Kristin Kirkpatrick
Appearances
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So once we have kind of that hijacking of overtaking of having healthy liver tissue being replaced by unhealthy, fibrotic, inflamed tissue, the liver no longer works the way it should. And that causes a whole host of problems.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I think sometimes when I talk to my patients, many of them say, well, you know, I'm just really trying to avoid toxins. So I just have glass. I'm not using plastic anymore. And, you know, they'll name a few things that they think are kind of the keys to not having those toxins. But really, We are exposed to toxins all the time. So it's not just diet.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
It is walking outside our front door and being near a car that's driving by. It is being in the environment. It is what happens when we're completely stressed. There are toxins everywhere. And the liver is the main organ. And it works a little bit, of course, with the kidneys as well to be able to detoxify.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And we could talk about this a little bit later, Drew, but it remains one of the frustrations I have with like kind of detox diets or detox potions that are out there because no one does it better than the liver. And all we really need to do is start taking care of our liver to have that detoxification mechanism work well for us.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, and there's so much to change, right? Every day I feel like there's something else that we're finding is a toxin to the body. So even more reason why we need to take care of this organ and the detoxification process. So it's basically a three-phase process. The first process, if we imagine something coming in,
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Let's even look at something like that statin, or we can look at anything, a toxin coming in from food. So that comes in and the first phase is basically converting it into something that the body can understand to move on to phase two. So it's breaking it down and it is changing it from fat soluble to water soluble. And so making that change makes it able to kind of keep moving.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Now, there are some byproducts. that occur with this that can be a little bit harmful. Even one would say inflammatory. So once we release kind of the or get ready for the toxin to go to phase two, there is a release of some of those harmful substances. So this is why phase two is so important. So now we move into that phase two. Phase two is basically the preparation for removal.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Removal is phase three. So when we look at phase two, there are many different pathways that occur. Now we have this water soluble substance, and now we have to go through the pathways of just breaking it down so those really harmful components don't stay within the body. This is where diet plays a really huge role.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So looking at the role of amino acid metabolism, omega-3s, all of these things, antioxidants in the diet, these all make a difference in that phase two. So getting that pathway to where it should be. And then we go into phase three, which is elimination. So literally looking at, all right, we've done everything that we were supposed to in phase one and two. Now we need to get it out of the body.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And this was interesting because this kind of speaks to thinking about how things are excreted. A big chunk of my patients are on Ozempic or Wagovi or one of those drugs, and they suffer from constipation. And I had a patient tell me the other day, well, yeah, the constipation is my only symptom, but I'm not worried about it. I don't care about that. And I said, well, I am because...
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
phase three can't really occur if it's still stuck in the body, right? If we're constipated and we're not literally getting things out the way we used to be, then phase one and two could have worked, but now it's just kind of stuck there. It's not moving. And so it's still there.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So this is where we can look at really, you know, bowel movements and looking at stool testing and all of those things, even looking at the connection with microbiome and those components associated with that. But the detoxification is so important. It is one of the reasons why we absolutely needed this organ at birth.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And as I said before, one of my great frustrations when people spend their money on detox potions that, quite frankly, don't always have the science.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
will of course speak to how inefficient or efficient the connection actually is. Obviously individuals that are in cirrhosis, but even looking at individuals in what we would say kind of the second step, which would be looking at fibrosis, inflammation, they would have some challenges as well.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But anyone that has excess fats where that tissue is being replaced could see some issues with detoxification.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You know, the silent nature of this is really what I've seen in my practice and the hepatologists that I've worked with. Many people don't get diagnosed with this until they see their liver enzymes are up. And then that's kind of the warning symbol. What's going on here with your liver? So let's just go over some of the risk factors. Insulin resistance is probably one of the greatest risk factors.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, absolutely. This was such an alarming paper. It just came out a few weeks ago. And looking at the fact that individuals with fatty liver disease have twice the mortality rate of individuals that do not. So quite frankly, speaking on that one and more simply, you're more likely to die early, right? This is what it means. And the death would come from other associated diseases typically.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And this is what we have actually seen when we look at the data on fatty liver disease in general. Looking back at that data at heart disease and heart attack and stroke, more likely to occur in someone who has fatty liver disease. This paper also brought up death from common diseases such as cancers as well. So looking at the cellular changes that could occur based on poor liver health.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
We haven't seen as many studies looking at cancer in general. Of course, we do know that fatty liver disease is one of the top causes of liver cancer. You know, it used to just be that if you drank too much, then you're more likely to get liver cancer. Of course, that is also true. And we could talk two hours about drinking, right? and the data on drinking today.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But really, I think this looks at a varying degree of cancers, not just that liver cancer as well, if I remember correctly. So cancer is another big one. So it's kind of like the liver is like the hub. I referred to the liver in my first book as like the great and powerful Oz. And he's just kind of like the puppeteer to the other organs. And this study really shows it.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So the liver's not working great. It's probably not the first thing we're thinking of, but it's impacting cancer. It's impacting our thyroid. It's impacting our hearts, our brain. And so we think of those organs that are associated there, not realizing that it was the guy behind the curtain kind of pulling the puppet strings all along.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You know, I think that it's probably very complex, multifaceted. So it's probably not one thing that we can pinpoint. Once the liver goes bad, here's what happens. But it's probably a combination of things. I think the detoxification process that you brought up and the cellular damage, I think is a huge component.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I think inflammation in general, we do know that when you have liver disease and you're at more severe stages of it, your C-reactive protein, your sedimentation rate, inflammation levels tend to go up. We know that the microbiome is impacted. And so there's also that association between all of the components looking at gut health and the risk of cancer based on some of the components there.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
