#1 Absolute First Sign That Your Liver is Dying

It's not just going up; it is going up  exponentially. This epidemic of fatty  

liver disease is parallel to the epidemic of  obesity and type 2 diabetes that is spreading  

all around the world. If you remove those  factors, especially if you remove most or  

all of them at the same time for a period of  time, the body starts to reverse the adaptation.

Hello, Health Champion. Today we're going to  talk about the number one, absolute first sign  

that your liver is dying. When we say dying,  we're talking about the beginning stages where  

the liver is moving toward some sort of stress,  dysfunction, and degeneration. The reason we're  

looking for the absolute first sign is that many  of the traditional signs are actually quite late.

When we talk about things like jaundice,  abdominal pain, and swelling of the feet,  

legs, or ankles, when we talk about nausea  and several other signs and symptoms as well,  

we're talking about something that happens  quite late. You have to have substantial  

damage to the liver and significant reduction  in liver function before any of those show up.  

Instead of the traditional signs, we want  to start understanding this a little bit  

differently. We want to understand  what is the absolute first sign.

To start understanding that, we need to  know what the most common liver disease  

is because there are many different things  that can happen. You can have infections,  

you can have cirrhosis, but the number one  thing that happens is called nonalcoholic  

fatty liver disease. The reason they call  it that is that traditionally, historically,  

only alcoholics—people who drank severe,  high amounts of alcohol—would get a fatty  

liver. Then they found that most people  who got a fatty liver didn't drink alcohol  

or didn't drink excessively. So now they  call it nonalcoholic fatty liver disease,  

but of course, it's not a great description to  call something by what it isn't. Recently, they've  

also started calling it MAFLD, which stands  for metabolic-associated fatty liver disease.

My guess is that you probably have no  idea how prevalent this is. I don't  

think anyone takes this seriously  enough because around 35%, more than  

one-third of the entire adult population  in the world, have fatty liver disease.

I have a question for you: do you think that  number, that rate, is going up, going down,  

or staying about the same? Unfortunately,  the answer is it's not just going up;  

it is going up exponentially. It's an  epidemic of proportions that we have never,  

ever seen and that we just can't quite grasp. In  terms of healthcare costs, this is probably going  

to account for the majority of healthcare or sick  care expenses worldwide very shortly. Already,  

there are about 1.9 billion people, more than  a third of the adult population in the world,  

who have this fatty liver disease. Even at that  astronomical, unfathomable number, it may still  

be a low estimate because this is something  that's very rarely checked. There is a biopsy  

you can do to check it, but that's very invasive  and not entirely safe. There is an ultrasound,  

which isn't very specific or exact. What  we do know is that this epidemic of fatty  

liver disease is parallel to the epidemic of  obesity and type 2 diabetes spreading worldwide.

What we have to understand about type 2 diabetes  is that it is a modern disease. It's not an  

infection. It's not a purely genetic thing,  even though there is a genetic predisposition  

toward it. Type 2 diabetes virtually did not exist  200 years ago. There may have been a handful of  

cases around the world, but nobody paid attention  because it was so rare. As it started developing  

and increasing, we thought of it for the longest  time, in the last 50 years or so, as a primarily  

Western problem, something that happened to  Western industrialized nations such as the  

US. The US was the first, in the 1970s and 80s, to  have this exponential trend of obesity and type 2  

diabetes. Typically, diabetes will run a few years  behind obesity, but that differs a little between  

cultures. Just to illustrate how global this  problem is, the US might have been the first, but  

they are no longer even in the top 10 of the large  countries in the world. We have countries like  

Pakistan at over 30% diabetes, Kuwait at about  25%, Egypt at over 20%, Malaysia at 19%, Sudan at  

about the same, Saudi Arabia at 18.7%, and Mexico  at 16.9%. This is not limited to one continent or  

a few countries anymore; it is truly worldwide. On  this list, I've only included some of the bigger  

countries, those with at least 10 million or so in  population. However, many other smaller countries  

are also affected, with higher rates than some  of these, especially among tropical islands.

