Asking for a Friend - Health, Fitness & Personal Growth Tips for Women in Midlife

Ep.148 The Overlooked Key to Midlife Health: Why Your Liver Deserves More Love

• Michele Henning Folan • Episode 148

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The Missing Piece in Your Midlife Health: Why Your Liver Matters

You’re doing all the right things—eating well, moving, prioritizing sleep—but if your liver isn’t functioning optimally, your metabolism, hormones, and energy levels may still be working against you.

Your liver is a powerhouse, detoxifying your body, balancing hormones, and supporting fat metabolism. Yet, 30-40% of adults—especially midlife women—struggle with fatty liver disease without even knowing it. Symptoms like fatigue, stubborn weight gain, and poor sleep often appear long before lab work reveals a problem.

Dr. Supriya Joshi, a liver specialist, joins us to explain why midlife women are at higher risk and how simple habits—like strength training and even coffee—can support liver health. The best part? Your liver can heal in just months with the right approach.

Ready to optimize your health? Check out Dr. Joshi’s website for her liver health masterclass and 1:1 coaching.

You can find Dr. Supriya Joshi at:

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Are you ready to reclaim your midlife body and health? I went through my own personal journey through menopause, the struggle with midsection weight gain, and feeling rundown. Faster Way, a transformative six-week group program, set me on the path to sustainable change. I'd love to work with you! Let me help you reach your health and fitness goals.
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Michele Folan:

Hey there, if you've been watching from the sidelines telling yourself I'll start next week or I'll start when things aren't so crazy in my life, this is your wake-up call. Another year of feeling sluggish, frustrated with belly and back fat and stuck no thanks, you deserve better, and I've been where you are. I know how hard midlife changes can be, but here's the truth. Your body can feel strong, energized and capable again with the right strategy and support. That's exactly what I do in my coaching. So stop waiting. Let's make this the year you actually put yourself first. My next six-week midlife reset starts soon, so grab your spot now. Just email me at mfolan that's F as in Frank O-L-A-N. Fasterway at gmailcom. Your future self will thank you.

Michele Folan:

Health, wellness, fitness and everything in between. We're removing the taboo from what really matters in midlife. I'm your host, Michele Folan, and this is Asking for a Friend. Episode 87 on liver health was a game changer and it's still one of the top most listened to episodes of Asking for a Friend and honestly, I'm not surprised. The liver is one of the most powerful yet often overlooked organs when it comes to our overall health, especially in midlife. As I continue working with clients struggling with metabolic issues, it's become even more clear that supporting the liver is key to better energy, hormone balance and long-term wellness. That's why I knew I had to bring back Dr Supriya Joshi for a deeper dive into this critical topic. In this episode, we're unpacking why your liver health really matters, how it impacts everything from metabolism to aging, and what simple, practical steps you can take to keep it thriving. Dr Supriya Joshi, welcome to Asking for a Friend.

Supriya Joshi, MD:

Michele, thank you so much for having me back. I still remember how much fun I had the very first time we chatted and I'm so grateful that your community and people who are listening to you really realize how important the liver health can be for their future health.

Michele Folan:

Well, again, we think of it as that organ that processes alcohol, right, but of course it does so much more. Before we start and I do this every time I want to get rolling into the topic, but it would be really great for the audience to learn a little bit more about you, namely where you're from, your background, where you studied, and then also kind of like some family details, because people are always curious.

Supriya Joshi, MD:

Oh sure.

Supriya Joshi, MD:

So I was born and raised in the Toronto area in Canada and I went to medical school, did my residencies all at the University of Western Ontario in Toronto and I went to medical school, did my residencies all at the University of Western Ontario in Toronto and I'm a practicing gastroenterologist and I did further specialization in liver disease, which took a lot of years, and I've been initially in academic practice, then moved most of my career to community practice in one of the largest urban centers outside Toronto and after 20 years in full-time practice, I just went part-time a year ago to focus on liver disease and metabolic health and, realizing that people need more information, I've taken some coursework and coaching and lifestyle medicine.

