@Andy de Santis : 肝脏在人体内扮演着至关重要的角色，它执行超过500种功能，其中排毒功能最为重要。现代生活方式和环境因素给肝脏带来了更大的压力，导致脂肪肝等问题日益普遍。 预防和逆转脂肪肝的关键在于优化生活方式，包括改善饮食、增加运动量和考虑合适的补充剂。 在饮食方面，我建议采用高多酚地中海饮食，增加坚果、豆类、鱼类等富含多酚和ω-3脂肪酸的食物摄入，减少果糖和高果糖玉米糖浆的摄入。 运动方面，任何形式的运动都有益于肝脏健康，包括有氧运动和力量训练，高强度间歇训练可能对改善肝脏功能和降低硬度有独特益处。 补充剂方面，ω-3脂肪酸和益生菌是改善肝脏健康的最佳选择，可以弥补饮食中营养的不足。其他补充剂，如牛奶蓟、白藜芦醇等，其效果有待
肝脏，这个常常被忽视的器官，实际上是人体内一个至关重要的“沉默英雄”，执行着超过500种功能。其中，排毒功能尤为重要，它过滤血液中的毒素，确保身体正常运作。然而，现代快节奏的生活和环境污染给肝脏带来了巨大的压力，导致脂肪肝等问题日益普遍，影响着全球三分之一以上的人口。
作为多伦多注册营养师，同时拥有公共卫生营养硕士学位的Andy de Santis，将肝脏健康视为其营养理念的核心。他指出，脂肪肝并非仅仅是肝脏脂肪堆积那么简单，而是多种不良生活方式因素累积的结果，它与胰岛素抵抗、高甘油三酯、炎症和肠道菌群失衡密切相关。 脂肪肝的早期症状往往是疲劳，这很容易被忽视，因此及早关注肝脏健康至关重要。
Andy强调，逆转脂肪肝并非遥不可及。即使无法大幅减重，通过优化生活方式，依然可以有效减少肝脏脂肪含量，甚至逆转肝脏损伤。他提出的关键策略包括：
一、饮食优化：拥抱高多酚地中海饮食
我建议采用富含多酚和ω-3脂肪酸的高多酚地中海饮食。这意味着要增加以下食物的摄入：
同时，应减少果糖和高果糖玉米糖浆的摄入，这些物质主要存在于含糖饮料、能量饮料和碳酸饮料中。
二、运动：多种形式，持之以恒
任何形式的运动都有益于肝脏健康，包括有氧运动和力量训练。高强度间歇训练（HIIT）可能对改善肝脏功能和降低肝脏硬度有独特益处，因为它能显著增加心率和血流量，从而促进肝脏细胞的解毒功能。 但需注意，HIIT强度较高，需根据自身情况选择。 即使是简单的步行，只要坚持每周150分钟，也能带来显著的改善。
三、补充剂：有的放矢，谨慎选择
ω-3脂肪酸和益生菌是改善肝脏健康的最佳补充剂选择，它们能弥补饮食中营养的不足，并改善肠道菌群。其他补充剂，如牛奶蓟、白藜芦醇和姜黄素等，虽然在某些研究中显示出一定的益处，但其效果仍有待进一步研究，且需谨慎选择，避免过量或与其他药物产生不良反应。
四、其他关键因素：睡眠、饮食习惯和肠道健康
Andy最后强调，改善肝脏健康是一个循序渐进的过程，需要长期坚持。 不要轻视任何细微的改变，即使是每天增加45分钟的睡眠，或在饮食中增加少量豆类，都能带来积极的影响。 与其追求速效，不如建立健康的生活方式，让你的“沉默英雄”——肝脏，长久地守护你的健康。
Siim Land Podcast⋅11h ago
◉
01:39 肝脏在人体内执行超过500种功能，其中最重要的功能是排毒功能，因为消化系统中的血液会在进入身体其他部位之前先流经肝脏进行解毒、循环等处理。
◉
02:35 我选择专注于肝脏健康是因为脂肪肝影响了三分之一以上的人口，这使得它成为传递积极健康信息的一个很好的切入点，能够吸引人们的关注并促使他们采取行动。
◉
04:32 脂肪肝现在是导致肝癌的主要原因之一，未来可能成为肝移植的主要原因，因此重视肝脏健康至关重要。
◉
06:51 关注影响肠道菌群的食物，因为肠道菌群的状态会很大程度上影响肝脏健康。
◉
07:13 脂肪肝是可以逆转的，但病情越严重，逆转难度越大。
◉
07:48 果糖，特别是高果糖玉米糖浆，被认为是导致脂肪肝的重要因素之一，因为它在肝脏中代谢，并可能对肠道菌群产生负面影响。
◉
08:57 脂肪肝是多种不良生活习惯累积的结果，它只是身体内部功能失调的体现。
◉
10:01 肝脏脂肪含量超过5%即可诊断为脂肪肝，这并非大量的脂肪堆积。
◉
12:41 体重较高的人群患脂肪肝的风险略高，因为胰岛素抵抗在脂肪肝患者中普遍存在，而胰岛素抵抗会导致血液中脂肪酸增多，从而更容易在肝脏中异常储存。
◉
14:52 改善饮食、增加运动量、考虑补充剂，即使没有显著减重，也能有效降低肝脏脂肪含量。
◉
16:14 高多酚地中海饮食有助于降低肝脏脂肪，即使没有减重。
◉
30:24 ω-3脂肪酸、单不饱和脂肪酸对降低肝脏脂肪含量非常有效，而多不饱和脂肪酸（如葵花籽油）的效果不如前两者。
◉
38:00 ω-3脂肪酸和益生菌是改善肝脏健康的最佳补充剂，它们可以填补饮食中缺乏的营养成分。
◉
47:47 高强度间歇训练可以提高肝脏解毒细胞的功能，并降低肝脏硬度。
◉
48:28 运动有助于降低肝脏脂肪，其益处与体重减轻无关。
◉
50:12 任何形式的运动都比不运动好，理想情况下应结合有氧运动和力量训练，但即使只是快走150分钟/周也能对肝脏健康产生积极影响。
◉
57:13 细嚼慢咽有助于改善胰岛素抵抗；对于饮食均衡的人来说，先吃蛋白质和蔬菜，再吃碳水化合物，有助于改善饱腹感和胰岛素抵抗。
◉
57:46 豆类是改善肠道菌群和肝脏健康的被低估的食物。
00:00
Welcome to the Seamlon Podcast, our guest today is Andy DeSantis. Andy is a registered dietitian in Toronto and he has a master's degree in public health nutrition. 语法解析
00:28
Andy, welcome to the show. Thank you so much for having me. It's a pleasure to be here. Yeah, I'm happy to have you. And you talk a lot about the liver, which in a lot of ways is one of the most underrated organs in the body, and it's definitely very important. 语法解析
00:46
And it's also very, like, I guess, unique in the sense that, you know, you could lose almost entirety of your liver and it would still be able to regenerate, which is not the case with, like, your heart or your brain even. So, yeah, maybe we can get started with, you know, why is the liver, you know, so important when it comes to overall health? 语法解析
01:10
Yeah, well, the fact of the matter is the liver performs over 500 functions in the human body, right? On a broad level, some of those functions include carbohydrate metabolism, fat metabolism, protein metabolism, iron metabolism. It stores vitamin D, it stores other vitamins. But the most famous function and what it's most known for and arguably its most important function is the detoxification function, right? Because… 语法解析
01:39
when blood and i'm sure this will come out in today's discussion but when blood throws flows through the digestive system it goes to the liver next before it is suitable to enter the rest of the body and there's a very important reason for that it's because you know it needs to be detoxified certain things need to be recycled and so on so that would be a glimpse of some of the liver's functionalities gotcha yeah and how did you get involved with uh you know making liver your one of the main focuses 语法解析
02:08
Yeah, it's a great question. Essentially, what I found is I, you know, as a professional in the space of nutrition, you know, over a decade now, having written several books, looked into broad areas, help people with many different issues. What I found is that liver health is a very good proxy for my philosophy, which by that I mean, I have a vision for what high level eating is. And if I want to share that vision broadly, well, I have a choice. I can talk about weight loss, which I 语法解析
02:35
is relevant, but I don't love to put all my eggs in that basket. I could talk about general health, which is not always compelling, or I can speak about liver health. And now the liver, the health of the liver is compromised in a third of the population or more, you know, as it relates to the fatty liver. So it just seems like a great proxy for me to send a positive message where people are compelled to listen and act. So that is the reason primarily, and there are others, but that's the really big reason why I've chosen to specialize on liver health. Yeah. 语法解析
03:02
Yeah, and I guess in the modern world, there's just a lot more things that impose more stress on the liver. So like all these different environmental toxins, chemicals, bad diet, alcohol. So yeah, I guess more and more people's livers are overburdened. 语法解析
03:19
Yeah, theoretically, that's absolutely true. I mean, we're exposed to more and more objects in the air, in our food and elsewhere. And so the importance of the choices we make around lifestyle, diet, exercise, supplementation, it's not to say that those choices, the relevance changes or the nature of them changes, but they're more important because the stakes are higher. So I think that's fair to say. So maybe we can start with something like that is, again, 语法解析
03:44
I guess, more general. So what would be something that people kind of should do as a foundation in the 21st century to keep their liver healthy? And I guess maybe we can also backtrack of what happens if you don't have your liver health optimal? What other diseases can you get? And do actually people die to poor liver health? 语法解析
04:09
Yeah, it's a great question. So let me start with the second question first. So just last month, a study was published in a reputable cancer journal, and it found that fatty liver disease is now the number one cause of liver cancer in Sweden specifically. Now, I would expect that as more data becomes available in the years, months ahead, that this will become a more abundant finding. Right? 语法解析
04:32
Okay. Now, having spoken to doctors in this area, they expect that fatty liver disease, for example, will become the number one reason for liver transplant and so on. So the stakes are high insofar as if you don't take care of your liver health in the long term, you can get cirrhosis, you can get liver cancer, et cetera. But if you get like a fatty liver diagnosis, it's not urgent in the short term. Now, 语法解析
04:55
Part of your question is what happens in the medium term, which is between when you first get a diagnosis and between when really bad things happen. And that's a bit of a gray area. And the reason why is the number one symptom of fatty liver generally is fatigue. 语法解析
05:10
Right. Which is a very general symptom, which can occur for a variety of reasons. Right. So it's not as if like you can you can have multiple reasons why you're tired and fatty liver could contribute to that. But more interestingly, and this is actually the hard part is we don't know how does like slight malfunction in the liver manifest in terms of your daily life. 语法解析
05:31
One example I can give you is that what happens is when someone ends up with a fatty liver, which is the most common thing to go wrong with the human liver, right? It affects one in three people globally. It will affect four in 10 by 2050, I believe is the estimate. What happens is if that goes unresolved, 语法解析
05:49
then the liver can accumulate scar tissue, right? Which is known as fibrosis and it becomes more stiff. When that happens, blood does not flow as well through the liver, which means that the detoxifying cells in the liver may be less likely to access that blood that's flowing through, which means theoretically more stuff is getting through your liver undetected. 语法解析
