Mocktail Minutes

MASLD - WTF is it???

• Mocktail Minutes • Episode 143

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This week we are talking metabolic dysfunction-associated steatotic liver disease aka MASLD - or previously known as non alcoholic fatty liver disease. 

If you have questions, or topics that you want to hear about, head over to our Instagrams https://www.instagram.com/bayleethedietitian/ or https://www.instagram.com/brianna.dietitian/ and send us a DM! You can also follow the podcast https://www.instagram.com/mocktailminutes/


Featured Mocktails: 

The roasted purpose

Bloom 

Click play, sip back, and be empowered.

Baylee:

Hello everyone. Welcome back to this week's episode of Mocktail Minutes. This is Bailey.

Brianna:

And this is Brianna?

Baylee:

This week I am drinking a hot chocolate because it's like negative four degrees, but basically all I do is almond milk, heat it up, and then I broth in some chocolate collagen. I use the roasted purpose collagen right now.

Brianna:

Mm-hmm.

Baylee:

Not bad. Very

Brianna:

Nice.

Baylee:

extra protein for the day.

Brianna:

I like it. Yeah. It's. It was iced over and then Texas became Texas again and we're like 40 degrees. So we survived the winter storm. I'm doing, I'm doing another Bloom energy drink. I'm doing the peach mango. It's good. I just always forget that they have like 180 milligrams of caffeine in it. So again, I did not plan accordingly, so I won't be drinking the whole thing, but I like it.

Baylee:

Yeah, I had a coffee this morning and then I was gonna drink one of the just ingredients, new energy lemonades. I was like, probably not a good idea to drink two caffeine drinks back to

Brianna:

don't eat that. Yeah, that's, yeah.

Baylee:

probably

Brianna:

But these ones are like, I wonder if the just ingredients ones have like L eating in them.

Baylee:

do?

Brianna:

They probably do. Yeah. I feel like you're, you get less of that jittery feeling when they have those, but you still obviously. don't need like 300 milligrams of caffeine a day. That's We can relax.

Baylee:

ideal. Well, this week we are talking about, so it used to be called. Non-alcoholic fatty liver disease and now we have, it's called, so is N-A-F-L-D, now it's called metabolic dysfunction associated, is it stoic liver disease?

Brianna:

Yes.

Baylee:

M-A-S-L-D.

Brianna:

yes. Metabolic dysfunction, associated stato, liver D disease, stato, stato, That's what it means.

Baylee:

M-A-S-L-D.

Brianna:

Which we also call mash.

Baylee:

Yes. There's so many acronyms in the medical world and this is why a lot of them, like I know the acronyms, I know what they mean. Sometimes they just dunno how to say the words.

Brianna:

Or like you just get so used to the acronyms that like no one's ever using the words, you're just like, Hmm. Yeah. Yeah.

Baylee:

but there are. Different ways that you can kind of like damage your liver. So I think, and I feel like N-A-F-L-D has definitely became more well known where previously everyone thought about like liver issues associated like with being an alcoholic and so that's a LD alcohol associated liver disease. previously, like that's what we thought like. Livers got damaged. You're drinking too much because drinking excess amounts of alcohol over a long period of time, combined with some other risk factors can cause that buildup of fat in your liver. But fatty tissue can also build up in your liver even if you drink little or no alcohol. This is where M-A-S-L-D comes into play.

Brianna:

Yeah, so it was like non-alcoholic fatty liver disease, and now it is the metabolic dysfunction associated stoic liver disease because we're realizing that it is like more of a metabolic issue, and so. I think that's why they felt like the big push to like change it because it is a huge driving factor. Yeah. Let it make more sense because it really is, you know, contributing to like insulin resistance, visceral fat, dyslipidemia, and cardio cardiometabolic health. So when you kind of call it something like that, I think it helps you kind of get a bigger picture as opposed to just like, oh yeah, like I have fatty liver. Like

Baylee:

Mm-hmm.

Brianna:

what does that mean, you know? Yeah.

Baylee:

There's also talks of PCOS getting a name change too,

Brianna:

Hmm.

Baylee:

explain it better.'cause not everyone has this on their ovaries. PCOS.

Brianna:

Yeah, there's like four different types of PCOS. I think that's gonna be helpful because from, I'm not A-P-C-O-S expert from like the people that I follow that talk about it. There's like different things you do depending on which one you have. And so I think maybe not treating it all as like one thing is gonna be helpful'cause. PCOS is hard to manage.'cause I think simply because people don't know exactly like what's happening. Side note. Yeah. So that's cool. Yeah.

