Detox, Gym Supplements & Alcohol: The Liver Is a 'Forgiving Organ' Until It Isn’t With Dr. Edna

[00:00:00]Okay, from a little perspective, most people I think in their mind think [music] that anything that is natural is safe.

[00:00:07]>> And in fact, some of these medicines that have been used for weight loss are actually approved for fatty liver disease. So if you come to the doctor and you have fat in your liver which you detect on ultrasound if you have other signs or other ways in which you look for fat in the liver sometimes we prescribe for you weight loss medications so that [music] you can you can lose the weight so that your liver can can can can recover of course in addition to lifestyle and [music] exercises.

[00:00:32]>> Yeah. Yeah. I think that's that's a nice entry because you know many times you'd [music] think that someone just wants to lose weight but then if you look at them holistically you get to understand why losing weight is so important for their health.

[00:00:44]>> Yes. Precisely.

[00:00:46]>> Now you've talked about the liver and how it can manifest especially in symptoms. What are some of the symptoms we'll be seeing when someone has a liver [music] condition?

[00:00:54]>> Okay. So liver disease and maybe that's why it's called a silent organ.

[00:00:59]>> The [music] liver is very it's very evasive. So most people do not have any symptoms for liver disease until it's later and when they have symptoms they're very nonspecific. You can have swellings that are not cancerous in the liver especially some [music] women who are using oral contraceptives and um it can be followed up and um they go away.

[00:01:16]Brazability can also come from other things can also be the platelet number can be normal but they're not functioning well. All right. So when you're having easy [music] breability then the blood count is important because then it needs to be checked. Is it that maybe you're having abnormal platelets? And many times people brush their teeth and say, "Oh, it's okay for me to brush and spit blood."

[00:01:41]>> Hi guys, welcome back to of Health, the podcast where I give you not too little, not too much, just enough health information to help you make an informed [music] decision. My name is Dr. Hope and I always forget this. So before I introduce the guest of the day and she's a return guest. Let me just pause and allow you to subscribe if you haven't subscribed. If you're watching this for the first time, welcome to the channel.

[00:02:02]Please take a minute to subscribe and follow us across our social media platforms, which is Instagram, Tik Tok, Spotify, wherever you listen to your podcasts. Now that we have that out of the way, we have a returned guest.

[00:02:13]>> Thank you. Thank you.

[00:02:14]>> Dr. Edna is back and I just want her to reintroduce herself for those who had not interacted with her before.

[00:02:19]>> All right. Thank you very much, Dr. Hope. My name is Edna Camo. I'm a gastroenterenterologist and a a physician. I'm based in Nairobi and I'm I'm happy to be back.

[00:02:29]>> Yeah.

[00:02:30]>> Yeah. Thank you.

[00:02:31]>> Okay. Now, I don't know if you remember the the procedure or the process, but we need to find out how are you doing today? Where are you mentally, emotionally? A journey to inside out.

[00:02:40]>> Okay.

[00:02:41]>> Um today, I think I'm a bit curious.

[00:02:44]>> Okay. Um I've just finished some um some online conference and I've learned a new a lot of new guidelines. So I'm curious to see whether it works for my patients.

[00:02:55]>> I'm also very grateful for life. I think I've had quite a number of challenging patients and patients who remind me how beautiful life is when you're healthy.

[00:03:03]>> Mhm.

[00:03:03]>> Yeah. Well, that's so important by the way. And I think um just building on that throughout the week I've been seeing some of the doctors in Congo cuz we're shooting this around the time where Ebola is still a challenge and they've been celebrating the patients who have actually made it out of the hospital and I'm just like it's a whole community celebrating one patient and sometimes you forget how much effort you put into even just one patient >> and one life matters one you know one life is a family it's a community and that's the beauty about medicine it's so gratifying in such movements.

[00:03:36]>> Yeah, they were dancing like they're so nice. I was so happy.

[00:03:40]>> Instead of just showing the bad, like also show the good.

[00:03:42]>> Good. Yeah, that's nice.

[00:03:43]>> Okay. I don't think we should do the doctor seat because you answered all the questions unless your answers have changed. You think your answers have changed?

[00:03:49]>> Not changed. [laughter] >> All right. So, >> what are we talking about today? We want to talk about um just liver health >> because I think we're living in a day and age where there's a lot about detox >> and there's a lot about substance and alcohol consumption and over consumption. There's just a lot happening and the liver is the one being hit the hardest. So we want to have a conversation around that and just to see how well we can take care of our livers.

[00:04:16]>> So first and foremost, >> what are you seeing um commonly in the health space around liver health hepatology? What are you seeing commonly?

[00:04:25]>> Uh that's a very good uh question. The liver health has really changed over time from when I was in medical school to now. We're seeing a lot of more metabolic liver diseases.

[00:04:34]>> These are diseases that are driven by how we metabolize certain things that we consume. Glucose. These are diseases that are uh liver diseases that are driven by diabetes, hypertension, obesity, and that's the biggest problem.

[00:04:46]The second problem we're having is what we call drug induced liver diseases. And drug induced means things like uh what you've alluded to detox.

[00:04:53]a lot of overtheounter medication.

[00:04:55]Everybody wants to slim so they go and buy a slim tea.

[00:04:58]>> Everybody wants to look good. They go and buy a skin supplement to swallow.