06:09
And so there could be an accumulative effect of that in terms of how that affects inflammation and your other body cells exposure to toxins. But that's very hard to quantify if we're being honest about it. Right? Mm-hmm. 语法解析
06:21
So, yeah. And so to the other point, and there's a lot of things I could say here, but if I had to give one quick piece of advice before elaborating, I would say really pay attention to the foods that influence your gut bacteria. Because as I said, that the blood throws through the digestive tract, it goes to the liver next. So the state of the gut microbiome has a big role to play in the state of the liver as a result. Right. Can you like reverse that cirrhosis and the scarring? 语法解析
06:51
So the easy answer I would give is the worse it gets, the harder it is to reverse. And I think that's a fair statement because that is the case for the vast majority of health conditions. But insofar as can you reverse fatty liver disease? Can you reduce the amount of fat content in your liver? Absolutely. Can you reduce the amount of scarring in your liver? Absolutely. Will that be harder to do the further along it gets? Absolutely. 语法解析
07:13
also absolutely. Gotcha. Yeah, makes sense. And like, why does the fat accumulate in the liver? What is like, is there anything specific about it? Or is there something, I guess, uniquely damaging about it as well? Yeah, so there's a few different ways that we could look at this. The first is, you know, 语法解析
07:34
With any health condition, there's always a temptation to pick one item and to say, this is it. This causes the problem, right? And for fatty liver disease, the item that comes up generally is fructose and specifically high fructose corn syrup. 语法解析
07:48
And so you'll see, there's the charts, the ecological data. Hey, fructose consumption goes up, fatty liver disease goes up. And of course, there's limitations to comparisons of that nature. But what scientists believe is that, and so high fructose corn syrup is found mostly in North America, especially in pop, for the most part. Sugar, sweetened beverages, energy drinks, and pop. 语法解析
08:09
So scientists speculate that fructose, well, first of all, they know fructose is metabolized in the liver, so it's unique. And fructose may also negatively influence the gut microbiome. And that's a great connector of what I said so far. But I will also say that the idea that pop alone, let's just say I drink three cans of soda pop a day, but otherwise I'm doing everything perfect in my life. Probably I'm not a candidate for fatty liver, realistically speaking. 语法解析
08:38
Fatty liver, essentially, it's a manifestation, which is, let's say 33% of it is genetic, right? So it's not hugely genetic and genetics are irrelevant, but just a manifestation of kind of less than optimal choices accumulating. And it just so happened it manifested by fat being stored in your liver, like, you know, 语法解析
08:57
The accumulation of less than optimal choices around diet and lifestyle, they manifest in different people in different ways. Fatty liver is one of those ways. It's an increasingly common way. And it's also because our understanding and our ability to measure it has gone up, of course. So that also affects things in terms of how we observe it. But the easiest way to put it is it's just a sign that internally, things are not working as well as they should be. Because fat is not supposed to be stored in your liver. It's supposed to be stored elsewhere or used for other things. 语法解析
09:25
Right. Is there like a certain amount? Is it like synonymous with the visceral fat and liver? 语法解析
09:33
So, yes, essentially, I think that's a reasonable comparison. I mean, the extent to which they correlate, hard to say precisely, but I think that's a reasonable correlation to say that visceral fat and liver fat are related to a certain extent. Now, generally, when you want to put a number on it, 5% is the threshold number, okay? Now, it's very important for people to hear this. Now, the human liver, that's… Exactly. Okay. So, the human liver weighs three pounds, okay? Approximately. 语法解析
10:01
So if 5% of that or more is representative of fat, you can have a fatty liver diagnosis. So that is… 语法解析
10:10
It's not, it's not. And in kilos, all my mental math is poor. It's not a lot of kilos either. Right. So we're not talking, it's this mound of fat. It's very small amount. Right. So it's, so it's just that these small details, but what happens is that small amount of fat over time can grow larger, leads to inflammation, lead to scarring. And that's where the issues arise. Gotcha. Yeah. 语法解析
10:32
Yeah. So the visceral fat is also like around the other organs, pancreas and muscle intramuscular, et cetera. So the visceral fat is usually quantified throughout the entire body and the liver can be part of that. But the liver fat is specifically just the liver. Yeah. The liver fat imaging is distinct from other imaging and other estimations. Absolutely. Yeah. 语法解析
10:56
Before I continue on, I'll briefly mention to you about one of my favorite longevity gadgets, which is the Bond Charge Infrared Sauna Blanket. It's a cheaper and more convenient way to take the sauna anywhere at any time. I've talked a lot about the benefits of regular sauna use. I believe taking the sauna regularly is the second best thing for your longevity after exercise. In fact, the sauna mimics a lot of the health benefits of exercise. 语法解析
11:18
The sauna is also effective for excreting heavy metals and other chemicals we're exposed to on a daily basis. The Bond Charge infrared blanket is made of pure leather and it's low in EMF. It's got a rating of 4.9 out of 5 based on 176 reviews which is crazy. But I'm not surprised because I'm using the blanket almost every day and it gets the same job done as a regular sauna. Plus it's easy to clean and you can store it under your bed. Alright, back to the video. 语法解析
11:45
And yeah, what are some of the key things that determine the liver fat? Obviously, you mentioned fructose, but you also alluded that if you are otherwise healthy and you're only drinking soda and everything else is good, then you're not necessarily going to increase liver fat. So yeah, what is like, I guess like the calorie intake is also like just one of the biggest determinants then. Yeah, there's a lot there, right? So for sure, I mean, individuals who are at a higher body weight 语法解析
12:15
you know, all else equal, they could be at slightly higher risk. Why is that? I mean, insulin resistance plays a massive role. Insulin resistance is a universal feature, essentially a fatty liver, which is to say pretty much everyone who has a fatty liver has insulin resistance to some extent, right? And the simple reason why this is the case is that most people, when they think of insulin, they think insulin reduces the amount of sugar in my blood to oversimplify it. 语法解析
12:41
But insulin also reduces the amount of fat flowing in the bloodstream. Right. So it's oversimplification, but still true. The more fat that's flowing around the bloodstream in the form of free fatty acids, that's not supposed to be there. The more likely it will be inappropriately stored. Right. So some 语法解析
12:58
Some of the, let's say the hallmarks of fatty liver are insulin resistance, high triglycerides, which is one way to think of blood fats, right? Inflammation, and then gut microbiome imbalances, which I mentioned earlier. Now there's different ways people can arrive in those states. Like for example, a history of antibiotic use is a risk factor for fatty liver disease. And the reason why is because of the strong, 语法解析
13:20
between the microbiome and the liver. But there's different ways in terms of the precise choices people make that they can end up with high triglycerides and insulin resistance. But almost all of those ways are due to inadequacies in the diet. Now, there's also different dietary strategies that can be used to resolve fatty liver. So it's hard to say exactly how someone ends up there, but there'll definitely be patterns, right? Inadequate protein intake, lack of diversity in protein, lack of anti-inflammatory, antioxidant compounds in the diet, and so on. Yeah, it's like, you know, 语法解析