Supriya Joshi, MD:

I'm hoping to bring more information and education to empower my patients. So that's me professionally. I am married, I have an amazing husband and partner in life, I've got three great kids and my eldest is about to go to university. So we're at a very exciting phase in our lives and I'm blessed to have my parents nearby, who are aging. I'm sure a lot of us can relate to being in the sandwich generation and I'm the eldest of three siblings and I just love being active and traveling when I can.

Michele Folan:

Oh, wonderful. And speaking of family, you recently celebrated a great aunt's 100th birthday and that's such a huge milestone. You know what do you feel like made the biggest difference for her? How did she get so inspired to age intentionally?

Supriya Joshi, MD:

You know it's fascinating. She's just such a vibrant woman. She's still vibrant. You know she's only now being forced to use a walker, but she can walk independently and she's still very sharp. But I think her secret is always learning, always having a curious mind. She's a very active reader, very knowledgeable on world historic events, still remembers every date to this day and she is a social butterfly. Even this past weekend you know she wasn't tired we kept asking are you tired, want to get some rest? Nope, she is out there to celebrate and party as much as she can. And I remember growing up and visiting them. They were always hosting parties. And I remember growing up and visiting them. They were always hosting parties. So I think that active effort as social connections is a very big part of her success in life and in health, those blue zones.

Michele Folan:

They talk about community and people that get out and they go to the coffee shop. They're at the market shopping. You know all those things are super important to longevity, so we can't minimize that.

Supriya Joshi, MD:

Totally. She lives her life with as many friends as she possibly can. She's always got visitors, so I think that's a big message to all of us. You know, don't live in isolation, and if you see someone reach out and make a comment about them or to them, that engages someone else as well, right, versus just walking by in your own lane.

Michele Folan:

You know, what I love about following you, Supriya, is that you aren't just focused on liver health, you talk about all aspects of midlife health and it just seems that there's this interconnectedness in our bodies with all these systems. Can you talk a little bit about that, because I think you going from being a gastroenterologist to specializing in the liver, I think there's a tie in here.

Supriya Joshi, MD:

Absolutely so.

Supriya Joshi, MD:

When I see patients with my liver hat on, it's because there's something going on with their liver health, whether it's fatty liver or growth, or I have normal liver tests.

Supriya Joshi, MD:

But when I talk about the treatment, when it comes down to their lifestyle which is really a really underlying common theme for so many diseases we see today and that many of my patients already have, when I'm talking to them, so as a gastroenterologist and people will come to me with bloating and heartburn or altered bowel habit, a lot of the time the fix is increase your fiber intake, cut back on the processed food and junk food and sugar. Same things apply to majority of causes of liver disease and the same thing applies to prediabetes, type 2 diabetes, high blood pressure, high cholesterol, and the end result here is reducing someone's risks of a cardiovascular fatality. So there is a connectiveness and you've seen right through it and it's convincing our patients and the community and the people that there is a connection and we aren't born with the destiny to have these outcomes, but by making consistent efforts we can actually alter that life path.

Michele Folan:

There are detoxes that get advertised out there and I wanted to bring this up first because I see people talking about them, advertising them. You addressed this on the last podcast, but I think it is important to bring back up again. Are these liver detoxes necessary and what is really the end game with them?

Supriya Joshi, MD:

Companies that manufacture detoxes, which is a supplement or a drink or some concoction they want you to buy and consume, is nothing more than them preying on someone's weaknesses or inability or not having the knowledge that they can fix things themselves, and you're just putting money in their bank accounts. So there is nothing people can consume to detox their liver or improve their liver and health by consuming something. You actually have to pivot and change what you're normally eating and drinking and how much you move your body and your sleep quality and your stressors. So that's the whole basket under the umbrella of lifestyle and there's no point in spending your money buying these other concoctions because they're not going to do anything. In fact, they could cause more harm.