[00:05:01]>> And that is really changing the the paradigm of how the liver diseases look in Kenya. There's also been a surge of alcohol intake.

[00:05:08]>> Okay.

[00:05:08]>> And especially in the context of weight loss. So a lot of people are taking alcohol. That's a lot. And as a time they're losing weight >> and so that combination has really contributed to an increase in the alcoholic liver diseases. We certainly still have viral diseases like hepatitis still a problem but it's being over taken very very fast by the other causes especially so the metabolic liver diseases what we call the non-alcoholic fatty liver diseases.

[00:05:32]>> Okay. Yeah. Okay. Now let's just start with detox.

[00:05:35]>> Yes.

[00:05:35]>> We hear detox te detox this detox what >> as a specialist in that particular space.

[00:05:43]>> What would you say about what's happening in the spaces? Supplements and all these detox tees.

[00:05:47]>> Detox te. From a liver perspective, most people I think in their mind think that anything that is natural is safe.

[00:05:55]>> So every time people will if you're marketed for um you know a supplement, most people don't take the time to query it.

[00:06:01]>> They will easily just take that capsule and put it in their mouth without thinking that this could be harmful to their body.

[00:06:07]>> And because of that marketing, a lot of people have end up consuming things that are not very healthy in their for their liver. It comes in many forms as I said the slim tea and the detox. Yeah. And because they're not well regulated, most of these supplements and detox are very can be very injurous to the liver. Not all of them, but some of them. You see, unlike medicine that the the prescription medicine which you have a pharmacy control board that actually makes sure that the things that are in the that are in the medicine are well regulated. There's a lengthy lengthy approval process to get a drug into the country. Sometimes even takes up to years and uh it is measured. it is analyzed to get some drugs approved like um out of a country. It's a it's a very long process and even take studies that are in different faces sometimes starting with animals then going to humans and through different faces just make sure they are safe and in this they're able to identify liver injury.

[00:06:58]The same scrutiny and thoroughess is not is not adhereed to in terms of supplements. So we get these supplements having a lot of injury to the liver.

[00:07:06]>> In addition, most of them are composed of competing chemicals. So there are a lot of chemicals together and many people who take them take many of them together. So that compounds the problem and then most people because they think it's not a problem when they start to get liver problem they don't even say to their doctor. So many times when you're asking a patient do you take medicines?

[00:07:23]No. Do you take medicines? No. Do you take anything else? They say no because to them a supplement is not important to to the liver. Even her you know people say about the herbs you know either over the counter or the ones that you make.

[00:07:36]Not to say all of them are are bad but some of them are very dangerous to the liver. We also have the problem of overthe-c counter prescriptions that people take and some of those contribute to uh to I had a very interesting case when I was very starting off my career.

[00:07:49]This gentleman I took to hospital and we did all the tests that we needed to do because he had liver failure >> and he would still come and I asked were you taking any medicine he said I wasn't taking anything we did all the tests and later on I asked him what else do you take and oh by the I forgot to tell you I take some protein when I go to the gym. We actually ended up publishing that article because he had uh he had liver damage because of of supplements that he was taking and we know some of these things that people take in the in the in the in the in the gym are very loaded with steroids or proteins that can be injurous to the liver.

[00:08:20]>> Yeah, >> that's so interesting cuz I see the days people taking a lot of like creatine creatine >> and I'm just like oh okay.

[00:08:28]>> So most of them are not regulated and because of that they have they might contain things which are injurous. The good thing about it is that the liver is very forgiving.

[00:08:36]>> So it has regenerative capabilities. So if these things are detected then before permanent damage occurs, most of them can be you can regain good functioning of the liver. Okay.

[00:08:45]>> And I'm sure we'll come to how the liver disease >> presents. Yeah. And I think it's interesting you see that because I found it so interesting just doing a bit of research on supplements cuz I feel like it's something I talk about all the time >> and the supplements according to the FDA are categorized as food products.

[00:09:00]>> Yes. So of course they don't need to go through all the regulatory approvals that medicines need to go to. Okay. Now you said um >> there were other causes. Weight loss is also a common um >> contributor to liver disease and now we're seeing um this a whole transition to people looking to lose weight through various forms exercise medication. M >> is there any impact of some of the medications that we're being put on on the liver?

[00:09:30]>> Okay.

[00:09:31]>> Actually, most of the medicines that people are using the conventional medicines that we the GLP1s and semiglutides and and those kind of medicines, most of them are are very well regulated and they do not have evidence of liver disease. It is the nonconventional weight loss medications that we can see maybe cause liver disease. But the ones which are FDA approved let's say American body that approved and usually that's most countries what they use most of them are very well regulated and by the time a medicine is released the amount of liver injury that cause is so minimal that it is not important to the general population otherwise it is recalled >> I think in terms of weight loss it is usually in terms of patients especially who take alcohol so people consume a lot of alcohol and they having they've lost a lot of weight and so they're not even eating enough and then patients who also are taking paracetamos so you're having paracetam but you're underweight you know so the dose of what you're taking should actually be less than what you you know you should be taking >> so those are some of the ways in which weight losses were ever but sometimes and I think this is important to allude to weight loss is very good for the liver as I said one of the leading causes of liver disease in the country is nonolic fatty liver disease I can define that it's um it's a disease whereby you have excess fat >> in the body which is then stored in the liver in most cases it's an innocent bystander in the liver and doesn't cause a problem. But sometimes it progresses and begins to cause inflammation in the liver and so the liver begins to get inflamed and then it becomes scarred and it begins to fail.