13:49
Some people are obese because of eating too much sugar. Others are obese because of eating too much fat. But, you know, there's like no single diet that everyone who is overweight or has a fatty liver follows. They all have, you know, different diets. But yeah, like you said, they will develop insulin resistance or hypertriglyceremia that leads to liver fat accumulation. 语法解析
14:10
Essentially, yeah. Right. And I guess like the resolving that would also be the opposite of that, that you lower triglycerides, lower insulin resistance, lower inflammation and lose weight. 语法解析
14:23
Yeah, essentially. And let's just talk about that last part for a second, the lose weight part. I mean, the most conventional guidance that someone will receive if they've been diagnosed with a fatty liver and they have a limited interaction with a healthcare provider is to lose weight. But really, when a doctor tells you to lose weight, what they're really saying is optimize your diet, move your body more, maybe consider strategic supplementation, right? And you very likely will lose some weight if you do those things, but it's really… 语法解析
14:52
I mean, hard to attribute… 语法解析
14:54
to what extent each of these things influences, but a massive part of that influence is the diet itself. And why do I say that? It's because there's ample evidence that dietary changes and physical activity in the absence of significant weight loss, reduce liver fat content. And the only reason that's very important to say is because I work a lot of people in this area and not everyone has the capability to lose a significant amount of weight. Whether the calorie restriction is too unpleasant, 语法解析
15:21
They don't have the ability to expend much energy physically because of their age or their physical status, right? So for those individuals, they need to hear that you can optimize your diet, do smart things with your supplements, and hey, even walk 150 minutes a week, and you can significantly reduce your liver fat content and reverse the condition. You don't necessarily need to lose 30 kilos, but if you want to, you have every right to try, hopefully with the help of a professional. Yeah. So what I like some of these dietary changes that… 语法解析
15:50
will improve liver fat even without weight loss? Yeah, great question. If I had to put an umbrella term on it, and I'm going to go into the specifics, I would call it a high polyphenol Mediterranean diet that would be curated for the individual, which is kind of obvious. I mean, not everyone likes every food that exists that's good. So you have to find what someone enjoys. So a high polyphenol Mediterranean diet is what I would say. Now, 语法解析
16:14
What does that mean? Well, the Mediterranean diet at baseline is pretty much asking you to, hey, listen, you probably, when I say you, I mean the general public, you probably don't eat many nuts in your diet right now. You probably don't eat many legumes like lentils and chickpeas, kidney beans. You probably don't have much diversity in your protein intake, which is to say most people consume a lot of red meat and chicken, and that's all good. That's fine. But they don't consume a lot of fish, right? Now… 语法解析
16:40
If we want to make a connection here, the omega-3 fatty acids, EPA and DHA, found in fish are quite effective at lowering triglycerides, as are nuts, right? So, I mean, they're directly related to the biomarkers of fatty liver, but then their benefit goes beyond that. Now, the word polyphenol is also important. So, polyphenols are a group of compounds. They're not vitamins and they're not minerals, so they're not essential in that way necessarily. 语法解析
17:05
But they are antioxidant, anti-inflammatory compounds that we see time and time again. When their intake is higher, metabolic health is better. One of the reasons for this, besides the fact they're anti-inflammatory and they have antioxidant capability, is that your gut microbiome quite enjoys them. They have a prebiotic effect on your gut bacteria, right? So… 语法解析
17:27
From there, there was quite a famous study done in 2021. And what they did is they gave people with a fatty liver a Mediterranean diet or high polyphenol Mediterranean diet. It was on the Gut Journal in 2021, if my memory serves me. What they found is that the high polyphenol Mediterranean diet was significantly better at reducing liver fat content. Now, the thing is, polyphenols are found in very specific foods in high amounts. For example, 语法解析
17:55
All vegetables have some polyphenols, but artichoke has by far the most. All fruits have some polyphenols, but blueberries have by far the most, right? Nuts have some polyphenols, but pecans and hazelnuts and almonds and ground flaxseed have the most. So someone could stumble upon a high polyphenol diet, but they could easily not as well. Gotcha. Yeah, that makes sense. And like coffee, teas, those olive oil, 语法解析
18:24
Those are all high. 语法解析
18:26
Yes. Coffee, absolutely. Green tea, absolutely. I mean, there's abundant observational evidence right now that coffee drinking, I have a coffee in front of me, three cups a day on average slows the progression of fatty liver disease, which is to say that coffee drinkers who have a fatty liver, generally, they show less liver stiffness, less fibrosis, right? And that is due to the high polyphenol content and generally just the massively high antioxidant content of coffee. And if you take the average person with an average diet, 语法解析
18:55
coffee drinking is a massive hack because it's for no effort at all. You're greatly increasing your exposure to these compounds. Right. What about sugar? Would it be the case that if you're not gaining weight, but you're eating sugar, would it still increase liver fat? And the same with like the high fructose corn syrup as well? Well, then you get into really fine details in terms of the context and the average output, right? Because 语法解析
19:24
like i said i mean like i said earlier you know so i gave the kind of rudimentary example if you drink three pops a day but everything else is perfect you're probably going to still be able to reverse fatty liver disease but i suppose it depends how perfect everything else is it depends on a lot of individual factors like what's an individual's caloric needs how good is good because there's different levels with nutrition right and the clearest example is you could you 语法解析
19:47
you can apply a Mediterranean diet poorly. You can apply it well. You can do a high polyphenol Mediterranean diet. And these are just three completely different levels of eating, right? But the reality is most people doing a Mediterranean diet poorly or eating, like what I should say is 语法解析
20:01
you know, I think the term like Mediterranean diet is limited. It's just a vision for pointing out what you're probably not doing enough of and that you should do more. It has limitations. Like, for example, the Mediterranean diet says not to eat yogurt, but yogurt is a great facilitator for berries and nuts, right? And we have ample evidence that yogurt, which influences the microbiome, actually helps with fatty liver. So I'm not a Mediterranean diet, you know, blindfold, go all in on that. Curated for individuals and new science. But 语法解析
20:30
It is really tough. I mean, to say you could eat sugar and reverse fatty liver, but it really just depends on what it is that you're doing and the totality of what you're doing. Right. Yeah. And it depends on how serious it is. Probably you can prevent getting it if everything is kind of moderate and you're generally healthy and you don't go overboard with it. But once you got it, then it's going to be a bit harder. 语法解析
20:54
For sure. I mean, the more issues that you've accumulated, I think the more serious you have to be to resolve them. But fatty liver is a condition where there's multiple levels. You could have 6% of your liver being consumed of fat, which is quite mild. And you could probably reverse that within three months. But then you could also have 60 or 70%. 语法解析
21:15
