The Liver Lowdown with Dr. James Burton

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Kind: captions
Language: en

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I watch while you were sleeping don't


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got no wall keep you you got someone


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else's dreams wake wake up


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call you get out the sun is creeping all


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right welcome everybody to this episode


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of transplant talks I'm Rachel Davis uh


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living liver donor psychiatrist and


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Mentor for the American transplant


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foundation and I'm with my uh co-host


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Anastasia Henry who's executive director


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of the American transplant foundation


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and today we are talking with uh Dr


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James Burton he is a professor of


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medicine at the University of Colorado


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anuts uh the section head of hepatology


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or he's a liver doctor and he's the


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medical director of liver trans


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so welcome Dr Burton thank you nice to


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be here today and I will turn it over to


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Anastasia to get us started off today


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I've been waiting for this day and for


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this episode for a long


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time my cousin who was my best childhood


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friend he died from liver failure before


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he turned 35 so this is extremely


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personal this is extremely challenging


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subject and also that something that


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that I'm so passionate about because


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liver is the only organ in our body that


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can regenerate we have an epidemic of


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liver disease we'll talk about it and we


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are so excited that we were able to get


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Dr Burton he's one of the leading


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hepatologist he's amazing he's


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passionate about Liver Health so let's


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jump in let's jump in thank you so much


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Dr Burton for being here my pleasure


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great time this is a great topic and one


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that I think it benefit many people and


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something I enjoy talking about yes and


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for all our listeners and for all our


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YouTube viewers so listen up because


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you're going to learn some incredible


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information that potentially can change


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your life and the health of your liever


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let's start with the notion of liver


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epidemic the first time I heard about


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liver epidemic specifically in the state


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of Colorado was earlier this year can


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you explain what it means epidemic liver


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disease epidemic is it local to specific


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States or is it nationwide


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issue well I think this uh when you


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refer to like an epidemic of Liver


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Health I mean uh there's multiple things


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that that refers to I think the one


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thing that stands out for us in our


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Liver Center is uh the the very


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widespread and increasing use of alcohol


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in America uh this has uh was something


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that was going up before the pandemic uh


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I think the pandemic lit it on on fire


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um I think we were fortunate enough to


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start developing some uh processes and


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evaluation of people with severe alcohol


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associated liver disease uh but those


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rates were increasing before the


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pandemic and then you know as we all sat


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around in our pajamas uh uh doing Zoom


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calls for the first time and having


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happy hour at two o'clock in the


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afternoon I think this is when things


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really started going up but you know


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alcohol is not the only problem in


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America right now and there's other


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problems uh associated with a term


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called metabolic dysfunction associated


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steatotic liver disease that's a fancy


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way of saying fat inflammation in your


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liver related to metabolic derangements


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like obesity and diabetes this too is a


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problem in America and it's something


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that's been going up you're seeing this


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in younger and younger people uh and the


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consequences of this is uh all these


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conditions can uh lead to sorosis uh and


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require


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transplant if you think about your


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patients 10 years ago what was the


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average age when people actually had a


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liver failure versus now that's a good


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question actually I I used to see older


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people coming to me when I say old my


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talking about my own age in their 50s


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who uh were diagnosed with therosis a


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lot of these problems had not really


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been developed they might be uh people


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who had long-standing diabetes obesity


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never told they had any problems with


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their liver until they decomp


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compensated with complications of


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jaundice or uh AES fluid in the abdomen


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or uh it might have been you know older


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men with who were long-standing drinkers


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of alcohol uh who came in with their


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wives and said they've been drinking


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alcohol for all their lives and had


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developed therosis I think in the last


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10 years we've started seeing younger


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and younger people with these problems


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um particularly with alcohol I mean I am


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today seeing patients who are in the


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early 20s who need liver transplants and


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finding out that they've been drinking


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alcohol since you know they were 13 or


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12 years old um that is very is a big


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change and uh I think the uh other


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change I'm seeing is younger and younger


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people who have abnormal liver test who


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have diabetes and obesity at an earlier


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age and I'm looking at these people now


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in their 30s and I'm saying hey I used


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to see you in your in your 50s you know


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but now we're seeing them earlier we now


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have some things we can uh we can you


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know address some of these problems with


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uh but certainly the age has shifted to


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younger uh younger people and for


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alcohol a big shift has been women I'm


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seeing more and more women uh who are


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developing alcohol associated liver


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disease than I had 10 years ago um so


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it's both a change in younger people and


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uh more


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females so how much alcohol is too


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much well that's a good question I think


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whenever I see a patient and I'm talking


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about about alcohol you just can't ask


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how many drinks do you have uh you have


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to quantify what a drink is and I


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remember seeing this woman in the


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hospital once and it was this big


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mystery of what her liver disease was


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though if you looked at her Labs it was


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like classic for alcohol associated


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liver disease and everyone kept asking


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her what do you drink she goes I drink


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one glass of wine and uh she uh was from


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Burma and there was a language barrier


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and everything and I went in to see her


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because they no one could figure it out


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and I asked her I said well what how big


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is your glass and she picked up a glass


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like this big and it held an entire


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bottle of wine and she was drinking that


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every day no one ever asked her how much


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wine are you drinking it was just saying


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one glass so I mean I have patients who


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have glasses that will fit an entire


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bottle in it so you need to be you need


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to ask what what you're drinking when


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you say I I always go through finding


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out how do you buy your alcohol do you


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buy it with a handle do you buy it in


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pints do you buy it uh in packs um


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quantify what they're drinking and then


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I ask you know if you drink beer do you


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drink craft beer do you drink you know


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Bud Lights I mean those are those are


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very different uh amounts of alcohol um


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people uh you know if you're drinking


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bottles of wine do you drink a whole


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bottle yourself you split it with your


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spouse I mean this gets you an idea of


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how much you drink you know if you're


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pouring mixed drinks are you just kind


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of like this or are you actually


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measuring shots so once you can identify


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perhaps how much people are drinking


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then then i' start telling saying to uh


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you know men and women you know one


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drink is moderate drinking for a woman


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uh two drinks would be moderate drinking


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for a man I often find that people uh


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underestimate how much they're drinking


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and most of the time I can actually


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double it so I think once I identify how


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much alcohol people are drinking then


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you can start to engage the patient into


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you know well that's actually quite a


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bit you know especially for small woman


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you know one thing that's not been known


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over years is Al bypass surgery for


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obesity can put you at more at risk for


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having alcohol associated liver disease


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wow with the same amount of alcohol so


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these people might not necessarily have


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an alcohol use disorder but they're


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doing the same things they were doing


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all before but they're not realizing


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that the impact of that alcohol can have


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on them so many takeaways just from this


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one answer so first of all like it's


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probably if you have any concerns about


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your alcohol usage it's a good idea to


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get a simple app um and just track your


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numbers right track your what are you


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drinking how much right and then when


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you are talking to your doctor they've


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heard it all they've heard they've


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you've heard it all right if you say I


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drink a bottle of wine and you think


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you're like the only person like you're


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like yeah right like i' I've heard it


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all right when nobody's going to


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surprise you so just being honest so


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you're not going into circle into


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circles right just being honest and


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saying this is where I am right now I


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would like to do better but this is


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what's happening I think that's number


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one and then number two so there there


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was a very specific example of a woman


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who was drinking a bottle of wine a day


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a night and she did develop liver


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failure so as I Was preparing for this


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episode a very good friend of mine told


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me that her primary care


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practitioner they told her and her


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husband that if they drink two glasses


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of wine per night every day of the week


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perfectly fine


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uh well I would say for a woman that


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would be moderate to severe drinking for


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the man it would be moderate drinking it


00:09:41.839 --> 00:09:43.990
might be okay I think as we've learned


00:09:44.000 --> 00:09:45.710
about alcohol this whole thing about the


00:09:45.720 --> 00:09:47.630
French paradox and there must be


00:09:47.640 --> 00:09:50.389
benefits of drinking red wine actually I


00:09:50.399 --> 00:09:52.110
think there's really no data that


00:09:52.120 --> 00:09:54.509
drinking alcohol at all cause has any


00:09:54.519 --> 00:09:57.069
benefit at what at all I mean not only


00:09:57.079 --> 00:09:59.470
is it have complications with liver


00:09:59.480 --> 00:10:02.550
disease it has complications of cancer


00:10:02.560 --> 00:10:04.230
it has complications of raising your


00:10:04.240 --> 00:10:07.790
blood pressure extra calories obesity I


00:10:07.800 --> 00:10:10.710
mean I I mean I wish I could tell you


00:10:10.720 --> 00:10:12.230
that drinking alcohol is going to save


00:10:12.240 --> 00:10:14.190
all your problems but there's really no


00:10:14.200 --> 00:10:16.389
benefit of alcohol in my opinion now


00:10:16.399 --> 00:10:18.230
that doesn't mean you one should live a


00:10:18.240 --> 00:10:19.949
life of sobriety if you don't want to I


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mean I enjoy having craft beers and uh


00:10:23.320 --> 00:10:25.750
uh a nice glass of whiskey from time to


00:10:25.760 --> 00:10:27.670
time but I mean I don't think that it's


00:10:27.680 --> 00:10:30.150
am it's about how you utilize it in your


00:10:30.160 --> 00:10:32.430
in your life and how does it impact your


00:10:32.440 --> 00:10:33.710
life not only from your health


00:10:33.720 --> 00:10:35.590
standpoint but how does it affect your


00:10:35.600 --> 00:10:39.110
relationships with other people um and


00:10:39.120 --> 00:10:40.910
your work and and those kind of things


00:10:40.920 --> 00:10:42.590
as well so it's not like alcohol is just


00:10:42.600 --> 00:10:44.350
a health benefit it can have all kinds


00:10:44.360 --> 00:10:46.829
of ranges of problem and we can't forget


00:10:46.839 --> 00:10:48.870
the psychiatric problems of course


00:10:48.880 --> 00:10:51.910
absolutely absolutely and a lot of times


00:10:51.920 --> 00:10:54.870
I see people who start drinking alcohol


00:10:54.880 --> 00:10:56.550
when I kind of go back and go when did


00:10:56.560 --> 00:10:58.790
this happen they say well I used to help


00:10:58.800 --> 00:11:01.829
me sleep at night you know and yeah it


00:11:01.839 --> 00:11:03.470
will help you sleep but that sleep


00:11:03.480 --> 00:11:05.829
you're getting is not good sleep and a


00:11:05.839 --> 00:11:08.230
lot of times people turn to their


00:11:08.240 --> 00:11:10.670
depression or their anxiety by drinking


00:11:10.680 --> 00:11:12.870
alcohol and you know that first drink or


00:11:12.880 --> 00:11:14.550
two it probably you know helps kind of


00:11:14.560 --> 00:11:16.190
relax you and stuff but then with that


00:11:16.200 --> 00:11:17.750
third or fourth you're probably causing


00:11:17.760 --> 00:11:19.550
more harm and you know what there's lots


00:11:19.560 --> 00:11:21.470
of good treatments for anxiety and


00:11:21.480 --> 00:11:24.030
depression out there that one shouldn't


00:11:24.040 --> 00:11:26.470
have to turn to alcohol


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right do we know why some people end up