Baylee:

yeah, so basically M-A-S-L-D, it's bad accumulation in the liver and. People who have metabolic dysfunction, even if they don't drink much or any alcohol. So your liver is supposed to regulate your blood sugar package and export fats, detoxify your hormones and byproducts, and also store glycogen, which is that like backup energy. when you have or develop M-A-S-L-D, the liver becomes overloaded with fat. become insulin resistance and. It's definitely gonna lead to inflammation. And so it's kind of like a whole body problem. It's not just like, oh, liver's outta whack. No, it definitely the entire body.

Brianna:

Yeah, and you can kind of think of it as like. Metabolic traffic congestion, so you develop insulin resistance, muscle and fat cells stop responding well to insulin, so blood sugar and insulin rise over time. Fat gets redirected to the liver, so excess carbs and fat. Convert into triglycerides, especially because, and everyone's a tiny bit different, but it's like thought to be like, you can only store about 400 grams or whatever of glycogen a day in the body. So if you're eating in excess or you're not utilizing, you know, glucose, well, it's gonna be, and you're sedentary and all that, it's gonna be driven to. The liver, which is gonna convert it into triglycerides. So then it re, it stores more fat faster than it can get rid of it. So it has that buildup around your liver and then mitochondrial stress and oxidative stress. So fat metabolism creates oxidative stress. So you have an increased oxidative stress, antioxidant, defendant defenses get overwhelmed and then that inflammation. So that's when it can, you know, turn into like that mash. And then I would think that the last thing is like fibrosis or scarring of the liver can develop over the years. And once your liver gets to a certain extent of scarring, it's non reversible. So like up to a certain extent you can reverse it. Your liver, like regenerates, it's really cool. But once it gets to a certain point it doesn't. But typically people are finding out that they have this issue once they start to see fibro like fibroids and they have like that fibrosis scarring. At that point you've done irreversible damage, so this is why it's important to like get ahead of it and know like what are the other like metabolic markers showing that like this is something that could be progressing.

Baylee:

Because the thing with it too is like you might not necessarily like feel symptoms

Brianna:

Mm-hmm.

Baylee:

on. So like, like pain in your upper right abdomen, that's where your liver is. It could be fatigue or just general weakness. Or maybe even some like fluid or swelling, the stomach and legs. But that's usually kind of like later stages. So this is where just kind of like staying on top of your health and seeing what's going on under the hood is helpful to kind of help catch it earlier, you want to look at your labs is gonna be the biggest thing I would see. And just like are your labs trending? So your liver enzymes, A-L-T-A-S-T, those are often checked and. Your triglycerides, so kind of red flags would be triglycerides over a hundred HDL, less than 50 for women, or less than 40 For men, fasting insulin above 10 A1C, 5.4 to 5.6 can actually be like an early red flag. It's still normal, but it's not optimal. And also like if your waist circumference is increasing,'cause again, it's not just that single number we wanna look at. We wanna look at what's been happening over past few years. Ferritin is also another marker. So ferritin is checked for iron, but in M-A-S-L-D it acts like an inflammation marker. If ferritin is elevated but you're not anemic, especially with pair with like high triglycerides or insulin, this can show up before a LT does. If you have risk factors present, imaging could be maybe requested by your doctor, and so that's when like maybe they would do an ultrasound or what's called like a fibro scan or there's another one MRI. PDFF, which is actually the gold standard for liver fat. your provider would order one of those, especially if you are two diabetic. You have PCOS, you have metabolic syndrome, you have persistent high triglycerides. You have a family history of fatty liver. They might push for it more than too.

Brianna:

Yeah, and this is imaging is the one that if you are like under a certain age, they might be like, eh, you don't need it. Like you kinda. Unless your provider's really on top of it, you might have to be a little bit more persistent of like, Hmm, no, I kind of want that. There's another, I was actually listening to a podcast the other day. There's another one called GGT, so it's a gamma glutamyl transferase test and basically it is testing for like, it's kind of testing like how your bile. Is doing. Apparently that's one of the really early signs that you could be having, like liver disease. It'll be high, but I guess it's just not a standard yet to like really test for it. But I, it's done a lot in the functional world and apparently I need to like double check on this, but it's like$3 or something, like to run. So it's like, it's kind of like how, like fasting insulin isn't really a. Standard thing to do yet, but it's like not expensive and it's kind of like an early detection. So I think like as it progresses again, you'll probably start to see something like that. But this is why they changed it to like the metabolic associated is because all of these biomarkers will be like out of range or start to like be trending out of range. So the thing with this is like. Typically in the past, especially when it was called like non-alcoholic fatty liver disease or the one that we know of can, you know, associated with alcohol is like someone needs to be like really overweight. Like they're really overweight or they're, you know, drink a lot of alcohol, but you don't need to be like in a larger body to have it. And there's actually a lot of people that are within a healthy BMI that do have it because remember you can be a healthy BMI and have not great visceral fat, so. Something just to pay attention to. But risk factors would include insulin resistance or pre-diabetes for sure. Type two diabetes. I think it's something like 70% of people with type two diabetes get liver disease that's crazy high.

