WEBVTT

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Initialize sequence coming to you live from
Houston, Texas, home to the world's

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largest medical center, in a bunch
of days on the day, Rocket Coty,

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this is Your Health First, the
most beneficial health program on radio with

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doctor Joe Bellotti. During the next
hour you'll learn about health, wellness and

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the provention of disease. Now here's
your host, doctor Joe Bellotti. Well,

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it is another outstanding Sunday evening in
Houston or wherever you are tuning in

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from the name of the program is
Your Health First. We're here every Sunday

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between seven and eight pm. And
as I've been saying now for twenty one

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years, our single minded goal is
to make you better consumers of healthcare.

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No fluff, no filler. It
is all legitimate, well sourced information for

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all of you. Now to participate
in the program, our website doctor Jogalotti

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dot com, Doctor Joegalotti dot com, and that's where you can sign for

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our newsletter. Look at all of
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You could send me a message,
communicate with our team and all the social

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media links are there doctor Joegalotti dot
com. Now on the program tonight,

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I would say, wherever you are
if you're in your car, if you're

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at home, grab a drink,
hopefully a non alcoholic drink for the topic

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tonight and settle in. This is
going to be a packed packed radio program

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tonight. Now you know, we
not that we go out of our way

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to talk about fatty liver. That's
that's a condition that that we talk about

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a lot and something that I see
every day as a liver specialist. But

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we have in the studio tonight two
experts, Doctor ran Deep Sunisia, a

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cardiologist. Ran Deep has been here
before. And somebody new to the Your

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Health First Family, doctor Mason Neuridine, who is new to Houston within the

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last year and a half and he
is a hepatologist similar to me. And

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we're going to really talk about the
interplay of heart disease and fatty liver.

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Fatty liver and heart disease and really
what you all need to know. So

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I'm going to start off with doctor
Sunesia, Welcome back to the program.

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It's been a few months, but
every February one you send me a text

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to say it's American Heart Month.
We have to talk. So here you

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are. I'm honored and privileged to
be here. Once again. Thank you.

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Well it's it's I'm gay and Mason. You're here talking about liver disease.

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Welcome to the program. It's an
honor to be here. Joe.

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I wanted to be on this show. I heard about it and I'm glad

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to be here today and here you
are live all right, So to get

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let's just start off, since that
is American Heart Month, doctric in Asia.

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In a nutshell, explain to everybody
how big of a problem heart disease

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is, because really, at the
end of the day, half the people

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are going to die from heart disease. Well, absolutely, it is the

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number one killer of people, not
only just in the US, but all

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over the world. A total of
twenty four percent of the deaths occurred because

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of cardiovascar illness. There is a
cardioscar death that occurs every thirty four seconds

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and an acute heart that occurs every
forty seconds in the US. So it's

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a staggering statistics. And the fact
is that this statistics not just holds true

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for the US, this is literally
all over the world, including the Third

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World and developing nations. In Asia, the incidence of heart disease and heart

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text is rising. Because of the
increasing incidence of obesity and other risk factors.

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Right, So, as a cardiologist, if you could say the most

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common thing that you say typically in
a day, what is more? High

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blood pressure? Is it? People? And heart failure, people having heart

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attacks? What do you think it
is? I would say hypertension hypilipidemia probably

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are the commonness because I see patients
you know, from all ages, you

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know, below sixty five, above
sixty five and hypertension hyperlipidemia probably is the

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commoness. And then along with that, Cordneouder disease comes, you know,

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asymptomatic, symptomatic, and especially in
the elderly population, conust to heart failure,

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as you know, is the number
one diagnosis for patients above the age

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of sixty five, both in the
offices and in the hospital admissions. Yeah.

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Now, when you see patients,
say a new patient sixty five,

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sixty eight years old with high blood
pressure, some cholesterol issues, and you

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bring up all of the risk factors, but you mentioned obesity as a risk.

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How do they react to that?
Well, you know, that's a

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stark reality. You know, based
on the statistics, forty two percent of

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the US population currently is obese and
they're talking about we will be crossing to

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fifty one percent by the end of
the decade. Unfortunately, because of the

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pandemic. In my practice, at
least the way I see it, approximately

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seventy five percent of the patient population
has gained between ten to twenty to thirty

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plus pounds. So in the last
three years, this pandemic has not done

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us any favors. We have been
less active, eating more and as a

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result we have packed one pounds.
Yeah. Now Amazon as a liver specialist

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and we're talking about obese here fatty
liver. I mean, it doesn't get

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any more clear what the problem is. Now. You were involved in the

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changing of the name of fatty liver. We've sort of gone away from using

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the word fat. So explain that
everybody what fatty liver is and and how

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the name changed. Sure, and
it's good to be here with a cardiologist.