I want to mention these separately because it's  interesting that places like French Polynesia  

have over 25% diabetes, Northern Mariana Islands  at 23.4%, New Caledonia and Malaysia are about  

the same, Marshall Islands at 23%, Mauritius and  Kiribati over 22%, and American Samoa at 20.3%  

type 2 diabetes. What these tropical islands have  in common is a warm climate. Traditionally, they  

would have had a good amount of tropical sweet  fruit and would have lived off these islands,  

doing a lot of fishing. They would have had  some coconuts and other plants plus a good  

amount of fruit. These people are probably  genetically adapted to eating quite a bit of  

sugar and high carbohydrate. Yet, just in  the last 20-30 years, they have developed  

extremely high rates of type 2 diabetes and  obesity. What's the difference? Historically,  

they ate real food, even if it included some  fruit and other carbohydrates. Now, with the  

addition of white sugar, processed sugar, white  bread, cereals, and processed foods, these are  

the insults that tip the scale. It's not that you  can't eat a little bit of fruit if you're healthy,  

or a good amount of fruit if you're healthy, but  you can't eat it in addition to these processed,  

high-carb foods. If you have developed type  2 diabetes, you have essentially broken the  

body's carbohydrate-processing machine. You  are carbohydrate intolerant, and now you have  

to pull way, way back on all carbohydrates, all  sugar, and all fruit to start reversing this.

The only direct way to measure a fatty liver is  with a biopsy, where they cut out a little piece  

and measure it. However, it's not a great idea  because it's very invasive, and there are some  

risks involved, so most people should not  go that route. You could get an ultrasound,  

which is an approximation and not all that  expensive, so it's doable. There's one more good  

approximation, a really good indication called the  fatty liver index. All you do is take your BMI,  

which is your body mass index—basically just  how tall you are and how much you weigh—and put  

that into a formula. Then you measure your waist  circumference, how big your waist is. You plug  

in a liver enzyme from your blood test, a very  basic marker included in just about every blood  

test called GGT. You also measure triglycerides,  which are a strong marker of insulin resistance,  

indicating how much fat is floating around in your  blood at any given time. This is very easy to do;  

there are calculators online that you can check  out (after this video, of course, so you don't  

miss any part of this understanding). You plug  the numbers in, and you get a number back between  

zero and 100. If it's less than 30, it's very  unlikely that you have fatty liver disease;  

you can basically rule it  out. The lower your number,  

the less likely you have fatty liver. If  the number comes back between 30 and 60,  

it's inconclusive. You'd probably want  to follow up with an ultrasound or other  

markers to help you understand if you have a  fatty liver. You're kind of in the gray zone  

here. If the number comes back over 60, it is  very likely that you have fatty liver disease.

Now, we want to understand a little  bit more about this. When we look at  

the four variables you put in, we need to  understand that insulin resistance is the  

strongest driving factor for all of this.  It's pretty much singularly responsible  

for driving these. I've talked about this  in many videos: obesity, type 2 diabetes,  

high triglycerides—all have to do with insulin  resistance. Type 2 diabetes is just the end stage,  

the fully progressed version of insulin  resistance. If you've watched some videos,  

you understand that insulin resistance is  merely an adaptation. We put the body under  

a certain stress, have a certain lifestyle,  provide conditions of high stress, high sugar,  

white flour, seed oils, high carbohydrate, high  processed foods. We overwhelm the metabolic  

machinery of the body, and it starts adapting;  it becomes insulin-resistant. If you remove those  

factors, especially most or all of them at the  same time for a period of time, the body starts  

to reverse the adaptation. If you read some of the  comments below this video, you'll find hundreds of  

comments over time where people talk about how  they did just that. They took out the sugar,  

the carbs, and the processed foods, and started  eating more real food—more meat, more leafy  

greens, more eggs, more non-starchy vegetables.  All these markers and indicators reversed.

If all these are markers of a fatty liver, and  insulin resistance drives these markers, the next  

step is to understand the early insulin resistance  markers on a blood test. You'll find most of  

these on almost any test. Unfortunately, the most  important one is hardly ever on there, which we'll  

talk about. The first thing to measure is blood  glucose. I've never seen a blood test without  

it. The problem is blood glucose fluctuates a lot,  depending on the time of day or your stress level.  

