S03_E02 - The Mighty Liver...

Speaker 1: 0:01

Welcome to the Healthy Matters podcast with Dr. David Hilden , primary care physician and acute care hospitalist at Hennepin Healthcare in downtown Minneapolis, where we cover the latest in health, healthcare and what matters to you. And now here's our host, Dr. David Hilden .

Speaker 2: 0:18

Hey everyone, it's Dr. David Hilton , and welcome to episode two of season three of the Healthy Matters Podcast. On today's episode, we are going to continue with a theme we started last season, one that takes us through some of the most essential organs in the human body. Previously on the podcast we've talked about your kidneys and your colon, and today we are going to discuss an unsung hero of the body and that is your liver. Again, we've all heard of it, but do you really know what it actually does and why it's so important? Well, joining me today is gastroenterologist and expert on the liver and liver disease, Dr. Jose Davis. Jose, welcome to the podcast. Thank you. David, tell me about yourself a little bit. So you're a gastroenterologist and you specialize in liver disease,

Speaker 3: 1:01

Correct? That's, that's my passion and I do half research, half clinical work. A lot of the research is global around the world.

Speaker 2: 1:07

And you, you work with me here at Hennepin Healthcare in downtown Minneapolis and here at the University of Minnesota. Where'd you start out your career?

Speaker 3: 1:15

I started in Argentina, south America. That's when I went to medical school. I grew up in a vineyard basically there. And then I moved to the United States to do research in neighboring Rochester. And then I kept my training at the university and landed here.

Speaker 2: 1:27

That's kind of a rich irony. So you're a liver doctor and you grew up on a vineyard? Yes. Say more about that.

Speaker 3: 1:34

<laugh> . So that is an interesting part of life, but I , I , part of my life is destroying the liver with , with wine and the other part is trying to save the liver

Speaker 2: 1:42

<laugh> <laugh> . Okay. First of all, what part of Argentina is your vineyard? And second of all, I want to find out is there any truth to that. In all seriousness is, is there any like safe amount of alcohol for for the liver?

Speaker 3: 1:56

Absolutely. So I'm from , uh, from a part of Argentina. It's called San Juan , like Puerto Rico, but in Argentina, neighboring Mendoza by the foothills of the Andes. Uh , and this is your question is fascinating because I'm , I'm into wine obviously due to my heritage and I always seen in this podcast and websites that they talk about the potential benefits of wine to the liver and to health. And it is pretty clear right now that alcohol has no benefit in health and definitely there's no benefit for alcohol towards the liver. Actually the main enemy of the liver is the alcohol.

Speaker 2: 2:27

So the glass of red wine a day that a lot of people hear about, well that maybe that's good for your heart, is that not true? And it's certainly not good for your liver, right?

Speaker 3: 2:34

Certainly not good for your liver. Those were initial studies. The what people talk about association studies. You associate one thing with another thing, but there is no direct link to that benefit. And definitely for the liver it doesn't work that way. I mean whatever alcohol you put in your body, your liver has to deal with it , it has to metabolize it. And really there's no good coming out of there. I always tell my patients, if you like to drink one drink here, one drink there, that's great. But certainly there is no health reason to drink.

Speaker 2: 3:05

Okay, before we move on to the biology of the liver, Argentinian wines, California wines or Chilean wines, what , what's the best obviously

Speaker 3: 3:14

<laugh> Argentinian

Speaker 2: 3:14

Wine. You grew up in a vineyard in Argentina. I'm

Speaker 3: 3:18

Slightly biased.

Speaker 2: 3:19

Okay. Okay. All right , fair enough, fair enough. Okay. Dr . Debe basics, liver 1 0 1, what does your liver do?