The reason for that is because the liver plays such a huge role in regulation of blood sugar. When the body senses that blood sugar is too low, the liver will work towards releasing the stored form of blood sugar. So we don't have that low blood sugar. And so there's a huge connection here. In fact, when we look at that one in four statistic,
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I think we probably need to learn more. We probably need to get more data. It's probably not as simple as we think, but it probably all stems from some component that the liver is not able to do any longer anymore. Detoxing is the most recognizable component, but we also know that obesity is an independent risk factor for certain cancers as well.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Again, is it because we're having an inflammatory storm occur within the body? Cytokines are going nuts. We have all of these things going on where the cellular damage is overloaded and cancer could occur. We need to learn more.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Absolutely. And I think one of the really concerning things here is just thinking about your audience and who you speak to each and every day, many of which are parents. So we are seeing liver diseases now being diagnosed in children as young as eight years old.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So, of course, that is also associated with insulin resistance, obesity, type 2 diabetes, and the risk factors that we had covered earlier. So, you know, the liver really, I always say it, man, it takes a punch. It can take a beating and keep going. It's like that Energizer bunny. So the good news is that it does take a long time to get to those latter stages.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But that's bad news if you're a child and you get this and you can't resolve it because now you have a whole bunch of time to be able to go to those latter stages where we start seeing these more severe consequences.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
we are looking at individuals who have insulin resistance or type 2 diabetes much greater in the stats, right? So probably 80% to 85% of individuals that are suffering from insulin resistance or type 2 diabetes probably also have fatty liver disease as well. And this just speaks to the dysregulation of what is going on in sugar, in their blood sugar.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, I would put the blame more on carbohydrates than than fat. You know, it's interesting. I was listening to a podcast the other day and saw this debate over red meats. And I just for my for my Today Show column, I just wrote an article on the carnivore diet. And my thought once I published it was like, well, this isn't going to be popular, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
It will be evidence-based, but not necessarily popular. But there's this whole debate, right? Should we just eat meat? And the debate is, well, look at our ancestors. They didn't have the modern diseases we had. But if we go back to the cavemen, they also didn't live that long, right? So if they lived into their 80s or 90s, would we have seen the development of heart disease?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Maybe, maybe not, right? They also didn't have access to carbohydrates as much. So back to this question about fats. You know, really, if you look at fat in general, fat tends to be a very healthy component, a dietary component for fatty liver disease. Number one, because it doesn't impact our blood sugar levels, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
We don't have an impact to insulin, which is a huge factor in fatty liver disease. But number two, we don't associate fat really, even with things like... you know, elevated obesity. This is a little controversial, but, you know, if you look at kind of how fat was vilified back in the 80s with heart disease, we don't really see that connection. Now we see it with sugar, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So there's all these components here that would make you... really kind of question, gosh, is my low-fat diet a really good option here? And it might not be, especially if that low-fat diet is paired with a very high carbohydrate level and especially if those carbs are stripped.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You and I were talking earlier today about wearing CGMs. I have my CGM on right now as well. It's so interesting to compare my patients and their data with someone who doesn't have insulin resistance and looking at how poor and how less efficient the body is at recognizing how much insulin is necessary. losing what we call that sensitivity.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah. So, you know, it's the big one that I've noticed that I've been talking about a lot with my patients lately is diet cola. And you brought up kind of the donut, right? And the donut is an obvious ultra processed food. It raises blood sugar, raises insulin. And it's obvious. It's obvious. But diet cola is also ultra processed.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And I have so many patients that will kind of show up to my office and say, like, I'm really limiting my ultra processed foods. And they've got like, you know, some sort of drink mixture in their water or they got the diet cola. And I was like, well, that's ultra processed. And the same mechanisms would occur with some of these foods.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I would really caution to my patients and to your audience, just don't. because something doesn't necessarily raise blood sugar or insulin doesn't necessarily mean it's not harmful in terms of the liver. Because we're making this big connection.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Hey, if your blood sugar, your insulin are dysregulated to begin with, and then you have something that makes it really go up high, that's really, that's overwhelming. That's overwhelming for the liver. So when we have things that maybe aren't impacting, diet cola is a great example.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
We just saw another study on looking at artificial sweeteners, I think two or three days ago, looking at how there was a huge increase of hunger that typically followed when you have a diet cola or another diet product. So that's kind of the first caution.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
If you're someone who's saying, gosh, I'm really trying to get out these refined carbohydrates, I'm trying not to have a donut, don't switch it to a fake donut that might have a whole bunch of artificial sweeteners, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, absolutely. I mean, we have seen that, right? If you look at studies looking at diabetics, consuming a diet cola over a regular cola makes a very big difference. We don't see the impact to blood sugar and things of that nature. So I do agree with that, but I think it's a gateway.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Insulin resistance is not having the sensitivity needed to give you the right amount of insulin to match the right amount of carbohydrate. So that is a huge risk factor. Obviously, that falls within the type 2 diabetes as well. Obesity, and we're looking at obesity here as waist circumference.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And that's where my challenge is, is that once you have the diet cola, you might be more prone to have other foods that are also processed. The way that I look at this, and you said you're not a diet cola drinker, I used to love diet cola. So you're talking as a former drinker. Not just former. I probably have one diet cola a month, and I look at it as my dessert. Like it is dessert.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
It is my thing that I'm gonna have once a month and I'm not gonna feel shame or guilt or any of those words that kind of take us out of intuitive eating. I enjoy it. I really, really enjoy it. And it's a once a month thing. So I tell my patients like, there's really nothing you have to give up completely, but we need to change the proportion of where it falls in the diet.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