[00:10:56]>> And in the western country is actually the leading cause of liver failure and the leading cause of liver cancers and liver transplant. We're seeing a similar shift in Kenya and studies that have been done in our country. We have obesity rates that are very up maybe to about 30% in certain populations and those are the people who are risk of getting that fatty liver disease. We have an increase in high blood pressure.

[00:11:15]We have an increase in cholesterols in our population, increase in our waist circumference. You see a lot of people walking around with big circumferences.

[00:11:22]So in that population, weight loss is very important. In fact, it has been found to be one of the biggest uh factors that actually reduce that fatty liver disease. So in that context, I'm happy when I see people are very enthusiastic about losing weight because then they're going to protect their livers. M >> and in fact some of these medicines that have been used for weight loss are actually approved for fatty liver disease. So if you come to the doctor and you have fat in your liver which you detect on ultrasound or you have other signs or other ways in which you look for fat in the liver sometimes we prescribe for you weight loss medications so that you can you can lose the weight so that your liver can can can recover. Of course in addition to lifestyle and exercises.

[00:12:05]>> Yeah. Yeah. I think that's that's a nice entry because you know many times you'd think that someone just wants to lose weight but then if you look at them holistically you get to understand why losing weight is so important for their health.

[00:12:17]>> Yes. Precisely.

[00:12:18]>> Yeah. Now you talked about something that's an interesting topic and I think we need to dive a bit deeper into it. Um paracetamol >> and the liver and also alcohol. So alcohol on its own of course um is a contributor to liver cerosis and liver cancers but also now these people who take >> alcohol and then you get the hangover then you wake up in the morning you take a painkiller most of the time the painkiller is paracetamol >> what does that interaction do for the liver is it safe would you recommend it >> talk to us a bit about that >> when you take alcohol and you have alcoholic liver disease your dose of paracetamol should reduce so for a normal person you're allowed up to 4 gram of paracetamol per day. This is dosed as two panadors four times a day.

[00:13:02]So one pad is 500 g, one gram four times a day. That's for a healthy liver. For a liver that is that is already has disease maybe because of the alcohol then you need to reduce it to about 2 g per day. So most people don't notice that. The other thing is maybe I should maybe start by talking about what is allowable amount of alcohol for a healthy person.

[00:13:19]>> So what is allowable for a female is what we call one standard drink. For male it is two. And how do we define a standard drink? It is a 330 ml beer which now contains about 5% of alcohol.

[00:13:32]If it is wine, it's about 150 for 12% alcohol. And if you're talking about the spirit, which is what most people use, it's about 30 40% you're talking about 45 mls. That is per the male, it's double. So two beers, you know, two maybe a glass of wine, maybe it's about 300 mls for the male and then maybe two tots or three tots of of spirits. Mhm.

[00:13:51]>> So by the time you a female is taking 14 um units per week and a man is taking 21 units then that is a colic liver disease you're getting that is significant alcohol and then you can have coexistence of problems and this is where we have a big challenge. So this person who has what you call metabolic fat uh liver disease in other words they're obese.

[00:14:12]>> All right they have hypertension they have diabetes and they're taking a lot of alcohol significant alcohol that is synergistic synergistic. So they have the compounding effect.

[00:14:22]>> Okay.

[00:14:23]>> And now they get now what you got liver alcoholic liver disease and alcoholic.

[00:14:27]And how that happens it's a gradual process. You're not going to get alcohol liver disease you know uh if you're taking uh over one period of time. It's going to be a gradual process. So you take this over a long period of time and you know it's about 10 20 years. So by that time your liver begins to do certain things. It begins by inflammation.

[00:14:43]>> So it just complains a little you go to the doctor and says I'm seeing something here. M >> by that point it's usually very reversible. Over time the liver begins to become scarred. I know you've all bought a liver and it's very nice looking and shiny.

[00:14:56]>> You cut it, it's smooth.

[00:14:58]>> Over time it gets fiber inside. When you get fiber inside it means it becoming scarred. And when it's becoming scarred it it doesn't function very well >> and then finally it begins to fail because you get a lot of pressure and that pressure is what you know doesn't have its functioning capacity and that back pressure goes to the other vital organs and then you start to see signs of liver disease. So it's a long treacherous process by the time people know about it. And then remember we also have hepatitis quite prevalent in our country.

[00:15:24]>> Yes.

[00:15:24]>> Say that louder and see it from the camera. [laughter] >> We have hepatitis quite prevalent. We above the 3% which means we're endemic >> and um if we have high percentages of liver of hepatitis B. All right. And then you combound it with now the fat in the liver and the alcohol or it's like adding fire and fire.

[00:15:42]>> Yeah.

[00:15:43]>> Okay. Okay. And how do we how does one get hepatitis B?

[00:15:47]>> Okay, so hepatitis B is is a transmittable disease.

[00:15:51]>> We normally get it from people we live with or our per or our mothers as we born.

[00:15:56]>> So let me start. Majority of the transmission happen when you're young when you're less than 5 years. And why this happens is because you don't have the immunity to fight the disease. If today you got hepatitis and you're older, your body's going to mount an immune reaction. So you're going to fight it out. You're going to get very sick, but you're going to fight it out so it will clear out. So >> then [snorts] if you're young, you don't have that immunity. So you're going to not have symptoms, but you're going to keep it in your body.