Speaker 3: 3:27

Yeah , so the liver is a , I mean it's an organ obviously large organ, the biggest solid organ in the body located on the right side below your ribcage and it is fun. Fact for the liver carries the most blood in your body at any single time. So about a quarter of your blood at any time is hanging out in the liver. The function of the liver is quite impressive. Uh , first of all, it detoxifies a lot of the toxins that come into your body and uh , uh, it actually metabolizes a lot of the drugs. This is an interesting fact because the liver, I mean it's not the kidney, so the gas , so it's no connection to the outside world. But what the liver will do is inactivate a lot of substance that are bad to your body. That is the main function. It's also your fuel storage. So glucose is storage and produced in the liver. So whenever you go to some exercise or anything, your liver is pushing that glucose out there. And finally, which I think is fascinating, a lot of people don't know this and the great majority of your clotting factors and your anti clotting factors are actually produced in the liver. So your liver has a capacity to make you bleed more or clot

Speaker 2: 4:36

More. So detox factory storage of energy and glucose clotting factors, lots of functions there. Is it a true statement to say that that everything you put in your mouth or most things that go into your mouth, whether they be food or drugs or recreational drugs, anything like that, do they get handled by your liver In most cases?

Speaker 3: 4:56

I would say the gray majority, yes. That's it . That's quite an accurate statement. Yes.

Speaker 2: 4:59

So hence alcohol's a toxin.

Speaker 3: 5:02

Alcohol is a toxin. Absolutely. And another fun fact, the liver is one of few organs that is interconnected with blood and the gut and the intestine. So a lot of the things are immediately absorbed from your intestine will go to the liver first. And your liver is the first barrier towards the rest of the body.

Speaker 2: 5:21

So I have heard , um, going way back to mythology that the liver can regrow. Is that a true statement?

Speaker 3: 5:28

That is a true statement. You mentioned something about the mighty liver and I , I think that's a very accurate word. There are two things that define the liver in my opinion as mighty one, you have to destroy about 90% of the liver in order for it to start failing. And secondly it regenerates. And that's the story of Prometheus that you told

Speaker 2: 5:49

Prometheus . Yeah , yeah ,

Speaker 3: 5:50

Yeah . So

Speaker 2: 5:51

The , you know , you know where Prometheus was like what's the story? He was condemned to have a bird or an eagle eat his liver every day .

Speaker 3: 5:59

Absolutely. He betrayed um , the main guard and then his punishment was to be crucified and to have an eagle come and eat a little bit of his liver every day because the liver kept regenerating or regenerating. So

Speaker 2: 6:10

Is that part of the reason that we're able to transplant parts of liver to other peoples? 'cause you can deal with it a little bit less of it.

Speaker 3: 6:17

That's exactly where I was going. Sometimes we can, we can transplant a small liver or a part of the liver to somebody else and that will regrowth and actually be enough to keep somebody alive.

Speaker 2: 6:26

That's fascinating. That's really fascinating. You only have one of 'em, so it's probably a good thing you do. And like the kidney can't do that and the lungs can't do that. The

Speaker 3: 6:33

Heart can't do that either. Yeah,

Speaker 2: 6:34

The , yeah , the heart can't do that. Yeah . So all the other organs can't do that. That's a fascinating part about the liver. So lots of different functions that the liver does. Let's talk about a few of the things that can go wrong and what we used to call fatty liver. Let's talk about that condition and start us out by what is the correct term? <laugh> .

Speaker 3: 6:53

Thank you David. So this is a brand new thing a few months ago, but all the societies in the world are pushing for this . So something we used to call fatty liver disease or non-alcoholic fatty liver disease is now called muscle D , which is metabolic associated thetic liver disease

Speaker 2: 7:11

Metabolic associated.

Speaker 3: 7:13

Yeah. So it means that you have metabolic issues in your body that lead to a stenotic liver disease at the end of the day, and I think that's what you alluded to, it's really the deposition of fat in the liver. And I like to explain that to my patients. So we, we all understand that if we eat fat, that fat might end up in our abdomens, in our arms, in our legs, where a lot of that fat can also end up in the liver. And once it's there it can actually create quite a bit of trouble over time.

Speaker 2: 7:42

How does it do that? It doesn't sound that serious. So what, you got a little fat in your liver. I got a little fat all over the place. That's why is it a problem?

