WEBVTT

NOTE duration: "00:04:47.232"


NOTE Confidence: 0.96320856

00:00:04.480 --> 00:00:05.440
So there are three main

NOTE Confidence: 0.96320856

00:00:05.440 --> 00:00:07.040
functions of the liver. The

NOTE Confidence: 0.96320856

00:00:07.040 --> 00:00:08.465
liver functions as kind of

NOTE Confidence: 0.96320856

00:00:08.465 --> 00:00:10.244
a big filter. It detoxifies

NOTE Confidence: 0.97641325

00:00:10.545 --> 00:00:11.744
anything that we eat that's

NOTE Confidence: 0.97641325

00:00:11.744 --> 00:00:12.945
bad, and it helps kind

NOTE Confidence: 0.97641325

00:00:12.945 --> 00:00:14.565
of to store and process

NOTE Confidence: 0.97641325

00:00:14.705 --> 00:00:15.684
a bunch of nutrients.

NOTE Confidence: 0.99639136

00:00:16.250 --> 00:00:17.450
In another sense, it also

NOTE Confidence: 0.99639136

00:00:17.450 --> 00:00:18.329
functions a bit like a

NOTE Confidence: 0.99639136

00:00:18.329 --> 00:00:18.829
warehouse.

NOTE Confidence: 0.9941893

00:00:19.450 --> 00:00:20.650
We tend to get nutrients

NOTE Confidence: 0.9941893

00:00:20.650 --> 00:00:21.390
in phases.

NOTE Confidence: 0.90656537

00:00:21.690 --> 00:00:22.970
During a phase of high

NOTE Confidence: 0.90656537

00:00:22.970 --> 00:00:24.395
nutrient supply, the liver will

NOTE Confidence: 0.90656537

00:00:24.395 --> 00:00:24.539
take the excess nutrients and

NOTE Confidence: 0.90656537

00:00:24.539 --> 00:00:25.055
store them typically as lipids.

NOTE Confidence: 0.8998362

00:00:26.314 --> 00:00:26.581
The liver also produces a

NOTE Confidence: 0.8998362

00:00:26.581 --> 00:00:27.295
ton of important proteins. You

NOTE Confidence: 0.8998362

00:00:27.595 --> 00:00:28.395
can kind of think of

NOTE Confidence: 0.8998362

00:00:28.395 --> 00:00:29.295
it as,

NOTE Confidence: 0.917852

00:00:29.914 --> 00:00:31.115
manufacturing many of these different

NOTE Confidence: 0.917852

00:00:31.115 --> 00:00:32.074
compounds. A good example of

NOTE Confidence: 0.917852

00:00:32.074 --> 00:00:32.905
that would be

NOTE Confidence: 0.9861314

00:00:35.520 --> 00:00:36.560
good example of that would

NOTE Confidence: 0.9861314

00:00:36.560 --> 00:00:38.159
be clotting factors, which the

NOTE Confidence: 0.9861314

00:00:38.159 --> 00:00:39.440
body needs for the blood

NOTE Confidence: 0.9861314

00:00:39.440 --> 00:00:40.020
to clot.

NOTE Confidence: 0.97494704

00:00:41.155 --> 00:00:42.195
And I think a big

NOTE Confidence: 0.97494704

00:00:42.195 --> 00:00:43.795
portion of how the liver

NOTE Confidence: 0.97494704

00:00:43.795 --> 00:00:45.574
is important for metabolic health

NOTE Confidence: 0.97494704

00:00:45.715 --> 00:00:47.074
is it helps to determine

NOTE Confidence: 0.97494704

00:00:47.074 --> 00:00:48.675
what happens to a lot

NOTE Confidence: 0.97494704

00:00:48.675 --> 00:00:49.850
of the nutrients that that

NOTE Confidence: 0.97494704

00:00:49.850 --> 00:00:51.290
we're eating. The liver is

NOTE Confidence: 0.97494704

00:00:51.290 --> 00:00:52.110
not designed

NOTE Confidence: 0.92139786

00:00:52.570 --> 00:00:54.010
for a state of chronic

NOTE Confidence: 0.92139786

00:00:54.010 --> 00:00:54.510
overnutrition.

NOTE Confidence: 0.9291939

00:00:55.770 --> 00:00:57.530
And what's happened historically always

NOTE Confidence: 0.9291939

00:00:57.530 --> 00:00:58.865
has been is that we

NOTE Confidence: 0.9291939

00:00:58.865 --> 00:01:00.325
do have periods of overnutrition,

NOTE Confidence: 0.9291939

00:01:00.545 --> 00:01:02.065
say the higher base. But

NOTE Confidence: 0.9291939

00:01:02.065 --> 00:01:03.985
inevitably, historically, it's been followed

NOTE Confidence: 0.9291939

00:01:03.985 --> 00:01:05.265
by weeks and months where

NOTE Confidence: 0.9291939

00:01:05.265 --> 00:01:06.630
we have under nutrition and

NOTE Confidence: 0.9291939

00:01:06.630 --> 00:01:07.910
then we fall back on

NOTE Confidence: 0.9291939

00:01:07.910 --> 00:01:08.970
the body's reserves.

