Dr. Yousef Elyaman
Appearances
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
So one of the major things is food, right? So food and insulin resistance is kind of at the top of the list. So our food, there's more sugar being added to our foods. There's higher carbohydrates. But when you look a little bit deeper into it, high uric acid as well. So that comes from eating too much fructose. Fructose, which is like high fructose corn syrup in all our...
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
So we have high fructose corn syrup. Alcoholism is on the rise. So alcohol is a toxin. So that also is going to affect the liver, along with small intestinal bacterial overgrowth. So bad bacteria in the gut. The gut can be as metabolically active as the cytochrome P450. Yeah.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And because of our current lifestyles, the bacteria in our gut or in our intestines are changing, and they're changing for the worst. And there is an association between small intestinal bacterial overgrowth, which is one of the major causes of irritable bowel syndrome, and having fatty liver disease.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Absolutely, right, right. Yeah, what did you say, a food baby? Food baby, you know, that bloating thing. That food pregnancy. Right. Yeah, so one alarming statistic, they looked at young men that were not overweight, And they found that they did something called a insulin resistance score test on them. And they found that more than half of them had insulin resistance.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And these are young men in their 20s, not overweight, normal ideal weight. So I think that kind of brings us to one of the first drivers, which is this insulin resistance concept.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Yeah, their blood sugar normal.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Correct? It's the huge driver of fatty liver disease. I would say it's the number one driver, but there are eight or nine drivers. So what happens is that due to inflammation, due to toxicity, due to too much sugar, like too much of a sugar overload or a carbohydrate overload,
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
when those receptors on our fat cells, we have these insulin receptors that are supposed to take sugar and put sugar into the cells. When they start to not work well, when they start to get resistant, there is an enzyme called hormone sensitive lipase. And what that enzyme does is it starts tearing up the fat in the fat cell and it sends the fat to the liver and it overloads the liver.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
So now you have this liver that gets overloaded. So the liver ends up with a whole bunch of triglycerides, which is one of the tests that we look on the lipid panel. Now, here's the interesting thing. So you could check a triglyceride level, and their level would look okay. And that's because some people genetically will decrease triglycerides in the blood. Increase it a lot.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
What the triglycerides do, when you end up sending a whole bunch of triglycerides to the liver, they turn into something called VLDL. Very low density lipoprotein. Triglyceride rich VLDL versus triglyceride poor. And VLDL becomes, there's another enzyme found in the lining of our blood vessel that is called lipoprotein lipase. And it turns it into the tiny dense LDL.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
which causes clogging of the blood vessel and heart disease, strokes, and heart attacks.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Right, yeah. What's happening in the liver? So what's happening in the liver? So we can go back to what's happening in the fat and then go right back to the liver. So number one, the fat starts to send the triglycerides to the liver and start overloading the liver.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
When that process is overloaded, then your fat cells, which actually your fat is, I don't know if you've done a podcast on this, but your fat is like an endocrine organ. It makes things like adiponectin. When the process is bad, adiponectin levels can go down, which causes more insulin resistance and more inflammation.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And then there are other hormones that can go up in the liver that can cause inflammation, like tumor necrosis factor. like leptin, so those go up and now that inflammation and worsening insulin resistance and all that fat make its way throughout the body and they go in the liver and the liver starts to accumulate and accumulate and accumulate and it just can't keep up with it.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
The liver packages it and sends it back to the fat. The fat takes it up. But then because of the insulin resistant, it shoots it right back to the liver. And you end up with this vicious cycle. In the meantime, the liver is not supposed to be storing fat. The liver is supposed to be making all these metabolic processes. It's supposed to repackage the fat.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And now when it gets overloaded and jam-packed, Now the liver starts to get inflamed. It starts to rust, oxidative stress. Sugar starts to get worse. And it kind of creates this metabolic nightmare.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
It's a vicious cycle.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Right. And see, and the thing is, I mean, we could just go, we could probably do a whole podcast on when you have fatty liver, all of the other imbalances, all of the other things that are thrown off in the human body.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Unfortunately, too many providers, too many doctors take a look at, say, oh, you have fatty liver, lose weight, and they don't really talk to them about it again, when really that is driving heart disease. It's driving Alzheimer's disease. It's driving cancer. The liver is supposed to be metabolizing our toxins. So now your liver is not working. It causes hormone imbalances.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
The liver is supposed to metabolize estrogen. So now you can't metabolize estrogen. Estrogen goes up. Progesterone goes down. Women start to have infertility issues. Infertility is big. They start to have mood issues. They start storing more weight. And men. Men start to have that estrogen effect. It blocks their testosterone. And it's kind of this, it just, it affects everything.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
No, it's not. Well, I'll tell you, now that we have technology, non-invasive, easily accessible technology to take a look at the liver, when we tell people that their liver has fat in it or there's an issue with their liver, I have not seen a more motivating driver of change. As a matter of fact, when I see liver enzymes being up,
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
I had a patient who I talked to her about, she had elevated liver enzymes. I said, I want to take a look at your liver. I sent her to do this test, it's called a fibrous scan. Before she came back, she had lost, she stopped drinking alcohol and she had lost 20 pounds. Amazing. Yeah, it came back, her liver was fine.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
But what happened, when people hear that their liver, there's a problem with their liver for some reason, it creates that motivation. Yeah. Which I can tell them, hey, you're gonna die of a heart attack and it doesn't,
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Right, yeah, we could put them in, we can post them in the- In the show notes. Heart attack, yeah, yeah, we could put them in the show notes, the percentages.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Right, and going, so in the conventional realm, unfortunately, we try to look at the disease kind of in a vacuum, right? Okay, so you have fatty liver. So what can fatty liver do? Well, the liver can start getting inflamed and then it can start to turn into fibrosis or hardening and then you can get cirrhosis, right? And nobody wants liver cirrhosis, right?