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What I tell my patients, this
disease is a cousin of the others,

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Yes, the obesity, the type
two diabetes, the hyperlipidemium, hypertension.

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Indeed, some people say it should
be part of the metabolic syndrome right

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under the umbrella and where it ends
up heart disease, right, and for

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the liver also crosis. So faty
liver is as it sounds. When fat

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goes into the liver, deliver usually
says, well, this is fat.

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I can handle it, like medications. I should handle all of those.

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But then when there's excessive eating or
there's excessive fat coming from the tissue of

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contaneous tissue under the skin to the
liver and the liver gets tired, he

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says, well, I can't handle
that much fat. And then the fat

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sits there, right, And that's
at the beginning of fatty liver, and

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then inflammation and scarring and as you
know cruses are then yeah, and you

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mentioned how we you know, cardiology
is holding hands with livid disease, liver

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diseases, holding hands with cardiolsgy.
It really is. Fatty liver is a

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manifestation of obesity. Hypertension a manifestation
of obesity. Cardinary artery disease manifestation of

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obesity. So in a perfect world
we could almost cohabitate and work under the

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same tent in a way managing these
patients. And many of your patients come

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to see me. My patients go
back and they have heart disease that we

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discover, so it really I think
it is a crisis. Now in the

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last minute, I at least ask
each of you how big of a public

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health threat is the whole fatty liver
scene with obesity amazing you, Yes,

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it's the estimator is around thirty percent
of the population in the United States they

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have fatty liver. Now in Texas
it's forty percent, right, and a

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lot of states is more than thirty
percent. Luckily, that's not causing problems

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on everyone is just like the subpopulation, but still a lot of them goes

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to the advanced stages about ten twenty
percent of thirty percent, that's millions of

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people. So it's kind of just
increased with the obesity. As mentioned earlier,

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from a public health standpoint, obesity
and heart disease they go hand in

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hand, and that the fatty liver. So it's the epidemic of obesity.

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As we talked about forty two percent, and especially in African Americans and in

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Hispanics, the obesity factor is more
than almost prevalence is more than forty five

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to forty eight percent currently in twenty
twenty one data which is supposed to exceed

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beyond fifty three to fifty four percent. So obesity, hypertension, hyperlipidemia,

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pre diabetes, diabetes, they are
all going hand in hand and with all

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that, corneoder disease is a silent
killer that comes along with that, right,

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Yeah. And the truth of the
matter is which Mason, you'll get

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into the people with fatty liver,
the dying of heart disease. Absolutely,

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you know. We like to think, and it's a sad thought to say

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that, well, everybody's needing a
liver transplant and they're dying of liver failure.

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But the truth is most are dying
of heart disease. It's the number

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one cause. Yeah, and death
and deathn't these patients. So we tell

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them, like, make sure your
cardiologist is looking at your heart. Yeah,

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yeah, you know. One one
question is we see so many patients

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and they may be seeing a cardiologist
because they're on a stat and they have

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high cholesterol, and be it the
primary care physician. Some cardiologists they're stopping

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their statins thinking that it's going to
harm the liver. What's your take on

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that as a cardiologist. No,
I absolutely recommend that they must continue to

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stating. However, I do want
them to see you a liver specialist and

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any other liver specialists, so that
they know that what is the degree of

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fatty liver, what extent of fatty
liberate it is? And there Mason and

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yourself will come in and tell us
the degree of fibrusis the their music to

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my ear, yes's exactly it.
So, Joe, you and I see

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patients every day coming to us and
they say it's the lipid or or another

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stat in that causes elevated liver enzymes. So as my callinggue mentions that we

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need to keep them mine because they
get a heart attack, and then we

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go there fatty liver and what on
deepshit is exactly the point is how bad

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it is, because it could be
a simple problem. It's just fat.

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But also, on the other hand, you want to know if they're going

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to souss or they just a step
away from cervices. So that's our job.

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Yeah, and again we'll get into
this and the next break. But

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a lot of people and there are
millions of people out there, many listening

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tonight that have a fatty liver,
and it's like, oh, it's not

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that big of a deal. We'll
worry about it later, all right,

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We're going to take a quick break. Come down to Joe Galotti. This

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is your hell first. Every Sunday
between seven and eight pm, we're talking

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fatty liver and heart to disease.
Stay tuned, don't move, raising your

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health IQ, one listener at a
time. Doctor Joe Galotti, this is

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your health first. Thanks very much
for tuning in on this Sunday evening.

