Liver Disease and Advances in Screening Technology

The fatty liver disease is a very common liver disease in the US. Something as simple as a five-minute scan could change your life when it comes to your liver.  Nurse practitioner and Liver Specialist Ann Moore, and Wayne Eskridge, CEO of the Fatty Liver Foundation, explains more about the topic on this segment.

Ann Moore, FNP-C, is a board-certified nurse practitioner with over 30 years of liver disease management experience. She currently works at the Institute for Liver Health, a private practice liver disease facility in the metropolitan Phoenix area which provides specialized diagnostics, evaluation, treatment, and access to clinical trials for patients with fatty liver and other liver diseases.

Wayne Eskridge is the Fatty Liver Foundation President and CEO. In 2015, Wayne was diagnosed with stage 4 NASH with cirrhosis. His desire to help others avoid his experiences led him to the decision to become a patient champion and to create the Fatty Liver Foundation.

– TRANSCRIPT OF INTERVIEW –

Neal Howard: Hello and welcome to the program. I’m your host Neal Howard. Thank you so much for joining us today. Liver disease is a very serious problem here in the United States and the cause may surprise you. Something that is as simple as a five-minute scan could change your life when it comes to your liver, whether it’s fatty or alcohol-related. Here to explain our nurse practitioner and liver specialist Ann Moore along with Wayne Eskridge, CEO of the Fatty Liver Foundation. He knows firsthand what it’s like to have fatty liver disease. Welcome to the program of both Wayne and Ann, how are you?

Wayne Eskridge: Very good, I’m great.

Ann Moore: I’m great, excellent to be here.

N: Well Ann as a nurse practitioner, what is it that you can tell us about liver disease and why it’s such a growing problem here in the United States?

A: Well, I’d like to start off with just a little message about the liver. Most people don’t spend much time thinking about their livers, but the liver is vital to health and life. Your liver performs 500 functions a day, including detoxifying the blood, storing vitamins and minerals and really it’s the energy warehouse transforming nutrients into energy and it’s a workhorse, no doubt. Liver disease is a growing problem in the U.S. in large part due to fatty liver. Fatty liver disease has become the most prevalent liver disease in the U.S. It impacts an estimated 100 million Americans which is a huge number of people in the United States who have fatty liver disease. It can impact people of any age, including kids. And one component of fatty liver, which is particularly problematic, is called “NASH” or Non-Alcoholic Steatohepatitis. That’s the more progressive form of fatty liver disease and that’s our concern today.

N: Who is at risk for NASH?

A: So it’s interesting. NASH is mostly a lifestyle-related disease. So people who have certain health conditions, which are very common in the United States, have a greater risk for developing NASH. Those conditions include type 2 diabetes, obesity, insulin resistance, high cholesterol, high blood pressure. So very common health concerns that many Americans have put you at risk for NASH. And NASH is simply “steato”, which is fat and hepatitis, which is generalized inflammation in the liver. This occurs when excess fat in the liver creates inflammation of the liver cells and the cells are damaged. Damage over time causes liver scarring and you can end up with a completely scarred liver from fatty liver disease or cirrhosis. So I like to call NASH the “Silent Epidemic” because most often, people have no symptoms associated with their fatty liver disease. It can progress for years even decades before someone gets a diagnosis, which usually occurs in late stage liver disease. By the time someone has a liver-related symptom, usually the liver disease is very advanced. Once you have cirrhosis, you’re at risk for the development of liver cancer, liver failure, the need for a liver transplant even diet forbid liver-related deaths. We expect by 2020, NASH is going to be the leading cause of liver transplant in the United States. So fatty liver disease is a serious healthcare concern in the U.S. today, there’s no doubt.

N: You said that many people go without symptoms for years as this progresses. What are the symptoms that would prompt someone to say, “Hey, I’ve got a problem other than what I maybe thought it was.”

A: So oftentimes, this NASH is diagnosed incidentally. Meaning, people go in for routine, liver blood tests and their liver numbers may be slightly elevated or perhaps their healthcare provider knows about the risk of type 2 diabetes and obesity and they have an imaging test which is suggestive of fatty liver infiltration. So oftentimes, no symptoms are associated and Wayne can tell you more about that.