Michele Folan:

Okay, you brought something up just a second ago about sleep and stressors. I don't know a lot of doctors out there that are really talking about sleep and stressors. How does that relate to overall liver health?

Supriya Joshi, MD:

Oh, a great question, I'm glad you asked that. Actually, overall liver health oh a great question, I'm glad you asked that actually. So when we don't sleep well for a variety of reasons whether it's late night, eating, alcohol consumption, sleep apnea, vasomotor symptoms of menopause or stress, keeping you up at night when you don't sleep, data shows the next day our core temperature is a little bit lower and we tend to seek comfort with comfort foods, and that can lead to weight gain and people are less physically active. So poor sleep can have a role on how you behave the next day, and often those behaviors next day aren't going to lead you to improved health. It's more about comfort seeking.

Supriya Joshi, MD:

So poor sleep is a direct correlation with a lot of leading to a lot of potential metabolic dysfunction and weight gain, and that ties into late night snacking and eating and, you know, even alcohol. So that's one way sleep contributes. And then there's the underlying reason why you're not sleeping, like if sleep apnea is present. That's already a manifestation of insulin resistance. And then we talk about cortisol or stress. We are tied into cortisol. We're tied into again it's the habits that lead people to seek comfort when they're under stress, and maladaptive coping skills are evident in many people. They just don't realize it, you know, seeking comfort from comfort from alcohol or a sugary drink or a piece of cake or snacking. They're not hungry, but they're seeking comfort and I think when people are under stress that's a normal adaptive behavior for a lot of people.

Michele Folan:

These are a lot of the same things that I talk about with my clients is get good sleep. You know, when you're stressed you get cortisol and then you get more ghrelin and then you're hungrier and you're making poor food choices. So I love this because it's like if we can all get on the same page and be speaking the same language, people will figure it out, but they're lucky to have you, because you obviously are very passionate about this and you really care. So I do appreciate that let's talk about fibrosis and fatty liver, because I believe we probably need to have some differentiation here of the two, because I'm not sure we all really know the difference between like fibrosis we think of there's like we have cirrhosis, right? Is cirrhosis part of fibrosis?

Supriya Joshi, MD:

Cirrhosis is the end result of ongoing progressive liver fibrosis. I'm happy to explain this. This is a really important thing to understand. So when somebody has a diagnosis of fatty liver, which means fat, the actual cell is in the liver and liver fat or fat's not supposed to be in the liver. A normal, healthy liver does not have that much fat in it. Under 5% is considered to be in normal health. So when someone has issues in their life that allows fat to be paused in the liver, it's now a disease state. So just the presence of liver fat means insulin resistance is present. Now the other options are that liver fat just stays there but the liver disease does not progress. So this person has fatty liver but if they don't change the reasons why it got there, then the liver fat will worsen.

Supriya Joshi, MD:

But then there's two avenues or two paths to go down, and sometimes they do overlap.

Supriya Joshi, MD:

The first is you just get progressive liver fat but you don't get the response of liver fibrosis, liver inflammation or liver cirrhosis.

Supriya Joshi, MD:

So I've got many people that have fatty liver disease without fibrosis and I tell them you know, your liver will last you your lifetime. You're not going to lead, get to develop cirrhosis and liver transplant, and that risk is very low. But if you don't make those changes of why you got fatty liver, you're going to go down this path and develop type 2 diabetes, hypertension and have a higher risk of heart disease and multiple cancers. However, we also know that people that have the comorbidities of type 2 diabetes, obesity and hypertension those people have the risk factors to have progression of liver fibrosis towards liver cirrhosis. So it's the people that have already developed multiple metabolic diseases. They're the ones at risk of liver failure, liver cancer and possibly needing a liver transplant in their lifetime. So, just to make it clear, people can just have liver fat, but no progressive liver disease, versus the people who have progressive liver fibrosis through the inflammatory response and liver scarring. So there's two trajectories, both of which, though, are also associated with metabolic diseases.