[00:16:21]>> So most people get it before 5 years old from household contacts or from people delivery or during delivery.

[00:16:27]>> So what the government has done and this has been from around 2001 for the last 25 years we have vaccination of vaccinations for hepatitis B. So it's prevent most people have gotten the shots and the three shots. So this is going to be less of a problem moving forward because it's a national universal vaccination process. So kids are getting vaccinated.

[00:16:46]>> Um then there people who do not have vaccinations and they can also now get vaccinated. Probably will come back to that. Yeah.

[00:16:53]>> Then there's hepatitis B that you can get now when you're older that can usually be from shared needles you know you know tattooing piercing sterile places like likes to do that. So shared needles sexually.

[00:17:05]>> All right. Yeah. and um through fluids that you share. People go for diialysis.

[00:17:10]>> Yeah. Or other medical procedures.

[00:17:11]>> Yeah. What about hepatitis C?

[00:17:13]>> So hepatitis C again most of it is transmitted later in life and this is usually from shared needles, sexual contact and also from people who use drugs, IV drug users very another problem in Kenya. So IV drug us with needles and that's why we in some of the rehabilitation programs for drug users you find who are given needles just to make sure that they don't share needles.

[00:17:32]That's one of the biggest parameters.

[00:17:33]Good news about hepatitis B, >> it is treatables, curables. One of the things that really revolutionalized over the last few years.

[00:17:40]>> So in about 12 weeks, >> most people can get cure. 24 weeks about 99% cure it for hepatitis C. But remember, hepatitis C is not a big problem in this country.

[00:17:50]>> Hepatitis B is a bigger problem.

[00:17:52]Hepatitis C, there are countries which have bigger problems like Egypt, you know, some of the central African countries. But in Kenya, it's not a big problem.

[00:17:59]>> Okay.

[00:17:59]>> Is hepatitis B curable?

[00:18:01]>> No, it's not curable.

[00:18:03]you don't have any cure for hepatitis but you can go to a level where you cannot see the disease what you call a functional cure >> but because it integrates onto the DNA of the person you cannot cure it and that's why it's important that's why vaccination helps but the medicines are so effective that if you take the medicines you'll not have any symptoms at all you're not at risk of getting liver failure you're not having a problem of getting liver cancer >> so not curable but treatment is is very very good >> yeah yeah I think why >> that had to come out very clearly is Because over the past couple of years we've been seeing the rise of sexually transmitted infections. So I know there's a focus on HIV but there are so many others hepatitis Bora etc. So sexual health is actually so important.

[00:18:45]>> Now you've talked about the liver and how it can manifest especially in symptoms. What are some of the symptoms we'll be seeing when someone has a liver condition?

[00:18:54]>> Okay so liver disease and maybe that's why it's called a silent organ.

[00:18:59]>> The liver is very it's very evasive. So most people do not have any symptoms for liver disease until it's later. And when they have symptoms, they're very nonspecific.

[00:19:08]>> Let me give you an example. If you present with hepatitis A, >> hepatitis A is the biggest one of the most trans transmittable hepatitis infections. We get it from water and from food. You're going to present initially with what? With chills, with diarrhea, with fever, you know, until your eyes become yellow. Nobody knows you have a liver disease. In fact, you'll go to casualty and people give him treatment for a flu. Right? So that's even hepatitis B until the yellowess comes in. Most of the times it's a nonspecific presentation. The same applies to chronic liver diseases.

[00:19:36]That is liver disease that has been there for a longer period of time. The initial presentation is vague. It could be getting tired. It could be lack of concentration. It could be uh just general fatigue. All right. Later on when now the liver becomes more damaged is when you start to get symptoms of liver disease like yellowess of the eyes, swelling of the body, vomiting blood, your stomach becoming swollen.

[00:19:58]But that is much later in the presentation. And because of that, most people present get very shocked that they have liver disease until it's too late >> because the body is able to camouflage that presentation of the liver disease until it's a bit too advanced.

[00:20:12]>> Okay. Yeah. Okay. Wow. So this just says please go for your annual checkup.

[00:20:16]>> Go for your annual checkups. Avoid any liver injury. And most times the good thing is about some of those ones like some patients who are very sick like patients will have you know very advanced very severe liver hepatitis A will recover very well because in the same breath the liver has a very high regenerative capacity. So even patients who are acute liver failure and are very sick in ICU some of them recover very very well. Yes. So it has a very high regenerative capacity. So it recovers very well. Unfortunately the later you present then that that that window is lost because by the time you get fibrosis and especially when you go to something called decompensation. So what happens with the liver >> in the initial phases it's able to function it's work around it. You have fiber here you have less production of proteins but the body is still functioning. Eventually as the liver gets damaged then those proteins become so low and the pressure goes to other areas. You start to get what is called decompensated and it's a downhill track for those things. your liver your quality of life goes down your um your mortality rate increases your risk of dying and at that point is when we start talk about liver transplant you know because those things are reversible but in the earlier faces even when you have fibrosis that's advanced before you decompensate much of it can be compensated so if you come in with advanced liver disease if you have hepatitis B we know if we treat the hepatitis B we know when you stop the alcohol that you'll slow down the liver progression will slow down it might not reverse to back to normal but it slows down. Okay.