W: I’m a typical case you know, the statistic if you have two friends, one of you has a fatty liver. I was a typical American mate and the usual diet gained a pound or two, a year ended up around 70 with kind of a chubby sort of a physique. But I felt I was healthy. I felt good, I didn’t believe I had any problems. But mine was discovered by accident and I basically went into the doctor one day as a healthy guy and came out with a cirrhosis diagnosis and absolutely scared the heck out of me. So I walked out thinking that I have a terminal illness, so I spent the next couple of years learning everything I could and figuring out what to do and made connections with some good doctors that helped me. And I’ve been able to stop the progression of my disease and actually reverse it through lifestyle changes and exercise. So I decided as a result of our success, which was, speaking my wife here ,but because most people fail at that. We view lifestyle as a diet but we can’t do that. So we formed the Fatty Liver Foundation to disseminate information to the patient population that’s science-based and then a lay language so that more people can stop the progression of the disease once they do find out about it and advice is getting tested early is the real key. I could have benefited greatly by knowing about this disease at an earlier stage.

N: And there’s a very simple test that can be used now to determine whether a person is being affected by fatty liver disease. Talk about this new fast screening technology.

A: Sure. It’s a great new tool that we use to diagnose fatty liver disease and assist with the diagnosis of NASH. Prior to this, we only had liver biopsy to diagnose NASH, which is invasive. It involves a needle and most people are not game for that and I don’t blame them. So now, we have this non-invasive tool, it’s called “Transient Elastography.” It’s similar to an ultrasound. It’s quick and painless, it can be done in about 15 minutes in an outpatient clinic or outpatient radiology department. It gives this critical information regarding fatty liver, including how much fat and how much scarring. So once we have the diagnosis, we can put people on the pathway towards a healthier liver. Wayne was diagnosed with cirrhosis but I want you to know that the livers are very forgiving organ. And once we have the diagnosis, the person can make changes to decrease the inflammation in the liver. The liver will actually regenerate new and healthy cells so you can reverse the fat and the scarring in your liver with just some simple lifestyle modification.

N: Where can we go online and learn some more about the screening?

A: Currently, there’s no FDA approved medications for NASH. But if you want to know more about the screening technology, I think Wayne’s website is a great location for good information, the way we’re getting informed.

W: We’re at fattyliverfoundation.org.

N: fattyliverfoundation.org. And what specifically would you Wayne, as a person who’s dealt with it and has been managing it, what would you like to tell folks above and beyond what we’ve learned today about NASH?

W: The priority of diet, I mean you have to not think about diet but you actually have to change the lifestyle. And one of the things you have to do is give up sugar. Sugar is the real enemy for the liver, but saturated fats, they need to go as well and low-salt diet. If you put those things together with exercise, you’re going to be able to help your liver a lot and that means basically you go to a Mediterranean style diet with lots of fruits and vegetables, limited red meats and other saturated fats. Concentrate on unsaturated fats and eliminate sugar to the extent that you can. And that means that anything that’s manufactured you can’t eat because it’s all got sugar in it.

N: Every bit of it.

A: So it’s easy for us to recommend this lifestyle changes and it’s very hard to do. But just so you know, even small changes can improve liver house. So a 3% weight loss can start removing the fat from your liver, a 10% weight loss can actually reverse fibrosis. So we’re not asking everyone to get back to their high school weight. So it’s just tiny step by step changes that can make a real difference in improving liver health.

A: It’s really consistency. If you can’t come and go with it, you have to adopt it and stick with it as a lifestyle.

N: As a lifestyle, not even a habit. A total change in lifestyle. Well, I appreciate both of you coming in today and talking with us Ann Moore and Mr. Eskridge. Thank you Wayne Eskridge, thank you both for coming in today and I’m hoping to talk with you again in the future.

W: Happy to be here.

A: Thanks for the opportunity.

N: You’ve been listening to Health Professional Radio. Transcripts and audio of this program are available at hpr.fm and healthprofessionalradio.com.au.

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