That diet cola for me is 10%, probably less of what I'm having in general.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And it just, you know, it's funny because my kid was talking to me the other day and we went someplace and he's like, Mom, you should have your Diet Cola. And I was like, it's like... That's early April. This is way too early. I have to go as far long as I can. And then I get to the end of the month and I enjoy it. Right. I'll only think about it if I just have it at the beginning of the month.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But my point here is, is this. I think, you know, having a Diet Cola is fine. But if that is your drink of choice, it is number one, replacing alcohol. space, literal space in your body for other good nutrients that you could have, right? So it's like, I'm having a diet cola, I'm not getting that. And it's also provides zero bang for your nutritional buck.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So 80 to 90% of the time, I want my patients having something that has some sort of benefit to their health span. So let's just not even look at liver, but let's go much more higher level and look at this concept of health span. When you have something, if I'm going to have a diet cola, does it contribute to my health span? No. Is it neutral?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
It's probably neutral if I'm going to have, you know, once a week or once a month. Is it going to be negative? Maybe now we're in the negative factor if I'm going to have it three times a day. So it just depends on kind of what the frequency is. But I do think, and I see this in myself as well, and this is my job, right? I talk to people about this all day long.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
When I have my diet cola, I'm more likely wanting to have something else like fries. It's just something that pops into my head. Right. I'm just like, oh, this diet cola is great. I like I'm going to I'm going to have it with a burger. Right. So I'm never like I can't wait to have my diet cola with my kale salad. No, that's not the connection. So I do think there's an association with that.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And of course, it's greater than diet cola. There's a million. If you look at protein bars, if you look at even protein powders today, you know, for the most part, the less ingredients something has, the better it's going to be for you. Diet cola doesn't matter the brand. There's a lot of ingredients, right? There's a lot of ingredients.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So one of the reasons, and we can talk about this later, but one of the reasons that the nomenclature from non-alcoholic fatty liver disease, which was NAFLD, changed to MASLD, M-A-S-L-D, so that is metabolic dysfunction associated steatotic liver disease, is because of the fact that we needed to recognize the metabolic features of this condition.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So and then the third thing I would say is in some ways it hijacks our taste buds. So if we think about our taste buds and we think, and we might define ourselves, as many of my patients define themselves as a sugar addict, okay? And so they'll do a nutrigenomics test. They'll find out that there's some epigenetics going on or genetics going on where they're more likely to have sugar.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And they'll say, you see, I told you I'm a sugar addict. When we have that great amount of sweet coming in from sucralose or aspartame, we're not giving our taste buds the opportunity to not want it. We're going to want it because we're giving it to it in such high intensity.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So again, if sugar is your thing and you're really trying to get off of it, this is why I suggest against getting off a regular cola with a diet cola. A diabetic population is a little bit different. You know, if it's a stepping stone towards better choices and drinks, then I could see that that could be beneficial. But if it's the drink of choice all day, it might not be the best choice.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I can't stand water. It's just so boring for me. So I had to figure out like, okay, I really wanted to get away from seltzer waters with natural flavors. And some people would say, well, gosh, that's so aggressive. Like having a lemon seltzer water, that can't be so bad for you. But natural flavors don't have to be disclosed what they are, right? They're proprietary.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So we're not quite sure what they're doing to the body. So that's number one. And so I actually just move towards a plain mineral water and I constantly have this bowl of lemons and limes in my house. It takes more effort. The bowl actually looks very beautiful.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I think that that can speak to like, you know, if you have flowers in your house or you've got a nice bowl with colorful fruits, then, you know, there could be something related to stress and lowering stress with that definitely does for me. But having access to that and just kind of putting that in my drink.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I get to the point sometimes where I forget about the Diet Coke and it just doesn't taste as good anymore. So we kind of, as much as we can learn a habit, we can unlearn a habit, but that takes time, effort, and alternative.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yes. And, you know, we basically we've seen this more in animal studies, but human studies, there could be some incidents, especially if you're insulin resistant, where the body is confused by the sweetness. Right. So we've seen this in animal studies where an animal will have a let's say a diet cola or just pure, you know, aspartame, a sucralose or some sort of artificial sweetener.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And the body is not given any calories, but yet the pancreas is like, no, no, there's some sweet here. So I need to release insulin because we have sweet. So if we have sweet, you need insulin. I don't know how much, but I'm going to release it. And then we have insulin circulating around with no job to do, which is a really bad situation for insulin.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So there is, again, we need more human studies there. And the other thing that I hear a lot in my practice as well is people just, killing themselves if they have any kind of processing at all, right? So we've got like, I'm sure you've seen this, the NOVA classification out of Brazil that classifies how processed food actually are kind of, you know, what bucket they go into.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And so that really speaks to the obesity perspective and waist circumference in general. So when we see waist circumference, the belly fat being larger, we know that then leads down a path of a greater incidence of insulin resistance, type 2 diabetes. So there's the connection there. Sedentary lifestyle.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So we've got like culinary ingredients, processed, non-processed, right? Ultra-processed. And so I a lot of times I'll tell my patients, you know, it's almost impossible to eat a completely unprocessed diet. Right. That means if you want to carry it, you're going in your backyard, you're pulling it from the earth and you're having the carrot. It's like it's almost impossible. So we can't like.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
slap ourselves you know on the back and say gosh you know you're so bad for doing this if we have something that has some processing because it's very hard not impossible um but it's hard for all americans to eat a completely unprocessed diet you have a piece of cheese there's processing there so again like i think defining ultra process from process is also important as well
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
One of the things I talk about, and again, this might seem a little aggressive because you made a great point that when we're asking patients to change so many things, it's like, here, change everything and also take away the diet cola. It's like, what?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But the other thing, too, to look at is when we consume something and it's a grain, are we consuming an intact grain or are we consuming a whole grain? Both are good. One might be a little bit better. So I'll give you an example. If you have whole wheat bread, that is whole grain, if it's whole wheat, right? It has all three components of the wheat kernel, the bran, the germ, the endosperm, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So whole, an actual word. But it had to go from that grain to the plants to create bread. versus just wheat berries or things like that. So that is another place where, again, it goes above and beyond the obvious of diet things. And I mentioned diet cola, but I will also say there's a huge emergence now of diet sweets. They can get diet licorice, diet peach rings. I know them all, okay?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I know them all because my patients ask me about them, right? Like, what about these? Like, what about this brand or this brand? So there's this huge opportunity for consumers now to eat the foods they used to love, but now without any of the consequence. But unfortunately, there's probably some consequence there. So this is a little more aggressive than that.