00:11:29.680 --> 00:11:31.870
with curosis and others don't or is it


00:11:31.880 --> 00:11:34.030
that everybody who drink a certain


00:11:34.040 --> 00:11:35.670
amount would end up with


00:11:35.680 --> 00:11:38.829
therosis well thank God not everyone who


00:11:38.839 --> 00:11:40.389
drinks heavily ends up with liver


00:11:40.399 --> 00:11:42.389
disease because I would be in a world of


00:11:42.399 --> 00:11:44.990
hurt you know I I I've seen that about


00:11:45.000 --> 00:11:47.870
10% of heavy drinkers will develop liver


00:11:47.880 --> 00:11:51.710
disease and um there's Pro there's


00:11:51.720 --> 00:11:53.590
obviously there's issues related to


00:11:53.600 --> 00:11:56.150
genetics I think there's co-actors with


00:11:56.160 --> 00:11:58.750
other liver disease so you may have


00:11:58.760 --> 00:12:00.389
there's a term this whole term of


00:12:00.399 --> 00:12:02.910
metabolic dysfunction Associated scat


00:12:02.920 --> 00:12:05.389
hepatitis or that can be there's now a


00:12:05.399 --> 00:12:08.269
term called met Al so metabolic problems


00:12:08.279 --> 00:12:11.829
with too much alcohol um I think um you


00:12:11.839 --> 00:12:13.629
know there's probably I you know people


00:12:13.639 --> 00:12:15.030
always tell me well I don't I don't


00:12:15.040 --> 00:12:17.230
drink hard alcohol you know your liver


00:12:17.240 --> 00:12:19.310
doesn't care how it looks uh it's a


00:12:19.320 --> 00:12:21.150
twocc carbon chain that gets to your


00:12:21.160 --> 00:12:23.430
liver and a lot of the times it's not


00:12:23.440 --> 00:12:25.670
the the alcohol going to the liver and


00:12:25.680 --> 00:12:28.230
causing damage a lot of where the injury


00:12:28.240 --> 00:12:30.949
starts is in the gut in the intestine it


00:12:30.959 --> 00:12:31.990
causes


00:12:32.000 --> 00:12:34.990
inflammation and that inflammation all


00:12:35.000 --> 00:12:36.790
the blood from your gut goes rushing to


00:12:36.800 --> 00:12:38.790
your liver so that inflammation that


00:12:38.800 --> 00:12:41.430
Cascade of events that leads to fat and


00:12:41.440 --> 00:12:43.750
disregulation and Metabolism problems in


00:12:43.760 --> 00:12:45.990
the liver occurs and that's very unique


00:12:46.000 --> 00:12:49.150
in each certain individual um and so I


00:12:49.160 --> 00:12:52.550
don't you know most people can you know


00:12:52.560 --> 00:12:54.389
I see people who drink tons and I'm


00:12:54.399 --> 00:12:55.990
afraid sometimes amazed they don't have


00:12:56.000 --> 00:12:57.790
liver disease and then I had people come


00:12:57.800 --> 00:12:59.550
to my clinic and go well God brother


00:12:59.560 --> 00:13:01.389
drinks twice as much as me how come he's


00:13:01.399 --> 00:13:03.030
not sitting here in front of me it's


00:13:03.040 --> 00:13:04.949
very variable and I don't think you can


00:13:04.959 --> 00:13:06.470
just measure the amount of alcohol and


00:13:06.480 --> 00:13:08.509
know that you're going to develop liver


00:13:08.519 --> 00:13:11.189
disease so when we're drinking that one


00:13:11.199 --> 00:13:13.550
glass of prco basically what's happening


00:13:13.560 --> 00:13:15.829
there's inflammation that is happening


00:13:15.839 --> 00:13:19.069
as we you know having that one drink so


00:13:19.079 --> 00:13:21.069
it's yeah I mean the the when you drink


00:13:21.079 --> 00:13:23.030
alcohol and you break it down and as


00:13:23.040 --> 00:13:26.110
asah alahh which causes you to have the


00:13:26.120 --> 00:13:27.750
feeling of being hung over the next


00:13:27.760 --> 00:13:29.590
morning that's not NE necessarily


00:13:29.600 --> 00:13:31.350
causing the damage it's the ongoing


00:13:31.360 --> 00:13:33.750
inflammation at the level of the gut


00:13:33.760 --> 00:13:36.189
that causes inflammatory cyto kindes and


00:13:36.199 --> 00:13:38.790
mediators of inflammation to go to the


00:13:38.800 --> 00:13:40.910
liver there's disregulation of fat you


00:13:40.920 --> 00:13:42.430
know what's very interesting about


00:13:42.440 --> 00:13:45.590
alcohol Associated uh liver disease and


00:13:45.600 --> 00:13:47.990
non-alcohol associated liver disease


00:13:48.000 --> 00:13:50.110
underneath a microscope they look the


00:13:50.120 --> 00:13:52.870
same they both have fat in the liver


00:13:52.880 --> 00:13:56.189
with Associated inflammation and


00:13:56.199 --> 00:13:58.670
honestly sometimes I'm shown a biopsy


00:13:58.680 --> 00:14:00.350
and I can't tell the difference between


00:14:00.360 --> 00:14:01.990
someone having too many donuts or too


00:14:02.000 --> 00:14:04.430
many Budweisers they can look the same


00:14:04.440 --> 00:14:06.150
so these it's interesting in that the


00:14:06.160 --> 00:14:09.030
two biggest causes of of liver disease


00:14:09.040 --> 00:14:11.870
in America alcohol and metabolic


00:14:11.880 --> 00:14:15.069
Associated dysfunction of uh fatty liver


00:14:15.079 --> 00:14:17.150
disease those are the two leading causes


00:14:17.160 --> 00:14:19.550
in America and they look the same on


00:14:19.560 --> 00:14:24.310
Imaging they look the same on uh on a


00:14:24.320 --> 00:14:27.829
biopsy so if if listeners are listening


00:14:27.839 --> 00:14:29.710
to this and maybe getting a little bit


00:14:29.720 --> 00:14:32.110
worried what what should they do if


00:14:32.120 --> 00:14:34.509
they're concerned about their


00:14:34.519 --> 00:14:37.550
drinking well I I mean I I see patients


00:14:37.560 --> 00:14:39.870
sent to me from their for abnormal liver


00:14:39.880 --> 00:14:41.829
test from their primary care doctors


00:14:41.839 --> 00:14:44.430
often times and the question isn't is


00:14:44.440 --> 00:14:46.430
this alcohol the question I'm posed is


00:14:46.440 --> 00:14:48.749
why are their liver enzymes elevated and


00:14:48.759 --> 00:14:51.189
I can tell sometimes walking into the


00:14:51.199 --> 00:14:53.629
room that it's due to alcohol there's


00:14:53.639 --> 00:14:55.870
very characteristic findings about the


00:14:55.880 --> 00:14:57.870
the way the pattern is there's very


00:14:57.880 --> 00:14:59.350
characteristic findings of on the


00:14:59.360 --> 00:15:01.470
Imaging you can see other lab testing


00:15:01.480 --> 00:15:04.389
that can suggest it so you know in terms


00:15:04.399 --> 00:15:08.949
of I think just a asking people I mean


00:15:08.959 --> 00:15:10.870
if you get to me and for me to tell you


00:15:10.880 --> 00:15:12.629
you're drinking too much these people


00:15:12.639 --> 00:15:14.550
have been doing this with their primary


00:15:14.560 --> 00:15:16.230
care or maybe they've even thought about


00:15:16.240 --> 00:15:18.470
it themselves so again I don't think


00:15:18.480 --> 00:15:20.790
it's as much as just to ask people how


00:15:20.800 --> 00:15:22.990
much do you drink I have three drinks


00:15:23.000 --> 00:15:24.949
check and move on to the next thing you


00:15:24.959 --> 00:15:27.110
should ask okay three drinks you're a


00:15:27.120 --> 00:15:28.670
woman how are these drinks you know and


00:15:28.680 --> 00:15:30.829
find out that it's six drinks so I think


00:15:30.839 --> 00:15:32.829
I think we all probably need to you know


00:15:32.839 --> 00:15:35.309
stop and pause and and and look at how


00:15:35.319 --> 00:15:37.350
much we drink I mean if you think about


00:15:37.360 --> 00:15:39.069
it in back in the olden days you could


00:15:39.079 --> 00:15:41.590
only drink wine and whiskey you know and


00:15:41.600 --> 00:15:43.590
there were bad beers and now we live in


00:15:43.600 --> 00:15:46.189
a in a especially in Colorado here we've


00:15:46.199 --> 00:15:48.870
got a huge craft beer industry a huge


00:15:48.880 --> 00:15:51.430
craft Distillery business they sell


00:15:51.440 --> 00:15:53.949
seltzers now with alcohol in them that


00:15:53.959 --> 00:15:55.910
are fortified with vitamins and we're


00:15:55.920 --> 00:15:58.030
told that this is somehow healthy for


00:15:58.040 --> 00:16:01.509
you so I mean you the amount of access


00:16:01.519 --> 00:16:03.670
to alcohol is overwhelming it's kind of


00:16:03.680 --> 00:16:06.710
become kind of you know kind of expected


00:16:06.720 --> 00:16:09.069
I mean it's advertised on TV you can't


00:16:09.079 --> 00:16:10.949
go to a sports game without lots of


00:16:10.959 --> 00:16:12.910
alcohol so I think it's something you


00:16:12.920 --> 00:16:16.110
know it's you know tobacco kind of


00:16:16.120 --> 00:16:18.189
shifted and you started putting warning


00:16:18.199 --> 00:16:20.509
s signs on it and saying this is bad and


00:16:20.519 --> 00:16:22.829
we outli outlawed tobacco and


00:16:22.839 --> 00:16:25.309
restaurants and on airplanes we don't do


00:16:25.319 --> 00:16:27.870
that with alcohol we serve alcohol in


00:16:27.880 --> 00:16:29.629
airplanes we serve Al called all these


00:16:29.639 --> 00:16:31.949
events and so I think that I mean that


00:16:31.959 --> 00:16:33.829
when the baseball started being faster


00:16:33.839 --> 00:16:35.389
there was criticism we won't be able to


00:16:35.399 --> 00:16:37.350
drink as much beer at the baseball game


00:16:37.360 --> 00:16:40.069
so I think there is a a big problem in


00:16:40.079 --> 00:16:42.990
America that we we drink too much we


00:16:43.000 --> 00:16:45.670
have too much access to it and and you


00:16:45.680 --> 00:16:47.269
guys are at least raising this question


00:16:47.279 --> 00:16:49.110
for people to start looking at how much


00:16:49.120 --> 00:16:51.230
they drink yes and I think you know


00:16:51.240 --> 00:16:52.870
someone as someone who grew up in


00:16:52.880 --> 00:16:55.309
Eastern Europe and definitely alcohol it


00:16:55.319 --> 00:16:57.670
was your number one uh prescription


00:16:57.680 --> 00:17:00.629
medication right depressants everything


00:17:00.639 --> 00:17:02.949
however there was not a


00:17:02.959 --> 00:17:05.350
culture at least back in the days when I


00:17:05.360 --> 00:17:07.270
lived there there was not a culture of


00:17:07.280 --> 00:17:10.829
this everyday consumption of alcohol so


00:17:10.839 --> 00:17:12.789
if there was a big party everybody would


00:17:12.799 --> 00:17:16.110
go you know go crazy but nowadays with


00:17:16.120 --> 00:17:18.549