Michele Folan:

Can you reverse fatty liver disease?

Supriya Joshi, MD:

Yes, and you can also reverse fibrosis if it's early enough. How do you do that? Well, persistent, consistent changes in whatever has led to the cause. So the terminology was non-alcoholic fatty liver disease, but now we realize there's actually an overlay. There are people who do drink alcohol. Plus they have dysfunctional lifestyles, or dysfunction might be a bit harsh, but you know not the most adaptive mechanisms in their lifestyle. So you want to minimize and ideally abstain from alcohol. We know that low risk alcohol intake is under two drinks a week, but none is best. More than three drinks a week is where you start to get the increased risks of heart disease and multiple cancers. So keeping a low is always best for overall health. Then we talk about the other causes in the lifestyle, and a big part of it is nutrition and physical activity and poor sleep are the biggest factors in all of this, in addition to some genetics susceptibility in some individuals.

Supriya Joshi, MD:

So when it comes to how you prevent it, I make people aware well, what are your current habits? You need to have self-actualization Like what are the habits you're living through right now, and has it been this way for the last few years, 10 years, your whole life, or is it just a very recent episode. So then we want to know is do you put sugar in your coffee or tea? Do you drink juice? Do you drink pop? Do you drink all those fancy, you know Starbucks drinks or whatever coffee vendor you're going to? And then what do you eat, you know, are you a bagel, a morning person? Are you someone who puts jam on their bread every day? Do you have cereal every day? And what are your lunch and dinner choices? And then do you snack and do you eat late at night? So that's the whole nutritional component of it.

Supriya Joshi, MD:

And then making people reflect back on that many people did not get the education on macronutrients. There's fats, proteins, carbohydrates, and are you getting protein in your diet? Are you getting enough fiber in your diet? Are you someone whose plate is filled with, you know, rice and beans, or you know, or a big, large bowl of pasta devoid of any vegetables? So those are the kind of questions people understand what they're consuming on a regular basis. So what are their dietary habits? Then comes are you moving? Do you walk? Do you get up after your meals? Are you sedentary at a desk all day long? And do you make any specific intentional effort to strengthen and move your body. So I think those are the main things that we try to focus on and then often, I hope, a little alarm bell goes off in their minds to realize they have to make some changes.

Michele Folan:

Yeah, because if you start painting the picture of what the long-term consequences are of possibly liver transplant or something like that, I mean I know that would scare the heck out of me, but sometimes changing those habits is a challenge in itself.

Supriya Joshi, MD:

Absolutely. And so while they may not necessarily have to worry about having end-stage liver disease, but it's in five more years, do you want to be on seven different pills? Yeah, you know, and if you can make these changes, you might come off some of these pills, and that's really an amazing thing to think about. And when we look at the globe, like what is the prevalence here, 30 to 40% of adults will have metabolic liver disease and 20% of them will go on to have progressive fibrosis, and that's the MASH metabolic dysfunction associated steatohepatitis, or MASH, m-a-s-h for short. And of those people with some element of inflammation and fibrosis, 6% are going to develop end-age liver disease. So when you look at those sheer volume of number of people affected by this, this is going to be a huge problem.

Michele Folan:

How are you diagnosing liver disease? Is it blood tests? Is it an ultrasound? What's typically the protocol here? Sure.

Supriya Joshi, MD:

So I think, initially because I'm a specialist people are often diagnosed or the alarm goes off in their primary care practitioner's office. So it's most often they've had blood work done for routine you know part of their routine physical or for monitoring of the side effect of medications they're already on and the liver enzymes are elevated. The other scenario is someone complaining of abdominal discomfort and then they go get an ultrasound. So if you have abnormal liver enzymes, an ultrasound needs to be done to make sure that there's nothing anatomically infiltrating the liver. Is it gallstones? Is there a growth? That needs to be done? So that's often how it's first alerted to the individual and then they get a further investigation. So what is the cause? Is there alcohol? Are there any? You know detoxes, herbal therapies, supplements you're taking. Are there other medications? You've seen other? You know caregiver for that you haven't shared with me. It's always what are people consuming is always the first question we really need to interrogate about. And then it comes down to looking for symptoms to be suggestive of other causes. You know, have you had health care in other countries? Have you had contaminated needles? You know hepatitis B, hepatitis C. Have they been ever screened for those things before, especially in the baby boomer population. You know where they're at risk of hepatitis C just by being a birth cohort when were you born, where have you traveled? And those give other suggestions for viral hepatitis risks.