[00:21:43]>> Yeah. And probably that's a good thing about the liver that regenerative. But when it's already advanced, when it's decompensated, then most of the time some people cannot recover and the quality of life, the chances of dying are pretty high.

[00:21:56]>> Yeah. After that, yeah.

[00:21:58]>> Do we do liver transplants in Kenya?

[00:21:59]>> No, not yet. Not yet. There's a lot of lobbying around that. There are a lot of regulations around that because it's transplants.

[00:22:06]>> So, currently we don't. Most people go to either um you know, South Africa or India.

[00:22:10]>> India. But I know there's advanced processes that are going on in the teaching universities. You Kenyata hospital is really advanced. Probably I hope in the next year or so it should be liver transplant. Really needed.

[00:22:21]>> Yeah. Yeah.

[00:22:21]>> Yeah.

[00:22:22]>> Okay. You've talked about the functions of the liver. If I remember well in med school there were 10 functions.

[00:22:28]>> Well I might not know it. [laughter] Maybe I could remember.

[00:22:31]>> Yes. I actually maybe I can summarize maybe the most important. Okay.

[00:22:35]>> Okay. I think one of the main functions of the liver is metabolism. So what does it metabolize? It metabolizes when your glucose.

[00:22:41]>> It's the one that takes your glucose and stores it into glycogen and breaks it down when you need it.

[00:22:46]>> So when you have a liver problem, one of the things you do is lack of energy. You can come down with low sugars because your liver is not functioning.

[00:22:52]>> It also metabolizes proteins, you know, in your in your body. The other thing that it does, it produces bile.

[00:22:58]>> So bile is what you require to digest your fat and to absorb it, you know. So it produces bile that goes to the small intestines and then you're able to digest your fat and absorb it. It's also the detoxifier >> and so when you take a lot of of chemicals they pass through even normal you know detoxification the liver has certain special cells that as your blood passes through the liver they're actually removed >> then it's also used in synthesis of certain things in the body one of the things it does it synthesizes proteins and the proteins it synthesizes the key one is called the abamine which is important for balancing your fluids in the body that is why you find people who have liver diseases get swollen because an imbalance between the amount of fluid that is in the organs, in the blood and in the circulation.

[00:23:41]>> So because the proteins are low, it's key in terms of immunity because it produces the proteins that are necessary for the immune function. So when the immunity is not working very well, then you'll find the liver is not working very the immunity goes down because you do not have the right the right protein the right proteins to fight your immunity. I think those are the key functions of the liver.

[00:24:00]>> Yeah.

[00:24:00]>> And coagulation you can't forget.

[00:24:02]>> Oh yeah. That's so so part of the proteins that are produced actually the ones for the bleeding. So if you do not have the liver is not working very well that you don't have the clotting mechanism so you start to bleed.

[00:24:12]>> Okay. You've mentioned um bile production of bile and how it's necessary for absorption of fat.

[00:24:18]>> Um I feel like it's hard to talk about the liver without talking about the bile duct.

[00:24:22]>> So I have a friend who recently um she was pregnant she delivered and of course pregnancy is one of the common causes of um what was it called?

[00:24:32]>> The five.

[00:24:33]>> What else?

[00:24:36]the fatty bile stones and of course now she's not able to eat fatty food so she had her surgery and now she's in recovery. Maybe we can speak to that just for the women's perspective cuz we're more at risk.

[00:24:47]>> Okay. I think I think when we talk about the liver it's the hepatitary system. So we have the liver then we have the gallbladder and we have the pancreatic system and they're all intertwined together and they work together. So what the liver does it produces bile then there's this small organ called the gallbladder that stores the bile that is stored there before it is used. So if you have certain things that increases the thickness of that bile and that's why the hormones come in that is where the pregnancy comes in that's why the cholesterol levels come in >> that is why being sick being obese been diabetic are risk factors for that stasis of the bile in that gallbladder it becomes aggregated and you get what we call cholesterol stones and those are the stones that usually will cause symptoms. Not everybody gets a problem from the gallstones. If you go for an ultrasound you're pregnant and an ultrasound is found that you have gold stones and they're not causing a problem. you don't need to do anything about them. However, if you go in and you have symptoms and you go into a casualty and you have symptoms that are suggestive of gallstones, in that case you need to be treated. And so probably your friend what she presented with was symptoms of gallbladder stones. So what happens as a bile is leaving the the the gallbladder. There's a duct there. It's called a cystic duct. So that it flows into the bile duct. So that stone what they usually would do they block and then because it's a duct it goes into spasms. Then you feel a very intense pain. you know like almost want to faint then that pain goes away because that stone then goes back into the bile duct and that sometimes it dropped in the gallbladder sorry sometimes it drop into the bile duct and so you'll see people presenting with yellowess of your eyes because the stone has dropped into the pathway where the bile is meant to be passing and so it's not passing now goes back into the system then you present with yellowess of the eyes okay >> uh same thing if you have a problem in the pancreas the pancreas is swollen maybe there's a cancer of the pancreas it blocks the bile duct So because of that the bile is not flowing. It then goes back into the system and then you get the yellowess of the eyes which you call jaundice.

[00:26:40]>> Okay. Okay. Very well summarized.

[00:26:43][laughter] >> Yeah. Now let's move into diagnosis. And we don't talk about diagnosis in form of like someone who's being treated. Let's talk about it from a preventative perspective.