all the wine clubs it's like I'll just


00:17:18.559 --> 00:17:20.949
have one two glasses of wine every


00:17:20.959 --> 00:17:24.710
single day can you talk to us how can


00:17:24.720 --> 00:17:27.189
you affect the health of your liver if


00:17:27.199 --> 00:17:29.350
you simply don't drink every day maybe


00:17:29.360 --> 00:17:30.909
if it's just one or two glasses but


00:17:30.919 --> 00:17:33.950
let's say you only drink 3 days a week


00:17:33.960 --> 00:17:36.430
will you make a difference for your


00:17:36.440 --> 00:17:39.430
liver well I I can't say that it's GNA


00:17:39.440 --> 00:17:41.549
make you worse I it's got to be helpful


00:17:41.559 --> 00:17:43.789
I mean I guess if you're having I mean


00:17:43.799 --> 00:17:46.870
there's The Chronic daily use of alcohol


00:17:46.880 --> 00:17:49.110
but also binge drinking is equally as


00:17:49.120 --> 00:17:52.630
bad I mean for for a man that would be


00:17:52.640 --> 00:17:55.149
five drinks for a woman four drinks and


00:17:55.159 --> 00:17:57.789
I mean even if you binge drink once a


00:17:57.799 --> 00:18:00.270
week that probably has the same impact


00:18:00.280 --> 00:18:02.390
as having moderate drinking on a daily


00:18:02.400 --> 00:18:04.750
basis and in terms of defining what an


00:18:04.760 --> 00:18:06.830
alcohol use disorder is you know bins


00:18:06.840 --> 00:18:08.750
drinking four or five times a month


00:18:08.760 --> 00:18:12.710
would be considered abnormal so um I


00:18:12.720 --> 00:18:13.870
mean I


00:18:13.880 --> 00:18:17.950
think drinking less is got is is go is


00:18:17.960 --> 00:18:20.710
the benefit how you go about doing that


00:18:20.720 --> 00:18:22.990
is going to be good but I I think if you


00:18:23.000 --> 00:18:24.510
just put all your drinks from the week


00:18:24.520 --> 00:18:26.390
and put them on the weekend not sure


00:18:26.400 --> 00:18:29.750
that's going to necessarily help you


00:18:29.760 --> 00:18:31.990
and my suggestion was instead of like


00:18:32.000 --> 00:18:33.830
let's say if you have these two glasses


00:18:33.840 --> 00:18:37.070
one glass per day if you simply keep the


00:18:37.080 --> 00:18:39.270
same amount absolutely no bit drinking


00:18:39.280 --> 00:18:41.350
but let's say you give your liver a


00:18:41.360 --> 00:18:43.789
thoughtful rest three to four days a


00:18:43.799 --> 00:18:48.190
week yeah well I mean uh I I think


00:18:48.200 --> 00:18:49.870
there's a lot of things related to


00:18:49.880 --> 00:18:51.950
alcohol that people don't realize you


00:18:51.960 --> 00:18:54.950
know causes problems you


00:18:54.960 --> 00:18:58.029
know you know so I see people who are


00:18:58.039 --> 00:19:00.190
having a hard time losing weight and yet


00:19:00.200 --> 00:19:01.950
they're drinking two glasses of wine a


00:19:01.960 --> 00:19:03.230
night and I'm like well gosh you could


00:19:03.240 --> 00:19:05.630
cut that out and you're getting rid of


00:19:05.640 --> 00:19:08.510
calories I mean the Improvement not only


00:19:08.520 --> 00:19:12.870
in blood glucose control um your sleep


00:19:12.880 --> 00:19:15.350
uh high blood pressure I mean people


00:19:15.360 --> 00:19:17.470
start to feel better when they stop


00:19:17.480 --> 00:19:19.029
drinking I think that's something you


00:19:19.039 --> 00:19:22.390
notice even after uh several weeks and


00:19:22.400 --> 00:19:24.070
you know we were talking earlier about


00:19:24.080 --> 00:19:26.149
you know the benefit of you know taking


00:19:26.159 --> 00:19:28.270
a month off of alcohol you know January


00:19:28.280 --> 00:19:30.190
is coming up people notoriously want to


00:19:30.200 --> 00:19:32.870
quit drinking in January I think a lot


00:19:32.880 --> 00:19:35.549
of the benefits of stopping alcohol for


00:19:35.559 --> 00:19:37.950
a month is looking back and seeing how


00:19:37.960 --> 00:19:40.909
well you feel and I think a lot of


00:19:40.919 --> 00:19:43.510
people don't realize the impacts alcohol


00:19:43.520 --> 00:19:46.310
has on your overall health um and


00:19:46.320 --> 00:19:48.110
sometimes just taking that dry you know


00:19:48.120 --> 00:19:50.149
that month of dry January to really feel


00:19:50.159 --> 00:19:52.350
like oh my God I feel so much refreshed


00:19:52.360 --> 00:19:55.950
I'm saving money um aspect of my life I


00:19:55.960 --> 00:19:57.990
have more energy I have more exactly I


00:19:58.000 --> 00:19:59.149
can think better


00:19:59.159 --> 00:20:02.310
mhm and we actually this January for the


00:20:02.320 --> 00:20:04.630
first time ever we will be doing Li


00:20:04.640 --> 00:20:06.750
refresh challenge four weeks we're going


00:20:06.760 --> 00:20:09.750
to start January 10 and I encourage


00:20:09.760 --> 00:20:11.270
everyone to sign up it's a free


00:20:11.280 --> 00:20:13.190
initiative it you will learn so much


00:20:13.200 --> 00:20:15.270
about your Li Health and we will try to


00:20:15.280 --> 00:20:17.870
reset our lever and learn healthy new


00:20:17.880 --> 00:20:20.070
habits together so go to americant


00:20:20.080 --> 00:20:22.950
transplant foundation.org to sign up


00:20:22.960 --> 00:20:25.510
that will be a really fun initiative to


00:20:25.520 --> 00:20:26.750
do


00:20:26.760 --> 00:20:29.270
together some other questions they have


00:20:29.280 --> 00:20:32.789
so some patients ask what about liver


00:20:32.799 --> 00:20:35.909
detoxes what can we buy something from


00:20:35.919 --> 00:20:39.510
Amazon that plants plant-based fixs and


00:20:39.520 --> 00:20:42.710
this and that some people do cleanses


00:20:42.720 --> 00:20:44.270
right with machines what what are your


00:20:44.280 --> 00:20:45.750
thoughts on all


00:20:45.760 --> 00:20:49.710
that uh I see well I see people every


00:20:49.720 --> 00:20:53.789
week who have some uh liver toxicity or


00:20:53.799 --> 00:20:56.310
a drug induced liver injury which I


00:20:56.320 --> 00:20:58.630
often contribute to some herbal


00:20:58.640 --> 00:21:02.230
supplement or some cleanse or something


00:21:02.240 --> 00:21:04.750
where a patient is taking it because


00:21:04.760 --> 00:21:06.190
they're under the impression it's going


00:21:06.200 --> 00:21:10.110
to help them um so a lot of those things


00:21:10.120 --> 00:21:11.110
are not


00:21:11.120 --> 00:21:13.750
regulated uh some of them may have what


00:21:13.760 --> 00:21:16.470
might be considered benign things but


00:21:16.480 --> 00:21:19.190
you don't know what else is in there uh


00:21:19.200 --> 00:21:23.269
you know the liver was designed to do


00:21:23.279 --> 00:21:24.990
this work it's doing I mean you have


00:21:25.000 --> 00:21:27.390
more liver than you need first of all as


00:21:27.400 --> 00:21:29.310
evidenced by the fact that you can take


00:21:29.320 --> 00:21:31.430
60% of it out and give it to someone


00:21:31.440 --> 00:21:32.909
else or throw it in a bucket if there's


00:21:32.919 --> 00:21:35.510
a tumor in there so your liver is very


00:21:35.520 --> 00:21:37.750
resilient I think this idea that your


00:21:37.760 --> 00:21:41.830
liver needs to be detoxified or cleansed


00:21:41.840 --> 00:21:43.070
is really


00:21:43.080 --> 00:21:47.950
not based in any fact a reality and that


00:21:47.960 --> 00:21:49.990
a lot of the things that you could do to


00:21:50.000 --> 00:21:52.110
live a healthier life for your liver is


00:21:52.120 --> 00:21:55.830
to eat better avoid alcohol you know get


00:21:55.840 --> 00:21:58.669
your blood glucose under control you


00:21:58.679 --> 00:22:00.430
lose weight the Fat's going to go away I


00:22:00.440 --> 00:22:02.190
mean the a lot of these things are


00:22:02.200 --> 00:22:03.590
things that are going to help you more


00:22:03.600 --> 00:22:06.190
than uh something you buy on Amazon and


00:22:06.200 --> 00:22:08.350
a in a cleanse that's I think it's a


00:22:08.360 --> 00:22:09.710
gimmick to be honest with you it's a


00:22:09.720 --> 00:22:11.149
quick way of thinking I'm doing


00:22:11.159 --> 00:22:13.070
something but I think if you really want


00:22:13.080 --> 00:22:14.669
to have good lever Health you really got


00:22:14.679 --> 00:22:16.590
to focus on your entire health and your


00:22:16.600 --> 00:22:19.230
whole body are there any supplements


00:22:19.240 --> 00:22:20.830
that are particularly harmful or


00:22:20.840 --> 00:22:24.430
notorious for leading to liver


00:22:24.440 --> 00:22:27.909
damage uh well I mean there's there's


00:22:27.919 --> 00:22:30.430
been talks it with ashanda which a lot


00:22:30.440 --> 00:22:31.750
of


00:22:31.760 --> 00:22:34.789
people swear by and when you bring it up


00:22:34.799 --> 00:22:37.230
they feel like they that's no way I can


00:22:37.240 --> 00:22:41.909
stop doing that um you know cumin uh has


00:22:41.919 --> 00:22:44.390
you know big concentrated capsules of


00:22:44.400 --> 00:22:45.950
that I've seen patients come in with


00:22:45.960 --> 00:22:46.990
liver


00:22:47.000 --> 00:22:51.789
toxicity um I've seen red rice yeast uh


00:22:51.799 --> 00:22:53.350
toxicity in people thinking that's going


00:22:53.360 --> 00:22:55.510
to be good for them I mean there's so


00:22:55.520 --> 00:22:58.870
many things out there that I think are


00:22:58.880 --> 00:23:02.590
in packages that claim things and um you


00:23:02.600 --> 00:23:04.710
know a lot of times you I can look these


00:23:04.720 --> 00:23:07.789
up on you know the NIH has a good uh


00:23:07.799 --> 00:23:10.390
website on uh drug toxicity as well as


00:23:10.400 --> 00:23:12.630
herbal toxicity and sometimes you can


00:23:12.640 --> 00:23:14.870
find the drug that particularly uh that


00:23:14.880 --> 00:23:16.870
the person's taking and sometimes it


00:23:16.880 --> 00:23:19.070
isn't been reported but I mean whenever


00:23:19.080 --> 00:23:21.110
I see someone with an unexplained liver


00:23:21.120 --> 00:23:22.909
injury and I find they're taking


00:23:22.919 --> 00:23:25.350
supplements you know I have to tell the


00:23:25.360 --> 00:23:27.750
patient I they could be in this basket


00:23:27.760 --> 00:23:29.750
of pills you're taking here I have no


00:23:29.760 --> 00:23:31.990
idea and I don't even know what's in all


00:23:32.000 --> 00:23:34.470
these things often times if I can