Supriya Joshi, MD:

And then there's symptoms. You know, could they have autoimmune liver disease? Is there a family history of liver disease? And you're looking for genetic components. And then once we kind of figure out what the cause is, we then want to know well, what is the severity? Do you have fibrosis or not? Because that is really an important question. So that's a combination from some blood tests that we do abdominal ultrasound, and then fortunately most things today are non-invasive. So we can do a fibro scan, which is a non-invasive way to measure for liver fat and fibrosis stage. And there's also a blood test people can get calculated, called a FIB4, where they just plug in into the algorithm. You know their age, their platelet count and their AST values and then that will tell you are you low risk, intermediate or high risk for liver fibrosis? And then for very few people we still need to do a liver biopsy. But those are the traditional ways we assess someone for the cause of their liver disease and what their stage is.

Michele Folan:

You brought up hepatitis and maybe a differentiation here between B and C would be helpful, and then kind of the prevalence of it and how often are you seeing it in your practice?

Supriya Joshi, MD:

Okay, so we'll get down to the science here. So hepatitis B is a DNA virus and hepatitis C is an RNA virus, and that differentiates them in terms of how they work their way into our bodies. Both are blood-borne or body fluid-based infectious viruses that enter the body, often with tainted blood. Hepatitis B is extremely common in Asia, sub-saharan Africa versus. Hepatitis C is pretty much everywhere else in the world. Europe has also been affected by it, often related to needles or blood transfusions from way back, you know, decades ago.

Supriya Joshi, MD:

But both these viruses are often silent. They don't cause people symptoms. Sometimes they might make someone have yellowing of the eyes or jaundice, but most of the time there's no symptoms and it's detectable by screening for these antigens or antibodies and blood tests through liver enzymes and viral counts, and then, based on that, they can then be assessed for stage of liver disease and then go on towards treatment. So hepatitis C is now very much curable with all oral medications and as little as eight weeks and hardly any side effects. So right now the World Health Organization has made a goal to eradicate hepatitis C from the planet by 2030.

Supriya Joshi, MD:

Oh, wow. So to do that, we need people to be actively screened. You see, your primary care health provider, all you get is a hepatitis C antibody test and that will indicate if you are someone who might be at risk and then get that confirmed and treated. Whereas hepatitis B we have a vaccination for. This can be prevented and so many places around the world do advocate for vaccination at birth or around age 12. That's the other school-age children but that's very much preventable but not curable. So we have to treat people for hepatitis B.

Michele Folan:

Thank you for the delineation between the two, because I never really knew. So thank you for that. We're going to take a real quick break and we'll be right back, and when we come back, I want to talk about the prevalence of liver disease now in some of our younger people. Are you feeling overwhelmed by the changes that come with midlife, struggling with weight, energy or finding time for yourself? You're not alone. I get it because I've been there too.

Michele Folan:

I specialize in helping midlife women, just like you, transform their health and lives through personalized nutrition and coaching that fits your real life. Together we'll tackle those unique challenges, whether it's balancing your hormones, dealing with cravings or boosting your energy. It's not just about diets. It's about reclaiming your strength and confidence one step at a time. Check out the show notes of this episode and shoot me an email. I'd love to learn more about you and your challenges. Welcome back to the show. Before we took a break, I mentioned children, and maybe even our young adults, about how much more prevalent liver disease is in that group, and I'm making an assumption here based on the fact that we are seeing diabetes and other diseases creep into our youth much younger because of lifestyle and our food source. Are you seeing it in your practice?