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Again, when we are sedentary, we are more likely to be obese and especially having that belly fat. But we also don't have great regulation of our blood sugar again. So we're not utilizing the fuel that we need for activity. So sedentary lifestyle is another huge factor as well. Tobacco use, we know tobacco use can damage the lining of our vessels, so the endothelial lining.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But again, like instead of whole wheat pasta, could we just have something that's intact, wasn't created into another product? So this really gets into kind of eating closer to the farm, closer to the ground, to the bush, to the tree. You know, can we eat more foods that haven't been turned into other foods?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I would almost argue I'd rather you make your own sourdough bread at home, even though it might be made with refined grains, than getting a whole wheat bread that comes in a bag. Right. And it's not the bag that I have the issue with. It's just the fact that, you know, your hands weren't in it. You didn't create it yourself. It's going to last pretty long.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You put it in the fridge, probably last two weeks. So there could be something to be said about that, too. So, you know, I would say anything that has a huge amount of ingredients would be a place where I would say, let's let's let's rethink this. Could we have a better alternative here?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, so I think number one big picture is they're all real foods. And so that would be kind of like my high-level advice to people. If we just eat more real food, you know, Michael Pollan defined food as something that comes from nature, is fed from nature, and will eventually rot. And I think that's one of the best definitions of food that I have ever heard.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You know, if you look at food from that perspective, it's very easy on how you choose things like plants. And it becomes easier on how you choose things like animal protein. So comes from nature, fed from nature, for example, you want to go with a cow that is eating from grass versus grain, okay? Because that's not feeding from nature if they're eating grain. So just an example of that one.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So this is all real food. And then the other thing I would say is it also has foods that I don't know if I'd go into the detail of saying are controversial, but foods that I think patients say to me, well, gosh, I can never have chocolate again. I can never have coffee again. Right. without really having the data associated with it. So I think that's kind of big picture, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
If these 12 foods don't speak to you, choose 12 foods that are real, and you'll probably be in just as good of a scenario.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I cannot tell you, Drew, how many studies are out there looking at specifically fatty liver disease and coffee consumption. Coffee consumption has been associated with a lower risk of fibrosis, reversal of fibrosis. Fibrosis is the inflammatory inflammation that occurs when we get into those latter stages of liver disease. And coffee is probably good for a few reasons.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
When you look at the studies... There is some assumption that it has a lot to do with the bean, but it could have something to do with the caffeine as well. So the studies are positive, both in caffeinated coffee and decaf, number one. We know that there's a lot of bioactive compounds within the coffee bean.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You know, I always tell my patients, if you do one thing today to improve your dietary pattern, choose the deepest hued compound. Plants, right? So the plants that have the most color have the most benefit. So in theory, a red delicious apple will be slightly better for you than a yellow delicious apple, okay? Because it's got much deeper hue.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
It's why we see all these great studies on berries, things like that. It's hard to get deeper hue than a coffee bean. And it's controversial because I always get people saying, well, coffee will increase your cortisol and that increases glucose and all these bad things about coffee. You know, we have a gene called the CYP1A2. So CYP1A2.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And we know that that gene really kind of puts people into one of two camps. You're a fast metabolizer of caffeine or you're a slow metabolizer. Slow metabolizers of caffeine should not have that much caffeinated coffee. The data is very clear. It increases the risk of high blood pressure, heart attack, etc.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But if you tolerate caffeine, then the studies are pretty clear that having four or more cups a day can be very beneficial specifically to overall liver health. It's what we put in coffee that really ruins it. So that's that.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So we know that tobacco use puts us at risk for, of course, lung cancer and things like that. It's also a huge risk factor for things like dementia, right? So if you look at like Lancet's outline of the main risk factors for dementia, of course, tobacco use was in there. And that has to do with the damaging of what happens with our vessels.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah. Yeah. I mean, and even if like you're going to your coffee house, just ask for a black coffee with half and half. Right. So that's like a very it's actually cheaper. So, number one, it will be so much cheaper than the specialty drink. And it's probably a lot better for you if you have to have the sweetness. Then I would usually add in a stevia. Most coffee houses don't have allulose.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Otherwise, I would go with allulose over stevia in terms of how to sweeten. So, you know, even raw honey can be another great example as well. But, you know, that's kind of like changing our diet. our coffee order to your point makes a huge difference. Like you go to these coffee houses, you're just ordering dessert.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Like if you're craving cake, you should get the cake that you're looking at because there's really not going to be a huge difference between the amount of sugar and what you're getting in the coffee. So just a lot of benefit, a lot of benefit on that one. Mention, let me just back up and say that I've made connections to the heart, to the brain, to the liver.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
All of these are kind of interconnected in a lot of ways because they're all going on the same circuit, right? So blood flow. So if we have poor blood flow to the brain, risk factor for dementia. Obviously to the heart, risk factor for heart attack and stroke. And poor blood flow, looking at even like the hepatic artery and portal vein and all of these things connected to the liver.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
you know, that makes a big impact as well. So the association with berries has really been in the data that it really does help with overall blood flow. It helps with endothelial function. And it's got that very deep hue. So again, you know, what does that look like in terms of how you fit that into your diets, right? I know with my CGM, I love blackberries. I'm like, love blackberries.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But if I have blackberries alone, my CGM will go pretty high. It would probably be the highest point that I see during the day. If I add in, if I have like a tablespoon of extra virgin olive oil before those berries, I don't see as much of a spike. So again, there's little tricks of the trade that you can do to kind of impacted if your worry is, well, gosh, Kristen, I'm a diabetic.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I can't have too many berries because I get that from my patients. Right. Well, these are great. Not good for my blood sugar, though. Right. So, you know, working with an expert to figure out, OK, what are some of the things that I can do to kind of limit that spike? So essentially competition for digestion.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And of course, when we think about the liver, we have to remember that the liver is connected to a whole bunch of vessels, just like every organ is as well. Metabolic syndrome, that would again feed to the type 2 diabetes insulin resistance. Metabolic syndrome is essentially a way for physicians to say, okay, let's look at the factors that you have. Do you have hypertension?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, I agree with you 100%. And I also think, especially if you're monitoring a CGM, what's the recovery, right? So the spike is not as worrisome as the fact that it's not coming down. Right. So that that's the other thing as well to look at if you're really tracking that is my spiking and then just kind of hanging out there.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
