What if your fatigue, weight gain, hormone imbalances, and brain fog all traced back to a silent disease that affects 1 in 3 people—and you didn’t even know you had it? In today’s episode, I’m joined by Dr. Elizabeth Boham and Dr. Yousef Elyaman to talk about a condition that’s quietly becoming one of the biggest threats to our health: fatty liver disease—now renamed Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD). It’s not just a liver issue. It’s deeply connected to heart disease, cancer, infertility, type 2 diabetes, dementia, and even hormone dysfunction. The most alarming part is it’s often missed in traditional medicine because there’s no easy drug to prescribe. We break down: The real root causes—from sugar and starch overload to gut imbalances, toxins, alcohol, and chronic inflammation The surprising early warning signs your body might be giving you Why standard labs often miss it, and the tests you actually need The step-by-step functional medicine approach to reverse fatty liver naturally—using targeted nutrition, lifestyle upgrades, and proven supplements I also share the latest science on inflammation, why it’s the common thread between fatty liver and nearly every chronic disease, and how to calm it down at the root. This is the episode I wish every patient (and doctor) could hear—because fatty liver is reversible when you catch it early, and the ripple effects of healing it are massive. If you care about your energy, hormones, brain health, or longevity… this one’s for you. Dr. Elizabeth Boham is Board Certified in Family Medicine from Albany Medical School, and she is an Institute for Functional Medicine Certified Practitioner and the Medical Director of The UltraWellness Center. Dr. Boham lectures on a variety of topics, including Women’s Health and Breast Cancer Prevention, insulin resistance, heart health, weight control and allergies. She is on the faculty for the Institute for Functional Medicine. Dr. Yousef Elyaman is the founder and Medical Director of Absolute Health, a primary care functional medicine practice in Ocala, Florida. He is the 100th President of the Marion County Medical Society and the Functional Medicine Director at The Guest House Ocala, a trauma and substance abuse center. Dr. Elyaman also serves as the Medical Director for HumanN, a leading nutraceutical company, and is a Consultant for Quest Diagnostics Laboratory in their Wellness Division. He is teaching Faculty for the Institute for Functional Medicine on their Cardiometabolic module. Dr. Elyaman belongs to the first graduating class of the Institute for Functional Medicine. He is Board-certified in Internal Medicine and holds certifications in functional and integrative medicine as well. His leadership and expertise are reflected in his diverse roles, demonstrating his commitment to advancing medical knowledge and improving patient care. When not at work, Dr. Elyaman loves spending time with his wife and seven children where they live on a cattle and horse ranch. This episode is brought to you by BIOptimizers. Head to bioptimizers.com/hyman and use code HYMAN10 to save 10%. Full-length episodes can be found here: How To Prevent And Reverse Fatty Liver Disease with Functional Medicine The Best Diet to Reverse Fatty Liver Disease with Dr. Yousef Elyaman Why Fatty Liver Is So Common And How To Heal It
Chapter 1: What is fatty liver disease and why should we care?
So the liver really helps our body detoxify, metabolize chemicals from the environment, metabolize our own hormones, metabolize and get rid of toxins. And so we definitely don't want to have an under-functioning liver, that's for sure. And this is the prevalence of fatty liver disease.
is is is it is it is really really high and unfortunately it's increasing um but about 90 million people in the u.s have fatty liver disease and so that's uh it's and it's increasing in this country it's increasing worldwide the amount of fatty liver we are seeing so um
Liz, tell me more about, about a patient that we've had, because I think, you know, some of those patient stories are really helpful and instructive and give us a sense of how we think. Do things differently at the ultra Bono center and here in Massachusetts and Lennox and, and what you, what you found and what you were able to sort of help him with and how it, how it all worked.
Yeah. So. I had a 50 year old gentleman who came in to see me and he was told by his primary doctor that his liver function tests, his ALT and AST were mildly elevated. And so he came in because he was frustrated with his weight. He wanted to lose some weight. He was about 25 pounds overweight.
And he just mentioned to me that his doctor had said his liver function tests were a little elevated and that they were gonna be rechecking them in a few months.
And so, you know, we really got a good detailed history from him and we got a sense of what he was what his diet was like and and and, you know, what his what his alcohol consumption was like, because, you know, that's one of the first things, of course, we think about with, you know, fatty liver or.
or these elevated liver function tests were like, okay, how much alcohol is this person consuming? And what was interesting to me about him was he was pretty moderate in his alcohol consumption. He was having about two glasses of wine a night. And so not for a man, that kind of almost falls within what's considered moderation. So I was, um, you know, he was not a binge drinker.
He was not overusing alcohol from the, from the criteria we were talking about earlier, but I think the amount of alcohol he was consuming in, in connection with his diet and probably his genetics and many other things like his microbiome that we've spoken about, you know, that altogether was really impacting these liver functions for him. And so, um,
We noticed with his diet, it was not rich enough in vegetables, that's for sure. And really, that was probably the biggest thing I would say with his diet. It was just devoid of a lot of vegetables. And you were talking about some of the things, supplements we use for... helping the liver. You know, one of the things we think a lot about is sulforaphane, right?