NOTE Confidence: 0.9223746

00:01:09.350 --> 00:01:10.470
Modern life, say, in the

NOTE Confidence: 0.9223746

00:01:10.470 --> 00:01:11.510
last hundred years has been

NOTE Confidence: 0.9223746

00:01:11.510 --> 00:01:12.795
very unusual that

NOTE Confidence: 0.9846291

00:01:13.194 --> 00:01:14.955
most of the population has

NOTE Confidence: 0.9846291

00:01:14.955 --> 00:01:17.595
had excess nutrition day after

NOTE Confidence: 0.9846291

00:01:17.595 --> 00:01:19.115
day after day, and that's

NOTE Confidence: 0.9846291

00:01:19.115 --> 00:01:20.395
what ends up causing damage

NOTE Confidence: 0.9846291

00:01:20.395 --> 00:01:21.354
to the liver and many

NOTE Confidence: 0.9846291

00:01:21.354 --> 00:01:22.095
other organs.

NOTE Confidence: 0.8385666

00:01:27.490 --> 00:01:28.870
MASH is metabolic

NOTE Confidence: 0.99781775

00:01:29.250 --> 00:01:29.750
dysfunction

NOTE Confidence: 0.99618214

00:01:30.050 --> 00:01:31.270
associated steatohepatitis.

NOTE Confidence: 0.95946914

00:01:32.455 --> 00:01:34.315
MASH is a term where

NOTE Confidence: 0.95946914

00:01:34.375 --> 00:01:36.795
there is chronic over nutrition,

NOTE Confidence: 0.99659353

00:01:37.334 --> 00:01:38.615
where the liver is storing

NOTE Confidence: 0.99659353

00:01:38.615 --> 00:01:39.675
these excess nutrients.

NOTE Confidence: 0.97602046

00:01:40.090 --> 00:01:41.209
What ends up happening is

NOTE Confidence: 0.97602046

00:01:41.209 --> 00:01:42.890
you get both fat as

NOTE Confidence: 0.97602046

00:01:42.890 --> 00:01:44.569
well as inflammation in the

NOTE Confidence: 0.97602046

00:01:44.569 --> 00:01:45.069
liver.

NOTE Confidence: 0.9561268

00:01:45.930 --> 00:01:47.185
If you let that fat

NOTE Confidence: 0.9561268

00:01:47.185 --> 00:01:48.945
and inflammation go inside of

NOTE Confidence: 0.9561268

00:01:48.945 --> 00:01:50.465
the liver for long periods

NOTE Confidence: 0.9561268

00:01:50.465 --> 00:01:52.305
of time, that scar tissue

NOTE Confidence: 0.9561268

00:01:52.305 --> 00:01:53.425
starts to build up and

NOTE Confidence: 0.9561268

00:01:53.425 --> 00:01:54.784
can lead to cirrhosis of

NOTE Confidence: 0.9561268

00:01:54.784 --> 00:01:55.910
the liver. Which is a

NOTE Confidence: 0.9561268

00:01:56.070 --> 00:01:57.930
very severe condition and unfortunately

NOTE Confidence: 0.9561268

00:01:57.990 --> 00:01:59.290
a life threatening situation.

NOTE Confidence: 0.9722717

00:02:04.015 --> 00:02:05.535
For the majority of patients,

NOTE Confidence: 0.9722717

00:02:05.535 --> 00:02:07.375
the development of MASH appears

NOTE Confidence: 0.9722717

00:02:07.375 --> 00:02:09.135
to be very strongly linked

NOTE Confidence: 0.9722717

00:02:09.135 --> 00:02:10.755
to the development of metabolic

NOTE Confidence: 0.9722717

00:02:10.815 --> 00:02:13.050
syndrome. So patients who are

NOTE Confidence: 0.9722717

00:02:13.050 --> 00:02:13.950
either overweight,

NOTE Confidence: 0.9981036

00:02:14.410 --> 00:02:16.270
have high blood pressure, diabetes,

NOTE Confidence: 0.9743015

00:02:16.889 --> 00:02:18.190
their lipids are abnormal,

NOTE Confidence: 0.97768474

00:02:18.705 --> 00:02:19.745
or they tend to put

NOTE Confidence: 0.97768474

00:02:19.745 --> 00:02:21.425
weight more centrally on their

NOTE Confidence: 0.97768474

00:02:21.425 --> 00:02:23.105
abdomen instead of distributing it

NOTE Confidence: 0.97768474

00:02:23.105 --> 00:02:24.165
across their body,

NOTE Confidence: 0.99289536

00:02:24.625 --> 00:02:25.444
that predisposes

NOTE Confidence: 0.99230707

00:02:25.745 --> 00:02:27.264
them to also taking some

NOTE Confidence: 0.99230707

00:02:27.264 --> 00:02:29.010
fat and putting it instead

NOTE Confidence: 0.99230707

00:02:29.010 --> 00:02:29.990
inside of the liver.