you know, consumed by fat. And that could take you 18 months, right? And the thing is, all of this stuff is contingent on a high level of implementation. And it's very hard to assume the average person is going to go flip a switch and then do my vision for a perfect diet. It's not really reasonable. So there's a lot of nuance there as well. Right. If you're like a healthy… Does a healthy liver have then like zero fat or is it like… 语法解析
21:42
Is there some like 1% or 2%? Is it like normal? Yeah, I would say 1, 2, 3% in the context of other markers of your health being fine is pretty innocuous. You know, that amount, 语法解析
21:58
And there's different ways to get the liver imaging. Like that amount may not even be detectable on some imaging tests, right? There's something called a fibroscan, which is the best imaging we have. But some people will get ultrasounds, which can see liver fat, but they cannot quantify it as well as, let's say, a fibroscan can. But fibroscan technology is not as abundantly available as ultrasound technology, right? So there's also those kind of factors play a role as well. Yeah. 语法解析
22:26
Is the MRI better or is it more accurate? MRI is very accurate. However, it's an expensive, elusive piece of technology. So even in studies, okay, they may have MRI, but I don't know too many people who are getting MRIs for their liver. That's the reality in the context of limited resources. Yeah, yeah. And quicker and easier with a FibroScan then. Yeah. 语法解析
22:51
I've had a fibro scan personally. It's very, very quick and easy. And the output is fascinating because it measures liver fat and liver stiffness, which is related to the scarring. How much does it cost and where can people usually get it? Which physician do they need to visit? So, I mean, I think it'll depend a lot on geography. So here in Toronto, where I'm at, you're looking at… 语法解析
23:20
I think, $125 Canadian dollars for one scan, okay? Which is, you know, that's cheaper than it's to see me privately, for sure, right? So it's not incredibly expensive. And I think with a fibro scan, the reality is you get one scan 语法解析
23:36
You change your life and you get another one in three to six months. It's not like something you got to be checking in constantly because once you have the vision right, you're doing the right things, you're okay. Now, what we can also do is we can talk about what if somebody has no access to a fibro scan because not everywhere has a lot and not everyone can get one. What I would say is there's blood work you want to look at. So let's just say we have an individual. 语法解析
23:59
It has high triglycerides, low HDL, which is the quote-unquote good cholesterol, high ApoB, which is a marker of cardiometabolic health. When ApoB is high, triglycerides are high, and HDL is low, 语法解析
24:13
We have a very high level of confidence that things are not going well in the liver. So if you improve all those markers in the right direction, in the absence of imaging, the reverse is true. You can actually be quite confident that things are getting better in your liver. And those markers together are more valuable than looking at one or two liver enzymes, which is a mistake people make. Liver enzymes take time to change and they don't always accurately reflect what's going on in the liver. Clearest example of this is 语法解析
24:41
I've seen a study, it was in the Diabetes Care Journal, 12 months, 50% reduction in liver fat, liver enzymes did not change. So, you know, the smartest people, the smartest guidelines, they don't tell you to put all your eggs in the liver enzyme basket for those reasons. Yeah, and I've also seen that exercise can raise liver enzymes, right? Because of the intensity, especially lifting weights. 语法解析
25:07
Yeah, for sure. It depends on the context. I mean, even milk thistle, which is like a famous supplement in the world of fatty liver, in some people actually raises liver enzymes. It doesn't lower them universally. So yeah, there's variables there. They're just not as useful as a marker because they just don't accurately reflect what we're looking to reflect. Gotcha. And is like the waist circumference like any good estimate as well of some liver fat? 语法解析
25:36
So it is, there is a calculation, it's called the fatty liver index. And the fatty liver index takes into consideration waist circumference. It takes into consideration triglycerides. 语法解析
25:47
It also takes into consideration one of the liver enzymes. So this is actually a good segue. So the liver enzyme it takes into consideration is not AST or ALT, which are more talked about. It's GGT. So if one was to value any liver enzyme, GGT is the most predictive. So I would also put that out there. Okay, gotcha. And the rest of them are AST, ALT, ASP. 语法解析
26:15
ALP. ALP, okay, yeah. Yeah, those are the ones that you'll most likely find in blood work, yeah. Gotcha. What about alcohol? So that's quite notoriously known to be bad for your liver. How does it affect liver health and liver fat? So there are, I mean, with fatty liver as a condition, 语法解析
26:35
there is different types, right? The much more common type is the type that's not to do with, you know, alcohol abuse, right? So that's why, I mean, it's old terminology, but I still, it's called non-alcoholic fatty liver disease. There is new terminology, but I think it's too scientific and the average person has never heard the terms before, so I don't use it yet. Maybe in the future I will. So, you know, to be diagnosed with a fatty liver for metabolic reasons, what they generally do is they rule out the fact that you haven't been drinking 20 alcoholic drinks a week because that ends you up 语法解析
27:04
which is a very large number in which to be fair does is not really representative of most people right which is why alcoholic liver disease is not the hottest topic it's for subset of the population it's relevant but 语法解析
27:15
But yeah, it's safe to say that if you have a fatty liver, and really for any purpose, as we know, as guidelines continuously get revised, that alcohol is the quintessential example that less is more, right? As little as possible for optimal long-term health. So I think it's reasonable advice for anyone to reduce their alcohol intake if they can, particularly if they're concerned about liver health. But 语法解析
27:39
you know, again, it's kind of, it's kind of the same thing with the pop. Like you could drink seven drinks a week, which now in, in Canadian regulations is, is not advisable. Right. But have, and be doing perfect elsewhere. You're not getting fatty liver from that. Right. So. Hmm. Right. Is there also any difference between that type of alcohol and the strength? So it's like vodka or pure spirits worse or better than like cocktails? Yeah. 语法解析
28:06
Well, generally, if you have, I mean, I suppose it depends on the individual and how they interact with those beverages, right? Because all else equal, if you have a standard drink, you are being exposed to the same amount of alcohol in grams. So it really depends. Like if someone, if they have a beer, they don't like beer and they just, they have one and they're good. But if they have a gin and tonic and they suck four down because they taste good, you know, I think that is relevant. But I wouldn't say beyond that. I mean, beer has a very high glycemic index. So maybe there's extra damage. I mean, potentially, if someone already has 语法解析
28:35
problems with blood sugar regulation, there's extra less than optimal things. I think the glycemic index of beer is the same as white bread. It's 100. There are different types of beer, of course. What about wine? It has these polyphenols. Could it counteract the alcohol? 语法解析
28:53
Yeah, I think that the poly… I don't think so. I think that there's too many other foods where you can get polyphenols from that, you know, if wine was the only food that contained polyphenols and polyphenols were very beneficial, maybe it's a different conversation, but there's too many other ways that you can optimize your polyphenol intake. And I think the cost benefit for wine generally… 语法解析
29:13
does not go does not trend towards benefit right i think i don't i'm not sure but i would imagine that the french or spanish people probably have like lower rates of fatty liver and non-alcoholic fatty liver or if i'm not mistaken 语法解析