[00:26:52]>> So if I was to have an annual checkup and I want to ensure my liver is fully functioning, it's healthy, what are some key tests that I should do?

[00:27:00]>> Okay. So we have what we call the liver function test as part of general workup.

[00:27:05]A liver function test what it does it looks at the functioning of the liver and also looks at how the bile flows. So that those parameters >> so and also looks at the fun how the the the proteins or the functions that the the products that the liver produces.

[00:27:19]>> So when you do a liver function test it's going to tell you whether there's injury on the liver. So there are certain enzymes we call the A and the ALTS. If they are high it means there's inflammation in the liver. That inflammation is probably from certain things as we alluded to the alcohol there, you know, the weights because of the fat, the medicines >> and doesn't mean that if they're high the liver is not functioning. So they can't be high but the liver is functioning well.

[00:27:42]>> Yeah.

[00:27:43]>> The second test within that liver function are the ones that look for flow of bile. So those ones now are the ALPS and the gamma GTS. If there's a bit of blockage or a bit of narrowing of certain of the ducts of how the bile flows, then you'll find those parameters going up. Then there are those functions that the liver what the liver does. So the liver produces proteins. All right.

[00:28:04]It clears bile. Yeah. So you'll find when the liver is not working well you have an increase in billing and of course if there's a blockage you have an increase in the billin levels. You find your protein levels going down. So you'll find also something called the abinine levels going down. So that is a part of the liver function test. So, anytime you have an abnormal liver test >> in your medical test in your, you know, when you're doing your medical checkup, please have your general doctor refer you to a to a liver specialist. Not unless there's a clear reason. For instance, if you go in and you have a slightly elevated gamma GT, which is one of the parameters on the bile, yeah, and you have alcohol intake. So, most general doctors will be able to to treat that because it could they can associate that to alcohol intake. They can ask you to reduce your alcohol, recheck your liver function test after 3 months. They could do an atrasan, make sure there's no fat in the liver. If you're a female, you don't have to go and see the doctor.

[00:28:53]If for instance, other the other parameters that we use as auxiliary test for the liver. So when I look at your blood count and I see the platelets are low, one of the earliest parameters that goes on in liver disease because of pressure in the in the liver pushing back into some we call the spleen is the platelets become low. So when a patient has low platelet count, we think about the liver. So if you have an abnormal liver test and platelet, you must see a specialist because it could be increase in the fibrosis in the liver which will not be detected until it's too late on the liver function test. So you can have a normal looking blood test a slightly and then your platelets are low. All right, but there's probably fibrosis in your liver. So when we do your ultrasound, we find maybe there's an enlarged brain or we do a fibro scan some we do a called an elasttography and we find there's increased fiber. So you can trace it back into that. Yeah. So I think the take home message is this >> part of your medical checkup should be a liver function test. If it's abnormal and it's not explainable >> then go ahead and see a specialist.

[00:29:52]>> Okay. Okay. I think you've talked about lowering of platelets and maybe we can also speak about easy bruising.

[00:29:58]>> Yes.

[00:29:58]>> I know there are people who sometimes just a small >> snub and you find that you're bruising easily. Maybe we can also talk about that because it can be a sign of liver disease.

[00:30:07]>> Yes. Yes. Yeah. One of the other things that the liver does it's important for metabolism of vitamin A the fats soluble vitamins you call them A D and E and K which are important for the for the blood clotting.

[00:30:18]>> So and also as I said the blood clotting parameters are produced from the liver.

[00:30:22]So people who have liver disease present with bleeding but most of their bleeding is it can either as they're brushing their teeth because their parameters are high. It can also be when they they're cut they can also present with vomiting.

[00:30:33]Platelets would also indicate a lot of pressure in the liver that is being transmitted to the organis calling the spleen and so it would be low. So they can have pre can present with bleeding episodes. Yeah. But brisability can also come from other things. It can also be the platelet number can be normal but they're not functioning well. All right.

[00:30:50]So when you're having easy brisability then the blood count is important because then it needs to be checked. Is it that maybe you're having abnormal platelets? Many times people brush their teeth and say oh it's okay for me to brush and spit blood but it could be a place that you are not working in which case you have to have a blood counter and if it's abnormal you see a hematologist.

[00:31:08]>> Yeah. Okay. Yeah. Okay.

[00:31:10]>> Sour. Sour. Is there any imaging or >> Oh yes there is. Yeah. So part of the imaging so as part of general med wake up ultrasounds are not part of the general. Yeah.

[00:31:19]>> But if there's abnormality of uh of their functions the next test we do is an abdominal ultrasound. So the abdominal imaging of choice is ultrasound. The ultrasound is just like the one you do for pregnant women. It's a scan that scans the liver >> and what it's looking at is a structure of the liver. How does the liver look like? Is it looking big?

[00:31:37]>> Is there insect anything in the liver?

[00:31:39]One of the other causes of the liver problem is cancers in the liver.

[00:31:42]>> So either cancers that have gone to the liver or primary cancers in the liver.