Speaker 3: 7:49

That is a fair point. Now the problem is that , uh, once you have a bit of fat in the liver, the liver doesn't metabolize things very well and that also creates distension of the cells in the liver because we , we call it ba ballooning. So the , the cells in the liver become bigger and fatter and that creates a small degree of inflammation that now tomorrow or next year won't do anything. But over a period of say 10, 20 years, it can eventually affect your liver and make it hard because you have a continuous low degree of inflammation. What

Speaker 2: 8:21

Does the liver do in these metabolic or formerly called fatty conditions? Do , does , do they get hard as a rock or, or do they stop functioning or what, what's go what goes wrong?

Speaker 3: 8:30

Yeah , that's exactly what happens. So it starts getting harder and harder. So we , and there goes what we call fibrosis eventually once it's fibrosis. So this hardening of the liver is advanced . There are two problems that come with it. One of them is that the , the liver cells start to die, so it's less function, so it doesn't function very well. Secondly, the liver physically becomes hard. That is cirrhosis, right? As I said at the beginning, at any given time about a quarter of your blood is in the liver. When you have that liver so hard, that starts putting pressure in a lot of other blood parts of your body, like other vessels of your body. And that leads to a lot of complications such as viruses , et cetera , et cetera .

Speaker 2: 9:14

So you talked about, again, we're back to the alcohol and the non-alcohol causes. So alcohol clearly can lead to this. What are the non-alcoholic causes? Who gets

Speaker 3: 9:24

This? Yeah, so it's a great question. So the , the two most common causes as you alluded , is fat in the liver due to metabolic issues or alcohol consumption. Then there is what we, what people have heard, which are viral hepatitis, hepatitis A, B, C, D, N , E. And then beyond that there is an array of genetic diseases that are a lot less common, like iron issues. Copper issues. So there's a lack of metabolization, a lot of these minerals that can eventually lead to cirrhosis

Speaker 2: 9:53

As well when people hear fatty liver, even though that term is one we're getting rid of, is, is body fat related to that? Is that all , is that associated with say being overweight or, or can is it, is it independent of that ,

Speaker 3: 10:06

Uh , this fatty liver? And again, I want to clarify as you said , we're, we're talking about the old terminology. People think about it as one disease and I don't want to get complex, but it's actually more than one disease because it can be that you have fat deposit in your body and also gets more deposit in the liver. But we also have something we call lean muscle D which are people that are skinny actually and get more fat deposition in the liver. We know that people with diabetes actually have fat deposit in the liver regardless of whether this fat goes into other parts of the body or not.

Speaker 2: 10:38

Are these conditions I'm used ? You talked about cirrhosis is when your liver gets to be hard, it's a rock, it's a lumpy rock, not a mushy bloody piece of organ <laugh> . Yep . So to put it , to put it bluntly, I can just tell listeners that once it gets a cirrhosis, that's not a reversible process. But what about before it gets bad, someone's got a metabolic associated fat in their liver, they've got one of these things. How do you diagnose that? And then how do you tell people to try to avoid having an advanced cirrhosis?

Speaker 3: 11:07

That's perfect , that's a great point. So we, as you say , once you get to cirrhosis, very difficult, almost impossible to return in the middle. We have different stages of fibrosis of this hardening of the liver. Very difficult to diagnose them with symptoms. I mean usually these , all these diseases don't cause any symptoms. The way we define how hard your liver is is based on labs and of something called the fibro scan .

Speaker 2: 11:31

Many people have probably had a fibro scan or have at least heard of it , um, um, five years ago. No, now people now have ,

Speaker 3: 11:37

And the fibro scan is fascinating because it's a , it is a little device that you put in your skin that vibrates and tries to move the liver and based on how hard your liver is, it will give you a number. The fascinating part of why I why I'm bringing it up, you were talking about how hard the liver can be or not. So the fibro scan was actually invented in the fifties by the French. It

Speaker 2: 11:57

Was, yeah.