NOTE Confidence: 0.9954707

00:02:30.930 --> 00:02:33.330
Like many metabolic conditions, it

NOTE Confidence: 0.9954707

00:02:33.330 --> 00:02:34.069
is asymptomatic

NOTE Confidence: 0.9952439

00:02:35.169 --> 00:02:36.630
until it's too late.

NOTE Confidence: 0.99906164

00:02:37.005 --> 00:02:38.125
So that's why it's really

NOTE Confidence: 0.99906164

00:02:38.125 --> 00:02:38.625
important

NOTE Confidence: 0.97255373

00:02:38.925 --> 00:02:40.205
that whenever there are any

NOTE Confidence: 0.97255373

00:02:40.205 --> 00:02:42.044
indicators, and indicators may be

NOTE Confidence: 0.97255373

00:02:42.044 --> 00:02:42.865
things like

NOTE Confidence: 0.92933935

00:02:43.165 --> 00:02:44.865
blood test or ultrasounds,

NOTE Confidence: 0.9473328

00:02:45.530 --> 00:02:46.969
that that's taken seriously and

NOTE Confidence: 0.9473328

00:02:46.969 --> 00:02:48.110
we act upon it.

NOTE Confidence: 0.8141695

00:02:52.995 --> 00:02:53.895
As obesity

NOTE Confidence: 0.9918695

00:02:54.275 --> 00:02:55.475
and things like high blood

NOTE Confidence: 0.9918695

00:02:55.475 --> 00:02:56.695
pressure and diabetes

NOTE Confidence: 0.9773715

00:02:56.995 --> 00:02:58.355
are starting to rise inside

NOTE Confidence: 0.9773715

00:02:58.355 --> 00:02:59.875
of our country, we're starting

NOTE Confidence: 0.9773715

00:02:59.875 --> 00:03:01.919
to see a much higher

NOTE Confidence: 0.9773715

00:03:01.919 --> 00:03:04.260
prevalence of diseases like MASH.

NOTE Confidence: 0.9773715

00:03:04.480 --> 00:03:06.080
And unfortunately, we're starting to

NOTE Confidence: 0.9773715

00:03:06.080 --> 00:03:07.680
see a greater number of

NOTE Confidence: 0.9773715

00:03:07.680 --> 00:03:09.245
patients that that are developing

NOTE Confidence: 0.9773715

00:03:09.305 --> 00:03:09.805
cirrhosis

NOTE Confidence: 0.9950804

00:03:10.185 --> 00:03:11.625
as a result of having

NOTE Confidence: 0.9950804

00:03:11.625 --> 00:03:12.125
MASH.

NOTE Confidence: 0.9788736

00:03:12.505 --> 00:03:13.385
And the reason I think

NOTE Confidence: 0.9788736

00:03:13.385 --> 00:03:14.745
it's important to try to

NOTE Confidence: 0.9788736

00:03:14.745 --> 00:03:16.345
identify this early is we

NOTE Confidence: 0.9788736

00:03:16.345 --> 00:03:17.850
have much better treatment options

NOTE Confidence: 0.9788736

00:03:18.090 --> 00:03:19.130
now than even when I

NOTE Confidence: 0.9788736

00:03:19.130 --> 00:03:20.330
was in training to help

NOTE Confidence: 0.9788736

00:03:20.330 --> 00:03:21.130
you to be able to

NOTE Confidence: 0.9788736

00:03:21.130 --> 00:03:22.490
manage your weight, as well

NOTE Confidence: 0.9788736

00:03:22.490 --> 00:03:24.010
as medicines that can actually

NOTE Confidence: 0.9788736

00:03:24.010 --> 00:03:25.290
help to take fat and

NOTE Confidence: 0.9788736

00:03:25.290 --> 00:03:26.250
get it out of your

NOTE Confidence: 0.9788736

00:03:26.250 --> 00:03:26.750
liver.