[00:31:46]So if there's a swelling it will be seen. But you also have other inocent things that can be going on in the liver. You can have like a cyst in the liver which is an enlarged blood vessel >> in the liver. You can have swellings that are not cancerous in the liver especially some women who are using oral contraceptives and um it can be followed up and um they go away. Then we also look at the auxiliary organs. So we have the bile ducts. So as you're doing your ultrasound you're also looking at the bile ducts. Are they normal? Are they blocked? You know are they looking larger than expected? Is there something on the gallbladder? How does the pancreas look like? Sometimes you can be able to see the pancreas very well. Is there a large plane? All those compliments to the liver test. If you find a problem in the liver, depending on what is suspected to be the problem, then escalate either to an MRI or to a CT scan. We decide that based on what we're looking for. If I'm looking for the pancreas, >> I'll probably go for a CT scan first or the pancreatic protocol CT scan. If I have seen a lesion in the liver, I'll go for an MRI because I want to define it very very well. If I'm unclear what is causing the problem in the bile duct, I'll do a specialized MRI that looks at what is going on in the bile duct. Okay.

[00:32:49]>> Yeah. So that's how we we we progress and then sometimes what happens if you find a problem in the liver then that escalates the other tests that happen.

[00:32:58]So I go in and I see fat in the liver.

[00:33:00]So when we get fat in the liver and we have to think what are the causes of the fat in the liver. So how does the person see the fat? They find a very shiny liver. So here saying oh you have a fatty liver it shouldn't be left alone.

[00:33:11]Then you have to look for the causes the person overweight. If there's clear visceral you know your fat around your tummy you go and exercise. You just have to make the other parameters okay, the liver is okay, the benefits are fine, then you can just tell the person to lose weight.

[00:33:24]>> But if you find the person is not obese, then there has to be other reason. Are they using medicines that are causing fat in the liver? Are they using um uh are they are they having hepatitis B? So you test for hepatitis B. What are their diabetes tests like? So you do your regular diabetes test which are usually part of a general workup. You look at your cholesterol because you have to treat those parame >> as part of the treatment you're going to treat the blood pressure what you call the metabolic diseases.

[00:33:50]>> Then um if you find the person has all that is normal but your liver test found that things were abnormal like there were elevated enzymes then we go to very specialized test but that time you'll have gone and seen a specialist. Finally sometimes we do what we call a liver biopsy. So a liver bopsy is taking a small piece of that liver that goes to be looked at under the path under the microscope by the pathology. Tells us a lot of information. It's not done on everyone but sometimes that is what you need to make a diagnosis.

[00:34:16]>> Okay.

[00:34:16]>> And to define treatment.

[00:34:18]>> Okay.

[00:34:18]>> Yeah.

[00:34:19]>> Now just two two areas and then we can wrap it up. So well summarized.

[00:34:23][laughter] >> Um I think we can't talk about the liver without talking about its function in metabolizing medication. So you said some medications >> can damage the liver when taken in large amounts or like a higher dose. But also when it comes to substance use, are there any drugs, illicit drugs that we're seeing more and more causing liver disease in the generation today or in the population?

[00:34:48]>> In the population, I think we maybe talked a little about this. Part of them is the supplements >> and supplements come in different forms and also both the steroids over the counter supplements. But let me not even go there first. Let me start with the regular medication, the prescribed medications.

[00:35:03]>> So prescribe medications can cause liver diseases. One of the biggest problem has people talk about is paracetamol. So when you get paracetamol liver injuries as I alluded to people who have underlying liver diseases patients who have like alcoholic liver diseases, patients who have you know uh liver failure taking a lot of alcohol of paracetamol allowed grams is four grams per day. Some people should be two grams. The people who want to commit and they take a lot of paracetamol they take maybe 20 tablets of paracetamol then they get liver failure. All right. So that is acute liver failure because of prescribed medicines that are healthy otherwise do not cause a problem but because you've taken too much then you get acute liver failure. Some of the side effects of even regular medicine including a good you know antibiotics some of them can present with liver disease and this effect can be even days months later. So you might present with abnormal liver test and the doctor keeps asking have you taken some medications.

[00:35:55]It's called drug induced liver injury.

[00:35:57]It is not common. Some of it can be also because of allergies. They are medicines that cause allergic reactions you get like the way you get a skin reaction get an allergy in the liver and some of them is because they cause deposition of certain things in the liver. So regular medicines in some rare circumstances can cause liver injury anical liver drug induced liver injury. Sometimes even takes us to do a liver biopsy to see that that is a cause of the >> of the liver problem. Yeah.

[00:36:22]>> Then [snorts] we have other medications.

[00:36:23]Now the supplements also work in a similar way to the medications. Some of them cause um cause because of the dosage that you have to take. Some of them cause allergies. Some sometimes it change the way the bile ducts are inside the liver. We have small ducts the ones that remove the bile. If those that are affected by medications then the bile becomes accumulated in the liver then that causes the liver uh to fail. Um then of course alcohol itself is a big cause of um of liver failure and you can present with alcoholic liver disease.

[00:36:53]>> Both in the acute where you present with heavy alcohol ingestion. you've just been drinking a lot of alcohol and you come in [snorts] acute liver failure and sometimes you go into liver failure, your body shuts down. You start to bleed, you get confused, you know, um you're very unwell because of alcohol liver, you've overloaded your liver with alcohol. Good thing is that can be reversed. You know, unfortunately, some people even die because of that. In countries where they do liver transplant, you can actually get a liver transplant. Then there's a slower process of liver failure which now comes over time when you're scarring the liver and damaging the liver. And that is what that presents late.

[00:37:28]>> Are there other illicit drugs? Maybe cocaine and alloc.