That could be an indicator that like, OK, maybe my metabolic health can have some improvement. But if I'm spiking, I refer it to, you know, you really want kind of more valleys than roller coasters. So I'm going to go up a little bit and then I'm going to slowly come down versus this huge spike. And then I'm going to hang out there at the very top and then I'm going to nosedive to the bottom.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Right. So, you know, that is another place where we can look at a little bit more intricate detail as far as how something's impacting us. But absolutely, there's a few things that are as frustrating by someone saying, I can't have fruit anymore. Someone told me there's too much sugar. Because there's a very big difference between fruit and a piece of licorice, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And like all of the antioxidants that come. And so I think I agree with you. I would never want someone to give up fruit. But if you are someone who's hemoglobin A1C is, and I hear this, especially my postmenopausal women, they're like, I was normal my whole life. Now I'm 5.7. Can't move the needle. I don't know why.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So if that is you, then, you know, some of these things where maybe you have a little bit more fats with something even as healthy as fruit. If you have an apple, maybe you have it with some almond butter. Those are things that could kind of help with, you know, the blood sugar management.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Do you have sleep apnea? Is your hemoglobin A1c 5.7 or above? You have enough risk factors here for us to say that you've got metabolic syndrome, which is basically just a cluster of these symptoms that lead to metabolic dysfunction. High lipids can fall into that as well. And we recently had some news coming in from Cleveland Clinic and Dr. Nissen looking at stealth cholesterol and
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Oh, yeah, absolutely. I could not agree more. And I think this conversation, and I know you've had guests talking about this as well, has only been exemplified by, you know, the popularity of GLP-1 drugs, right? Because we do see the propensity of individuals to lose muscle and sometimes a tremendous amount of muscle, not in all cases.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
If people are working with an expert, then we can kind of offset that in some ways. But when we lose muscle as we age, of course, we have the risk of sarcopenia. So just kind of muscle wasting. But it also there's a direct impact to our overall mortality. So going back to this mortality conversation, the less muscle you have, the more likely you are to fall, to break a hip.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You know, all of those things associated. But yes, from the glucose perspective, it's why our glucose goes up when we are exercising, right? We would think our glucose is automatically just going to go down. That's not always the case. If you don't have enough, the glucose sometimes goes up to give the muscles what it needs to utilize to get energy and able to get through that workout.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So again, it's different for... for everyone, but having more muscle is huge. And I love that you had the DEXA scan because, you know, I always tell my patients, like, if you've got a scale at home that you're getting on every day, throw it out because all it tells you is your stuff. Fat, muscle, water. That's it. It's just here's all the stuff that makes you. That's it.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
There is no breakdown of your fat to muscle ratio. And so that's a much more important perspective than just some magic number. And a lot of my patients have a magic number. If I'm just 125 pounds again, I'll be happy. Right. So, well, 120 pounds, 120 pounds of fat is very different from 125 pounds of muscle.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah. So I think, you know, let's like obviously like kiwi, any kind of the other fruits are going to be really important in terms of antioxidants. Edamame, we can kind of clump with a legume since it is a legume. We know that plant-based proteins make a big difference. And we also know that edamame in particular has isoflavones, which may play a role in reducing fatty liver disease.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
The dark chocolate, I think, is a big one. So For my patients, I'm going with either like a raw cacao that they can put in smoothies or things like that, or just going with something like a 74% or greater. It's hard to get a good tasting chocolate that doesn't have some sugar in it. So again, getting ones that have a little less sugar, better quality, that always can make a big difference.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Green tea has components in green tea, like looking at the actual compounds that we have in green tea that we know reduces inflammation levels. So there's an association there. Extra virgin olive oil, there's been independent studies looking at extra virgin olive oil and, again, reducing fibrosis so that inflammatory markers that occur within the liver decrease.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Poultry and wild fish as just two great options, again, in terms of lean sources of protein. Not everyone wants to go completely plant-based. So I would say those are wonderful sources. And we've got the data. All of this is backed by evidence.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And then nuts and seeds, you know, really just an option as another way to get more monounsaturated and healthy polyunsaturated foods into your diet as well. So again... Studies with all of these, they're all real food, but they're all things that can kind of help us from a multi-organ capacity, which ultimately helps the liver as well.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
and some of the potential pharmacological approaches that can go towards this. So a lot of lipids in the news, and that's a good thing. Makes us think about the fact, maybe I should get my lipids drawn, right? Hypertension, again, falls into that metabolic syndrome. And unfortunately, age. Age always plays a factor, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, so it depends on the patient, really. I mean, you and I were talking a little earlier today, and I think I can't remember if you use this word or not, but we were talking a lot about finding a person's why. And that's where I start every single appointment. Someone will come in and say, well, I'm here because I want to lose 40 pounds. Okay, great. Let's table that for a moment.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
What I want to hear is what's your why beyond weight loss? What? What are you talking about? Like, what's your why? What do you not want to become? And unfortunately, sometimes we look at those that came before us. Oh, OK. I don't want to get dementia like my mom had. I don't want to get the heart attack like my brother had at the age of 40. OK, that is a why.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And so I always start with those whys to look at what dietary pattern makes sense. For someone who has extreme genetic lipid abnormalities, everyone's having heart attacks in their 40s, I am probably not going to include red meat as an option. So that's a great example of where I might look at that.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Another example where red meat might not be an option could be with an individual who says, I'm on a really limited income. I can't get wild meat. I can't get bison or elk. I just am getting like the ground beef that is like just the cheapest option at my store. I probably am not going to recommend it. We're going to go for a different option there.