Dr. Sarah Wakeman
speaker
484 appearances
2 recordings
2 series
first heard Jan 2025
last heard May 2025
Dr. Sarah Wakeman’s voice in public audio — every appearance, attributed to the second.
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You would still be able to live and they would get a second chance at life from that part of your liver. So it's this really cool organ that can regenerate. But it can only regenerate up to a point. So once you get to a level where you have a lot of scar tissue in your liver, we call that cirrhosis, you sort of reach a point of no return where at that point the liver can't heal itself.
So I sort of think of it like, to use a baking analogy, if you're making muffins or a cake, You're going along, you're mixing all your ingredients and you realize before you put things in the oven, like, oh, I forgot the eggs. You can still add the eggs in and like whisk it all together and it's going to be okay.
If the muffins are baking in the oven and you forgot the eggs, you can't like pour the eggs on top and make the batter the same. And the liver is sort of like that, that up to a certain degree, you can actually completely repair the effects of things like alcohol or obesity, other things. But once you pass that point into scar tissue, the liver can't regenerate anymore.
And so when you think about that graph or just the rising rates of liver disease, the main drivers of liver disease are obesity and two is alcohol. And so those are the leading causes of liver transplant. And the thing that is so sad is, I mean, I see this all the time working in the hospital is, first of all, we're seeing younger and younger people coming in and liver failure.
So people in their 20s coming in and fulminant liver failure from alcohol and then dying in the hospital. And the terrible thing is that they often didn't even know that this was causing a problem in their health. And by the time they get to the hospital, they're so sick, it's too late. And yet all of that could have been prevented or even repaired if it was caught sooner.
And so that's where I think this education of understanding, like, what really are the health harms of alcohol? And that we have normalized binge drinking on many occasions, especially in young people, as being totally normal. And yet there are very serious health consequences.
Yeah. I mean, so first, every person is different. One blowout weekend, you probably would be fine. Anyone would probably be fine. The challenge is one blowout weekend then leads to like multiple blowout weekends. And then over time, that can actually accelerate the damage to your liver.
as long as you haven't gotten to that scarring phase. So once you get too far down that path, even if you were to stop drinking, your liver won't recover. The hard thing is that we don't totally understand who and why that happens so young too. So this is an active area investigation because there are people who've been drinking for 60 years and their livers don't show signs of scarring.
And then we're seeing these young people at 25 who come in and die in the hospital. And so there are individual factors that you don't have any way of knowing that are gonna impact your risk of developing liver inflammation and scar tissue. And so the safest way to prevent that is to not drink in these really high ways that we know are going to lead to harm.
The other way is to get medical care because often we do detect these things through blood tests and we can do ultrasounds. And when we see those early phases, so what happens first is you actually get fat deposition in your liver. That's the first step. And then we see inflammation and fatty liver.
And if you don't stop the thing that's driving those changes, over time we see the development of what's called fibrosis, which is like scar tissue. And then that scar tissue gets more and more advanced to the point that your liver stops functioning and you either die or you need a liver transplant.
Yeah. So obesity. Food does. Yeah, food. So your liver is very involved in glucose metabolism. So our diet and our body weight impact our liver health. And the other medications, so acetaminophen or Tylenol, which is a very common over-the-counter pain reliever, above a certain threshold can cause... Serious liver damage.
So sometimes we'll see cases where someone didn't realize that like their cold medicine plus the Tylenol they were taking both had that ingredient and then they go out and drink heavily and that kind of combination effect can cause liver damage.
So again, it varies person to person. For liver damage, it does tend to be the moderate to higher amounts that cause damage. One thing is that having these big surges, like these massive binge episodes, is probably more harmful than drinking at a moderate level for a long period of time. Those big surges cause a big buildup of that toxic byproduct that your body has to clear.
And so if you have several years of binge drinking heavily, that actually probably is going to cause more damage than a longer period of time of just drinking above the risk limit. So really trying to minimize and avoid those very heavy drinking episodes is incredibly important.
And then keeping it to those low risk guidelines, which we just learned are kind of eye opening and how low risk they are is going to reduce the risk of liver damage.
No, I mean, alcohol has effects across our body. So many parts of the body can be affected by alcohol. So kind of starting from the top, your brain. And we can look at this with pictures like an MRI. Oh, I've got one. Yeah, I think.
Yeah. To me. So when we do an MRI of someone's brain, we basically, this is like a cross slice. So it's almost like you're facing me and I'm cutting your face off and looking at your brain onwards. Healthy brain tissue is the gray and white matter. And you want it to be as plump and like taking up as much space as possible because that's where all of your brain activity is.
When people get really old or have dementia, one thing we see is more and more the black space is essentially water. So we see the brain start shrinking and shrinking, and there's more water and less active healthy brain tissue. That process is accelerated with heavy alcohol use. And so you can see here, this is a 43-year-old person with...
severe alcohol use disorder where their brain looks the way, you know, a 90-year-old with dementia would look because of that brain damage over time from alcohol use. And so we can actually, a form of dementia is related to alcohol use. And so your brain can be hugely impacted with alcohol.
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