00:23:34.480 --> 00:23:35.950
convince the patient to get off


00:23:35.960 --> 00:23:38.430
everything their liver tests get better


00:23:38.440 --> 00:23:39.950
and then they and then a few months


00:23:39.960 --> 00:23:41.590
later I get their Labs back and they're


00:23:41.600 --> 00:23:43.310
back abnormal again and the patient's


00:23:43.320 --> 00:23:45.909
gone back to taking them it really


00:23:45.919 --> 00:23:47.789
probably requires taking them all off


00:23:47.799 --> 00:23:49.470
and then going back each one and seeing


00:23:49.480 --> 00:23:51.470
which one has it I mean there's some


00:23:51.480 --> 00:23:53.110
that you know I'm not talking about


00:23:53.120 --> 00:23:55.870
vitamins here I'm not talking about I'm


00:23:55.880 --> 00:23:57.990
talking about herbal supplements things


00:23:58.000 --> 00:24:00.909
that you know you don't know these


00:24:00.919 --> 00:24:03.350
things are not regulated by the FDA


00:24:03.360 --> 00:24:05.909
what's in them may be true what's extra


00:24:05.919 --> 00:24:09.789
in there is probably what the problems


00:24:09.799 --> 00:24:13.549
are is there such thing as taking too


00:24:13.559 --> 00:24:16.029
many


00:24:16.039 --> 00:24:18.990
vitamins uh well there I mean you can


00:24:19.000 --> 00:24:21.269
get uh liver toxicity from taking too


00:24:21.279 --> 00:24:23.630
much vitamin A so I mean there is well


00:24:23.640 --> 00:24:26.750
described uh toxicity from vitamins I


00:24:26.760 --> 00:24:28.950
mean honestly I think if someone is


00:24:28.960 --> 00:24:30.350
taking


00:24:30.360 --> 00:24:34.350
vitamins um they're probably just having


00:24:34.360 --> 00:24:37.549
expensive urine because your body if it


00:24:37.559 --> 00:24:38.870
doesn't need it it's just going to get


00:24:38.880 --> 00:24:41.350
rid of it and people who really need


00:24:41.360 --> 00:24:43.230
vitamins I think are people who have


00:24:43.240 --> 00:24:45.909
chronic uh gastrointestinal diseases


00:24:45.919 --> 00:24:47.789
where there may be impacting or there


00:24:47.799 --> 00:24:50.029
may be impairment of absorption of


00:24:50.039 --> 00:24:52.630
vitamins uh or you might have a SE I can


00:24:52.640 --> 00:24:54.190
think of some severe liver diseases


00:24:54.200 --> 00:24:55.870
where you might have a problem absorbing


00:24:55.880 --> 00:24:59.269
fat soluble vitamins but for healthy


00:24:59.279 --> 00:25:02.070
people eating a well-balanced diet I


00:25:02.080 --> 00:25:04.630
mean our bread in America is fortified


00:25:04.640 --> 00:25:07.590
with thymen and folate and thing I mean


00:25:07.600 --> 00:25:09.430
as long as you're eating a well-balanced


00:25:09.440 --> 00:25:13.149
diet I don't think we most people need


00:25:13.159 --> 00:25:16.750
vitamins um no do take does taking a vol


00:25:16.760 --> 00:25:19.430
multivitamin hurt you no does it hurt


00:25:19.440 --> 00:25:22.149
your pocketbook maybe uh that may be up


00:25:22.159 --> 00:25:24.190
to a person to decide what they want to


00:25:24.200 --> 00:25:26.590
do but I don't think we most people who


00:25:26.600 --> 00:25:29.190
are healthy don't need to take vitamins


00:25:29.200 --> 00:25:31.070
supplementation now what if someone has


00:25:31.080 --> 00:25:33.230
had a liver transplant are they more at


00:25:33.240 --> 00:25:35.909
risk for effects from certain vitamins


00:25:35.919 --> 00:25:38.389
or are more likely to need certain


00:25:38.399 --> 00:25:40.110
vitamins I would say as long as their


00:25:40.120 --> 00:25:42.669
liver transplants working well uh the


00:25:42.679 --> 00:25:44.430
goal of a liver transplant is to make


00:25:44.440 --> 00:25:46.470
you back to normal and most of my


00:25:46.480 --> 00:25:48.230
patients who have had liver transplants


00:25:48.240 --> 00:25:50.909
I would consider as normal as you and me


00:25:50.919 --> 00:25:52.950
and uh the only difference is they take


00:25:52.960 --> 00:25:54.750
an immunosuppressant medicine that most


00:25:54.760 --> 00:25:57.430
patients don't take and then there's


00:25:57.440 --> 00:25:59.350
Tylenol so what about Tylenol I think a


00:25:59.360 --> 00:26:01.470
lot of people don't realize how much


00:26:01.480 --> 00:26:04.710
Tylenol is too much uh that's a good


00:26:04.720 --> 00:26:07.669
question um when I see patients in my


00:26:07.679 --> 00:26:09.470
clinic most people have severe liver


00:26:09.480 --> 00:26:11.430
disease most patients I am seeing in my


00:26:11.440 --> 00:26:13.470
clinic have uh endstage liver disease


00:26:13.480 --> 00:26:15.710
and need liver transplant and they ask


00:26:15.720 --> 00:26:17.710
me what medicine they can take for pain


00:26:17.720 --> 00:26:19.430
and surprisingly I tell them they should


00:26:19.440 --> 00:26:21.029
take aetam menen or


00:26:21.039 --> 00:26:23.990
Tylenol um acetamin and Tylenol have


00:26:24.000 --> 00:26:27.909
taken in doses of 2,000 milligrams a day


00:26:27.919 --> 00:26:29.789
even someone that who has the worst


00:26:29.799 --> 00:26:31.149
liver function at the top of the


00:26:31.159 --> 00:26:34.710
transplant list can tolerate that um


00:26:34.720 --> 00:26:36.909
what's bad for people with with with


00:26:36.919 --> 00:26:39.350
therosis and severe liver disease are


00:26:39.360 --> 00:26:41.510
taking non-steroidal anti-inflammatories


00:26:41.520 --> 00:26:44.029
these can cause ulcers in the stomach


00:26:44.039 --> 00:26:45.789
these people have a lot of congestion of


00:26:45.799 --> 00:26:47.269
blood around the stomach so a little


00:26:47.279 --> 00:26:49.389
bleeding turns into a lot of bleeding


00:26:49.399 --> 00:26:51.230
and most importantly in severe liver


00:26:51.240 --> 00:26:54.029
disease uh those drugs can precipitate


00:26:54.039 --> 00:26:57.669
uh uh kidney failure so um uh I think


00:26:57.679 --> 00:27:00.070
it's very well known that people are


00:27:00.080 --> 00:27:02.350
told oh you can't take a camenen because


00:27:02.360 --> 00:27:05.110
you have liver disease um I usually


00:27:05.120 --> 00:27:07.389
counsel my patients that they can do it


00:27:07.399 --> 00:27:08.590
because they've often been told they


00:27:08.600 --> 00:27:10.350
haven't and if you look on the bottle of


00:27:10.360 --> 00:27:12.269
cedam Menin it says please consult your


00:27:12.279 --> 00:27:14.510
doctor I think in America the one thing


00:27:14.520 --> 00:27:17.510
that's a problem with acetaminophen and


00:27:17.520 --> 00:27:20.230
uh and Tylenol is that you can go to


00:27:20.240 --> 00:27:23.669
Costco and buy 500 tablets in a bottle


00:27:23.679 --> 00:27:26.430
uh though in uh in the United Kingdom


00:27:26.440 --> 00:27:28.750
they put it in blister caplets


00:27:28.760 --> 00:27:30.070
uh and they've actually shown a


00:27:30.080 --> 00:27:32.990
reduction in acute liver failure from


00:27:33.000 --> 00:27:34.789
acetaminophen uh and it's probably


00:27:34.799 --> 00:27:36.590
because people just get tired of popping


00:27:36.600 --> 00:27:38.870
the pills uh when they doing having a


00:27:38.880 --> 00:27:40.710
suicide attempt but in America you can


00:27:40.720 --> 00:27:43.269
go to Costco and easily buy two bottles


00:27:43.279 --> 00:27:46.430
of five 500 milligrams uh and without


00:27:46.440 --> 00:27:48.669
any ease take it so I think uh in


00:27:48.679 --> 00:27:51.870
America the problem is one of too much


00:27:51.880 --> 00:27:54.149
ease uh and you got to keep in mind


00:27:54.159 --> 00:27:55.630
there's a lot of other medicines with


00:27:55.640 --> 00:27:58.470
acetaminophen in them cold medicine so


00:27:58.480 --> 00:28:00.029
you need to look on the back of any


00:28:00.039 --> 00:28:01.789
medicines you're taking to see what's in


00:28:01.799 --> 00:28:03.830
them cold allergy medicines might have a


00:28:03.840 --> 00:28:06.710
cedam Menin in them um and then you know


00:28:06.720 --> 00:28:08.549
the fact that you can the tablets are


00:28:08.559 --> 00:28:11.549
not 250 milligrams but 500 you can get


00:28:11.559 --> 00:28:17.070
up to 2,000 milligrams pretty


00:28:17.080 --> 00:28:19.789
quickly well I do we want to talk about


00:28:19.799 --> 00:28:22.110
leaving lever donation because that is


00:28:22.120 --> 00:28:26.590
such an exciting and not wellknown


00:28:26.600 --> 00:28:28.909
area so of


00:28:28.919 --> 00:28:30.990
often I'm talking to someone they're


00:28:31.000 --> 00:28:32.710
like you can donate a part of your


00:28:32.720 --> 00:28:34.470
liever and you're going to be okay I was


00:28:34.480 --> 00:28:37.710
like yeah talk to Rachel Rachel Davis


00:28:37.720 --> 00:28:39.549
well as you as you know as you mentioned


00:28:39.559 --> 00:28:41.430
earlier it's the only organ except for


00:28:41.440 --> 00:28:43.070
maybe your skin if you consider that an


00:28:43.080 --> 00:28:44.310
organ that can


00:28:44.320 --> 00:28:48.070
regenerate um and uh yes it is very it's


00:28:48.080 --> 00:28:50.669
remarkable uh that someone uh can you


00:28:50.679 --> 00:28:54.310
can take someone's uh diseased liver out


00:28:54.320 --> 00:28:57.590
completely and replace it with 50 60% of


00:28:57.600 --> 00:29:00.509
a normal liver and within a month uh


00:29:00.519 --> 00:29:02.310
both of the liver and the recipient and


00:29:02.320 --> 00:29:04.509
then the donor have uh reach gone back


00:29:04.519 --> 00:29:06.950
to their normal volume one thing about


00:29:06.960 --> 00:29:09.350
liver uh um living donor liver


00:29:09.360 --> 00:29:10.750
transplant the liver it doesn't


00:29:10.760 --> 00:29:12.909
regenerate like a salamander's tail so


00:29:12.919 --> 00:29:14.470
if you donate the right lobe it doesn't


00:29:14.480 --> 00:29:17.230
just grow back the if the donor's left


00:29:17.240 --> 00:29:18.750
with the left lobe the left lobe gets


00:29:18.760 --> 00:29:20.350
bigger and the recipient receives the


00:29:20.360 --> 00:29:22.070
right lobe the recipient's liver will


00:29:22.080 --> 00:29:25.190
grow back but yeah um it's something uh


00:29:25.200 --> 00:29:27.590
we do here at the University of Colorado


00:29:27.600 --> 00:29:30.630
uh um and um there are a number of


00:29:30.640 --> 00:29:32.350
places across the country that have the


00:29:32.360 --> 00:29:34.389