The better marker is called A1C (hemoglobin A1C),  a 3 to 4-month average of what your blood glucose  

is. It's an estimate but a fairly reliable one.  Then we look at some inflammatory and metabolic  

markers. If we take total cholesterol and divide  by HDL cholesterol, if we have high insulin and  

chronic low-grade inflammation, total cholesterol  tends to go up, and HDL tends to go down. If  

this ratio is high, it's an indicator of insulin  resistance. The same holds true for triglycerides  

divided by HDL. We have some liver enzymes you get  on almost all blood tests. GGT might be something  

you have to ask for, but ALT is on every other  blood test I've seen. These are liver enzymes  

inside metabolically functioning liver cells.  These enzymes are not supposed to be in the  

bloodstream. The amounts they measure come from  liver cells that break and spill their enzymes  

into the bloodstream. A small amount is normal  because we always have a certain cell turnover.  

When too many cells break simultaneously,  these levels go up, indicating liver stress.

That being said, you could have a fatty liver  where the cells are not sick enough or stressed  

enough to start breaking yet, so you could have a  fatty liver without these numbers being elevated.  

Triglycerides are a strong indicator of insulin  resistance because insulin resistance is when  

your cells resist sugar and fat—they've had too  much fuel already. Triglycerides are simply fat  

in the blood, fuel trying to get to the cell. If  the cell is resisting, the triglycerides stay in  

the blood. The best marker for insulin  resistance is insulin, unfortunately,  

hardly ever measured. I've measured it on every  blood test for the last 10 years on all my  

patients because it's such a good basic marker  to start understanding metabolic health. Yet,  

I have patients who tell me they ask their doctor,  and they flatly refuse; they laugh, they ridicule  

it. This means nobody understands what it does,  what it tells us, and I'll show you in a second.

Insulin and C-peptides are equivalent  markers, two ways of measuring almost  

the same thing. Insulin is the easier and  usually slightly cheaper marker to measure.  

C-peptide you can measure if you're trying to  troubleshoot and get more information around  

type 1 diabetes or another condition.  There's one more thing called HOMA-IR,  

not a marker but a calculation. It stands  for homeostatic model assessment of insulin  

resistance. You plug in glucose, multiplied by  insulin, to see how much blood sugar rises and  

how hard the body is working to keep it down.  If you measure glucose in mg/dL, divide by  

405. If you measure in mmol/L, divide by 22.5.  An ideal number would be around 1, indicating  

high insulin sensitivity. As it goes up,  you're becoming more insulin resistant.

Here's how we understand this: if you have good  metabolic health and this much blood glucose,  

if your cells are not resisting the fuel, it  should take a moderate amount of insulin to  

keep that under control. If you start eating more  sugar and processed foods, and 5 years later,  

the glucose is still about the same, it's  because it's a controlled variable. The body  

compensates and works hard, but it takes more  insulin to maintain the same blood glucose.  

You're becoming more insulin resistant. If  you continue for several years, the glucose  

might go from 90 to 98, barely noticeable, but  insulin has increased even more. This is why  

it's useless to simply measure blood glucose  or A1C because they're controlled variables,  

not reflecting where you are on this spectrum.  For example, an HOMA-IR of 1 could be 2.5 or 4,  

indicating increasing insulin resistance. Even  with slightly higher blood glucose, you might  

still be called diabetic at 126, with very  high insulin, and an HOMA-IR of 6 or 8.

Understanding this helps in avoiding sick care  and practicing prevention. If you want to avoid  

a fatty liver, you need to understand  what causes it and recognize the early  

signs. The earliest, most subtle sign is  that your insulin and HOMA-IR are increasing.  

Measuring the right markers early helps catch  the process while it's still easy to reverse.

For more detail, I've created a blood work course  for a bigger picture and better understanding of  

what's happening in the body. My clinic can also  provide blood work to ensure you get the right  

markers. I'll put a link below where you can check  that out. If you enjoyed this video, you'll love  

that one. To master health by understanding  how the body really works, subscribe,  

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