Speaker 3: 11:58

But in order to understand when these big wheels of cheese were ready to be sold, somebody later on decided that that technology could be applied to the liver and they were using the fibro scan . So I actually tell my patients that their liver is like a big cheese.

Speaker 2: 12:14

It's a big wheel of cheese. This is the best episode ever. <laugh> , we've talked about wine, we've moved into cheese with Dr. Davises

Speaker 3: 12:21

<laugh> and i I I do tell my patients you get your liver can be like soft cheese or can progress until it's blue cheese and you don't want to blue cheese

Speaker 2: 12:29

Because

Speaker 3: 12:30

It's crumbling on his heart. And this is a reality. So,

Speaker 2: 12:32

So some french cheese makers invented this little device to help determine if their cheese was right? Absolutely. And then somehow now we do it on people's liver.

Speaker 3: 12:41

Exactly. Somebody thought that the liver was like a cheese and that was a good idea and now we use it to understand how hard your liver is basically.

Speaker 2: 12:46

That's fantastic. So if you have some of these liver diseases and you end up with a liver specialist, you might get a fibro scan and I would say you, that's what you'd get here at Hennepin Healthcare.

Speaker 3: 12:55

Absolutely. And that's what you get here where one actually we're one of the few centers that has this in the cities and once we look at your fibro scan , we understand why hardly the liver is , we can advise in how to improve that if this is due to exclusively fat in the liver, that is because of metabolic reasons. Either you're overweight, you have diabetes, there are some things that you can do to your body. And I , here's where I like to clarify. There's a lot of things that you can do bad to your liver. Yeah , there's not a lot of things that you can ingest that can help your liver.

Speaker 2: 13:23

Do people ask you that? What can I do? What can I take to make my liver healthier?

Speaker 3: 13:26

A hundred percent in the US advertising for herbals is a little bit more regulated outside of the US not that much. So a lot of people have seen advertising about herbals that are great for the liver to clean the liver. A lot of them don't work. The don't work. And some of them are harmful for the liver. So it's not a lot that you can take to actually help your liver. The only thing we're finding that is better for your liver is actually coffee conception .

Speaker 2: 13:53

Coffee's good for it. Absolutely. Hallelujah. You know I love that <laugh>. It

Speaker 3: 13:57

Is awesome. I I do have to clarify. When you start putting cream and sugar in your coffee, I do that . You start pulling that

Speaker 2: 14:03

Out. We're gonna go grab a cup of coffee, maybe not a glass of wine. And when we come back we'll continue our conversation with Dr. Jose Deus . Stay with us. We'll be right back

Speaker 4: 14:15

When head up in healthcare says we are here for life. They mean here for you, your life and all that it brings. Hennepin Healthcare has a hospital HCMC and a network of clinics both downtown and across the west metro. They provide all the primary care and specialty care you would expect to find. But did you know they also have services like acupuncture and chiropractic care available at many of their primary care clinics and at their integrative health clinic in downtown Minneapolis. Learn more@hennepinhealthcare.org. Hennepin Healthcare is here for you and here for life.

Speaker 2: 14:53

We're talking with Hennepin Healthcare gastroenterologist and liver specialist Dr. Jose Davis. Let's shift gears to hepatitis. Jose. There's hepatitis A, there's B, there's C. Can you walk us through all of these letter named hepatitis conditions?

Speaker 3: 15:08

Absolutely. So first fact the hepatitis is inflammation of the liver. So there's many conditions that can lead to that. Alcohol can do that. There are some immune ones. When people talk about hepatitis, the letters you're talking about are the viruses. So one virus was term A and another one was B and another one was C. And really depending on when they were found basically or discovered,

Speaker 2: 15:29

It's not very creative. The naming system, definitely not A, B, C 'cause they're not the same, they're different viruses,

Speaker 3: 15:35

They're all very different viruses transmitted in very different ways. But I think we can all agree the hepatologists are not creative people. Yeah , <laugh>

Speaker 2: 15:42

Say that , look, you're studying the intestines <laugh> . Now I'm not saying you're nerds, I'm not saying that, but you're studying the intestines. Okay, so we're not gonna get through all of them, but let's talk about the three big ones, A, B, and C. And let's start with A, how is that transmitted from person to person ?