Supriya Joshi, MD:

Well, I would have to say at first I'm an adult specialist so I don't see kids, okay, but I do get referred, and referred to me when they do turn 18. And we're much more commonly seeing fatty liver disease being referred because children. You know the prevalence of obesity and being overweight in children is more than doubled compared to 1980. So we are definitely seeing it. We're seeing children with significant liver fibrosis. We're seeing children with type two diabetes, high blood pressure. It's quite concerning. It's very concerning and very upsetting because it doesn't need to be this way and it is treatable. But it's really hard to treat when you know kids may not want treatment at this phase in their lives. It's hard for them sometimes to see where they're headed when they're so young, and that's just an issue with maturity.

Michele Folan:

When we're looking at treatment. Are the GLP-1s now part of treatment for liver disease?

Supriya Joshi, MD:

Not yet, although I cannot wait for them to be so. So the GLP-1s, as you know, have shown evidence for improved control, for type 2 diabetes, obesity management and, more recently, even for patients with cardiac disease and for heart failure, reducing episodes of heart failure. There was a trial published in the New England Journal a few years ago which failed when it came to looking at fatty liver disease, but, as liver specialists we all knew the biggest flaw was it just wasn't long enough. It takes decades for liver fibrosis to occur. It's not going to go away in 12 months in the majority of people or any significant amount of people.

Supriya Joshi, MD:

So right now there's a five-year trial going on called the ESSEN study, and the 72-week data was literally just put out a few months ago, and it showed. So week 72 of this five-year study, there is already a significant amount of improvement. In fact, it showed about 62% of individuals had improvement and reversal in hepatic fibrosis and about 37% had resolution of the inflammation from fatty liver disease. So very exciting. So that's quite convincing and hopeful that this will be something that we will have in our armamentarium to treat people who need a prescription for it. And it should be clear, though, the people in these trials have stage two or stage three fibrosis.

Michele Folan:

Okay, so let me ask this question Is the reduction in the insulin resistance why this works, or is it because there's actual GLP-1 receptors in the liver?

Supriya Joshi, MD:

So there actually are not GLP-1 receptors in the liver. I think this is all due to the weight loss. Yeah, okay, it's probably the weight loss effect and caloric less calories in probably Okay.

Michele Folan:

I didn't know, because I know there's GLP-1 receptors in the brain and I was thinking, okay, maybe there are GLP-1 receptors in other organs as well.

Supriya Joshi, MD:

Yeah, I think it's all indirect, and it certainly is from improving insulin sensitivity. That's the main way, right. You're improving insulin glucose metabolism and the liver can more appropriately do its correct job.

Michele Folan:

You had brought up sugar and as part of you know these conversations that you have with your patients, and I did a video a couple of weeks ago about added sugars in food. Do you have a recommendation for a limit in added sugar to food, and that does not include fruit, as we always try?

Supriya Joshi, MD:

to preface. Yeah, so I really do advertise and educate, but the WHO guidelines that came out in 2015. So you know, women should not have more than you know six added teaspoons a day, men nine, and children, you know three to six, so that people can keep track of what they're consuming and make an active effort to stay within that budget.

Michele Folan:

Okay, so six teaspoons would be about 24 grams, 25 grams of.

Supriya Joshi, MD:

You got it, four grams of sugar being one teaspoon. Everyone has to learn that math.

Michele Folan:

Yeah, and you know it's frightening because I did a little comparison of added sugars based on, like a grande latte, vanilla latte, and that was 20 grams of added sugar that's almost your whole allotment for the day. And like a McDonald's small sweet tea and I've worked with people who drank a couple of those a day and you think about those. Are that hidden, sneaky sugar that people don't really account for? And it's just some of these just small, small changes that we can make in our diets that can just pay off so big in the long run? Absolutely. Yeah, you had mentioned something about coffee, though Now we're not talking the sugary stuff from Starbucks. But what is it about coffee that is actually recommended for liver health or just overall health? I?