29:31
it's going to be lower, you know, to some extent than North America. But there's, you know, there's so many differences. And we talk about Mediterranean diet, pattern of eating. I mean, that's probably the most obvious, I suppose. Yeah, yeah, absolutely. So yeah, you're not going to be, no point in trying to get the polyphenols from wine. Maybe a little bit, but not a lot. I've personally never told someone to do, yeah, there's something about that guidance that I wouldn't, I personally wouldn't feel comfortable. Yeah. 语法解析
30:00
Yeah. What about like these different types of fats? So omega-3s, PUFAs, saturated fat, etc.? Yeah, that's a great question. It's something that I've been exploring for the last several years, but even more so actually last few weeks. So we have to go through these one at a time because there's different types here. So first of all, 语法解析
30:24
Omega-3 fatty acids, and particularly EPA and DHA. So we have to start by understanding these are only found in fatty fish. Salmon, sardines, trout, herring, mackerel, perhaps some different types in other geographical locations, but those are the usual suspects. So people who have a higher exposure to omega-3s have a lower risk of fatty liver. When an individual with a fatty liver increases their omega-30 intake, liver fat levels go down. 语法解析
30:52
Now, why is this? Now, also, if we have any vegans or vegetarians, you can supplement EPA and DHA from algae-based supplements. So it's not as if it's only for people who eat fish. And many people do not like fish. That's also a reality because I talk to people all the time what they eat. Whatever the reason is, their partner doesn't like the smell. They can't bring it to the office because of the smell. It's too expensive. All good. You don't need to eat it, but you have to supplement it. So omega-3s definitely help with insulin sensitivity, definitely are anti-inflammatory. 语法解析
31:21
And they definitely help with fat metabolism. Now, fat metabolism is a super broad term, but the easiest way for me to put it is that it means when fat metabolism is optimal, and one way to help optimize this through eating omega-3s, it basically means your body is doing with fats what it should be doing. So being stored in the liver… 语法解析
31:41
is not what it should be doing. Being used for energy stored elsewhere for hormone production is what it should be doing, right? So omega-3s help to correct that balance. And I've actually, I've seen evidence that people with a fatty liver actually have less omega-3, less omega-3 fats implanted in their liver cell membranes. So that's also a fascinating finding, okay? So that's one. Then you get into monounsaturated fats, right? Again, they have very… 语法解析
32:10
Monounsaturated fat intake goes up. Assuming it's not in a massive calorie excess, then liver fat goes down. If you're consuming 2,000 extra calories, gaining weight, it may not be the case that that happens. And there's a study I encountered the other day, but I'll talk about that in a moment. So monounsaturated fat, what is that? Avocado, nuts, olives, and olive oil, right? So again, great example of the Mediterranean diet. Most people… 语法解析
32:37
don't view nuts as foods to be consumed regularly. I think if you, you know, if you tell someone, Hey, I eat broccoli once a week, that's my vegetable for the week. Inherently, most people are going to know that's not quite right. You know, I mean, this day and age, of course, you know, things are evolving in terms of how some people think, but let's just go, go with the traditional guidance. Um, but if you tell someone you have nuts on a Monday and Friday, um, 语法解析
33:03
good for you. Right? So I think there's a gap there in people's perceived value of these foods. And not to mention the fact nuts have magnesium, vitamin E, polyphenols, and so on. So monounsaturated fats, lower liver fat, lower insulin resistance. Okay. And then you get, you know, PUFAs, the omega-6s and like the seed oils. So here's the thing. Okay. In studies that compare 语法解析
33:29
saturated fats with PUFAs on liver fat specifically, which is my outcome of interest. PUFAs are like, so sunflower oil has been demonstrated in human trials to be superior to butter in terms of its effect on reducing liver fat, right? People can talk about other things, all good. But if we're talking about the outcome of liver fat in terms of human evidence that we have 语法解析
33:53
PUFAs are superior, but monounsaturated fats and omega-3s are the pinnacle. That's where energy should be spent. And I'm not here to tell someone not to eat red meat or not to use butter or whatever the case may be. But objectively speaking, if your concern is liver fat content and the health of your liver, 语法解析
34:12
I don't see the argument, for example, that butter would be superior to olive oil to cook with. It's just, it's not, it's certainly not based on human evidence. Yeah. Yeah. And it's the same example of your pop example that, you know, if you're only eating butter and red meat, for example, which a lot of people are, 语法解析
34:29
They're excluding all the other things, then, you know, chances are you're okay. Still, granted, you're not, you know, eating, I don't know, 10,000, 1500,000 calories or something like that. So, yeah, like it's a, it depends on the context. Again, like there's ways people can manage around it the same way people can, you know, drink pop and to not get fatty liver. 语法解析
34:51
Yeah, exactly right. There's all these things that you could take liberties in, but if you take liberties at every opportunity, you're right. I mean, that's a problem in and of itself, but also it's a problem because it displaces the other foods that are important, right? So that's absolutely correct. Yeah. And again, I guess the studies are, if all things are equal, like if the calorie intakes are the same and they're controlling all the variables, that's the way you do like a study to see, okay, which of these specific, I guess, ingredients influence the outcome. 语法解析
35:17
Yeah. Well, let me, let me give you a more precise example. So the study that I'm referring to, if I was discussing on my social media the other day, I think it was a 2018 study, I believe out of a diabetes care journal. What they did is they overfed people either saturated fat or monounsaturated fat, right? So overfeeding means all else equal, they give them a thousand more calories. Okay. The saturated fat, which came from butter, um, primarily, um, 语法解析
35:40
Okay. That led to a 55% increase in liver fat content. And it also led to reduction, sorry, increase in insulin resistance. The model unsaturated fat from pecans and olive oil led to only a 15% increase in liver fat. Now remember the context is overfeeding by a thousand calories. So we're not necessarily expecting a great outcome. And it led to no negative influence on insulin resistance, right? So if we did a swap study, I would expect the model unsaturated fat outcome would be great. 语法解析
36:08
Right. Because it was an excess. It obviously skews a little bit what the outcome is. Yeah. Yeah. I guess it also matters what you replace it with. So, uh, you know, a lot of these heart disease studies as well, if you replace, uh, 语法解析
36:19
you know sugar sweetened beverages and refined grains with butter you do better but uh but if you replace you know omega-3 fats and monounsaturated fats with butter you do better than the butter so there's like you know yes here's to it so the best is like omega-3s and monounsaturated fats and i guess uh some of these uh you know nuts and seeds 语法解析
36:41
A hundred percent. And I look at nutrition as a game of averages and also a game of balance. So, you know, another message I would offer people is to think about, you know, what you've consumed most up to this point in your life, right? Like statistically speaking, you've likely had more butter and red meat than you've had salmon and almonds, right? And that's what, and you know, it's not to say that's the blame for where you are. 语法解析
37:04