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We've been discussing heart disease. We've
been discussing liver disease, fatty liver and

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in the studio to friends, colleagues
and experts. I would say Maison new

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Adine, founder of Euston Liver Institute
Houstonliverinstitute dot com. And doctor Randeepsunasia,

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founder of Houston the Cardiology Center of
Houston. Their website is Houston Cardiology dot

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com. Welcome back to you both, Doctor Neurdean, I'm gonna I'm gonna

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get to you talking about fatty liver
as the the uh colver expert here tonight.

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So many people are walking around with
fatty liver, very nonchalant, sort

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of there head in the sand.
Oh I got a fatty liver, but

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it's not a big deal. What
do you say to everybody tonight. That's

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listening tonight about the reason to get
a bit serious about this. That's a

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key question. The last thing that
you want to end up is having soross

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out of the blue. You end
up in deliver doctor's office. You don't

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drink alcohol and you're being told you
have seruces and you and I see that

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every single dage. All right.
So now, the American Association for the

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Study Liver Disease, the American Gastroentology
Association, since twenty twenty one, they

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made it really clear that we should
not put our head in the sand,

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that we should look for those that
they have advanced disease. And it's easy

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if you have type two diabetes or
like Crandeep mentioned earlier, hypertension to slipidemia

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and these risk factors they make fatty
liver warse. So you got to ask

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your primary care or your doctor to
look deeper into your liver. If they

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say don't worry about it, as
them actually for additional tests because they have

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risk factors. And we can talk
about this, h but you know,

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I feel fine. I feel fine, doctor Nourrodine. What are you bugging

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me about this for? And it's
an asymptomatic disease. You don't feel symptoms,

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you don't feel nothing, and all
of a sudden they're showing up in

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your office. Joe, you see
that with fluid in the abdomens called assietys

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or complication from serviuce right, So
we gotta tell them. You really have

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to pay attention. Elevated liver enzymes
could be okay, but it could be

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a problem. There's certain tests.
I mean, there's something called FIP for.

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If you google it, you'll find
what's a FIP for. It's a

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numbers an age and some blood test. And your doctor need to know about

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this. If they don't know about
this, to ask them what is my

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FIP for? Gool it? If
I be for google it and you know,

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I would say, well, tomorrow's
a holiday, some people might not

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be working, but Tuesday or Monday
for those that have to work. Call

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you doctor if you know you have
fancy liver. I really we're going to

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start a movement here, Dotter neurody. Call your doctor say hey, what

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is my FIB for? Why not? And I think we need to do

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that. And I've got some of
my staff, some PA's of mine in

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the studio here what do we say
to our patients deliver suffers in silence,

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and so don't be put off that
I feel good, I look good.

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Now the difference with heart disease,
many patients could be silent, but a

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lot of people have chest paining,
their short of bread, they've got palpitations.

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How do you how do you try
to instill in your patients? And

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you are a great communicator, I
would say, without a doubt, instill

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on them the need to take this
seriously, their heart disease or their risk

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factors. You know, good communication
and education of the patients is critically important,

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as you know. And you know
I say announce of prevention worth a

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pound of cure. So you know, I am a very big believer of

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coordinaty calsium scores, and we have
so many patients walking in with a high

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pretention hypperlipidemia, obesity, any risk
factor. I am a very big and

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strong believer of corodinary calcium score.
And it's like you know Phipps four score.

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Here, every patient needs to know
the cordinary calcium score. They really

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need to know where they stand.
And once you know your coronarty calsium score,

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the beauty of that is FO one
hundred and forty dollars probably the best

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one hundred and forty dollars you'll ever
spend. And Houston method system across the

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entire city does this. It's a
three minute test, totally non invasive,

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gives me an aus a wealth of
information and you know where you stand,

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what your coordinaty calsium score is not
the entire story, but yet it's a

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phenomenal start where you stand. And
the key is once you know your cornerity

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cassium score and you know where your
persentile is. Because the cornity custium score,

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we are able to see that individual, standardize them against the Meser registry,

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calculate the personile based on age and
gender, and we are able to

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say, hey, you know what
you are in the nineteenth percent time when

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I've had these patients. Sixty year
patient comes in the score of three hundred

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four hundred, you're already in the
ninety fifth percentile and one meaning trouble,

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meaning trouble because one risk potential trouble. So because you know the Carney cultium

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score, as you know the classification
as I follows, zero is none,

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one to ten is minimal, eleven
two hundred mile one hundred and one to

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four hundred is multi monit four and
severe over one thousand very severe. So

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once you know your score and where
you stand here persontile, it's a stark

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reality and that increases compliance of using
aspirint statin as a very big thing.