Supriya Joshi, MD:

know decaf also has the same capabilities. Definitely it's one of the polyphenols, the antioxidants, and there's another part of the coffee that is helpful in reversing hepatic fibrosis and reducing even the risk of liver cancer. I should rephrase it doesn't really reverse fibrosis but it prevents progression in the fatty liver and reduces cancer risk. So there is definite benefit to coffee and so if people can tolerate it, if they're coffee drinkers, I say you know, if you can get two to three in before 2 pm, it might be beneficial for your health. And I say that time cut off so they get good sleep again. Yeah, I was just going to say we don't want to disrupt it.

Michele Folan:

Yeah, we don't want to disrupt your sleep, but it's okay to get the coffee. And yeah, and you mentioned earlier too about drug-induced liver injury. How common is that and from what is this like supplements? What are you seeing most often?

Supriya Joshi, MD:

Well, any medication can cause drug injury. So I think that's one part. But when people, when doctors, are prescribing prescription drugs, we're very aware which ones might cause a side effect and the risk benefit has already been discussed with the patient. So if they're on it, we're monitoring for it. The issue is when people start taking supplements because they think, oh, it's natural, it's got to be better than a prescription. But what they don't realize, there is absolutely no FDA regulation.

Supriya Joshi, MD:

These have not been studied, and when you look at formulations of herbal therapy or supplements, you're at risk of having things that are impure. You have interactions with other, cheaper compounds mixed in there and you have mega dosing. Some people might think, oh, the more, the better, but there's not and in fact there's a lot of ingredients out there that are very harmful to people, and people need them every day. I'm talking about green tea extract, turmeric, ashwagandha. You know these are things you hear people talk about all the time, but they don't realize it could cause you harm. It can even cause, you know, liver failure. Other ones include, you know, even high doses of turmeric, black cohosh and red yeast rice. Those are the ones that we know can more commonly lead to liver dysfunction, especially if you're combining that with other prescriptions that you're on, because they still get filtered by your liver, they still go through the same cytochrome metabolic pathways and especially if it's too much. That can cause dysfunction.

Michele Folan:

All right, so now you got me a little concerned because I take turmeric and it does help. It does help with my creaky joints. So is there a threshold that we know like what's too much? Is it just individual? You know, I don't know the answer to that.

Supriya Joshi, MD:

I think if it's something in a capsule form, you know you'd have to individually read about what what it is you're taking to make sure it's not causing you harm. All right, yeah, I don't have that exact answer. It's, I don't think. Again, these are not FDA regulated, so we don't know. Right, oh, and that's true.

Michele Folan:

I mean, we people ask me about supplements all the time and I'm like look, number one. I am not a doctor. I take a certain number of things, but I've been taking them for a long time. I've run them by my doctor. It's an individual choice to take supplements, but you've really got to do your homework.

Supriya Joshi, MD:

And that's exactly it, and also disclose it to your healthcare provider. It's important to know what you're taking, because people don't realize that supplements can interact and that would be really scary, because if you're not conscious, you can't tell someone.

Michele Folan:

You know that you're. You're right, you can't tell someone.

Supriya Joshi, MD:

You got to tell people share your information so that they know what you're on, Because we've had people come in, you know, in liver failure and literally finding out what they're taking can be a real challenge.

Michele Folan:

Yeah, oh, my goodness, hey. Can you share a patient success story where they made proactive changes to reverse their liver disease?

Supriya Joshi, MD:

Oh, gosh, I'm so blessed to have so many stories. I just I love them. One of my favorite ones, that was just a few weeks ago and this was someone who was referred to me and when he got the appointment to see me he was waiting there's still a wait list. He was waiting there's still a wait list. He was waiting a few months and he found me on my social media and actually went through so many of my old posts which I've only been posting for about a year and a half now and he implemented pretty much everything and he did not realize his lifestyle was that much off key, leading to overall health dysfunction.