expertise in doing this I mean the


00:29:34.399 --> 00:29:36.830
outcomes with living donation are


00:29:36.840 --> 00:29:39.549
equivalent to having a cavic


00:29:39.559 --> 00:29:42.830
transplant um I think uh in my line of


00:29:42.840 --> 00:29:45.549
work I see lots of people who are sick


00:29:45.559 --> 00:29:47.110
and would benefit from a liver


00:29:47.120 --> 00:29:49.590
transplant but uh they're just not sick


00:29:49.600 --> 00:29:51.630
enough to get high on the transplant


00:29:51.640 --> 00:29:54.710
list I tell people when I see anyone who


00:29:54.720 --> 00:29:57.149
needs a liver transplant uh who doesn't


00:29:57.159 --> 00:29:59.389
is not so sick that they need a full


00:29:59.399 --> 00:30:01.590
liver or are already at the top of the


00:30:01.600 --> 00:30:03.909
transplant list I did I do discuss


00:30:03.919 --> 00:30:06.509
living donor liver transplantation it's


00:30:06.519 --> 00:30:09.269
like getting out of line I mean if


00:30:09.279 --> 00:30:11.070
you're on the transplant list it's like


00:30:11.080 --> 00:30:13.990
being in a long line you know maybe at a


00:30:14.000 --> 00:30:15.950
barbecue waiting for hamburgers to be


00:30:15.960 --> 00:30:18.710
thrown on your plate living donation is


00:30:18.720 --> 00:30:20.149
like coming to the barbecue with your


00:30:20.159 --> 00:30:22.350
own steaks I mean you don't have to wait


00:30:22.360 --> 00:30:25.470
in line it's a scheduled procedure um


00:30:25.480 --> 00:30:27.470
I've seen patients who need to improve


00:30:27.480 --> 00:30:29.110
their Nutri nutition so we have a goal


00:30:29.120 --> 00:30:30.710
date of you're going to improve your


00:30:30.720 --> 00:30:32.509
nutrition to get a transplant on a


00:30:32.519 --> 00:30:35.389
Tuesday in in December type thing so it


00:30:35.399 --> 00:30:37.789
takes away a lot of the when will I get


00:30:37.799 --> 00:30:40.630
transplanted the unknown um it's an


00:30:40.640 --> 00:30:42.310
incredible I mean I'm not I don't want


00:30:42.320 --> 00:30:45.230
to minimize the uh risk to a donor it's


00:30:45.240 --> 00:30:47.230
a major operation that a donor is going


00:30:47.240 --> 00:30:48.950
to undergo especially if it's a right


00:30:48.960 --> 00:30:52.350
lobe uh trans uh transplant or


00:30:52.360 --> 00:30:55.509
donation um though I have seen the


00:30:55.519 --> 00:30:57.110
benefits of it and we've all seen the


00:30:57.120 --> 00:31:00.029
benefits of it uh and uh it's something


00:31:00.039 --> 00:31:03.149
that you know I think if I know a lot of


00:31:03.159 --> 00:31:05.070
patients have a lot of I don't want to


00:31:05.080 --> 00:31:07.470
put my loved ones through that you know


00:31:07.480 --> 00:31:09.590
I sometimes turn it around and say well


00:31:09.600 --> 00:31:11.310
how's your loved one going to feel if


00:31:11.320 --> 00:31:13.389
you die on the transplant list waiting


00:31:13.399 --> 00:31:17.590
for that thing and why get so sick that


00:31:17.600 --> 00:31:20.710
you're in the hospital or in the ICU on


00:31:20.720 --> 00:31:23.590
dialysis to get your liver transplant


00:31:23.600 --> 00:31:25.750
you know I there's so many times in my


00:31:25.760 --> 00:31:28.269
career where I've seen a patient who has


00:31:28.279 --> 00:31:30.549
the very beginning stages of you know


00:31:30.559 --> 00:31:32.990
requiring a transplant and and they're


00:31:33.000 --> 00:31:34.430
saying well I guess I'm going to have to


00:31:34.440 --> 00:31:35.950
get sicker in order to get better and


00:31:35.960 --> 00:31:37.629
I'm like well why don't we just do this


00:31:37.639 --> 00:31:39.310
now why don't you take a month off of


00:31:39.320 --> 00:31:41.830
work you can have a liver transplant


00:31:41.840 --> 00:31:43.870
you're not going to lose out on your


00:31:43.880 --> 00:31:46.110
health put yourself at risk you're your


00:31:46.120 --> 00:31:47.870
recovery is going to be faster so


00:31:47.880 --> 00:31:49.669
there's a lot of a lot of benefits of


00:31:49.679 --> 00:31:51.710
this option unfortunately it's not you


00:31:51.720 --> 00:31:54.190
know available for everyone uh but you


00:31:54.200 --> 00:31:55.750
know it's one of those things if you


00:31:55.760 --> 00:31:58.230
know if you don't ask people no one's


00:31:58.240 --> 00:32:00.830
going to do it I I had a police officer


00:32:00.840 --> 00:32:03.389
and I he had a disease of his bod duct


00:32:03.399 --> 00:32:05.549
and and he felt like you know he didn't


00:32:05.559 --> 00:32:07.230
have anyone to donate him I said you're


00:32:07.240 --> 00:32:10.190
a police officer do do your do your


00:32:10.200 --> 00:32:11.950
fellow police officers know you need a


00:32:11.960 --> 00:32:13.629
liver transplant he goes well I don't


00:32:13.639 --> 00:32:15.389
I'm pretty private person and stuff and


00:32:15.399 --> 00:32:18.350
I go I can understand being private but


00:32:18.360 --> 00:32:21.590
I guarantee it if you go and tell your


00:32:21.600 --> 00:32:24.669
your crew of firefighters or police


00:32:24.679 --> 00:32:27.430
officers or other former military people


00:32:27.440 --> 00:32:29.509
that you need a liver transplant and he


00:32:29.519 --> 00:32:31.549
did on the following week he did and


00:32:31.559 --> 00:32:33.350
four people wanted to come forward to


00:32:33.360 --> 00:32:35.950
donate so you'd be surprised I always


00:32:35.960 --> 00:32:38.190
tell people you know I have family


00:32:38.200 --> 00:32:40.190
members who want to be the advocate for


00:32:40.200 --> 00:32:42.070
the patient and they maybe they aren't


00:32:42.080 --> 00:32:44.310
candidates to be donor but they could be


00:32:44.320 --> 00:32:47.029
a donor Champion for that recipient and


00:32:47.039 --> 00:32:49.070
getting the word out getting it out on


00:32:49.080 --> 00:32:51.310
social media mentioning you know my


00:32:51.320 --> 00:32:53.590
brother my sister my Aunt my father


00:32:53.600 --> 00:32:56.070
needs a liver transplant hey blame it on


00:32:56.080 --> 00:32:57.950
me go back to your community go to to


00:32:57.960 --> 00:32:59.830
your church and say Dr Burton says I


00:32:59.840 --> 00:33:01.350
need this you know if it makes you feel


00:33:01.360 --> 00:33:03.149
better but it's a it can make a huge


00:33:03.159 --> 00:33:05.950
difference in people's lives yeah and I


00:33:05.960 --> 00:33:07.509
think what what a lot of people don't


00:33:07.519 --> 00:33:08.870
think about well when you're the one


00:33:08.880 --> 00:33:10.909
who's sick it's hard to think about it


00:33:10.919 --> 00:33:12.750
but a lot of us in fact the majority of


00:33:12.760 --> 00:33:14.549
the population feel better when we do


00:33:14.559 --> 00:33:16.590
things to help people right for those of


00:33:16.600 --> 00:33:19.629
us who aren't sociopaths and I will say


00:33:19.639 --> 00:33:22.230
personally you know it donating the


00:33:22.240 --> 00:33:23.590
right L with my liver is one of the


00:33:23.600 --> 00:33:25.389
coolest things I've gotten to do in life


00:33:25.399 --> 00:33:27.830
and it was an honor and a privilege and


00:33:27.840 --> 00:33:30.230
I was you know I'm happy I was and still


00:33:30.240 --> 00:33:33.070
am healthy enough to do it and I think


00:33:33.080 --> 00:33:35.430
speaking with other live living donors


00:33:35.440 --> 00:33:37.190
people feel the same way like it's a


00:33:37.200 --> 00:33:39.190
really cool exciting thing to do and


00:33:39.200 --> 00:33:42.590
it's nice to be able to help someone um


00:33:42.600 --> 00:33:44.310
I've never I've never met anyone who did


00:33:44.320 --> 00:33:48.830
it who regretted it right right same I


00:33:48.840 --> 00:33:50.509
am I do have a question that I'm curious


00:33:50.519 --> 00:33:52.430
about though I think for some liver


00:33:52.440 --> 00:33:55.029
diseases um they're viewed through a


00:33:55.039 --> 00:33:57.230
lens lens of judgment or the idea that


00:33:57.240 --> 00:33:59.029
someone did this to themselves so for


00:33:59.039 --> 00:34:01.350
example with alcohol related liver


00:34:01.360 --> 00:34:05.629
disease um or metabolic liver disease do


00:34:05.639 --> 00:34:08.909
you use um let's say alcohol related


00:34:08.919 --> 00:34:10.790
liver disease do you use living donors


00:34:10.800 --> 00:34:14.790
for alcohol rated liver disease and um


00:34:14.800 --> 00:34:16.990
is there controversy about that um do


00:34:17.000 --> 00:34:19.990
people who are non-directed living


00:34:20.000 --> 00:34:23.470
donors have concern about this I mean


00:34:23.480 --> 00:34:24.950
well that's a good question I mean when


00:34:24.960 --> 00:34:27.710
I see a patient who has alcohol


00:34:27.720 --> 00:34:30.109
associated liver disease one could argue


00:34:30.119 --> 00:34:32.950
metabolic associated liver disease could


00:34:32.960 --> 00:34:36.190
you know have a role in there uh I mean


00:34:36.200 --> 00:34:37.909
historically decades ago there were


00:34:37.919 --> 00:34:39.710
people with hepatitis C who got


00:34:39.720 --> 00:34:42.349
Hepatitis C through intervenous drug use


00:34:42.359 --> 00:34:45.389
so I I mean as a physician taking care


00:34:45.399 --> 00:34:47.869
of people with liver disease my role is


00:34:47.879 --> 00:34:49.430
to take care of the person's liver


00:34:49.440 --> 00:34:51.669
disease and if I think that a living


00:34:51.679 --> 00:34:54.149
donor would be good for them that's


00:34:54.159 --> 00:34:57.430
between my me and and that recipient now


00:34:57.440 --> 00:35:00.910
when I see a donor to evaluate a donor I


00:35:00.920 --> 00:35:03.270
do ask them especially if they're coming


00:35:03.280 --> 00:35:05.910
forward to donate specifically to


00:35:05.920 --> 00:35:08.950
someone if they know why they have liver


00:35:08.960 --> 00:35:12.069
disease um I do like to hear that they


00:35:12.079 --> 00:35:14.470
know that it's due to alcohol and I do


00:35:14.480 --> 00:35:16.710
ask them you know how would it impact


00:35:16.720 --> 00:35:18.910
you if you know the recipient went back


00:35:18.920 --> 00:35:21.589
to drinking because you know


00:35:21.599 --> 00:35:25.230
alcohol um alcohol use disorders are are


00:35:25.240 --> 00:35:28.109
