Ep 99: Fatty Liver Disease and Type 2 Diabetes
Fatty liver disease can be present in up to 70% of people with type 2 diabetes–and most don't know they have it. Drs. Edelman and Pettus sit down with a hepatologist and a patient whose journey may change how you think about liver health.
Most of what shapes your long-term health doesn’t announce itself. The conditions that quietly affect millions of people with diabetes like high blood pressure, kidney disease and fatty liver tend to develop for years before producing a single symptom. That’s exactly why being proactive about your health matters so much. Liver disease is one of those quiet conditions: deeply tied to weight, blood sugar, and metabolic health, are far more common than most people realize. Understanding the basics like what fatty liver is, how it can progress to Metabolic Dysfunction-Associated Steatohepatitis (MASH), and what tools now exist to catch it early. Why not get a head start that patients who end up with cirrhosis and or need a liver transplant often wish they had.
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MASH STATISTICS
What the Research Tells Us About MASH
- MASH is metabolic. It develops when fat builds up in the liver and triggers inflammation and scarring, most often linked to obesity, type 2 diabetes, and metabolic syndrome.
- It’s largely silent. Early-stage fatty liver and MASH typically produce no symptoms. By the time fatigue and other symptoms appears, the disease may already be advanced.
- The liver can regenerate. Studies continue to show that the liver has a remarkable ability to heal when the underlying drivers like weight, blood sugar, inflammation are addressed.
- Simple tests can flag it. A standard blood panel combined with a calculation called FIB-4 (using age, AST, ALT, and platelet count) may help estimate fibrosis risk before more invasive tests are needed.
- Treatment options are expanding. Lifestyle changes, GLP-1 medications, and a newer class of liver-directed therapies are reshaping what’s possible including, in some cases, reversing fibrosis stages.
- It rarely travels alone. Liver, heart, and kidney disease are increasingly understood as a connected condition (cardio-renal-hepatic-metabolic syndrome) meaning what helps improve one may help the others.
I knew about a fatty liver about 5 years ago during a CT scan for another problem. The tech doing the CT scan told me. I did question my primary but we did nothing about it until my new doctor listened and he did an ultrasound. I am in late stage three and a type 2 diabetic for about 50 years. The diabetes is controlled to a point and am on ozempic. We are trying to work out what happens next. My high blood pressure is very well controlled runs about 120/66. I just found out the stage within the past week. I have an appt with my primary next week to go over what comes next.
Good luck to you, and glad you are working with your doctor to determine the next steps and best treatment options.
It is amazing
.I was just saying today that Dr’s have you take test after test…get the results but rarely give you a remedy until it reaches a dangerous point or they push pills to see what will work..nothing in the medical field today is anywhere it eas years ago..
I had a fatty liver with diabetes years ago..nothing was done until it reached cirrhosis of the liver..end stage..and now it’s too late…we all have to be our own advocates..Medicine today has become just a business
Doctors are considered drug dealers to me
I’m a 68 year old woman with recently diagnosed type 2 Diabetes, my kidneys have “innumerable” cysts but have not been officially diagnosed yet. My primary doctor thinks I probably have fatty liver disease but she hasn’t suggested that I have any kind of testing for it. I have high blood pressure that is being treated usual reading is 122/86. I have a large hiatal hernia that has caused my stomach to go up in my chest, behind my heart for the second time. I had surgery 13 years ago to repair the hernia, return stomach to its place and a gastric sleeve. Will a gastric bypass fix some of the other issues?
This is a tough situation and a super complicated question. It would really be best for you to speak directly with a GI surgeon, as this is not my specialty.
I learned this from Dr William Davis about denuovolipogenesis and insulin resistance. I have fatty liver disease and trying to reverse or not make it worse. I am following Dr Davis protocol. He states that all wheats and grains have to be eliminated. I also introduced L Reuteri and L Gasseri fermentated yogurt to my diet. To eliminate endotoxemia. My diet is mostly protein, vegetables, salad. I am experiencing insulin resistance. Exercise is a key also which is hard.
I’m not knowledgeable about that therapy, but semaglutide and Rezdiffra have been proven to reduce fatty liver, and I would not negate those two options.
I am taking resdiffra and the diarrhea is killing me
You might ask your doctor what you can do about the diarrhea because there are dugs that treat it. Reducing the progression of fibrosis is so much more important, so hang in there.
O have fatty liver. What do I do to change iy
There are a few different types of treatment therapies, so it’s really best if you speak with your healthcare provider to determine the best treatment for you.
How can someone that’s prediabetic
have liver problems?
Anyone with risk factors for liver disease can develop it whether they have diabetes or not. Risk factors include insulin resistance, obesity, high cholesterol, high blood pressure, metabolic dysfunction, and excess use of alcohol.
I was diagnosed with S1 F2 on the lower end of both of those. I have the genetic markers from hemochromatosis but so far my iron is very stable. In fact I’m on the lower end but I am a blood donor about three times a year. My primary doctor just told me today that she didn’t think my liver was going to improve. I am pre diabetic but have had a lot of cortisone over the past few years from an injury and then cornea transplant. My BMI is 27 so I could lose some weight but 8m not obese. I’m devastated by what I was told today. She wants to put me on mounjaro and give me a diabetes diagnoses since my last test put me 8n to that category. However, I do think it’s standard to have two test before making that diagnosis. I did say to her, if my liver can’t be reversed then eventually I will need a transplant and I don’t want more diagnoses on my list than I actually have and she said I was catastrophizing. I’m not a hypochondriac but may consider a new doctor now. What would be my best option at this point? I have the genetic markers for HH but I may never develop that. It’s only heritage at this point. We don’t actually know what the issue is and it’s only been recently that my a1c has risen. The liver thing has been going on for a while with wait and monitor. It’s all very frustrating.