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Right, same thing for what we're
I think they're ahead of us in a

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way in doing that and we're only
now sort of lagging. We've got these

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millions of people with fatty liver.
They're head up where the sundown shine.

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And this is what you're trying to
do. Yeah, and deep, you'll

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be proud of me. I'm in
my forties and I have got my calcium

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score or they multiple times auso.
Yes. So indeed, like one of

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the things I was attending one of
the leadership meetings in the American Association for

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Steady Delivered Disease and they said,
we wish that we have this FIP for

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sign on a billboard. Yeah,
in the city, if you have type

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two diabetes or metabocrist factors, get
your FIP four. Yeah, so get

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that. Yeah, all right,
So two things learned. Get your calcium

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score and your FIB four FIB number
four everybody during the break, look it

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up and you can calculate your fIF
four. All right, I am doctor

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Joe Galotti. This is your health
first. Every Sunday we are here.

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You are our best to educate the
public. Stay tuned news, weather and

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traffic. Well right back, Welcome
back everybody, doctor Galati. I hope

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you have had a great weekend.
A little time to recharge your batteries.

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I went out today on sort of
a leisurely walk and my wife and I

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get a little nutty trying to track
our steps and our activity on our watch,

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and we came up a little short. We didn't get to ten thousand,

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but then we went to Costco and
I'm proud to say I hit my

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ten thousand mark. Another three thousand
steps in Costco today, So another two

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or three thousand steps and two hundred
dollars. That's what it costs these days.

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So I'm in the studio with doctor
Amazon Nouridine, a hepatologist and researcher

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here in Houston at the Houston Liver
Institute. In Doctor n Deep Sunasia,

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former chief of Cardiology at Houston Methodist
Hospital West and he is with Cardiology Center

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of Houston Mason with regard to fatty
liver. We were talking about the FIB

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four. Another tool which is almost
equivalent to the one hundred and forty dollars

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for the calcium scores is fiber scan. How does that fit in? And

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again, if people have fatty liver
that they're listening tonight, or they have

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a loved one, they can get
the FIB four. But I would say

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maybe up a higher level of accuracy, maybe with the fiber scan. In

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a nutshell, tell everybody about that, right on, Joe. So someone

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is googling it. It's labs and
age and they're like, they see the

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score in's high. What do we
do next? So you have that in

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office or liver offices. It's ultrasound
like machine. You think you're doing regular

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ultrasound. It's different. People start
getting ultrasound, that's not it. This

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one is kind of like vibrating like
machine like ultrasound. We put it on

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the right side of the body,
which the liver is, and within five

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six minutes it tells you exactly how
much fat you have in your liver and

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more importantly, if there is corning
in deliver, which is the problem because

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cerosis everyone heard about cerrousis right,
it's complete scarning of deliver. So this

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one tells you if you are on
the road to that from zero, one,

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two, three four, it tells
you exactly what it is in less

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than them ten minutes. Yeah.
The other thing is and at every opportunity

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to mention this corosis does not mean
you are an alcoholic. And a day

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doesn't go by where you tell somebody, hey, you have cirrhosis or we

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believe you're close to cirrhosis, and
they get insulted saying, how dare you

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call me an alcoholic? Absolutely,
so this is the old man used to

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be non alcoholic fat you living disease. And that's where sort of the name

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change came in. Yeah, and
the people it was like a process,

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voting process, and people patients said, when you say non alcoholic, even

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if I go to my neighbor and
I say I have no alcoholic fatty liver

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disease, first thing, they just
like omit that word none and they think

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I'm alcoholic. And then they hear
the word fatty and I think of myself

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fat. So we changed that to
call something mazzled. It's a long name,

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but basically this disease is actually the
most common cause of cirrhosis right without

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drinking right, and it's related to
food and overweight right excess. Speaking of

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that cholesterol again, many people have
elevated cholesterol and what makes me, I

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don't wan say laugh, but I
sort of giggle inside. I just have

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a touch, just a touch elevated. It's not that bad. My doctor

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wants to watch it, even though
I have five years of high cholesterol and

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treglis rides. So they come to
you, and let's say you start them

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on a statin or some drug to
lower therapy lower the cholesterol. What are

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the options, both drug wise and
non drug wise to treat high cholesterol.

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Yeah, I think we have to
manage the cholesterol based on the risk factors.