[00:37:35]I'm not an expert on that, but yes, there are some some medications that people inject and also recreation drugs that actually have been attributed to especially long-term chronic slow damage to the liver.

[00:37:45]>> Okay.

[00:37:45]>> Yeah.

[00:37:46]>> Okay.

[00:37:46]>> But I must emphasize alcohol is a big thing because you have seen a lot of people taking alcohol. Um and not just in the liver, in the pancreas. in the pancreas. So patients take alcohol then they start presenting diarrhea because of chronic pancreatitis because because they're not having the enzymes in the pancreas. The pancreas has failed because of that. So that sustained alcohol and nowadays people think it they socialize around alcohol. We're exposing our kids to alcohol very early.

[00:38:12]So people are going to take al for a long period of time. So that accumulative effect will be a long period of time. As I said allowable amount of alcohol for a female, one standard drink a day, two standard drinks for for a man. Beyond that, you're abusing alcohol.

[00:38:25]>> Okay.

[00:38:26]>> Most people don't have control.

[00:38:27]>> Yeah. Okay. I think that was very important to emphasize.

[00:38:31]>> Now, just so that we can wrap it up, >> we've talked about what damages the kidney. So, how can we take care of our kidney of our liver? Sorry.

[00:38:40]>> All right. I think the first thing you can do to take care of your liver is first start by annual medical checkups.

[00:38:44]Do what your parameters are.

[00:38:46]>> If it's make sure you're vaccinated, >> all right? And vaccination is allowed, you know. So, we should be testing for hepatitis B. So, how would we test for hepatitis B? You just go and tell the casualty doctor, I want to be tested for hepatitis B. And if you're not immune, you can be vaccinated. Most people, as I said, vaccination program started um about 25 years ago. So, most people more than 25 years have not been vaccinated.

[00:39:08]It helps to have vaccination. It's not standard practice because there are people who are at high risk like people who are going for diialysis or medical workers. Those ones it's standard or people who have HIV that is routine. If you're not in that bracket of people, then it's not routine care. You can request that to happen. So that's prevention. The other prevention is, you know, if you get hepatitis, if you're drinking water that is clean, make sure you don't get hepatitis A, good thing he A is curable. Then avoiding things that damage the liver, avoiding the supplements, please. Anything that is written natural is not safe.

[00:39:38]>> Doesn't mean it's safe.

[00:39:39]>> But unless you make it yourself, you're getting your ginger, you make it. But anything that you take and you're told is natural, please don't take it that it's safe.

[00:39:47]question and these things that don't have anything written what they are and you're popping it into your mouth and you be very careful in very circumstances do you actually need to take a supplement >> very few circumstances do you need a supplement and it can be prescribed why don't you have the doctor prescribe for you the vitamins that you require measured and then given to you over the counter medications please don't take them you need to it needs to be clear when you're taking the medications take care of our weight >> you know women obesity not women everybody obesity make sure that obesity is not there because that damages the liver make sure your diabetes and high blood pressure very well controlled so that you don't get chronic liver diseases and then alcohol I think I've alluded to that and then when you have a liver disease please don't trivialize it most people say oh yeah that parameter had been seen some years ago I'm always told my is okay high you know no >> any parameter that is abnormal in that liver test should have a reason for it >> okay >> all right Yeah, >> I think that's that's it. That's a a crash course on liver [laughter] >> and the liver sour. I think we'll summarize that. And I think the first the best place to start is an annual checkup so that you can know what your normal is. Yeah. Know your numbers. And remember last time we said don't just know the numbers, know what they mean.

[00:41:05]>> What exactly?

[00:41:06]>> Yeah.

[00:41:06]>> All right. So let's wrap it up. You can give us a parting shot.

[00:41:11][laughter] >> I think for me is exercise. It's been shown that if you exercise and just lose even 5% of your body weight, you actually reduce the fat in your liver.

[00:41:21]>> It doesn't have to be a lot of exercise.

[00:41:23]It could be resistance testing twice a week >> just as So get out of your beds.

[00:41:27]>> Please walk around this weekend.

[00:41:28]>> Okay.

[00:41:29]>> About 150 minutes per week is all you need.

[00:41:31]>> Okay. Okay. Actually, yeah. And that's not too much across the >> 20 minutes per day.

[00:41:35]>> Yeah. Yeah.

[00:41:36]>> All right. I think for me it's just >> be keen on what you're putting into your body, what you're ingesting. Yeah. It's not everything that claims to be natural is safe for you. And we're not saying it's not natural. We're just saying it's not necessarily safe for you. So, be very keen on that.

[00:41:51]>> All right. Do you Where can the people find you?

[00:41:54]>> I'm based at the footy suits. That's where my private practice is. Yeah. So, and I work also I take patients in hospital if they need inatient care.

[00:42:02]Yeah.

[00:42:02]>> Okay.

[00:42:02]>> Yeah.

[00:42:03]>> Thank you so much for coming another time.

[00:42:05]>> Thank you. Looking forward to the next one.

[00:42:06]>> To the next one.

[00:42:07]>> Yeah.

[00:42:08]>> Thank you.

[00:42:08]>> Thank you guys for making it this far.

[00:42:10]Please be sure to like, to comment, to subscribe, to share this with someone who you think should probably listen to this. And please take care of your liver.

[00:42:21]>> Take care of your liver. It's very important. And that's a wrap. [music] >> [music]