NOTE Confidence: 0.948864

00:03:27.315 --> 00:03:28.834
So the medication, Riz Defra,

NOTE Confidence: 0.948864

00:03:28.834 --> 00:03:31.075
that's been approved actually increases

NOTE Confidence: 0.948864

00:03:31.075 --> 00:03:32.114
the metabolism in the liver

NOTE Confidence: 0.948864

00:03:32.114 --> 00:03:33.235
and it mobilizes a lot

NOTE Confidence: 0.948864

00:03:33.235 --> 00:03:33.955
of the fat in the

NOTE Confidence: 0.948864

00:03:33.955 --> 00:03:35.820
liver. And the rationale there

NOTE Confidence: 0.948864

00:03:35.820 --> 00:03:36.540
is that if we can

NOTE Confidence: 0.948864

00:03:36.540 --> 00:03:37.360
take the

NOTE Confidence: 0.9471363

00:03:37.660 --> 00:03:38.780
stress away from the liver,

NOTE Confidence: 0.9471363

00:03:38.780 --> 00:03:39.500
so we can take the

NOTE Confidence: 0.9471363

00:03:39.500 --> 00:03:40.620
fat away from the liver

NOTE Confidence: 0.9471363

00:03:40.620 --> 00:03:42.800
and therefore stop ongoing injury,

NOTE Confidence: 0.98485076

00:03:43.375 --> 00:03:44.415
that the liver will then

NOTE Confidence: 0.98485076

00:03:44.415 --> 00:03:46.095
actually repair itself, which does

NOTE Confidence: 0.98485076

00:03:46.095 --> 00:03:46.915
tend to happen.

NOTE Confidence: 0.9883498

00:03:47.695 --> 00:03:48.815
At Yale, we have a

NOTE Confidence: 0.9883498

00:03:48.815 --> 00:03:50.815
dedicated fatty liver program where

NOTE Confidence: 0.9883498

00:03:50.815 --> 00:03:52.410
we take care of patients

NOTE Confidence: 0.9883498

00:03:52.410 --> 00:03:54.010
that have fatty liver from

NOTE Confidence: 0.9883498

00:03:54.010 --> 00:03:55.610
any causes, and we work

NOTE Confidence: 0.9883498

00:03:55.610 --> 00:03:56.730
in a big group of

NOTE Confidence: 0.9883498

00:03:56.730 --> 00:03:57.930
providers to try to be

NOTE Confidence: 0.9883498

00:03:57.930 --> 00:03:59.685
able to find a tailored

NOTE Confidence: 0.9883498

00:03:59.685 --> 00:04:01.365
regimen for patients to be

NOTE Confidence: 0.9883498

00:04:01.365 --> 00:04:03.205
able to help them get

NOTE Confidence: 0.9883498

00:04:03.205 --> 00:04:04.345
rid of their MASH

NOTE Confidence: 0.9821841

00:04:04.724 --> 00:04:05.605
and make it so that

NOTE Confidence: 0.9821841

00:04:05.605 --> 00:04:07.545
their risk of developing cirrhosis

NOTE Confidence: 0.9821841

00:04:07.765 --> 00:04:09.410
down the line is as

NOTE Confidence: 0.9821841

00:04:09.410 --> 00:04:10.430
low as possible.

NOTE Confidence: 0.99144924

00:04:12.170 --> 00:04:13.530
So I think with approval

NOTE Confidence: 0.99144924

00:04:13.530 --> 00:04:14.650
of a new drug, we

NOTE Confidence: 0.99144924

00:04:14.650 --> 00:04:16.330
need to be more aware

NOTE Confidence: 0.99144924

00:04:16.330 --> 00:04:17.449
of the patients that are

NOTE Confidence: 0.99144924

00:04:17.449 --> 00:04:19.485
out there. And I would

NOTE Confidence: 0.99144924

00:04:19.485 --> 00:04:21.645
suspect less than one out

NOTE Confidence: 0.99144924

00:04:21.645 --> 00:04:23.085
of ten patients who have

NOTE Confidence: 0.99144924

00:04:23.085 --> 00:04:24.685
MASH are actually aware of

NOTE Confidence: 0.99144924

00:04:24.685 --> 00:04:25.645
it. Most of them are

NOTE Confidence: 0.99144924

00:04:25.645 --> 00:04:27.800
just going about without realizing

NOTE Confidence: 0.99144924

00:04:27.800 --> 00:04:28.699
that they have MASH.

NOTE Confidence: 0.990305

00:04:31.160 --> 00:04:32.440
I think it's important to

NOTE Confidence: 0.990305

00:04:32.440 --> 00:04:33.639
talk to your primary care

NOTE Confidence: 0.990305

00:04:33.639 --> 00:04:34.839
provider and ask them whether

NOTE Confidence: 0.990305

00:04:34.839 --> 00:04:35.765
or not you should be

NOTE Confidence: 0.990305

00:04:35.765 --> 00:04:36.964
screened for the presence of

NOTE Confidence: 0.990305

00:04:36.964 --> 00:04:38.245
this disease and whether or

NOTE Confidence: 0.990305

00:04:38.245 --> 00:04:39.685
not referral to a specialty

NOTE Confidence: 0.990305

00:04:39.685 --> 00:04:40.904
clinic would be important.