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Or we're going to look at different alternatives. But those would be some of the things, right? Like what I would recommend or don't recommend oftentimes will take multiple visits and hours to really kind of peel back the layers of what works for someone, right? And that's really kind of, I'm not against red meat, but I'm very specific into how much and what kind, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I think like what's really important to look at is the fact that mindful eating is really at the top of this. I mean, we know that weight loss is going to make a huge difference in improving fatty liver disease. So looking at the weight loss goal, of course, is big. But right under that in the blue boxes is this mindful eating.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So tapping into intuitive eating, you know, how often are we sitting down to eat a meal and our cell phone is right there and we're just kind of scrolling or we have the nightly news on. We don't recognize, like, is that causing me to eat more because I'm just not recognizing how much stress that's providing to me. Right. So so I think mindful eating is important. is really quite difficult.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I probably meditate for five minutes every day and people would say, well, gosh, you should do more. But many people don't do any. So if I can fit five minutes in and maybe combine it when I'm in the sauna, kill two birds with one stone. So kind of look what makes things easy for you in order to incorporate some of these more mindful approaches. Intermittent fasting, I think, is another big one.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I was coaching a group of menopausal women the other day, and someone had brought up hot flashes, and another woman brought up gray hair. And I said, gosh, do you remember? You don't remember. But do you remember when we were a baby, we didn't have any of these. Our skin was great. Everything was wonderful. And that's because our cells were wonderful and so young.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
We just had a study coming out, I think, yesterday or the day prior, looking at time-restricted eating in combination with weight loss efforts to really help with weight loss maintenance. So We are surrounded by food 24-7, and it is ingrained in every aspect of our life. I mean, you can't go to a party without a spread, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And if you do go to a party and there's no food, you're like, what's wrong with these people, right? So it's like food is always associated in every single thing that we do. So I think that's really important to look at our frequency of eating. Intermittent fasting has been shown to be very beneficial. If we just look at NAFLD and NASH,
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So non-alcoholic steatohepatitis, that's getting into the fibrosis, the inflammation. And then the last one is really once you're in the non-reversal phase. So cirrhosis, much different properties on that one. But obviously we've talked a lot about this reducing sugar, all of this. And then finally looking at alcohol. Should you have any alcohol?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Um, if you've got fatty liver disease, my argument is no. Now this was an actual study. And so their recommendations were perhaps moderate amounts, um, are allowable, but I would never use the word beneficial. So that's kind of, it's the nomenclature here where, where I would look at this. Like if you're going to have alcohol, put it in the same camp as that diet cola and that donut.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Once a month. Once a month. So it's not that you can't have it, or let's say twice a month. And having it not at all will be a huge step in the right direction. We just don't know if there's any safe amount of alcohol now. So I think those are big ones. And then, of course, based on this study, looking at the DASH diet, the MIND diet, the Mediterranean diet...
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
DASH and MIND are derivatives of Mediterranean diet. It's very hard to beat the structure of the Mediterranean diet. Where I alter the diet is basically looking at what are the numbers for insulin resistance or type 2 diabetes. Based on the severity of those numbers, I am going to alter the carbohydrates within the Mediterranean diet, but that's going to be on a case-by-case basis.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Well, I think doing something is 500 times better than doing nothing. All right. And so we've seen some studies come out about this, even just getting a half hour a week, which to people that exercise, they're like, what? That's I mean, come on. Who just does a half hour a week? A lot of people do zero hours a week.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
As cellular damage occurs, so does our risk for chronic conditions, including fatty liver disease.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I think if you're right now doing nothing, going for a walk for 10 minutes will be a huge step in the right direction. So I think getting out of this mind frame that, well, I don't have an hour to be able to do this. You know, just getting out of that, any kind of activity is going to be good. I also think looking at the actual data, getting a certain amount of steps in.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So I equate that to walking. If you don't have time to do a formal walk, then all of those cliche recommendations we've seen in the past do work. Parking further away from where you're going to. My kids didn't have sports one day, and so we needed to go to the mall, and I parked at the opposite end, and we have a huge mall.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And they're like, why aren't you parking at the – and I was like, no, because you guys need to walk today. So we're going to – if the mall is it, we're going to walk as far as we can to get to this store. So looking for those opportunities, I think HIIT training has a lot of data. related to fatty liver disease.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So what that could look like is I'm taking a walk and every 10 minutes, I'm going to spend 30 seconds in an all-out sprint, right? So doing something that gets, you know, obviously making sure everything is safe with your physician, but doing something that gets the heart rate up significantly. And then finally, You know, not just aerobic, but anaerobic.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
There is just as much benefit as we can see with resistance training. And you don't have to have a set of weights. You can use your own body weight. You know, anything that that makes your muscles get torn and then rebuilt is going to help to build that muscle mass. And that's going to help with longevity as well.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah. Well, you know, there's been a lot of studies looking at GLP-1s and fatty liver disease. And if you just go and visit clinicaltrials.gov and you put in semaglutide or liraglutide, and fatty liver disease, you will see that there are so many trials underway right now.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So we're going to see new data coming out and obviously data coming out about mental health, alcoholism, addiction, all of these things with GLP-1s that we are discovering. Yes, semaglutide has been used for decades with diabetics and it seems to be relatively safe. And the studies do tend to also show the safetiness in fatty liver disease patients as well.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I think they are potential game changers for sure. And I've seen it in my patients. Where the challenge lies is what is the off ramp? What is the exit strategy? And so very few people think about the exit strategy when they are going into it. And so that is really the key.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