are diseases that are character Iz by


00:35:28.119 --> 00:35:29.950
relapse and you know the biggest


00:35:29.960 --> 00:35:31.790
predictor of long-term sobriety is maybe


00:35:31.800 --> 00:35:34.870
being sober for five years so I think I


00:35:34.880 --> 00:35:36.150
you know the fact that someone might


00:35:36.160 --> 00:35:38.630
have a slip can happen so I when I talk


00:35:38.640 --> 00:35:40.750
to a donor I always kind of go through


00:35:40.760 --> 00:35:42.349
how would that make you feel and


00:35:42.359 --> 00:35:45.109
everything and surprisingly I think the


00:35:45.119 --> 00:35:46.670
type of pre people that come forward to


00:35:46.680 --> 00:35:48.910
be donors are doing it for the right


00:35:48.920 --> 00:35:51.550
reason they aren't being judgmental and


00:35:51.560 --> 00:35:53.309
they're there to give them a chance at


00:35:53.319 --> 00:35:56.790
Living altruistic people donors that we


00:35:56.800 --> 00:35:58.309
have this is something we've been doing


00:35:58.319 --> 00:35:59.870
at the University of Colorado more and


00:35:59.880 --> 00:36:03.309
more since 2016 or


00:36:03.319 --> 00:36:07.150
17 we um if someone comes forward and


00:36:07.160 --> 00:36:09.190
and doesn't know someone and wants to


00:36:09.200 --> 00:36:12.069
donate I bring it up and say well you


00:36:12.079 --> 00:36:13.990
know liver disease from alcohol is a


00:36:14.000 --> 00:36:15.870
common cause I mean is that something


00:36:15.880 --> 00:36:17.910
you're against I've never met like an


00:36:17.920 --> 00:36:20.390
altruistic person who's already Don half


00:36:20.400 --> 00:36:21.829
of them have already donated a kidney


00:36:21.839 --> 00:36:24.109
who says oh no no it must not go to a


00:36:24.119 --> 00:36:27.030
person who drinks alcohol um I mean a


00:36:27.040 --> 00:36:28.470
lot of times


00:36:28.480 --> 00:36:31.670
uh I I can't say that most of the times


00:36:31.680 --> 00:36:34.630
um that is an issue I mean


00:36:34.640 --> 00:36:37.470
obviously if someone comes forward being


00:36:37.480 --> 00:36:40.309
altruistic you know we do want to make


00:36:40.319 --> 00:36:43.829
sure that you know we're not going to I


00:36:43.839 --> 00:36:45.430
guess my point about some if we're


00:36:45.440 --> 00:36:47.790
offering uh someone a liver transplant


00:36:47.800 --> 00:36:49.790
from an altruistic living


00:36:49.800 --> 00:36:52.470
donor we we feel that that person is


00:36:52.480 --> 00:36:54.270
going to do well with that


00:36:54.280 --> 00:36:56.630
organ much like everyone on the


00:36:56.640 --> 00:36:58.230
transplant list I mean we wouldn't put


00:36:58.240 --> 00:36:59.870
someone on the list if we didn't think


00:36:59.880 --> 00:37:02.109
they were ready to have a transplant and


00:37:02.119 --> 00:37:05.390
make good use of that that gift so uh


00:37:05.400 --> 00:37:07.309
but it's a question that comes up and I


00:37:07.319 --> 00:37:09.190
we often bring it up the hard thing is


00:37:09.200 --> 00:37:11.550
if someone says oh I was told the


00:37:11.560 --> 00:37:12.990
recipient has like you know


00:37:13.000 --> 00:37:15.190
hemocromatosis and you're like that's


00:37:15.200 --> 00:37:17.790
not what they have you know that that


00:37:17.800 --> 00:37:19.870
doesn't feel quite right but that rarely


00:37:19.880 --> 00:37:23.630
comes up so this is one of the very


00:37:23.640 --> 00:37:25.069
popular questions that we are being


00:37:25.079 --> 00:37:28.710
asked so if somebody has a lib failure


00:37:28.720 --> 00:37:29.950
due to


00:37:29.960 --> 00:37:33.710
alcoholic um abuse and they feel like


00:37:33.720 --> 00:37:35.950
they're not worthy they will never get a


00:37:35.960 --> 00:37:38.150
transplant from a disease donor from a


00:37:38.160 --> 00:37:40.430
living donor this is simply not true and


00:37:40.440 --> 00:37:42.470
the medical team will work with you and


00:37:42.480 --> 00:37:44.309
they will make sure like if if this is a


00:37:44.319 --> 00:37:46.309
person who says I've been drinking all


00:37:46.319 --> 00:37:48.309
my life and I'll continue to drink all


00:37:48.319 --> 00:37:50.430
my life well you know that's probably


00:37:50.440 --> 00:37:52.030
not the best candidate for transplant


00:37:52.040 --> 00:37:54.190
like that's not going to happen but if


00:37:54.200 --> 00:37:57.069
the medical team is certain that this


00:37:57.079 --> 00:37:59.990
person is on the path of sobriety and


00:38:00.000 --> 00:38:02.030
committed to sobriety and there are


00:38:02.040 --> 00:38:04.670
resources that available do you provide


00:38:04.680 --> 00:38:06.030
support for your patients to make sure


00:38:06.040 --> 00:38:07.870
that they still sober stay sober after


00:38:07.880 --> 00:38:08.670
the


00:38:08.680 --> 00:38:11.589
surgery well I tell people look we're


00:38:11.599 --> 00:38:13.470
not doing a brain transplant we're doing


00:38:13.480 --> 00:38:17.390
a liver transplant and you have an


00:38:17.400 --> 00:38:20.750
alcohol use disorder okay it has caused


00:38:20.760 --> 00:38:22.270
you to go into liver


00:38:22.280 --> 00:38:24.950
failure and if we just fix your liver


00:38:24.960 --> 00:38:26.390
and don't address the alcohol use


00:38:26.400 --> 00:38:28.550
disorder we are IGN ignoring the major


00:38:28.560 --> 00:38:30.910
component that caused your


00:38:30.920 --> 00:38:34.270
problem and a lot of times people I I


00:38:34.280 --> 00:38:36.550
mean I only a few times in my hisory in


00:38:36.560 --> 00:38:38.630
my career has someone said I plan to go


00:38:38.640 --> 00:38:40.349
back to drinking after a liver


00:38:40.359 --> 00:38:42.950
transplant most people say I'm never


00:38:42.960 --> 00:38:46.150
drinking again well granted that's what


00:38:46.160 --> 00:38:49.030
everyone tells me but you know data


00:38:49.040 --> 00:38:50.910
would show 20 or 30% of people will have


00:38:50.920 --> 00:38:52.750
a relapse and go back to at least some


00:38:52.760 --> 00:38:54.349
component of drinking maybe not harmful


00:38:54.359 --> 00:38:57.550
drinking so I always approach it as look


00:38:57.560 --> 00:39:00.030
we need to give you the tools to


00:39:00.040 --> 00:39:02.550
understand why you drank to understand


00:39:02.560 --> 00:39:04.910
you know what the circumstances were


00:39:04.920 --> 00:39:08.390
around why this happened to you and it's


00:39:08.400 --> 00:39:10.309
not just me making this decision it's a


00:39:10.319 --> 00:39:12.589
multidisiplinary group we have everyone


00:39:12.599 --> 00:39:15.870
who has an alcohol use disorder sees a


00:39:15.880 --> 00:39:18.069
transplant psychologist they see


00:39:18.079 --> 00:39:20.589
transplant social work they see a


00:39:20.599 --> 00:39:24.990
hepatologist and we in most cases will


00:39:25.000 --> 00:39:28.390
have the patient engage in alcohol treat


00:39:28.400 --> 00:39:29.829
going before a


00:39:29.839 --> 00:39:32.870
transplant to and it's not like just


00:39:32.880 --> 00:39:34.950
because someone is six months sober and


00:39:34.960 --> 00:39:37.190
has done the treatment oh everything's


00:39:37.200 --> 00:39:38.589
going to be fine I mean there's some


00:39:38.599 --> 00:39:41.069
people who have done alcohol treatment


00:39:41.079 --> 00:39:43.829
are six months sober and I think they're


00:39:43.839 --> 00:39:45.710
high risk to going back to drinking


00:39:45.720 --> 00:39:47.069
because they've done it all their life


00:39:47.079 --> 00:39:48.870
so I don't know why this would be any


00:39:48.880 --> 00:39:52.069
different um I think what has changed is


00:39:52.079 --> 00:39:55.109
that we have now seeing younger and


00:39:55.119 --> 00:39:57.950
younger people who have had shorter and


00:39:57.960 --> 00:40:00.510
shorter periods of heavy alcohol use who


00:40:00.520 --> 00:40:02.349
are presenting with severe alcohol


00:40:02.359 --> 00:40:04.950
Associated hepatitis where they're going


00:40:04.960 --> 00:40:08.109
to die in the next month or so without a


00:40:08.119 --> 00:40:10.230
liver transplant and they don't even


00:40:10.240 --> 00:40:13.109
have time to engage or approach their


00:40:13.119 --> 00:40:15.829
disease much less comprehend every


00:40:15.839 --> 00:40:19.230
aspect of their disease so I think it's


00:40:19.240 --> 00:40:21.270
that has been a change for our program


00:40:21.280 --> 00:40:22.790
and I think a lot of programs in


00:40:22.800 --> 00:40:25.750
developing what I might call a high-risk


00:40:25.760 --> 00:40:29.349
uh uh pathway or a limited sobriety


00:40:29.359 --> 00:40:31.990
pathway where maybe people haven't fully


00:40:32.000 --> 00:40:34.430
done the work they need to do but they


00:40:34.440 --> 00:40:37.150
show good prognostic indicators they've


00:40:37.160 --> 00:40:39.910
got social support they've got Insight


00:40:39.920 --> 00:40:41.990
they they recognize the use alcohol in


00:40:42.000 --> 00:40:43.870
them they don't have comorbid


00:40:43.880 --> 00:40:45.950
psychiatric diseases personality


00:40:45.960 --> 00:40:47.870
disorders you know it's not like they


00:40:47.880 --> 00:40:50.150
failed alcohol treatment several times


00:40:50.160 --> 00:40:51.910
including inpatient stays and things


00:40:51.920 --> 00:40:53.750
like that so they've got some good


00:40:53.760 --> 00:40:56.430
favorable factors and we've you know we


00:40:56.440 --> 00:40:59.510
started a process of evaluating patients


00:40:59.520 --> 00:41:01.670
like that uh in in


00:41:01.680 --> 00:41:04.470
2019 and I'm really glad we developed it


00:41:04.480 --> 00:41:06.670
because when the pandemic hit everything


00:41:06.680 --> 00:41:09.030
just got went nuts and uh and we were


00:41:09.040 --> 00:41:11.390
ready for that and uh you know the first


00:41:11.400 --> 00:41:13.470
30 patients we put through that that


00:41:13.480 --> 00:41:16.390
pathway uh not one of them had a relapse


00:41:16.400 --> 00:41:19.270
with phosp tidal ethanol test which is a


00:41:19.280 --> 00:41:21.910
test that can really assess for you know


00:41:21.920 --> 00:41:23.870
probably more you know at least moderate


00:41:23.880 --> 00:41:26.550
alcohol after a year after a transplant


00:41:26.560 --> 00:41:29.430