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Chapter 2: How can fatty liver disease be diagnosed and tested?
And so it's really important that we take care of our liver. And so what's considered normal for alcohol intake? For men, it's less than 10 drinks And for women, it's less than five drinks a week. And so we know that problems with the liver can occur when we're drinking too much.
So we see problems when people are binge drinking or consuming more than 14 drinks a week for men or more than seven drinks a week for women. So I think it's important we also talk to our patients about what is moderation with alcohol? How do we take care of our liver, both from all aspects of nutrition and lifestyle?
So there was also an interesting study came out recently looking at cancer and alcohol and showing that there's a dramatic increased prevalence of cancer. Even a little bit of alcohol may actually increase the risk of cancer. So it's not just fatty liver, but it was a Japanese study with 63,000 adults where they looked at people who are drinking alcohol, and it was a concern.
But that aside, besides just the overload on your liver, besides just the stress on your liver's ability to deal with all the normal toxins we have to deal with, what happens when you have a fatty liver is it drives inflammation in the body. And it's linked to heart disease, to cancer, to diabetes. to even dementia and all sorts of things that we don't think necessarily related to a fatty liver.
So fatty liver is sort of an early warning sign and clue that there's something wrong in your body and it's causing a risk, an increased, dramatically increased risk of all these other problems. With that said, how do we know if we have fatty liver?
You know, one of the first ways we find out is with general blood work. So if you do a metabolic panel, comprehensive metabolic, a panel on a patient, and we look at these markers like the AST and the ALT, and if they're elevated, either high end of normal or elevated above the normal range, you know, that's something we really have to be thinking about is, is this fatty liver?
Should we go on and do an ultrasound? of the liver to see if we are seeing some fat deposition in the liver. And so that's one of the ways we start to see it most frequently with our patients.
Yeah, absolutely. And so there's other tests you can use, which I've had personally, just because I started biohacking, kind of like to check everything. But you can do an MRI and look at liver fat. And it should be less than 2%. And many people have very, very high liver fat. I thankfully have less than 2%.
You can also, uh, they're actually also doing a fiber scans, which look at the fibrous content, the fiber, uh, sorry, the, the scar tissue from the fatty liver, and they can use ultrasound scans. And those are good for measuring the degree that you can deliver biopsies.
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Chapter 3: What are the root causes driving the rise in fatty liver disease?
So if there is some concerns about fatty liver, you wanna get a sense of what their toxic load has been in their lifetime. What is their weight? What is their nutrition? What are they eating? And what is their microbiome like? And so we can really evaluate all of that. and get a sense of how best to help this patient, that individual patient improve.
Because we know that for some people, it may be more focusing on toxic load. For somebody else, it may be focusing more on alcohol intake. For somebody else, it may be more they're eating way too many carbohydrates, refined sugars, soda, you know, coffee drinks, muffins, and not exercising enough, and that whole metabolic syndrome process.
So we want to really help focus the treatment plan on that individual patient. And I think that's what's so special about functional medicine is it's really looking for that underlying root cause for that underlying patient so that they can reach their optimal health. And we know that problems with the liver and fatty liver impact our immune system and how well we fight off infections.
It impacts how we can digest food, metabolize food. It impacts our nutritional state in our body. So there's so many reasons why we really want to
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Chapter 4: How does insulin resistance contribute to fatty liver disease?
Look deeper here.
Why do you think this is increasing? I mean, it clearly was there, obviously, when we were in training, but it's just exploded. You know, we see 75% of the population is overweight, 42% are obese, 93.2% are metabolically unhealthy, which is essentially what this is, a metabolic-associated fatty liver disease, right? So if 93% of us have some metabolic dysfunction, what's driving that?
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...
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.
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.
So there's a- That's when you're bloated and you get a food baby after eating. Right. Not bloating is because there's bacteria in your small intestine, which should not be there. that then ferment the food that you eat, particularly starches and carbohydrates, that then give off all kinds of toxic metabolites that can then poison your liver. That's what you're saying, right?
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.
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.
Now, just to kind of back up on that, that's a stunning statistic. 50% of healthy, normal weight 20-year-old men have prediabetes or some degree of insulin resistance, which is on the way to prediabetes.
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Chapter 5: What biological processes cause harm in a fatty liver?
Chapter 6: How can fatty liver disease be reversed through functional medicine?
And as you were mentioning, we're seeing this huge rise in fatty liver, not only because of alcohol, but because of how high blood sugar, high levels of insulin, toxins like glyphosate and all the other toxins you mentioned. medications that people are taking all are putting stress on our liver and making it so then our liver can't do what it needs to do to detoxify.
So it becomes this vicious cycle of we're inundated with toxins that are impacting our liver, but then the liver can't work as well. And so then we can't get rid of the toxins that we're inundated with. So it becomes a vicious cycle of having issues with our detoxification system in our body.