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And here the calroinety calcium score plays
a very big role. If they

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have lipids which are mildly elevated and
your score is zero, you know,

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then the management would be different.
But if they have premature corgnatory disease with

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high calcium scores, then you become
very obsessive about managing their ldeal much more

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better. Bringing down below seventy and
now the newest recommendations from May of twenty

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twenty three are bring them down LDL
below fifty five one. So the options

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we have are obviously the cornerstone statins. We have a fair number of statin

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lipid soluble non lipe is soluble.
We have to figure out what works for

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the patients starting low go to high
intensity status, which are travel status and

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reserver statin. If non cogina disease, we tend to start with those.

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Key is that you have to monitor
the patients carefully because TATAN associated muscle symptoms

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which is present in up to twenty
five percent of the population. It has

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happened if you ask the patients they're
having these non specific militias. You have

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to monitor the patients because if that
affects the quality of life, then you

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have to reduce the dose. Add
non statin in the form of zittamite can

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be added. And now we have
phenomenal other therapies in the form of pskin

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and inhibitors that can be added on
to the most well toiled dose of statin.

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We have two of three of those
in the market. And then we

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have also now of the new inclyas
round which is lequio, which can be

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given once every six months. The
first dose so there are other options there,

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but statin still remain the corner store. How because with fatty lever,

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we talk about losing five percent of
their body weight, ten percent of their

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body weight, which in someone that
is hundred pounds overweight, that's not that

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much. I mean, it's a
decent amount of weight. Do you ever

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feel that losing twenty pounds is enough
to lower their cholesterol and their risk?

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Absolutely, lifestyle modification plays a key
role. It helps you reduce your degrees

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of inflammation, reduces the LDL,
reduces your A and C, will reduce

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your overall degree of inflammation everything.
So lifestyle modification will contribute anywhere from ten

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00:24:29.240 --> 00:24:34.000
to twenty percent. And you know
those are important because you just cannot just

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write prescription to the patient. Lifestyle
modification is critically important, and I say

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weight loss is the best medicine.
There is no doubt about it, right.

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I just want to make a comment
for the people who are listening.

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We're blessed to have these medications that
run the mentioned, but I just want

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to make sure people also know that
fatty liver cannot be treated with these status

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00:24:56.839 --> 00:25:02.000
and UNTI fat They're important to be
on it to protect heart disease, but

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00:25:02.160 --> 00:25:07.839
tatty liver unpartocularly has shown not to
be solved by statins or psks. There

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00:25:07.839 --> 00:25:12.119
are other medications for them, but
we put these. We asked ran Deep

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00:25:12.160 --> 00:25:18.039
and the cordiologists to help us managing
the slipidemia bad closure on these patients so

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they don't get the heart attack right, So maybe we'll jump to research.

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Doctor Nurdine is a national and international
expert within research, especially in fatty liver

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00:25:33.440 --> 00:25:38.200
disease. Where are we at with
these new drugs? What is the hope

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00:25:38.240 --> 00:25:44.160
for the future? And thank you
for asking this question and asking me to

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be here today, and joy your
show is always timely and this is a

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very timely time for factory liver.
Why so in New England Journal paper this

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is the top medical journal that we
know of as doctors, we just published

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the paper on therapy for or faty
liver or its advanced forms called MASH.

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00:26:03.000 --> 00:26:10.559
The paper came out two weeks ago. But also there is an expected therapy

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to be hopefully approved by the FDA
next month in March twenty twenty four.

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00:26:15.519 --> 00:26:22.519
We're watching for this news. So
rismitero is probably gonna be the first drug

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00:26:22.559 --> 00:26:26.680
approval for MASH, which is the
advanced form of fatty liver. So we

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00:26:27.440 --> 00:26:30.160
used to be told, Okay,
we send these patients to you guys,

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00:26:30.200 --> 00:26:33.720
you do fiber scan and then what
is just weight loss and exercise. So

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00:26:33.759 --> 00:26:38.240
the answer is no. Now we
have medications that they're gonna be hopefully in

334
00:26:38.319 --> 00:26:41.200
the market next month. But you
know, when people come to your office,

335
00:26:41.359 --> 00:26:45.359
you have these options. They are
in clinical trials, they are in

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00:26:45.400 --> 00:26:49.200
research, and importantly, some people
say, well, I don't want anyone

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00:26:49.240 --> 00:26:53.680
to experiment on me, and I'm
just gonna wait. But guess what some

338
00:26:53.720 --> 00:27:00.000
of these medications are actually if they
approved for other indications such as wait longe

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00:27:00.200 --> 00:27:03.559
and type two diabetes, but the
FDA is requiring them to do it on

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00:27:03.640 --> 00:27:08.160
fatty liver patients and NESH and many
of them are weight loss medications. So