Speaker 3: 15:57

As you said there's A, B and C are the big ones. A, the big difference here is that A is acute meaning you get it, you get rid of it. B and C are chronic. Once you get it, very difficult to get rid of them. A is transmitted through food basically is , you know you get contaminated food, it goes into your mouth, your liver gets sick, the majority of the people will recover, you'll be fine. B or C are quite different. B is very similar to HIV. You get it through blood, through intercourse. It can be from mother to child. It is actually the most common liver disease in the entire planet. B, B, B .

Speaker 2: 16:34

But that is the whole planet.

Speaker 3: 16:35

Yeah , the most common cause of liver disease in the entire planet. In some areas outside of the United States, about six to 8% of the population are infected. That's almost one in 10 . It's a big number. And then hepatitis C is mainly transmitted by blood. So sharing drugs through the same IVs. So if you get a transfusion before the nineties. So there's a lot of reasons that you can get that but only through blood basically. And that's the main difference between those three.

Speaker 2: 17:03

Do you recommend the vaccines for hepatitis

Speaker 3: 17:07

A hundred percent? In my world it is. I always say that is , it is almost shocking that the most common cause of liver disease in the world is viral . Hepatitis B, which it is a vaccine preventable disease that has been around since 1991.

Speaker 2: 17:22

Yeah , it's not new. Nope , we've been vaccinating against hep BI had to have hep B before I could go to med school. Absolutely I got all the vaccines. Absolutely. What about C? What about hep C?

Speaker 3: 17:30

C is interesting. There's no vaccine for Hep C, however there was a breakthrough in 2015, which is a treatment for hepatitis C. So historically the treatment for hepatitis C has been to say the least brutal. You had to inject a substance called interferon for a year. Only half of the people got cured, the other half didn't. 2015 we discovered new medications. Nowadays it's a fully curable disease by taking one pill a day for about two months with almost no side effects.

Speaker 2: 18:01

And it works.

Speaker 3: 18:01

It works in over 99% of the cases. I would

Speaker 2: 18:04

Put that one the treatment for Hep C in the one of the handful of things that have happened in my medical career over the last 20 years. 20 years ago we didn't have anything then we had this other treatment with interferon that you're talking about and that was a eh , it didn't work that great And now finally we have a treatment for that and it works. That is a massive uh , advance in medical uh , technology. Let's shift a little bit to lifestyle in your liver health. Uh, you have mentioned earlier that there's nothing you can proactively take that is beneficial to the liver except maybe coffee is kind of good for you but there's a lot of things that you can take that are harmful to your liver, food, medications , street drugs. Could you just kind of talk about that a little bit? Uh, what's harmful?

Speaker 3: 18:44

This is a very important point because as we mentioned earlier, the liver is the first barrier between what you eat and drink and the rest of your body. And do remember that even whether you have a healthy liver or whether you have an unhealthy liver because say you have hepatitis B still what you eat or drink matters because the last thing you want is your liver to become sicker even than what it is . I would say that there are more things that are harmful to your liver than helpful. There are two things that are quite detrimental to the liver. The first one and everybody knows is , is alcohol. Yeah , alcohol is not good for the liver period. There has been over the years a lot of discussion whether a little bit of alcohol is good, a little bit of alcohol is bad. Uh , bottom line, most of the studies are showing that alcohol is bad. Uh , if you want to have some alcohol here and there, have a drink. We're all humans. I think that's great. I would like to give you a word of caution in how you can do that. And this is gonna sound inverted 'cause I'm gonna give healthy advice in how to healthy drink alcohol, which doesn't make any sense, but obviously try not to drink more than one to two drinks a day. Ideally keep it to one drink a day, try not to binge drink. That definitely has a different connotation for the liver.

