotting factors. It regulates cholesterol, and blood sugar levels. It does help with immune function and hormone function.

So when you have cirrhosis or end stage liver disease, in general, a lot of these processes are compromised, and as the liver becomes severely damaged from long term and progressive fatty liver disease or ongoing alcohol abuse, it can lead to serious complications such as liver failure, obstruction and backup of blood flow from the liver resulting in enlarged veins in the esophagus, which can lead to life-threatening bleeding.

 It can cause enlarged spleen, which has a whole, you know, downstream effects as well. And it can also cause fluid buildup in the abdomen. Another thing is cirrhosis can lead to buildup of ammonia, which can affect brain function. We refer to this as hepatic encephalopathy. Other things, cirrhosis may also lead to liver cancer, kidney failure, bleeding, and various other types of infections as well.

Scott Webb: Right. So we definitely don't want cirrhosis. We want to try to avoid that, and we want to try to get fatty liver disease under control. And you touched on a little bit earlier about how we can live healthier, eat healthier. How about medical treatments, medications, things like that to help slow or even prevent the progression. 

Vikram Patel, MD: In general, when it comes to slowing down progression of fatty liver and to prevent cirrhosis, I can't stress enough, but treatment and control of the underlying risk factors is the most important thing. So, you know, medications, you can take medications to help control your diabetes and control cholesterol. 

There are quite a few new weight loss medications that are out there now that can help control obesity, which can help you with weight loss and help with fatty liver sort of indirectly in that sense. And when it comes to direct treatment specifically for fatty liver, putting aside all those risk factors; we didn't really have any medications until recently. Within the last year, a new medication called Rezdiffra just came out, but as of right now, it's only applicable to a certain subgroup of patients with fatty liver and a certain degree of scarring. And again, I do want to stress the most important treatment for fatty liver is lifestyle changes and treatment of those underlying risk factors as I mentioned before.

Host: Yeah, lifestyle for sure. Lifestyle behavior. And I wanted to drill down a little bit more and talk about the foods. Like what should we include and what should we avoid?

Vikram Patel, MD: Diet is the most important thing. So if there's one thing you want to Google and you know, follow is Mediterranean diet is probably the most healthy diet out there. But yeah, focusing on nutrient dense foods such as fruits, vegetables, whole grains such as quinoa, lean proteins such as chicken, fish, and even beans, are beneficial. Try eating healthy fats such as unsaturated fats like olive oil, avocados, and nuts. And, fatty fish like salmon is also pretty, is good too. Another thing, increasing fiber intake. And, you know, another important thing is while eating these foods, mindful eating with portion control and avoiding overeating is really important.

Also limiting intake of sugary drinks, sweets, desserts, processed foods such as white bread, pastries, and chips. You really want to avoid those things as well.

Host: I definitely should have eaten before I hosted this Doctor. But it's great to have you on today. Great to benefit from your expertise, understand fatty liver disease a little bit better. Just give you a chance here. Final thoughts and takeaways.

Vikram Patel, MD: One other thing that I want to add on here is for all the coffee lovers, black coffee is the best form of coffee for liver health. And it's actually been shown to protect the liver, when having about three cups a day. So the only time you want to be careful with coffee is when you start adding sugar or creamer or flavored syrups.

You may be contributing to liver fat and some other points to remember, fatty liver is a treatable disease and mostly can be managed with lifestyle changes. Another bullet point would be 150 minutes of exercise per week is recommended. Maintaining healthy weight, making sure you're controlling those risk factors that we talked about before.

And also if you have any of these risk factors or for our patient listeners, if you do have any of these risk factors, it won't hurt to ask your doctor about getting checked and evaluated for fatty liver, so you are aware and you can make those necessary changes early in its course in order to prevent cirrhosis, which can lead to several complications including premature death and need for liver transplant.

Host: Definitely. Well, like I said, I appreciate your time today, your expertise. I'm going to run and get something to eat. Thank you so much. You stay well.

Vikram Patel, MD: All right. Thanks Scott.

Host: And to schedule an appointment with Dr. Patel, please call 831-424-8888. 

Host: And to listen to more of our podcasts, please visit salinasvalleyhealth.com/podcasts. And if you found this podcast to be helpful, please be sure to tell a friend, neighbor, or family member. And subscribe, rate and review this podcast, and check out the entire podcast library for additional topics of interest. This is Ask the Experts from Salinas Valley Health. I'm Scott Webb. Stay well, and we'll talk again next time.