Baylee:

a lot.

Brianna:

Yeah. If you're someone that has like high triglycerides, so like maybe you're just someone who's like, oh yeah, every time I get like blood work, they're just like kind of high, you're at risk having low HDL or that that. Cholesterol that we really wanna see a little bit higher. It's like our healthy cholesterol, the one that helps to like excrete or helps you tra the transport of excess cholesterol. PCOS, sleep apnea. Sleep apnea is a big one. Chronic stress and poor sleep again. Sleep apnea and then the rapid weight cycle so that yo-yo dieting. So this is where it would be like, oh, I lost 30 pounds and then I gained 40 pounds and I lost, you know, 20 pounds and then I gained 40 pounds. So a lot of those like crash dieting to where like you lose a lot at once and then you gain all back because when you've crash dieted and you've lost a lot of weight very quickly, we know it's muscle. So what you are gaining back is fat. And when you're just gaining rapid fat, that's not For your body.

Baylee:

Bodies don't love that.

Brianna:

Yeah.

Baylee:

And the good thing about this is that it can be reversible, especially the earlier you catch it It's one of M-A-S-L-D is one of the most, I improvable metabolic conditions that we actually see when you know, like what to focus on. So definitely don't want to do any extreme restrictions, like do the crash weight loss, that yo-yo dieting, you don't want any detoxes. What you do wanna do is, number one, fix insulin resistance so you can improve liver fat before like the scale changes. So thinking about your protein, your carb structure, your meal structure, how are your carbs distributed? Even a five to 7% body weight reduction can cut fat dramatically. But even like body recomposition helps too. where strength training comes in. This should always be a non-negotiable. We've definitely gotten to where we make it a negotiable part of life, but muscle clears glucose, it lowers your insulin demand, it reduces fat delivery to the liver, it's going to improve liver fat independence of weight loss too. You wanna choose fats that help deliver export fat. So like. Extra virgin olive oil, fatty fish, avocado, nut, and seeds. you wanna limit more of your processed oils, your fried foods, your high fructose sweeteners. Even modern amount of alcohol intake is gonna slow that recovery during these phases too. So, reduce, flush, avoid if you're feeling crazy. I mean, that's a whole nother conversation, but choosing some. Supportive. Thats So your liver needs specific nutrients to help move fat out. Choline, omega threes, magnesium, vitamin D, are all kind of key players there. And then Brianna mentioned like the sleep. So sleep loss worsens liver fat within days, minimum of seven hours of like good quality sleep. Your liver actually kind of follows your body clock. Aggressive fat loss. Approaches. So rapid fat release is going to overwhelm your liver. A LT and a ST may spike before improving. So we went slow and steady, which is safer and more sustainable. And I guess that would, that would be the main thing. So yeah, move. Let your bouncing meals sleep, support your liver. Remove lots of high sugar, refine. I would say remove refined sugars, reduce your alcohol as much as possible.

Brianna:

Yeah, nothing extreme. And there's like the, there's like a really old school way that we used to, go about like giving you nutrition therapy for like liver disease and it was like low fat, like, but we now know that like your liver struggles more with like fructose and refined carbs. So those, again, highly processed foods. So I would worry less about fat unless it's like Bailey said, like ultra processed foods, fried foods, you know, like the more unhealthy fats. But I would also be really mindful of like my carbon intake, specifically my refined carbs and fructose, not from fruit, but fructose as in like high fructose corn syrup because fructose, you, your liver metabolizes it. It's a little bit different than glucose. And so, you know, things like this is one reason why soda is not great is it just burdens the liver. Like having that much fructose at one time, your liver can't use it like it needs to. And that accumulates fat, especially if you're. Sitting at your desk or whatever. The other thing that I do like to point out, and this is, I would say it's debatable, but I don't know why it's debatable because we do have research on it, but a lot of the artificial sweeteners can increase those liver enzymes, so like the A-L-T-A-S-T. So if you're someone who's like, oh, okay, I'll just go from. Like, you know, instead of my regular Starbucks to the sugar free or from soda to like, I'll just drink the same amount. Like diet. You do wanna be mindful of it because that can still hurt your liver. So if you're someone who's like in the early stages, you know, you need to reverse it. This is where I would get like really particular about the stuff that you're eating.'cause that's gonna have such a big impact and you can reverse it and then maybe later you add certain things back in. But just making those swaps simply may not be. Enough

Baylee:

yeah, you can improve it. Actually, I don't wanna say like quickly, but like you can definitely see changes. Liver fat can actually decrease within two to four weeks. Your liver enzymes can improve within 12 weeks. sensitivity is also going to improve before. Even your scale weight changes now, like fibrosis takes a little bit longer, but early changes are going to be more, quote unquote, easily reversible. Your liver is actually very resistant. I mean, think about it. You can take parts of your liver out

Brianna:

Yeah.