now I think when we relook at that data


00:41:29.440 --> 00:41:31.790
we said oh we may have been a little too


00:41:31.800 --> 00:41:34.069
strict in our criteria because we


00:41:34.079 --> 00:41:35.470
probably should have seen some people


00:41:35.480 --> 00:41:37.790
relapse and then you know we kind of


00:41:37.800 --> 00:41:39.630
maybe expanded a little bit and then saw


00:41:39.640 --> 00:41:42.630
some uh relapse but we've we've we've uh


00:41:42.640 --> 00:41:44.670
realized that we don't have a six-month


00:41:44.680 --> 00:41:46.710
sobriety rule there's nothing magic


00:41:46.720 --> 00:41:49.069
about six months I mean the reason


00:41:49.079 --> 00:41:51.470
sobriety should be entertained before


00:41:51.480 --> 00:41:53.589
transplant is you know your liver has


00:41:53.599 --> 00:41:55.309
the ability to regenerate as we're


00:41:55.319 --> 00:41:57.230
talking about and your liver can improve


00:41:57.240 --> 00:41:59.950
prove once you stop drinking I sometimes


00:41:59.960 --> 00:42:01.630
see people at a month that I think are


00:42:01.640 --> 00:42:04.309
going to die in the next several months


00:42:04.319 --> 00:42:06.790
and I start the process of evaluating


00:42:06.800 --> 00:42:08.309
transplant and then they come back in a


00:42:08.319 --> 00:42:10.430
month and they're dramatically better


00:42:10.440 --> 00:42:13.829
and so I think um I think sobriety the


00:42:13.839 --> 00:42:15.349
reason one should have sobriety is you


00:42:15.359 --> 00:42:17.309
might not need a


00:42:17.319 --> 00:42:19.710
transplant now someone gets to the point


00:42:19.720 --> 00:42:21.470
where it looks like they might need a


00:42:21.480 --> 00:42:23.190
transplant say they're sick enough that


00:42:23.200 --> 00:42:24.589
they would need a transplant but then


00:42:24.599 --> 00:42:26.549
they're sober they're able to get out of


00:42:26.559 --> 00:42:28.870
the hospital and they have what we call


00:42:28.880 --> 00:42:31.349
compensated therosis or you know they're


00:42:31.359 --> 00:42:32.589
able to function with their liver


00:42:32.599 --> 00:42:34.630
disease are they eventually going to


00:42:34.640 --> 00:42:36.829
probably need a transplant or could they


00:42:36.839 --> 00:42:38.230
possibly live the rest of their life


00:42:38.240 --> 00:42:40.510
like that I have I have many many


00:42:40.520 --> 00:42:43.150
patients who I have taken care of for


00:42:43.160 --> 00:42:46.150
now coming up on 20 years with alcohol


00:42:46.160 --> 00:42:47.109
related


00:42:47.119 --> 00:42:50.870
therosis who have well-defined therosis


00:42:50.880 --> 00:42:53.150
their liver works completely fine the


00:42:53.160 --> 00:42:55.109
only caveat is that they're at risk for


00:42:55.119 --> 00:42:57.790
developing liver cancer so do need to


00:42:57.800 --> 00:42:59.950
have uh at least twice annual Imaging of


00:42:59.960 --> 00:43:03.230
their liver but having therosis doeses


00:43:03.240 --> 00:43:05.150
not mean I'm going to die without a


00:43:05.160 --> 00:43:07.589
liver transplant people need liver


00:43:07.599 --> 00:43:10.390
transplants if they have therosis with


00:43:10.400 --> 00:43:13.829
complications and those would be varices


00:43:13.839 --> 00:43:15.710
these dilated veins in the esophagus


00:43:15.720 --> 00:43:18.390
that can bleed aites fluid in the


00:43:18.400 --> 00:43:22.270
abdomen ayop goofy confusion from not


00:43:22.280 --> 00:43:24.750
being able to clear toxins or liver


00:43:24.760 --> 00:43:26.230
cancer those are reasons to have a


00:43:26.240 --> 00:43:28.230
transplant there's also you could you


00:43:28.240 --> 00:43:30.150
might be doing totally fine but there's


00:43:30.160 --> 00:43:32.670
a scoring system called the meld score


00:43:32.680 --> 00:43:34.710
and then and if it's you know it used to


00:43:34.720 --> 00:43:37.870
be 15 it's probably down closer to 11


00:43:37.880 --> 00:43:40.510
where you will have benefit of having a


00:43:40.520 --> 00:43:42.190
liver transplant than keeping your


00:43:42.200 --> 00:43:44.190
current liver but the type of patient


00:43:44.200 --> 00:43:46.069
you're talking about that I take care of


00:43:46.079 --> 00:43:47.870
has a mild score of six or eight that's


00:43:47.880 --> 00:43:50.710
my mild score is six so it is not a


00:43:50.720 --> 00:43:52.710
death sentence and I I wish there were


00:43:52.720 --> 00:43:55.910
people who so many times I see people in


00:43:55.920 --> 00:43:58.150
my clinic who are coming to see me for a


00:43:58.160 --> 00:43:59.990
consult and they've spent the last month


00:44:00.000 --> 00:44:01.630
waiting to see me thinking I'm going to


00:44:01.640 --> 00:44:04.230
die any minute now and then I say well


00:44:04.240 --> 00:44:05.990
the good news is you're going to make it


00:44:06.000 --> 00:44:08.430
you know and and so just having therosis


00:44:08.440 --> 00:44:11.150
is not a death sentence and I have lots


00:44:11.160 --> 00:44:13.549
of patients with therosis the management


00:44:13.559 --> 00:44:15.670
of that is really making sure you get


00:44:15.680 --> 00:44:18.069
screening for cancer which uh in


00:44:18.079 --> 00:44:19.870
patients with alcohol associated liver


00:44:19.880 --> 00:44:22.950
disease hepatitis C even if it's been


00:44:22.960 --> 00:44:24.790
cleared you know you're talking about


00:44:24.800 --> 00:44:27.589
rates of 2 to 4% a year of getting


00:44:27.599 --> 00:44:29.870
cancer you know I've got hundred of


00:44:29.880 --> 00:44:32.309
those patients uh being seen in my uh


00:44:32.319 --> 00:44:34.190
office every month I mean two or four of


00:44:34.200 --> 00:44:36.230
them are going to get cancer every month


00:44:36.240 --> 00:44:37.910
now you can't with liver cancer that


00:44:37.920 --> 00:44:39.870
often requires transplant because the


00:44:39.880 --> 00:44:41.750
definitive treatment of liver cancer is


00:44:41.760 --> 00:44:43.790
surgery and if you have curosis you


00:44:43.800 --> 00:44:45.390
can't often just whack off half your


00:44:45.400 --> 00:44:47.710
liver to take a tumor out so it often is


00:44:47.720 --> 00:44:49.910
an indication for a liver


00:44:49.920 --> 00:44:52.829
transplant I would like to ask you how


00:44:52.839 --> 00:44:55.910
can you test your liver health I just


00:44:55.920 --> 00:44:57.470
had a conversation with with the


00:44:57.480 --> 00:45:00.870
volunteer two days ago and he said oh I


00:45:00.880 --> 00:45:03.190
go to this acupuncturist and she does


00:45:03.200 --> 00:45:04.750
something and she tells me the precise


00:45:04.760 --> 00:45:06.270
health of all my


00:45:06.280 --> 00:45:09.150
organs let's address that and what can


00:45:09.160 --> 00:45:11.390
you actually do to find out how healthy


00:45:11.400 --> 00:45:12.309
is your


00:45:12.319 --> 00:45:15.030
liver well that sounds wonderful I I


00:45:15.040 --> 00:45:17.710
wish I had that test to be able to tell


00:45:17.720 --> 00:45:20.630
everyone well I mean I sometimes see


00:45:20.640 --> 00:45:23.230
people who have had Imaging of their


00:45:23.240 --> 00:45:25.349
liver that shows therosis and you look


00:45:25.359 --> 00:45:27.710
at their Labs you look at them and


00:45:27.720 --> 00:45:29.710
there's no way to know that they had


00:45:29.720 --> 00:45:32.270
therosis I mean it is true that most


00:45:32.280 --> 00:45:35.230
people with with with liver disease have


00:45:35.240 --> 00:45:37.390
overt evidence of it with abnormal liver


00:45:37.400 --> 00:45:40.470
test but there are there are uh you know


00:45:40.480 --> 00:45:42.670
with hepatitis C for example 10% of


00:45:42.680 --> 00:45:44.549
people with normal liver test people


00:45:44.559 --> 00:45:46.470
used to think oh you don't need any


00:45:46.480 --> 00:45:48.430
treatment or worry about this but 10% of


00:45:48.440 --> 00:45:49.829
people with hepatitis C would develop


00:45:49.839 --> 00:45:51.950
curosis there's a percentage of people


00:45:51.960 --> 00:45:53.670
out there with fatty liver disease with


00:45:53.680 --> 00:45:56.549
obesity diabetes uh who probably are


00:45:56.559 --> 00:45:58.510
developed fibrosis with normal liver


00:45:58.520 --> 00:46:02.790
test so I don't I I mean in terms of uh


00:46:02.800 --> 00:46:05.190
you know are there true liver function


00:46:05.200 --> 00:46:07.790
test there are a few tests out there


00:46:07.800 --> 00:46:10.990
that can actually um assess you know the


00:46:11.000 --> 00:46:13.390
function of the liver they're not


00:46:13.400 --> 00:46:15.230
something you do probably for people who


00:46:15.240 --> 00:46:18.309
don't have any other suggestion or signs


00:46:18.319 --> 00:46:21.030
of that um I would have a hard time


00:46:21.040 --> 00:46:22.710
thinking that you could stick a needle


00:46:22.720 --> 00:46:24.870
someplace in the body and know


00:46:24.880 --> 00:46:28.109
everything about it but um I don't I


00:46:28.119 --> 00:46:29.950
must admit I don't have uh that


00:46:29.960 --> 00:46:33.510
experience or expertise but um I would


00:46:33.520 --> 00:46:36.069
say just because someone I mean there's


00:46:36.079 --> 00:46:38.750
people out there with fat in their liver


00:46:38.760 --> 00:46:40.349
who have normal liver tests who don't


00:46:40.359 --> 00:46:42.309
know it and it gets picked up


00:46:42.319 --> 00:46:44.710
incidentally well just having simple fat


00:46:44.720 --> 00:46:47.829
in your liver may not be a problem


00:46:47.839 --> 00:46:49.430
however if you have simple fat in your


00:46:49.440 --> 00:46:51.470
liver because you drink too much alcohol


00:46:51.480 --> 00:46:53.549
that's a potential problem if you have


00:46:53.559 --> 00:46:55.349
fat in your liver and you're obese and


00:46:55.359 --> 00:46:57.390
you have borderline diabetes


00:46:57.400 --> 00:46:58.910
that potentially could be a problem in


00:46:58.920 --> 00:47:01.349
the future so I think when you find


00:47:01.359 --> 00:47:04.230
these things it is it does lead to you


00:47:04.240 --> 00:47:07.349
know raising your threshold and and


00:47:07.359 --> 00:47:09.549
trying to you know modify the risk


00:47:09.559 --> 00:47:11.190
factors that might put you at risk for


00:47:11.200 --> 00:47:14.069
developing liver disease in the