When you get on these drugs, let's say you were a type two diabetic, you had fatty liver disease, you had all these risk factors. And you went on Ozempic. All of your numbers improved. Your weight is improved. Your inflammation levels are down. Amazing. Just absolutely amazing. But are you now on it for life? That's what we're still trying to figure out.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Or do you have the capacity to wean off, get off of it, and not have your numbers be impacted? So we had a huge study, I believe it was out of JAMA, about two or three years ago, once the popularity started increasing, looking at the fact that about a third of these patients do put back on a significant amount of weight, and more concerning, when the weight comes on, the numbers go up.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So all of these things that improved come back. So it's not to say that the drugs aren't effective. They are very effective. But the question is, are you on them for life? And what are the long-term consequences? And we just don't know the answer to that. So that's kind of number one. And the second thing is, if you're going to do these drugs, you have to do it alongside your practitioner, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And the challenge that I see, you know, I'm a mom of two boys, which means I have access to all these moms at the school who are getting their drugs, who don't have blood sugar problems. They're getting their drugs from med spas, things like that. So it's not meant to at all criticize these places.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But if you are getting your drug from this place, is it just, hey, here's your three month pay us and then like good luck to you? Or are you being followed? Are your dietary patterns being followed? Are you working with a personal trainer? Are you working with someone if you're having constipation? We talked about those risk factors with constipation.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So those are the things we don't have conversation about. So I don't think the drugs are bad. In fact, I've seen the opposite. They've been so highly effective. But I've seen people... improve so much that when we even start the conversation of, okay, let's start thinking about weaning down, they'll be like, I'm not getting off these drugs. Are you out of your mind? Like, I'm not.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
I'm going to stay on these for the rest of my life. If I get off these drugs, cravings come back. And unfortunately, they're right.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And I think some are able to do that. I've known many different kind of med spa, different services that have physician oversight that are wonderful. You have to meet with the physician every other week to talk about your dietary pattern and talk about things like constipation.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
But I think this is a term I used earlier in the podcast is, you know, you really want to get bang for your nutritional buck 80 to 90 percent of the time. But if you're on a GLP, it's got to be 100% of the time. You have no capacity. You have no extra room to say, like, I'm going to have this handful of gummy bears and I'm not going to gain a pound because I'm on a GLP.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
You have such a limited capacity to get enough calories in, which is ultimately what leads to weight loss. that you can't take anything outside of anything that's nutrient dense. You have to have nutrient density for your microbiome, for inflammation levels just in general, but to get that nutrient density, right? So that's the other thing that I see with patients is that they're on the drug.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So they're like, well, man, I still have my McDonald's every day, but I only have it once a day and that's my meal. And this is great, right? So it's kind of like, You have to get bang for your buck in every bite. Every bite has got to have meaning.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, it's absolutely true, Drew. I mean, we see this also with the data looking at dementia and Alzheimer's as well, looking at individuals that have the same aging cells as other individuals, yet from an epigenetic standpoint. So looking at gene expression and looking at all the associations with that lifestyle, you mentioned social activity, which is a huge component.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, I think, and I know we talked about this a million times, but I think just try and make an effort to eat more real food and to move more. Those two simple things can play a huge role, right?
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Maybe even a greater role, to your point about aging and not getting chronic diseases, maybe even a greater role than what we have previously been relying on, which could have been pharmaceutical drugs or... Pills, potions, any kind, right? Eat more food, walk more. That's a huge key.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, absolutely. So Instagram and Facebook, it's Fuel Well with Chrissy. So exactly as it sounds, K-R-I-S-S-Y. And if you feel well, you feel well. So that's the connection with that one. So we just need to fuel well and better in general. And hopefully our health span will be enhanced.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Thank you, Drew. Such a pleasure and an honor to be with you.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
They're not getting the diseases that we're seeing individuals get here in the United States or other areas of the globe. So you're absolutely right. Age alone is not the risk factor. We've seen people beat that based on lifestyle choice. But age definitely contributes to it if your lifestyle is one that doesn't speak to better health.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, so Drew, it's really interesting. This data is actually a little bit older. We don't have the updated data yet. Some assumptions now are that it could be as severe as even one in three. Could be greater than what we think. Definitely one in four. Fatty liver disease is simply having excess fat in the liver. So the liver is supposed to have some fat.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Once you get over about 10% of fat and fat starts to overtake healthy liver cells, now you have something called fatty liver disease. And that's basically the gist of what it is. But it is what comes because of it that really is the alarming factors, right? And this phrase that I used, once fat overtakes healthy liver tissue.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Yeah, absolutely. You know, one of the things that I tell my patients and the hepatologists that I've worked with, I hear them say this all the time. If your liver doesn't work, nothing else does, right? But yet we don't give it the attention it deserves. We just focus on the brain and the heart. And of course, they're important, right? But The liver is necessary to allow those organs to work.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
So number one, looking at the absorption of vitamins, there's so much discussion now on nutrient density as there should be getting more nutrient density in our diet. But if your liver is not working and you're getting nutrient density, you don't have necessarily all the mechanisms to be able to get the vitamins, the minerals, all of those components together.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
from good foods that you might be eating. Hormone production. So we know there's connections with looking at things like hypothyroid and things like that, that we know are directly impacting the liver. So when we think about hormones in general, the liver plays a role in our hormone function.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And so again, if we start having the liver break down, not have the healthy tissue it needs, then hormone function can be also a huge component as well. Obviously, bile production, we need bile production that works with the gallbladder to be able to break down things like fats, iron storage. So there's a condition called hemochromatosis, which is basically iron overload.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
It's relatively rare, but we have to make sure we have a good balance of iron within the body. And of course, iron gives us that energy, if you will, to our red blood cells. It oxygenates those red blood cells. So that's really important.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Protein synthesis, we already talked about glycogen and really kind of that stored form of glucose, being able to recognize, hey, we're a little bit too low here in our tank. We need to release some. And so the liver plays a role with that. Cholesterol synthesis. So the liver plays a huge role in cholesterol. In fact, such a big role that
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
When individuals are for the first time prescribed a statin, liver enzymes are typically one of the things that a physician will be monitoring to make sure that the statin is actually going through that detox phase, right? So the statin goes directly to the liver. The liver isn't working or there's some components of the statin that's not jiving with the body. The liver enzymes will indicate that.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
Absolutely. Absolutely. And we've seen studies, which we talk about in the book as well, that looking at heart attack, stroke, cardiovascular conditions is one of the main causes that we sometimes see of death with individuals that have liver disease.