Baylee:

help someone else survive. You're like regenerate.

Brianna:

This is one reason why, you know. You see a lot of people who could be alcoholics for years and not die right away because your liver really is like super resilient and will try to regenerate. So just remember, you know, all the stuff going around. That's like if you have kidneys in a liver, like your body's detoxing. But our liver is responsible for detoxing literally everything. And if you are putting a lot of like, you know. Refined carbs in it, a lot of sugar, a lot of alcohol, and then a lot of other toxins, right? Like stuff you put on your skin, stuff like that. Your liver could be bogged down. So even though our body does this great thing, like detoxing, it might be struggling. So it's worth kind of looking into to help, like don't just be like, well, I have a liver, so I'm good. I mean, everybody with, you know, liver disease has a liver.

Baylee:

Which we've actually said.

Brianna:

Mm-hmm.

Baylee:

But that's coming, I guess from more of like you're in good health standpoint,

Brianna:

Yes,

Baylee:

point to bring up. Where like, yeah, if you have liver and kidneys, they should be detoxing, but it's like what's the toxic load going on

Brianna:

yes.

Baylee:

So you may need more liver support.

Brianna:

The majority of people that I see worried about detoxes are people who are healthy.

Baylee:

Yeah.

Brianna:

I think that's why we've said that because there's so many people that like wanna get into the weeds about things and like, what detox do I need? I'm like, well, I don't ever really need one.'cause you're extremely health conscious where if you're someone that's. Eating a lot of fast food, very sedentary. You drink a lot of alcohol, maybe you take a lot of prescriptions. That's the other thing, you know, you start to get, you know, metabolic disease, you're probably on a couple of medications for things. All of that adds a load. So that's where we're like, okay, let's help your detox pathways. Yeah.

Baylee:

Yep. So yeah, if. Doctor practitioner has brought up N-A-F-L-D or M-A-S-L-D. Like you said, this can be reversible. You want to make these lifestyle changes to help preserve your liver health for a long time. Not only if you've been diagnosed, but also just in general. These are all great things to do to keep your liver healthy or reverse any liver damage you may have. Even if you don't feel symptoms, that doesn't mean you're. Liver scarring isn't occurring. take care of your body, take care of

Brianna:

Yeah.

Baylee:

Something that is crazy because you know, like, I mean everyone knows about like the yellowing of the skin when your liver, so I had never seen it until I was working in the hospital. It is crazy'cause I kind of thought about it more as like almost like a jaundice baby. Where they kind of, it almost like, I think a jaundice baby sometimes they just look more tan unless you like do like the finger test where you like press their chest. I saw a yellow person, like their whites of their eyes were yellow

Brianna:

Yeah.

Baylee:

like clearly yellow. It was interesting.

Brianna:

It's,

Baylee:

a little

Brianna:

yeah.

Baylee:

than like how I've seen it with babies.

Brianna:

Yeah. Because that's how it's like compared is like, oh, they're jaundice skin. I'm like, I don't look really? You're yellow.

Baylee:

it one time.

Brianna:

You're absolutely yellow.

Baylee:

are glowing.

Brianna:

Yeah. That doesn't look like it's supposed to look like that. And obviously when you're at that point. There is some irreversible damage, so definitely if you're yellow.

Baylee:

Yes.

Brianna:

No, but this is why it is important to do like, just monitor your, you know, those biomarkers and get your labs done. I would say a minimum every six months. And we, this is nice'cause we work for a company where we can order labs. So even if your insurance is like, oh, we're maxed out, we can't cover it. We can order like these basic labs for you that are covered. So definitely if you've ever had anything out of range or it's been a while since you've had blood work done, get it done or get. Get with someone that can get it done, help you interpret it, and then help you make those lifestyle changes. Because I feel like the, the majority of stuff that we talk about, like diet and lifestyle changes make a huge impact, especially the earlier you know about it.

Baylee:

Hundred percent.

Brianna:

Yeah,

Baylee:

you listen carefully to all of our episodes, a lot of our recommendations are similar.

Brianna:

so true. Right? My mom.

Baylee:

blood sugar, balancing meals,

Brianna:

Sleep monitor alcohol, like move your body. Yes.

Baylee:

This is

Brianna:

Yeah.

Baylee:

powering your body, so it makes sense.

Brianna:

Mm-hmm.

Baylee:

many different things. It's not just like, oh, alcohol only affects your liver.

Brianna:

Yeah. A lot of things, yeah. Affects your liver. So there's our soapbox. Do all the things we say to do every week.

Baylee:

Yeah, and you'll be a superhuman.

Brianna:

Yeah, legitimately.

Baylee:

All right everyone. Well, we will be back next week with a brand new episode. Thank you for listening, and we'll talk to.

Contributor

Baylee

Host
Contributor

Brianna

Host