And as we've spoken about before, the liver is such a critical organ within the body's natural ability to detoxify and handle all the toxins we're exposed to. Maybe we weren't put together to handle all of these toxins, unfortunately, that we're exposed to, but we do have this ability to handle toxins and we wanna take care of our body so we can handle the toxins that we are exposed to.
And so it's really important that we take care of our liver. And so what's considered normal for alcohol intake? For men, it's less than 10 drinks And for women, it's less than five drinks a week. And so we know that problems with the liver can occur when we're drinking too much.
So we see problems when people are binge drinking or consuming more than 14 drinks a week for men or more than seven drinks a week for women. So I think it's important we also talk to our patients about what is moderation with alcohol? How do we take care of our liver, both from all aspects of nutrition and lifestyle?
So there was also an interesting study came out recently looking at cancer and alcohol and showing that there's a dramatic increased prevalence of cancer. Even a little bit of alcohol may actually increase the risk of cancer. So it's not just fatty liver, but it was a Japanese study with 63,000 adults where they looked at people who are drinking alcohol, and it was a concern.
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Chapter 7: What are the risks of ignoring elevated liver function tests?
But that aside, besides just the overload on your liver, besides just the stress on your liver's ability to deal with all the normal toxins we have to deal with, what happens when you have a fatty liver is it drives inflammation in the body. And it's linked to heart disease, to cancer, to diabetes. to even dementia and all sorts of things that we don't think necessarily related to a fatty liver.
So fatty liver is sort of an early warning sign and clue that there's something wrong in your body and it's causing a risk, an increased, dramatically increased risk of all these other problems. With that said, how do we know if we have fatty liver?
You know, one of the first ways we find out is with general blood work. So if you do a metabolic panel, comprehensive metabolic, a panel on a patient, and we look at these markers like the AST and the ALT, and if they're elevated, either high end of normal or elevated above the normal range, you know, that's something we really have to be thinking about is, is this fatty liver?
Should we go on and do an ultrasound? of the liver to see if we are seeing some fat deposition in the liver. And so that's one of the ways we start to see it most frequently with our patients.
Yeah, absolutely. And so there's other tests you can use, which I've had personally, just because I started biohacking, kind of like to check everything. But you can do an MRI and look at liver fat. And it should be less than 2%. And many people have very, very high liver fat. I thankfully have less than 2%.
You can also, uh, they're actually also doing a fiber scans, which look at the fibrous content, the fiber, uh, sorry, the, the scar tissue from the fatty liver, and they can use ultrasound scans. And those are good for measuring the degree that you can deliver biopsies.
Uh, and I think, you know, what, what we see is, is really in functional medicine, a roadmap for healing the liver in ways that just doesn't exist with the traditional medicine or conventional medicine.
So talk about what are the ways that, you know, in addition to the testing we talked about, we'll look at insulin resistance, we'll look at particle size, we'll look at inflammation, we'll look at a lot of things that traditional doctor wouldn't look at. What are the beginning things we do from a dietary lifestyle and supplement perspective to reverse fatty liver?
I mean, one of the first things we do, right, is of course we get a good detailed history from our patients. and try to get a sense of what's going on for them. Get an understanding of their timeline of their health. And that can help us find out what may be driving health problems in that person.
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Chapter 8: How does alcohol consumption influence fatty liver and overall health risks?
which causes clogging of the blood vessel and heart disease, strokes, and heart attacks.
Okay, this is so juicy right here, I'm just going to unpack a little bit. Because basically, just to kind of put things in context, in France, there's a delicacy called foie gras. Oh, yeah. Which I probably didn't pronounce right, but foie gras, whatever. And that means, in French, fatty liver. Now, most people think that if you eat fat, you get fat.
And that fatty liver must be coming from all the fat we eat. But what you just said was that in fact it's not true, that it's actually the sugar and refined starches and carbohydrates, the flour and the sugar that we're eating in pharmacologic doses that's overloading our biology and causing that carbohydrates to turn into triglycerides, which then turns into fatty liver.
And then you're in this vicious cycle where the fatty liver then creates all sorts of other problems. So let's kind of unpack what happens biologically when you have a fatty liver. You get a fatty liver, and so your liver's looking like a fat goose or duck liver, and you don't wanna serve it on toast, unless you're maybe Hannibal Lecter.
And then you've got a process going on in that liver that's just more than the accumulation of fat. So what are the things are happening in the liver that end up causing harm? You mentioned that the type of cholesterol we get because of that fatty liver is the dangerous small, dense cholesterol we talked about in the podcast. We did a whole podcast on cardiovascular risk and lipid analysis.
So the small, dense cholesterol particles, which by the way, everybody listening, your doctor's not measuring when you go to get your cholesterol test. Less than 1% of cholesterol tests in America are for the right cholesterol test, which is called lipoprotein fractionation. And it's looking at the particle size, the particle number, the VLDL numbers.
And you can get all that, by the way, through functionhealth.com forward slash mark. It's a company I co-founded. It's a lot of people that get access to the right amount of information and data. So functionhealth.com slash mark, you can get the right panel so you can see what's going on.
And we also measure insulin, although soon we're going to be measuring this insulin resistance score, which is very exciting.
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.
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