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Most people know that liver cirrhosis is a bad thing and then you can also get liver cancer. But like you just mentioned, they have more of a chance of dying of a heart attack. than of the liver cirrhosis when they have fatty liver. So I think that's what you were alluding to. But I think the beautiful thing, and I'm so fortunate or grateful that I found functional medicine because,
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
We don't look at fatty liver as a disease in itself. We say there is a process that is happening. Part of a syndrome that's happening. Part of a syndrome. And everybody is unique on what's causing it. Because some people, it's insulin resistance. Some people are eating lots of the way that their body deals with fructose. They start to increase uric acid. And it's the uric acid that is driving it.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Where other people can have thyroid dysfunction that's causing it. And others could have an issue with, can have an issue with bad bacteria in the gut. So other people have a iron overload that is causing it. And others were exposed to different toxins. And it's probably a combination of multiple things.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Right, right, it's a prebiotic. Lactulose is a prebiotic, so you're feeding the good bacteria. So we were manipulating the microbiome, and we thought we were just making them poop. And it was amazing. It would take them out of that hepatic encephalopathy.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And actually it changed that. So they first went to metabolic associated liver disease. Then they changed it again because they... Yeah, whoever they are, the big panels. Actually, multiple panels got together and they talked to patients. But I think we should talk about that story a little bit, right?
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
So non-alcoholic fatty liver disease was basically you're naming a condition by saying what it was not. It's not alcoholic. It was kind of weird anyway. Even though that it was called non-alcoholic fatty liver disease, people associated with alcohol. Because alcohol was in the name, and they have to explain it to their family. No, I'm telling you, it's non-alcoholic. So you had that negative.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And then the fatty had a stigma, so they changed it to metabolic-associated or metabolic dysfunction-associated fatty liver disease. But then they changed it again because they're like, Fatty is stigmatizing, so we want fat out of it. So now it's metabolic dysfunction associated steatic, which means fat, liver disease. No, steatic, liver disease.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
So now you took everything out that anybody could understand.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Right, right, but now they don't get shamed as much.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Yeah, yeah, it's fancy, it's fancy. Whatever. So...
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Now it's called mazzled. Mazzled, mazzled.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Okay, so you go to a traditional hepatologist. It's a liver specialist. A liver specialist. They see the patient, they tell the patient you have fatty liver disease, go ahead and try to lose weight, right? They may give them vitamin E, probably are gonna give them the wrong kind of vitamin E, because we know that there's different forms of vitamin E.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And then, if you're lucky, many will say, no, don't stay away from vitamin E. And then they see if you're bad enough to be enrolled in a study. And if you are, then they'll put you on a drug, right?
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
There is one now. We just, in March, we have one called Resmediram. And we should probably unpackage that later because there's implication. But yes, so there's finally one drug. It costs only $4,000 a month. Is that it? Yeah, that's it. And it can cause all kinds of side effects as well. Great. But that being said, it's all about getting them, okay, we have a disease. We named it, right?
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
We need to tame it with a particular drug. But up until March, before that, what would they be telling you? Some would say, ask your doctor if he would prescribe semaglutide for you. Ozempic. Ozempic. That's currently what they'll tell you. For weight loss, because when you lose weight, fatty liver gets better. Right. So what would we do? We would take a look at the FibroScore.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
And I do want to talk about this FibroScore, or the FibroScan, because this is extremely important.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
Yes, unfortunately we don't. So semi-glutide. Okay, I was down picker, right? Yeah. And then? Yeah, and that's it. And then they just kind of leave you there. And most of them are not getting a fibroscan. Most of them don't know how bad it is. They don't know if they have fibrosis, which is hardening or not. And they just kind of wait until things get really bad.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
They might give you metformin or they'll give you the Ozempic or maybe some of the... Although metformin hasn't been found to decrease fatty liver disease, it's kind of... But they may give you that. They definitely will say, you have a high risk of heart disease, so make sure you're on a statin drug. So they will put you on a statin drug. And the problem is it's a double-edged sword.
The Dr. Hyman Show
Fatty Liver Is the New Smoking—And 90 Million Americans Have It
The statin drug can cause liver toxicity, but also it can change the way the lipid metabolism. So you know you may be hurting the liver, but you may be helping the heart, right? So it's kind of one of those.