but there's a balance to strike because different foods have different benefits, right? And they expose you to different compounds. So it's not this, again, it's not one thing good, one thing bad per se. It's a matter of balance. And if you've been underexposed to one thing and overexposed to something else, then if your goal is optimizing your health, you have a balance to strike for the next phase of your life. And that's very often how I'd pose the argument, I guess. Yeah. What about supplements? So there's a bunch of different supplements out there. 语法解析
37:32
And I guess often people can also say that too many supplements or some specific supplements can also damage the liver. So yeah, maybe we can start with what supplements are healthy for the liver and help with liver enzymes or liver fat. Yeah. So the two most well-studied supplements for liver health, and when I say liver health, I mean fatty liver because fatty liver is the thing that goes wrong with the liver, right? In the majority of cases. 语法解析
38:00
And this won't be surprising based on what we've talked about. Omega-3 fatty acids and probiotics. Now, neither of these are essential, but if we go through things, if an individual does not eat fatty fish… 语法解析
38:18
There's no exposure to EPA and DHA. So an omega-3 supplement, barring very unique situations where they have medications that interact with it, whatever the case may be, it's pretty much an obvious choice, right? Because you're not getting exposed to that compound. That compound has a clear benefit on your body, right? Omega-3s are quite well studied. They improve markers of liver health. Probiotics, same thing. 语法解析
38:40
Most people, or I mean, many people with a fatty liver have an over-representation in their gut microbiome of less than helpful bacteria. Gram-negative bacteria is a technical term, which are just, they produce compounds that go to your liver and do damage. Not good, right? Probiotics have a role. I mean, look, a probiotic alone is not going to change your life, but probiotics help to optimize the environment in the gut so that healthier bacteria can thrive and at least have a fighting chance of 语法解析
39:05
especially if you feed them well with polyphenols and other compounds, right? So, 语法解析
39:10
Probiotics and omega-3s are the most well-studied supplements. Now, what I'll also tell you, which I forgot to mention earlier, is I've even seen evidence that omega-3s help to lower some of the bad bacterial levels that are common in fatty liver because increasingly, scientists actually believe that omega-3s have a prebiotic effect, which is the fancy way to say they help your gut microbiome. So that's very interesting as well. It speaks to the interconnectedness, right, of the body. So those two stand above and beyond everything else, okay? 语法解析
39:38
From there, okay, so for example, there was a study in the Cell Journal, I believe it was, that gave people the dried extract of camu camu, which is an Amazonian berry. And so what makes this thing unique? It's very high in polyphenols, right? It found it modestly reduced liver fat. Now, 语法解析
39:57
Here's the thing. You give that to the average person with a low polyphenol diet, it's going to have a meaningful benefit. But you have an individual who's eating a high polyphenol diet, there's going to be diminishing returns. That supplement probably is not going to do anything because you're already heavily exposed or adequately exposed to those compounds. So the best supplements are what fill in the gaps of what you're not doing, right? I think that's also important. I'll be honest, beyond that, you can find one-off studies. Hey, CoQ10 does this or turmeric does that. 语法解析
40:26
And maybe it helps a little bit. And what I say to those cases is if you have an overlapping concern, like CoQ10 might also help with migraines, might help with muscle pain with people on statins. If you have all those three concerns, okay, it makes sense. Let's go for it. Take CoQ10. Why not? High risk, low reward. But for fatty liver per se, the evidence isn't really there. Gotcha. Even milk thistle, which is very popular. 语法解析
40:56
It doesn't have a lot of evidence. So milk thistle might lower liver enzyme levels, but the only problem is we just finished going through why liver enzyme levels are not even that important. And the compound in milk thistle, the active ingredient, it's called silymarin. It's a lignin. And lignins are also found in ground flaxseed, which are also high in polyphenols. So I would just say have some ground flaxseed, you know? Yeah. 语法解析
41:21
What about like berberine? That's also commonly mentioned. 语法解析
41:27
Yeah, I mean, berberine does help with insulin resistance and it could have a benefit. People have trouble with it sometimes with the digestive consequences and so on. And it's not the same as the other supplements where it fills an explicit gap. And so it's, yeah, it's one of those things. It's not something I personally in my practice recommend just simply because I think what it offers, we can replicate through the diet. 语法解析
41:53
strongly you know what i mean right which is not the case with omega-3s if you don't eat fish yeah makes sense um and the supplements that damage the liver or potentially are harmful i've seen a lot of like reports that certain herbal supplements especially like the ones that might be contaminated with you know heavy metals or something that they can have negative effects on the liver 语法解析
42:18
Yeah, I mean, to that, I would say, I guess it depends, right? Because you could make an argument that certain supplements, especially, I don't know if they're not third-party tests or they're random herbal supplements, are bad for the liver, but… 语法解析
42:33
How is that going to manifest? Are you taking this random herbal supplement for life? Are you taking it for a week? Why are you taking it in the first place? You know what I mean? So I would do research in those areas, consult health professionals if you can. But it's hard to say that you're going to take this one supplement, it's going to compromise your liver health for life and that you need to be fearful of any herbal supplement that exists. 语法解析
42:56
But yeah, you can find evidence of the misuse of supplement, of any supplement potentially having a problem with the liver, given that, um, given the liver's role in the body. But it's not something that, uh, that I think is massively, um, relevant, but it could be relevant for some people if they're doing interesting things. Yeah. So let's say, for example, you're taking on an ashwagandha, um, that is a herb and let's say it is purely digested. It's kind of pure. If you take, um, 语法解析
43:24
I guess, larger amounts, I don't know, like 1,000 milligrams or something like that or above for many months. Would that have any effect on the liver fat, liver injury or liver enzymes or anything like that? Yeah, I mean, I've not seen that broadly. I know there are cases that are reported, right? You see cases, right? This person took Oshawa for this period of time. 语法解析
43:48
But there's a few things there. I mean, there's a lot of contextual factors like how's this individual's health to begin with? What else are they doing? Right? You know, how vulnerable have they made themselves to something like this as a result of their other choices? I think that's relevant. Now also, it's also about appropriate use. Like ashwagandha is a, I see ashwagandha as a 语法解析
44:09
Short-term stress management supplement. So if you're using in a prolonged fashion, I don't believe, and I've spoken with naturopathic doctors about this, that that is the proper use. So the improper prolonged use of any supplement theoretically could have a negative influence on your liver health for sure. So I would just say if anyone out there uses oxygon, it is one of the most popular herbal supplements and everyone is stressed. I understand that. 语法解析
44:31
It's not really intended for forever use. I mean, you have to at some point have other stress management tactics to offer you some benefit and maybe deep breathing exercises, which by the way, I've seen evidence of lowers cortisol levels, lowers blood sugar levels, right? In conjunction with other changes. So I think that's the bigger issue more so to say that ashwagandha is toxic to the liver, you know, which is not the case with short term use, proper use and otherwise healthy person. Yeah. 语法解析