00:47:14.079 --> 00:47:17.390
future and I will say I I do have people


00:47:17.400 --> 00:47:20.230
come to me and say that they're worried


00:47:20.240 --> 00:47:22.069
they drink too much can I check their


00:47:22.079 --> 00:47:25.710
liver enzymes and I often say sure yes


00:47:25.720 --> 00:47:27.390
we can


00:47:27.400 --> 00:47:29.990
also your liver enzymes may be just fine


00:47:30.000 --> 00:47:31.150
and that doesn't mean you're not


00:47:31.160 --> 00:47:34.109
drinking too much


00:47:34.119 --> 00:47:36.790
um yeah absolutely I


00:47:36.800 --> 00:47:40.470
mean I sometimes see people who I see


00:47:40.480 --> 00:47:42.549
and knowing they have alcohol associated


00:47:42.559 --> 00:47:45.069
liver disease and then you know they go


00:47:45.079 --> 00:47:46.910
on a period of sobriety and then they


00:47:46.920 --> 00:47:48.510
see their liver test are normal and then


00:47:48.520 --> 00:47:50.309
they think oh I can go back to drinking


00:47:50.319 --> 00:47:52.790
so I mean I think the difference between


00:47:52.800 --> 00:47:55.589
an alcohol use disorder and having


00:47:55.599 --> 00:47:57.630
alcohol associated liver disease are two


00:47:57.640 --> 00:47:59.750
different things there are way more


00:47:59.760 --> 00:48:01.470
people out there drinking way too much


00:48:01.480 --> 00:48:03.990
alcohol putting themselves at risk you


00:48:04.000 --> 00:48:07.990
know climbing ladders driving


00:48:08.000 --> 00:48:11.270
intoxicated falling down the stairs you


00:48:11.280 --> 00:48:13.309
know not to mention you know their


00:48:13.319 --> 00:48:15.589
relationships with other people their


00:48:15.599 --> 00:48:18.870
spouses their family you know engage and


00:48:18.880 --> 00:48:21.190
impacts on their work that have nothing


00:48:21.200 --> 00:48:24.829
to do with the health of their liver um


00:48:24.839 --> 00:48:26.470
and and as we've said multiple times


00:48:26.480 --> 00:48:28.670
there's so many benefits of of limiting


00:48:28.680 --> 00:48:31.109
alcohol not just for you know Liver


00:48:31.119 --> 00:48:34.190
Health um and and having liver normal


00:48:34.200 --> 00:48:36.990
liver enzymes would be suggestive of


00:48:37.000 --> 00:48:38.950
it's not causing major problems for your


00:48:38.960 --> 00:48:40.990
liver today but it doesn't mean go out


00:48:41.000 --> 00:48:42.950
and drink more or don't address all the


00:48:42.960 --> 00:48:45.390
problems alcohol may have in your


00:48:45.400 --> 00:48:47.670
life and I think it's important to point


00:48:47.680 --> 00:48:49.589
out that alcohol use disorder does not


00:48:49.599 --> 00:48:51.470
discriminate right so I treat a lot of


00:48:51.480 --> 00:48:54.109
very high functioning patients including


00:48:54.119 --> 00:48:56.789
Physicians and um you know other


00:48:56.799 --> 00:48:58.309
professionals who have alcohol use


00:48:58.319 --> 00:49:01.510
disorder and it it's also not a disorder


00:49:01.520 --> 00:49:03.950
of fault it's a you know it's


00:49:03.960 --> 00:49:06.069
a like you said you don't do a brain


00:49:06.079 --> 00:49:08.270
transplant it is a brain disorder and it


00:49:08.280 --> 00:49:10.309
it's a brain disorder that we have


00:49:10.319 --> 00:49:13.270
treatments for and you know I asked


00:49:13.280 --> 00:49:15.230
earlier what can people do if they're


00:49:15.240 --> 00:49:16.950
afraid they might be drinking too much


00:49:16.960 --> 00:49:19.950
and um one we'll put some resources in


00:49:19.960 --> 00:49:22.150
the description of the video here so


00:49:22.160 --> 00:49:24.190
that you can um kind of check things out


00:49:24.200 --> 00:49:26.710
on your own and also I would encourage


00:49:26.720 --> 00:49:28.950
encourage you to go to your primary care


00:49:28.960 --> 00:49:31.510
doctor or even your therapist and and


00:49:31.520 --> 00:49:33.270
just broach the topic and say hey I'm


00:49:33.280 --> 00:49:35.349
worried that I might be drinking too


00:49:35.359 --> 00:49:40.069
much and um most providers will not be


00:49:40.079 --> 00:49:42.069
judgmental they'll actually be thrilled


00:49:42.079 --> 00:49:43.309
that you brought it up and they're


00:49:43.319 --> 00:49:44.870
curious and that you're interested in in


00:49:44.880 --> 00:49:46.789
learning more and um we'll be able to


00:49:46.799 --> 00:49:49.030
support you in that if you don't feel


00:49:49.040 --> 00:49:51.069
comfortable going to uh Healthcare


00:49:51.079 --> 00:49:54.789
professional you can um just Google um


00:49:54.799 --> 00:49:56.789
alcohol support groups and you'll find


00:49:56.799 --> 00:49:58.390
all sorts of groups there's AA if you're


00:49:58.400 --> 00:50:01.109
not a big fan of AA there's uh different


00:50:01.119 --> 00:50:04.230
variations of peer support groups um as


00:50:04.240 --> 00:50:06.309
Anastasia mentioned there's apps you can


00:50:06.319 --> 00:50:08.190
just go into your app store and Google


00:50:08.200 --> 00:50:10.990
alcohol use or stop drinking or you know


00:50:11.000 --> 00:50:12.349
anything like that you'll find apps that


00:50:12.359 --> 00:50:14.470
can help you so you know I think we've


00:50:14.480 --> 00:50:16.109
talked about a lot of things today that


00:50:16.119 --> 00:50:18.309
might be kind of scary and might make


00:50:18.319 --> 00:50:20.069
people feel bad like they maybe they're


00:50:20.079 --> 00:50:22.190
doing something wrong and I guess what I


00:50:22.200 --> 00:50:23.710
really want to highlight is it's it's


00:50:23.720 --> 00:50:26.309
not wrong it's just something that can


00:50:26.319 --> 00:50:27.950
affect your health and there are things


00:50:27.960 --> 00:50:29.870
you can do about it so it's important I


00:50:29.880 --> 00:50:32.270
think to be aware of the impact it can


00:50:32.280 --> 00:50:35.789
have I I couldn't agree more I think one


00:50:35.799 --> 00:50:37.670
thing I do see is patients who are


00:50:37.680 --> 00:50:39.870
preferred to me they've got liver


00:50:39.880 --> 00:50:43.390
disease and for some reason in their


00:50:43.400 --> 00:50:45.230
mind you know someone with an alcohol


00:50:45.240 --> 00:50:47.470
use disorder is someone drinking out of


00:50:47.480 --> 00:50:50.430
a paper bag and you know in the alley


00:50:50.440 --> 00:50:53.109
you know I've seen very successful you


00:50:53.119 --> 00:50:56.150
know companies business company owners


00:50:56.160 --> 00:50:58.390
and I've seen mothers taking care of


00:50:58.400 --> 00:51:01.030
three children who do an excellent job


00:51:01.040 --> 00:51:02.510
of taking care of their kids the problem


00:51:02.520 --> 00:51:04.670
is when the kids go to bed they're


00:51:04.680 --> 00:51:06.589
turning on Netflix and having forg and


00:51:06.599 --> 00:51:08.390
tonics you know but they get up and do


00:51:08.400 --> 00:51:09.990
the work the next day so I mean these


00:51:10.000 --> 00:51:13.750
are it's it's um yeah it is not uh I


00:51:13.760 --> 00:51:15.190
think there's a stigma sometimes


00:51:15.200 --> 00:51:17.510
associated with this uh that maybe


00:51:17.520 --> 00:51:19.510
prevents people from getting help I mean


00:51:19.520 --> 00:51:21.630
there's now you can do alcohol treatment


00:51:21.640 --> 00:51:25.829
completely online these days um and you


00:51:25.839 --> 00:51:27.309
know that's very


00:51:27.319 --> 00:51:29.190
helpful for us living in a rural


00:51:29.200 --> 00:51:31.349
environment where people can't get to


00:51:31.359 --> 00:51:33.109
some of these resources but there's a


00:51:33.119 --> 00:51:35.030
lot of different options as you mention


00:51:35.040 --> 00:51:36.870
I think for people to get the help they


00:51:36.880 --> 00:51:38.390
need and I think the first thing is just


00:51:38.400 --> 00:51:40.549
maybe doing an inward look and seeing


00:51:40.559 --> 00:51:42.069
how much you do you know there are some


00:51:42.079 --> 00:51:45.630
calculators online uh uh uh that can


00:51:45.640 --> 00:51:48.349
questionnaires uh I think audit is one


00:51:48.359 --> 00:51:50.430
where you can fill out 10 questions and


00:51:50.440 --> 00:51:52.150
it kind of puts you in a category of


00:51:52.160 --> 00:51:55.630
whether alcohol has it the CDC has a a


00:51:55.640 --> 00:51:58.109
check your drinking uh part of their


00:51:58.119 --> 00:52:00.910
website that asks you questions and then


00:52:00.920 --> 00:52:03.030
tells you what the chances are you might


00:52:03.040 --> 00:52:04.549
have a problem with alcohol and I think


00:52:04.559 --> 00:52:06.630
those are some things to kind of


00:52:06.640 --> 00:52:07.990
consider and start


00:52:08.000 --> 00:52:11.349
with and also if you are drinking


00:52:11.359 --> 00:52:13.549
heavily more than several drinks a day


00:52:13.559 --> 00:52:15.349
you probably don't want to just stop


00:52:15.359 --> 00:52:16.589
because a lot of people will go through


00:52:16.599 --> 00:52:18.470
alcohol withdrawal so it's important you


00:52:18.480 --> 00:52:21.230
reach out for support in in um cutting


00:52:21.240 --> 00:52:23.470
back and eventually


00:52:23.480 --> 00:52:26.589
quitting and if you are on the weight


00:52:26.599 --> 00:52:29.230
list for a lever transplant or you


00:52:29.240 --> 00:52:31.309
interested in learning more learning


00:52:31.319 --> 00:52:33.710
more about leaving lever donation we


00:52:33.720 --> 00:52:36.589
have an incredible mentorship program at


00:52:36.599 --> 00:52:38.589
the American transplant foundation so


00:52:38.599 --> 00:52:40.549
make sure to check it out and maybe you


00:52:40.559 --> 00:52:44.309
can even get Rachel as your


00:52:44.319 --> 00:52:46.950
Mentor all right well thank you Dr


00:52:46.960 --> 00:52:48.630
Burton and Anastasia I think this has


00:52:48.640 --> 00:52:50.109
been a very interesting and useful


00:52:50.119 --> 00:52:52.710
discussion and um it's been a pleasure


00:52:52.720 --> 00:52:55.270
talking with you it's been my pleasure


00:52:55.280 --> 00:52:56.829
talking with you as well have a great


00:52:56.839 --> 00:53:03.710
day thank


00:53:03.720 --> 00:53:06.510
you up


00:53:06.520 --> 00:53:11.390
call W you get out the sun is creeping


00:53:11.400 --> 00:53:15.880
wake wake up call