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00:27:08.519 --> 00:27:12.000
patients when they come to our offices
like you office, Joe, I'm sure

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00:27:12.039 --> 00:27:15.640
when you put them on clinical trial
for fatty liver and they start losing the

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weight and we're seeing fatty liver also
helping they get early benefits. With FDA

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00:27:22.119 --> 00:27:26.400
approve medications for other indications that they
are safe. So we used to be

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accused that we don't have enough tools. We actually have a lot of tools

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00:27:29.079 --> 00:27:33.200
and deliver off right now. Once
this new medicine is FDA approved within the

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00:27:33.279 --> 00:27:40.720
next few weeks, I would almost
anticipate that there's going to be a lot

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of patients that are going to be
infused into the system to be evaluated for

349
00:27:47.359 --> 00:27:52.960
these medications. But since we have
doctor Sinasia here, we're going to see

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these patients and see they have high
cholesterol, they have hypertension. So I

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think everybody involved this, with this
influx of patients are going to have to

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00:28:02.799 --> 00:28:06.960
carefully look at them. If they're
not coming from a cardiologist, we're going

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00:28:07.000 --> 00:28:11.279
to have to act on their behalf, stratify what risks they have, and

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00:28:11.440 --> 00:28:17.279
get them into the right people for
that sort of global care. What do

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00:28:17.319 --> 00:28:21.400
you think of that? Absolutely,
because anybody who's got fatty liver probably has

356
00:28:21.440 --> 00:28:25.799
coordinary disease. Also, yes,
I'm working out today asking I'm going to

357
00:28:25.799 --> 00:28:30.440
ask my patients to do the calcium
score. I used to shy away from

358
00:28:30.519 --> 00:28:33.880
recommending it test, and I just
I emphasize. I tell them I had

359
00:28:33.880 --> 00:28:37.880
a patient with chest pain and he's
like, oh, my doctor just that

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00:28:37.599 --> 00:28:40.920
stressed as and was normal. I'm
like, no, no, no quot

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00:28:40.920 --> 00:28:44.480
to cardiologists. It's and he ended
up with corllioism and had a stint right

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00:28:44.519 --> 00:28:47.440
at the end of the day.
But I think these patients, once we

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00:28:47.480 --> 00:28:51.920
start caring for them, it's important
to prevent the number one cause of this

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00:28:52.319 --> 00:28:56.079
death in them, which is cornogy
disease hard heart attacks. Now, I

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00:28:56.119 --> 00:29:04.519
think and it really reinforces this connectivity
and brotherhood and sisterhood or personhood whatever we're

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00:29:04.519 --> 00:29:10.680
gonna call it, between cardiology and
livid disease. We cannot under understate that.

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All right, final segment coming up. I do hope all of you

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are enjoying this conversation with doctor Neuridean
and doctor Sunasia. I'm doctor Joe Galotti.

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Don't forget doctor Joe Galotti dot com. Stay tuned. Final segment coming

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right up. Josh's playing one of
my favorite songs here. Well, final

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00:29:30.119 --> 00:29:33.039
segment here, we have a little
under ten minutes. And for those that

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may be just joining, we have
doctor ran Deep Sunasia, acclaim cardiologist here

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in Houston. Houston Cardiology dot Com
is his website. And then Mason Neuridean

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leading the charge in livid disease research
with Houston Liver Institute dot com here in

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Houston and around the world. So
we've been talking about liver disease, fatty

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liver, heart disease, the interplay
with cholesterol and obesity. Now alcohol.

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Now this is not necessarily a discussion
of alcoholism or addiction, but for those

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00:30:18.359 --> 00:30:22.880
of us in liver disease, we
get very sensitive with alcohol, even small

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00:30:22.960 --> 00:30:26.799
amounts. If you have fatty liver
or hepatitis B or hepatitis C, that

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00:30:26.839 --> 00:30:30.359
can make the liver disease worse.
So what's your position. What do you

381
00:30:30.359 --> 00:30:37.200
tell everybody tonight if you have fatty
liver and what to do about alcohol?

382
00:30:37.880 --> 00:30:42.400
Yeah, so I'll just go buy
the guidelines by our society. First of

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00:30:42.440 --> 00:30:45.480
all, if you have cerusis,
you got to stop, Julian, you

384
00:30:45.519 --> 00:30:48.240
know that. I know that.
It's not just because like we want to

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00:30:48.240 --> 00:30:52.400
punish you. Because serus is and
alcohol is badness. It's going to go

386
00:30:52.440 --> 00:30:56.319
to the bat side. The liver
is going to limp further. And more

387
00:30:56.359 --> 00:31:00.359
importantly, you are more prone to
developed livery cancer if you drink alco oni.