44:58
I've also heard that NSAIDs, so like aspirin and these other anti-inflammatory pharmaceuticals, they can be damaging to the liver. Yeah, I mean, so you made a mention about the liver regenerating capacity and that's 语法解析
45:16
What I've seen in the literature is I think individuals who lose a lot of their liver from, I think, acetaminophen poisoning, like taking way too much, and for whatever the reason, the liver can recover from that, right? So just to go to your point. I mean, yeah, theoretically, I mean, given that the liver is the detoxifying agent in the body, 语法解析
45:36
And to be fair, like what that means, it means either it transforms something into a healthier state, which usually what it is does for drugs, right? Drugs come into the body, the liver transforms them so they're less toxic. So yeah, if you overexpose your liver to, and NSAIDs are very common medications, which is why it comes up, right? So yeah, misuse of any medication is not good. That includes antibiotics, that includes painkillers, whatever the case may be. Absolutely. People need to be intimately aware of that. And the liver is only one of the many reasons why that's not good. 语法解析
46:06
Gotcha. NAC is one supplement that is also often mentioned for alcohol intake and liver health. Is there any evidence that it has benefits? In regards to what specifically? Liver health. Yeah. So in people who consume large amounts of alcohol, NAC offers some sort of protective effect? Just generally as well for the liver. Yeah. 语法解析
46:36
Yeah, I mean, so I've not seen that. So that doesn't mean I can't confirm or deny that's the case. I think that if you have like, if you have a choice to consume less alcohol, I don't think any supplement protects you from excessive alcohol use. I'll just say that statement. I've not seen the evidence in that area. That's one area I haven't looked into, but I will now. But I think the easy answer is there's no supplement that can protect you from prolonged overuse of alcohol. 语法解析
47:02
And even if NAC offers some protection, like whether via an antioxidant mechanism, you know, you can get that through optimization in your diet, right? And through really making a proper lifestyle change. What I'll offer in lieu of answering that question is something interesting. So, 语法解析
47:21
The cells in the liver that are responsible for detoxification are called the Kupfer cells. Okay. These are the cells that do the roles that we associate with detoxification in the liver. Now, physical activity, which we haven't really talked about too much, definitely helps. But specifically, high intensity physical activity has actually been demonstrated. I believe this was a 2017 study. I think it was in the Scientific Reports Journal. 语法解析
47:47
High intensity in internal training, not resistance training, not study state cardio was actually shown to increase the detoxifying ability of these cells. 语法解析
47:58
And it also reduced liver stiffness, which is a very hard thing to do. Maybe because high intensity interval training really increases heart rate and blood flow. And that has carryover effects. And to be fair, it was only in one trial. So we'll see what more research has to say. But that's another fun finding to share. Gotcha. Exercise then is obviously beneficial. Does it help with liver health irrespective of weight loss? You mentioned the blood flow. Is that one of the other mechanisms? 语法解析
48:28
So physical activity absolutely helps in the absence of weight loss. That's clear, right? Now someone could do physical activity and eat well and lose weight. Of course they can't. But the benefits of physical activity are not contingent on weight loss when it comes to reducing liver fat, right? And again, this should make sense to people. And this is why at the beginning I said it's, 语法解析
48:48
0.1, 0.2 pounds of fat on the liver. It's not a huge amount, right? So when you do physical activity, insulin resistance gets better. It activates certain proteins in the body that help with fat metabolism. And so it's that carryover effect, right, that has the influence on the liver. And what I say in regards to HIIT activity is that was some speculation on my part. And the reason why I speculate that the intensity of the blood flow may be relevant is that 语法解析
49:17
When the liver is more stiff, right? Blood flow is more poor, which means that, like I said, there's less access to these Kupfer cells, right? Blood can miss them, right? So, and we saw that only HIIT workouts increased or decreased liver stiffness, increased the functionality of those cells. So that's why I offer that bit of speculation. I mean, I could be totally wrong. Someone who's smarter than me might refute that, but it's just a speculation based on the studies I've seen. Gotcha. Yeah. 语法解析
49:44
Is there any difference between aerobic and resistance training? There is in terms of how it influences different proteins in the body. So they basically help the liver in different ways, is what I would say. But beyond that, I think with physical activity, there's different levels. If you take an individual who's doing nothing, and then you tell them to walk 150 minutes a week briskly, 语法解析
50:12
That will make a change in their liver health. If they already do that, then what's the next level? Well, you have resistance training, you have high intensity interval training, you have cardiovascular training. And really, it comes down to what are they willing and inclined to do? I mean, you know, resistance training has obvious benefits for healthy aging, you know, having a, you know, good heart, good heart health has obvious benefits. So 语法解析
50:32
It depends on what an individual is willing to do. And HIIT activity has unique benefits for the liver, but it's unpleasant. And not everyone has the capability to go work at 80-85% of their VO2 max. So that's another factor to consider. So it's really individualized. Yeah. Anything is better than nothing. But ideally, you should do both aerobic and resistance training. No. And if you can't, don't underestimate walking. Again, doing nothing versus walking 150 minutes a week is a massive difference. 语法解析
51:01
right so can't underestimate that yeah you mentioned uh stress and cortisol and often say people say that you know stress is also something that promotes visceral fat and liver fat is there any like differences between the type of stressors and does it actually like increase your liver fat irrespective of the let's say calorie intake 语法解析
51:26
Well, I would say irrespective of calorie intake, perhaps not. But here's what I'll say is that stress, and there's been studies done on this, but when you expose someone to the amount of cortisol they might experience in a stressful situation, it actually reduces blood flow to parts of the brain that are responsible for stress. 语法解析
51:46
food choice and appetite regulation. So that's obviously one of the reasons why stress influences food behaviors. So I think it's very hard to disentangle stress from affecting food behaviors. I think many people are vulnerable to the effects of stress on food behaviors, which is why you see deep breathing exercises and meditation can reduce blood sugar levels and reduce cortisol levels. There's obviously something there. But 语法解析
52:12
I mean, the extent to which stress affects one's food intake varies from person to person. I think that is where the real effect will be on the liver. I mean, someone could do, you know, there are people who thrive under stressful situations in the long term. Is that better than having everything perfect and not being stressed? Maybe not. Maybe it's better not to be stressed, potentially. But it's tough. I think there's not a lot of evidence for me to make a high-level claim connecting cortisol with fatty liver. I think I'd be speculating. Right. 语法解析
52:40
So yeah, it's more about the behavior that stress promotes, not the innate effects of cortisol itself. Yes, and it's also due to how resilient is someone to stress, right? Because again… 语法解析
52:58