Speaker 2: 19:55

And what is binge drinking? How much? Uh ,

Speaker 3: 19:57

At least if you are a male having more than three drinks in one day, if you're a female, more than two drinks in one day, that brings a different degree of damage at the time. So basically three drinks in a week divided in three different days are not the same. That drinking the three drinks one time

Speaker 2: 20:14

All at one time.

Speaker 3: 20:15

The other thing I recommend people sometimes if you like to drink it almost every day or every other day, give a break to your liver. Stop drinking for three, four days at a time. One, two weeks at a time. You give time to your liver for your liver to clean and relax and kind of like get back to normal. So people don't talk about that but I tell my patients, try to not drink for three, four days a time

Speaker 2: 20:34

And it'll do that if you give yourself a break of four days or a week or something like that.

Speaker 3: 20:38

Absolutely you will see that the inflammation comes down a little bit. We know that from fibrous count what we were talking earlier. Yeah , I mean it helps your liver. The second toxin that I would like to talk about that people don't think about is a soda intake. A lot of the pop that we drink actually deposit

Speaker 2: 20:54

Solid work 'cause we're , and it's pop, I say pop, it's

Speaker 3: 20:57

Pop. I say soda,

Speaker 2: 20:58

<laugh> soda. <laugh> soda. Most of most people would say soda. Okay, you're saying that's bad.

Speaker 3: 21:03

That is definitely bad in if you take a lot of it. If you have a little bit here and there is fine David, I can tell you when you walk into my office, if I'm talking to some of my patients with fatty liver disease that get that from drinking a lot of soda, a lot of pop and you hear me talking to them, you think that I'm talking about heroin addiction. Yeah. Because it is very difficult for me to get them to try to stop drinking pop.

Speaker 2: 21:27

Right, right .

Speaker 3: 21:27

Pop deposits fat in your body. Diet pop. The reason why diet pop doesn't make you fat is because your liver will suck the fat. So that's even worse for your liver. So that is the other recommendation that we have. Try to decrease the amount of soda that you do.

Speaker 2: 21:42

We have had a few guests on this show from a variety of specialties say that soda pop just doesn't have any redeeming qualities. It's just not good for you and you're another one. It's striking to me and you've done this podcast now for, we're in our third season and I've heard it a number of times, it's just not good

Speaker 3: 22:01

For you and we don't think about it.

Speaker 2: 22:03

What about medications? People you can go to the, the , the drugstore aisle is aisle after aisle after aisle of things that you can buy over the counter or that you get by prescriptions. Are they hard on your liver?

Speaker 3: 22:13

A lot of them can be. I said oph is uh , the most well known one that can be quite detrimental to your liver. But remember a lot of the medications will get metabolized by the liver if you take a little bit here and there might not be a problem if you start taking a lot of them. That can be a problem for the liver. Absolutely.

Speaker 2: 22:31

What about recreation, drugs, street drugs? That

Speaker 3: 22:33

Is a big subject. I can tell you that a lot of them do not affect the liver. They get metabolized by the liver but they don't , don't affect the liver. A big uh , exception is actually ecstasy. Hmm . Ecstasy gets metabolized by an enzyme in the liver, which about 5% of the population doesn't have a normal activity. So there is a group of people there that by taking ectasy can have actually an acute liver failure of the same degree as acetaminophen and this is not very well known . So that one you definitely has to be cautious

Speaker 2: 23:05

With. What about other things people can do in their lives for liver health? Um, exercise for instance,

Speaker 3: 23:10

Exercise is actually a great option and is in the liver is particularly helpful. We know that exercise helps in a lot of aspects by making you leaner . However, in the liver, independent of that exercise can actually help the oxidation of materials in the liver. So there are plenty studies showing that aerobic and and aerobic exercise can actually help eliminate the fat in your liver. So I would say my patients anywhere between three to five times a week. Aerobic exercise is a little bit better walking, running, but anaerobic exercise at a little bit higher intensity. Even 20 minutes a day, three to five times a week will help deliver

Speaker 2: 23:50

Great advice. Now Jose, you do uh , clinical caress here at Hennepin Healthcare here in downtown Minneapolis. You also do research in liver disease. Could you just tell us what kinda research you do?