388
00:31:00.559 --> 00:31:03.920
Right, not good. So the
data on fatty liver, if it's

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00:31:03.960 --> 00:31:08.480
in early stages, the data is
kind of all over the place, and

390
00:31:08.799 --> 00:31:14.599
some people say minimum amount are okay, especially if it's a wine, that

391
00:31:14.599 --> 00:31:19.240
that's okay. But by time you
start getting scoring stiffness in the liver,

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00:31:19.880 --> 00:31:23.519
especially like the one you do with
fibers, can you see them preserces or

393
00:31:23.519 --> 00:31:27.319
have some scarring, it's probably better, especially in the pre sources stage,

394
00:31:27.359 --> 00:31:33.359
to stop and focus on a healthy
lifestyle. But earlier stages in moderation,

395
00:31:33.720 --> 00:31:38.480
in the right amount, it's probably
allowed for now right now on the flip

396
00:31:38.519 --> 00:31:42.279
side, patients come up to us
and again we're on the liver side,

397
00:31:42.319 --> 00:31:51.240
we're taking a detailed alcohol intake history
and we'll red flag it and we'll say,

398
00:31:51.640 --> 00:31:55.960
you know that three glasses of wine
or you know, at lunch or

399
00:31:55.960 --> 00:31:59.160
in the evening is a little too
much, or it is too much in

400
00:31:59.200 --> 00:32:06.119
the setting of fatty liver. And
the classic response is, well, I'm

401
00:32:06.160 --> 00:32:09.680
doing it for my heart, and
you sort of want to throw the flag

402
00:32:09.720 --> 00:32:15.960
out and say foul ten yards you're
out. So from you, doctor Sunasia,

403
00:32:16.519 --> 00:32:20.400
no, I think what do you
say? Very important that you know,

404
00:32:20.440 --> 00:32:23.039
we need to make people aware of
the amount of alcohol they're drinking.

405
00:32:24.240 --> 00:32:29.720
For women, as you know,
it is one drink per day and total

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00:32:29.799 --> 00:32:34.720
more than seven drinks per week is
considered excess. For men, it is

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00:32:34.759 --> 00:32:37.680
two drinks a day. And you
have to also understand when you ask a

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00:32:37.799 --> 00:32:43.079
patient, so I drink a glass
of wine and one serving is four ounces,

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00:32:43.160 --> 00:32:45.559
so you know they're saying, oh, you know what, dark You

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00:32:45.559 --> 00:32:49.720
know, I had like this big
glass, and he's just showing me a

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00:32:49.720 --> 00:32:55.160
big before. That's that's three to
four servings in one sitting, right,

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00:32:55.319 --> 00:33:01.519
and that's excessive. And obviously we
tell them that that ultimately has number one

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00:33:01.960 --> 00:33:07.480
negative cund deliver with fatty liver because
they are obese already, excess calories,

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00:33:07.640 --> 00:33:13.160
and then you have excessive alcohol as
negative impact on alcoholic card in myopathy also,

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00:33:13.559 --> 00:33:16.599
so those are things, and then
excesscalories. Every one ounce of wine

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00:33:16.720 --> 00:33:20.960
has twenty five calories. And I
just this last week had a patient.

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00:33:21.160 --> 00:33:23.599
I mathematically calculated him and I said, you know what, in order to

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00:33:23.599 --> 00:33:27.759
lose one pound, you have to
have a negative balance of thirty five hundred

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00:33:27.759 --> 00:33:30.240
calories, right, And if you
do five hundred calori less per day,

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00:33:30.440 --> 00:33:31.880
and every day of the week,
you loss a pound. And that five

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00:33:31.920 --> 00:33:37.480
hundred I divide into two parts two
fifty two fifty two fifty less caloric intate

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00:33:37.079 --> 00:33:42.440
primarily affecting carbs, bread, pasta, dessert, snacks, potatoes, rice,

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00:33:42.480 --> 00:33:45.279
alcohol, And he said what,
Yes, I said alcohol part of

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00:33:45.319 --> 00:33:46.200
carbs. He said, yeah,
carbs. Yes, I said, that's

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00:33:46.200 --> 00:33:50.160
all part of cars. And if
you reduce two and fifty calories per day

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00:33:50.319 --> 00:33:54.119
and two and fifty calories of increasing
utilization meaning burning mode does half of a

427
00:33:54.240 --> 00:33:59.079
brisk walking, jogging, running,
whatever you may do, and very important