Obviously, I look at a lot of studies, which is why I keep saying this. I mean, there was a trial where they gave people omega-3 supplementation, EPA and DHA for several months, and they tested the severity of the cortisol response and it decreased following a period of EPA and DHA supplementation. So how well are you living such that you can be resilient to the effects of stress? That's also a big question to ask, right? Yeah. In this context and sleep- 语法解析
53:22
I guess, uh, has some role as well, you know, reducing stress and managing food behavior. And, you know, there are studies that if you're in a calorie deficit, but you sleep, you know, five hours, then you lose proportionally more muscle than fat compared to sleeping eight hours. So, um, 语法解析
53:39
I guess the two questions here are again, like, you know, does a sleep duration and sleep quality affect the liver fat irrespective of the calorie intake and vice versa? If you're in a calorie deficit, you know, will you lose or will you keep more liver fat if you sleep shorter? Yeah. Yeah. No, this is a, this is a great question. A very fun question. So, so let's go through a few things then. Okay. So first of all, 语法解析
54:04
So scientists are increasingly interested in brain insulin sensitivity. So specifically to how sensitive the parts of the brain are to insulin. And what we see in long-term studies is that people with better brain insulin sensitivity 语法解析
54:20
generally lose more visceral fat during a weight loss intervention. So now I'm starting to get warmer in terms of what you asked me. Now, it's also the case that short sleep duration, which is to sleep less than seven hours a night, is not good for insulin resistance and insulin sensitivity. So you can kind of see the connection there. You can see kind of how that could happen. Now, 语法解析
54:45
Now, obviously, poor sleep also negatively affects the gut microbiome. So yeah, I mean, all else equal, you're going to make challenges for yourself if you don't sleep well. That's because of negative influences on the gut bacteria, negative influences on insulin resistance and insulin sensitivity, right? And obviously, to your point, poor sleep also affects your food choices. It affects parts of the brain that are responsible for making good choices around food and appetite regulation. Now, 语法解析
55:11
I'll offer some good news and some important news is that very often when people… 语法解析
55:16
are not going to get enough sleep. I'm guilty of this myself. If I'm not going to get eight hours of sleep or seven hours, I'm like, you know what? If I'm going to get six or five, I'm going to be tired anyway. Whatever. It doesn't matter. And scientifically, that's incorrect. What I've seen evidence-wise is if you sleep less than seven hours a night or less than six hours a night, and you can get 45 minutes more sleep to go over the six or seven hour threshold, that change alone can protect you from the negative effects of sleep loss. 语法解析
55:44
So which is to say, like, you know, don't underestimate the importance of an extra 45 minutes, even if you're getting less than optimal sleep. And I think people need to hear that because I think we're all guilty of that to some extent. But physiologically, there is a benefit for an extra 45 minutes, even if you're not sleeping enough. But yes, low sleep can destroy your insulin sensitivity. So in terms of exact correlations. 语法解析
56:06
the studies aren't there. I'm aware of this because I'm constantly looking at the evidence. I don't see like, there's obvious evidence that poor sleep is associated with high risk of fatty liver. I mean, that's obvious. It's associated with everything bad. Right. But in terms of like high level refined conclusions about that, they don't exist as far as what I've seen. Gotcha. Yeah. Yeah. And I mean, if you're, if you had like a bad sleep, then even short 20 minute nap can be a huge game changer, even just how you feel. Um, a hundred percent as 语法解析
56:32
as much as you can with the sleep. Yeah, is there anything else specific that we didn't cover that is worth mentioning when it comes to liver health and liver fat? 语法解析
56:44
Well, what I would say, which is something that everyone can apply, is to eat slowly and mindfully. Fast eating is strongly associated with insulin resistance. So that's one thing. For individuals who eat, let's say, a quote-unquote balanced traditional meal, which is to say they have a carbohydrate, a vegetable, and a protein, if they struggle with satiation or they struggle with insulin resistance, I could offer an additional piece of guidance, which is to eat the protein and vegetables at your meal first. 语法解析
57:13
Now, the better your diet quality is, the less important it is to do this. Because if you're eating lentils, broccoli, and salmon, you know, that's pretty much all good how you eat the meal, right? But the more help you need, the further behind you are in terms of catching up with your health, the more beneficial details like that will be. Okay. The only other thing I'll add. 语法解析
57:35
is… So I consider personally legumes, which are lentils, chickpeas, kidney beans, and black beans to be the most underappreciated family of foods. Okay? 语法解析
57:46
They have, legumes have a very strong influence on the gut microbiome, right? So if you're thinking, what can I eat that's going to have a, you know, that science is telling me is going to improve the levels of healthy gut bacteria, which in turn is going to improve my liver health, I would think about legumes. And people don't really appreciate their value and they're economical, they're easy to eat, they're very satiating, all the things that someone wants when they're trying to improve metabolic health and liver health. 语法解析
58:11
legumes offer and you don't even need that many half a cup at one meal a day a quarter cup even i've seen studies even a quarter cup a day reduces the insulin resistance and liver cells so i would offer that guidance as well um but beyond that i think yeah it was a great comprehensive conversation great questions yeah i also like black beans and the guinea beans they're very tasty yeah before i ask my last question where can people learn more about you and your work 语法解析
58:38
Yeah, on I'd say Instagram and TikTok. So AndyVRD is my handle. And all the stuff I'm talking about today, when I talk about these studies and these facts, it won't be hard to find them because I share them openly on my social media. So yeah, I would say those two places. Awesome. We'll put the links in the show notes. And my last question is, what's this one piece of advice or a habit that you wish you adopted sooner? Oh, wow. You know what? I would say… 语法解析
59:08
I became a dietitian because I needed to be, I needed a dietitian when I was younger. So I wish when I was 16, instead of taking a five-year convoluted path to learn what it meant to eat well, I saw a dietitian. I would have saved myself a lot of unnecessary suffering. So it's a big props to my profession. All right. That sounds good. Well, yeah, thanks for coming to the show. It was very insightful and educational. And yeah, I'll be happy to have you back in the future. Appreciate you having me on. It was a great chat. All right. See you around. 语法解析
59:36
Alright, that's it for this episode. Make sure you check out my new book, The Longevity Leap, on Amazon. I'd also appreciate if you shared this episode with a friend or family member. Other than that, my name is Seem. Stay tuned for the next episode. Stay empowered! 语法解析
Edit:2025.04.08
核心主题：肝脏健康，特别是脂肪肝
1. 肝脏的重要性与独特性 (00:46 - 01:38)
2. Andy 为何关注肝脏健康 (02:08 - 03:01)
3. 现代生活对肝脏的压力 (03:02 - 03:43)
4. 肝脏健康不佳的后果 (04:09 - 06:20)
5. 脂肪肝的可逆性与成因 (06:21 - 09:24)
6. 脂肪肝的诊断标准与内脏脂肪关系 (09:25 - 10:55)
7. 脂肪肝的关键决定因素 (11:45 - 14:22)
8. 逆转脂肪肝的策略 (14:23 - 18:19)
9. 关于糖、酒精和脂肪种类的讨论 (18:20 - 37:29)
10. 补充剂与肝脏健康 (37:30 - 46:05)
11. N-乙酰半胱氨酸 (NAC) (46:06 - 47:19)
12. 运动与肝脏健康 (47:20 - 51:00)
13. 压力、皮质醇与睡眠 (51:01 - 56:42)
14. 其他实用建议 (56:43 - 58:37)
15. 总结与嘉宾信息
整体信息： 肝脏健康至关重要，脂肪肝是普遍问题，与生活方式密切相关。通过优化饮食（强调高多酚地中海模式，富含Omega-3、MUFA、豆类、蔬菜水果），规律运动（任何形式都比没有好，HIIT可能有独特优势），管理压力和保证充足睡眠，以及明智使用补充剂（优先考虑Omega-3和益生菌填补空白），可以有效预防和逆转脂肪肝，维护肝脏健康。即使不减重，生活方式的改善也能带来显著益处。
Edit:2025.04.08
Edit:2025.04.08