Speaker 3: 24:00

My research focuses on biomarkers for liver cancer. Liver cancer has a particularity, it's unique. It doesn't happen in anybody. It has to happen in people with liver disease. So anybody can get breast cancer, anybody can get colon cancer. You only get liver cancer if you have some disease in your liver. Call it cirrhosis, fatty liver, hepatitis B. So we know the population that we need to screen. It's not the entire planet, it's the people that have liver disease. However, we don't have great screening tools. So what my lab tries to do is find different tools like biomarkers in blood that are easy to measure or even we're using artificial intelligence to look at the liver in different ways that can tell us who might get liver cancer in the next six to 12 months so we can catch the cancer early on and cure it .

Speaker 2: 24:49

That's terrific. So in your research and your clinical cares, you're fighting the good fight for liver's health. I really appreciate that. I find that fascinating. So before I let you go, I'm gonna ask you a couple of questions. Are there any misconceptions about the liver that you'd like to dispel for our audience?

Speaker 3: 25:03

Uh , one common misconception is that people sometimes believe that the liver will hurt and that is because of the location of the pain, but we, we really can't feel the liver. So liver doesn't hurt and as I said earlier, you have to kill 90% of the liver in order to get symptoms. So it's a very noble organ. So if you think your liver hurts, you probably should be looking elsewhere

Speaker 2: 25:25

I think look for something else. Yeah , yeah . Okay. So you , so when someone has belly pain and they say my liver hurts, it's probably not, but how can you then identify liver disease? Are there symptoms or blood tests or what, what , what, what should people know? Yeah,

Speaker 3: 25:39

It's a great question. We have symptoms but they're usually late symptoms by the time you have symptoms. The liver disease has advanced quite a bit. I would say the main friend that we have is our blood test . There are liver enzymes that we call that are very sensitive and they can tell us when there are problems with your liver.

Speaker 2: 25:58

I order those all the time. We often call 'em liver function tests. They're not, that's kind of a misnomer, but they're enzymes that we're measuring in your blood

Speaker 3: 26:05

And, and one when a small piece of the puzzle there , that doesn't mean that it's one of these enzymes is a little bit elevated. You are in trouble. Doesn't mean that it's just helps us know what's going on with your liver.

Speaker 2: 26:16

So that's the best way to be proactive is there's liver blood tests . Now last question. If you could wave a magic wand, Jose for your patients, what would you wish to make? Go away in liver disease, that's

Speaker 3: 26:28

Actually relatively easy. I would say be aware of your alcohol intake. So we all like alcohol in different forms. There's no amount of alcohol that is good for your liver. That doesn't mean that you don't have to drink. It just means you have to drink moderation and give a break to your liver. That is the one substance that will punch your liver over and

Speaker 2: 26:49

Over. That is really good advice and I appreciate you saying that and I appreciate you being on the show today, Jose. It's been great chatting with you. It's

Speaker 3: 26:55

Been great. Thank you for having me. It's been a lot of fun.

Speaker 2: 26:57

So much to know about the body. I've picked up a lot about liver disease from Dr. Debe today. And I hope you have as well. I hope you'll join us in two weeks for our next episode. And in the meantime, be healthy and be well.

Speaker 1: 27:10

Thanks for listening to the Healthy Matters podcast with Dr. David Hilden . To find out more about the Healthy Matters podcast or browse the archive, visit healthy matters.org. You got a question or a comment for the show? Email us at Healthy matters@hcme.org or call 6 1 2 8 7 3 talk. There's also a link in the show notes. The Healthy Matters Podcast is made possible by Hennepin Healthcare in Minneapolis, Minnesota. An engineered and produced by John Lucas at highball . Executive producers are Jonathan , CTO and Christine Hill . Please remember, we can only give general medical advice during this program and every case is unique. We urge you to consult with your physician if you have a more serious or pressing health concern. Until next time, be healthy and be well .