428
00:33:59.119 --> 00:34:01.839
part in this, in these lifestyle
modifications, as long as you don't have

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00:34:01.839 --> 00:34:06.200
any history of co ind to heart
failure, sixty to seventy ounces of water,

430
00:34:06.640 --> 00:34:13.679
that stimulation of metabolism reduces uppetite critically
important right now, you know,

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00:34:13.920 --> 00:34:19.320
back Amazon, back to you with
lifestyle changes. We you know if you

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00:34:20.440 --> 00:34:24.079
is it true to say if we
didn't have obesity, there'd be no fatty

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00:34:24.079 --> 00:34:29.239
liver. That's a little bit of
a stretch. But what do you what

434
00:34:29.239 --> 00:34:31.760
do you think? Yeah? I
mean it. I want to point to

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00:34:32.239 --> 00:34:37.159
lean fatt lean fatty liver here.
Yes, if we solve obesity, the

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00:34:37.199 --> 00:34:45.559
problem will decrease significantly. Nevertheless,
there are some people unblessed with the lean

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00:34:45.599 --> 00:34:52.199
fatty liver. Usually they have something
called insulin resistance meaning this is their body

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00:34:52.480 --> 00:34:58.400
doesn't handle insulin well. And if
you actually want to know each patients are

439
00:34:58.400 --> 00:35:01.679
those those are the patients that look
fine, and then you look under their

440
00:35:01.719 --> 00:35:06.639
shirt and they have this small belly
there that's coming from insult resistant. Asian

441
00:35:06.639 --> 00:35:09.280
people, yes, a lot they
have lean, faty liver people from India

442
00:35:09.280 --> 00:35:13.800
actually as well. Faty liver is
a big problem there and they have it

443
00:35:13.880 --> 00:35:21.480
on the lean side. So it
goes back to the right amount of eating

444
00:35:21.800 --> 00:35:25.440
as well as the type of eating. So you actually you were talking like

445
00:35:25.559 --> 00:35:30.199
hepatogeously, the slow carb, the
slow carb, you were talking about a

446
00:35:30.199 --> 00:35:35.480
lot of people that are they look
fine, they not overweight, They eat

447
00:35:35.519 --> 00:35:39.159
all of those a lot of sugars
and they get this insult resistant and they

448
00:35:39.159 --> 00:35:43.760
get fat over pretty amazing. So
doctor Senesa, we're going to get you

449
00:35:43.800 --> 00:35:47.000
back on next week to finish up
American Heart Month. We'll get off the

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00:35:47.039 --> 00:35:52.800
liver, but you're holding your own
here, I must say last fifteen seconds.

451
00:35:53.000 --> 00:36:00.719
Message for tonight on heart disease messages, lifestyle modification plays the critical weight

452
00:36:00.760 --> 00:36:05.320
loss is the best medicine and get
your coordinatory cut some score done. Critically

453
00:36:05.400 --> 00:36:08.480
important if you combind lifestyle modification,
got a good cardiologies, good evaluation,

454
00:36:08.719 --> 00:36:13.199
got a coordinator, cut some school
and obviously work on diet, exercise,

455
00:36:13.239 --> 00:36:16.760
weight loss and get your lips looked
at Nordy in fifteen seconds. Even if

456
00:36:16.800 --> 00:36:21.559
you drawn drink a lot. If
you have time two diabetes, you're overweight,

457
00:36:21.719 --> 00:36:25.199
or have I LOO pressure cholesterol,
know if you have FATI liver and

458
00:36:25.199 --> 00:36:29.400
how bad it is, and there's
a test called FIP four as your primary

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00:36:29.440 --> 00:36:31.679
care for it, we have options
for you. Perfect all right, the

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00:36:31.719 --> 00:36:37.480
two of you have been outstanding for
everybody. If you want to hear this

461
00:36:37.559 --> 00:36:40.679
again, this will be posted probably
in a three or four days as a

462
00:36:40.840 --> 00:36:45.639
podcast. You could re listen to
it, share it with your loved ones,

463
00:36:45.679 --> 00:36:51.400
but until then, get your FIP
four calcium score, take coke Q

464
00:36:51.719 --> 00:36:54.920
ten, if you're on a statin
and be well, love one another out

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00:36:54.920 --> 00:37:01.079
there. I'm doctor Joe Galotti and
we will see you next Sunday. You've

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00:37:01.119 --> 00:37:06.280
been listening to Your Health First with
Doctor Joe Bilotti. For more information on

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00:37:06.320 --> 00:37:08.800
this program or the content of this
program, go to your Health First dot

468
00:37:08.840 --> 00:37:22.960
com. M