Dhru Purohit Show
The Top Foods That Help and Harm The Liver with Kristin Kirkpatrick
And this, of course, speaks to many different factors, including inflammatory factors, but also looking at the mismanagement of overall lipids as well. So the liver definitely plays a role in that. And that kind of leads to one of the most important factors, which would be the detoxification qualities that the liver provides.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
Well, so number one, it is how the liver is impacting the rest of the organs, the ability for the body to be in a state of homeostasis. So being able to be in a place where the body is happy. The other thing we look at, though, is we really delved a lot into looking at things like waist circumference. And I know we'll get into that a little later.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
One of the things we refer to when we see someone who is carrying a lot of belly fat, a lot of fat in the midsection that is close to organs, we refer to it as kind of like this cytokine storm. So we know that when we have fat in the midsection, we're more likely to have insulin resistance. We're more likely to have that fat be what we would refer to as active.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
And that then increases inflammatory factors within the body. So if we look at a very high level and look at inflammation as the base of any disease, whether that's a mental illness or a physical disease, we know that it's someplace down the line the liver is playing a role. Now, we do have some instances where someone might develop fatty liver disease and does not have belly fats.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
It's more rare. A lot of times what we see there, which Dr. Hanane could talk more about, is more genetic abnormalities. But we do know that when the liver starts replacing fat with this healthy tissue, it no longer can take these processes that I detailed at the beginning of this.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
So being able to manage blood sugar, being able to manage our lipids, being able to convert the amino acids, and being able to make sure that we don't have too much ammonia in the system from protein sources, etc., Any place where that system goes wrong, we run the risk of having inflammation occur.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
So we're of course talking about systemic chronic inflammation that's unresolved that then can lead to chronic disease.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
Yeah, let me jump in. I would love to. And thank you for having us today, Drew. We're so honored and privileged to be on the show. You know, I think sometimes when I think about what my patients come to me with, it oftentimes is fatigue. And like I always say, who doesn't have fatigue? So fatigue can mask a lot of different other conditions.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
But a lot of times people will come to me and say, I'm just really feeling down. I'm really feeling not myself. And it's only after they go see their physician that they find out maybe their liver enzymes are elevated, things like that, that we might start to pinpoint it. And I think the reason for that, and Dr. Hananay can talk a lot better to this point, is that really the liver is so resilient.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
It speaks to its resilience. And it's not going to give you a lot of kind of the like hard signs in the first few stages. You can go a long time without feeling some of the more aggressive approaches to it. I'm feeling this and I must have fatty liver. So for me as a dietician, a lot of times my patients are coming in saying, I'm just tired. Maybe my skin's not great. I don't know what's going on.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
Maybe nothing. But what do you think? And then once we delve a little bit deeper, we can see that they're at risk for non-alcoholic fatty liver disease.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
Yeah, so the liver is involved in essentially every metabolic process that the body has. In our first book, Skinny Liver, we used a Rodney Dangerfield quote in the very beginning of it, and we said that the liver kind of is always screaming out, I'm not getting any respect. All the respects go into the heart, into the brain, and rightfully so, they're important organs as well.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
But the liver really takes care of every single process that we see from a macronutrient standpoint. So for example, when we look at sugar and we look at our consumption of carbohydrates and what happens to insulin, to glucose, to the stored form of glycogen, the liver plays a role in making sure that our blood sugar is constantly at a balanced level. And it adjusts it as necessary.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
And oftentimes we don't think about the liver being part of that, right? We think about the pancreas and we just think about insulin. But the reactions that occur with blood sugar management are all tied back to the liver. When the liver feels that there is too much sugar or they can't use the sugar, then the liver is going to store some of that sugar as fat.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
So it also has a role in lipid metabolism, in cholesterol. So when we're eating fat, it has a role in how the breakdown of fatty acids are as well. And then from a protein perspective, the liver is involved in making sure that amino acids can be converted into energy.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
So as a dietician, the kind of 101 of what I learned over 20 years ago, the basics are that our macronutrients, our carbohydrates, our protein, our fats, all of that somehow has to get converted into energy. And that's what we use as fuel. The liver plays a role in that conversion factor in every single one of these things.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
And this is why it's so linked to things like heart disease, like type two diabetes, et cetera. But really from a metabolic process, this is why we refer to it as kind of like the main thing that makes everything go, that makes everything communicate to one another. All of those organs are important, the heart, the brain, but the liver is what is making everything actually function.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
Yeah, so I would say looking at our metabolism in terms of how our blood sugar is managed, let's start with that. So insulin resistance, anything where we are overloaded as we typically are in the American diet with sugar, with refined carbohydrates, this is what is really leading to the storage of fat within the liver that then replaces healthy liver tissue.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
So yeah, fat is definitely, and fat has a role in it, but not as great of a role as sugar does. So I look at this as when we look at sugar and we look at the comparison to fat, really it's similar to what we saw in heart disease. Whereas years ago, we would think that saturated fat was the main culprit for heart disease. And if you just cut saturated fat, you're gonna be fine.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
You're not gonna get heart disease. Then we realized, based on research that came afterwards and even an alteration of our dietary guidelines, that it was sugar and it was an influx of too much sugar that then gets stored. So sugar is really the main culprit.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
This is why we took such a hard stance on looking at the carbohydrate content in some of our dietary patterns, which we can talk about later. But that's really what we're looking at. And I want to add one other point. Non-alcoholic fatty liver disease also has nothing to do with alcohol. And I think that's the other thing that we typically see.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
Someone will come in and say, well, I don't drink anything. I don't understand how I got this, right? But they might have some other risk factors. They might have an increased waist size. They might have insulin resistance, prediabetes. All of those things put them at risk.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
I would love to add that. So when we wrote the book, right? When you write this book, you have all the research in the world and then sometimes research comes out after that.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
So one of the things that came out after that was really interesting was all of the liver associated organizations actually changed the name from non-alcoholic fatty liver disease to metabolic associated dysfunction fatty liver disease.
Dhru Purohit Show
The Biggest Warning Signs That You Have Fatty Liver and What To Do About It
So it really saw the importance of the metabolic dysfunction end of it and taking away some of the confusion that a consumer might have or some of our patients might have that this is just related to fat or it's just related to alcohol. The metabolic dysfunction was now put in as one of the titles for how we look at this disease, which actually increases the accuracy of how we all look at this.