Supriya Joshi, MD:

He already was hyper, you know, pre-diabetic, he already had high triglycerides, he had all these other medical problems and he started intermittent fasting. He prioritized protein, trying to get 100 grams a day, prioritized fiber, cut back on refined carbohydrates, exercised, he started doing strength training. He did everything, started taking vitamin D supplementation and magnesium glycinate. So when I see him he does his blood work for me two weeks before our appointment, does his fiber scan right before our appointment and look at him go, fiber scan's normal. There's no fibrosis, no liver fat. His fasting, blood sugar was normal, triglycerides were normal liver enzymes were normal and I asked him what you do, because I followed everything you said and in three months you lost 25 pounds.

Supriya Joshi, MD:

Three months yeah, that's fantastic he was thrilled and he goes. You know it's not hard. The first couple weeks is hard, like any new. It just takes doing something two or three times. It's a new habit. So he had a great outlook. He also was in his forties. His parents had heart disease. Both his parents were diabetic and in his mind he goes. I thought everyone became diabetic when they're in their fifties. He thought that was just an automatic destiny because everyone he knew had type 2 diabetes at that age. The light bulb went off. It's like it doesn't have to be that way.

Michele Folan:

You know, I wonder how much better he felt, too, just overall, that feeling of well-being, by just eating better, sleeping better, all those things that you preach on your Instagram. He did.

Supriya Joshi, MD:

His heartburn went away. His bloating was much better. Bowel habits improved mental clarity. A lot of people report more mental clarity and more focus when they do intermittent fasting. Part of it could be this you're not filling your morning with sugary cereal and refined carbs that make you have that sugar crash. You know that partly could be why, but he felt fantastic.

Michele Folan:

I love these stories. Again, this is what I coach with my you know my clients, so that they don't have to come see you. You know that's the whole point, right? Oh my gosh. Hey, you brought up. I know part of metabolic disease is dyslipidemia, and when our lipids get out of whack, I know that becomes a big concern, and I've had clients here who have not gotten a very good report card from their doctor and they want to start making some changes. Do me a favor. Could you shed a little light on HDL versus triglycerides versus LDL and what is of most concern to you when it comes to liver disease and what really needs to be treated?

Supriya Joshi, MD:

Yeah, the metabolic liver disease. It's from the triglycerides. Really, that is the biggest thing. So high triglycerides, and all of this is developed from increased delivery of free fatty acids to the liver. The liver is doing its thing. The LDL and HDL just how the lipid is a vehicle for how it's carried in delivery to the other systems in our body. And we know that you want to have a lower HDL and a higher HDL, but they're not all bad. I think LDL has had a lot of bad press as well, but it really is the whole ratio of everything. Your APRA proteins are important as well, but, to keep it simply, when those triglycerides are high, you are heading towards metabolic disease and worsening metabolic dysfunction. So identifying your triggers for your hypertriglyceridemia is really the important thing, which is coming from alcohol, juice, excessive fruit, refined carbohydrates, essentially.

Michele Folan:

Yeah, people, when they think cholesterol, they automatically think animal fats and that sort of thing, but that's not necessarily the case. So thank you for that.

Supriya Joshi, MD:

And we also know, you know, menopausal women, they start to get dyslipidemia. You know it's all very much connected. So, as estrogen is declining, these issues start to occur. So there's also a hormonal influence, you know, and and I don't know if we talked about it the last time it was on, but you know, after the age of 50, that correlates with menopause for women, and so post-menopausal women are more than double to have fatty liver disease than pre-menopausal women. Wow, yeah, so there's definitely the role of reduction in estrogen and its role with insulin resistance.

Michele Folan:

You know we get dealt a bad hand.

Supriya Joshi, MD:

It's hard but you know, speaking of menopause, I feel like women we have to train for menopause. I feel like we have to train, starting in your almost like your 30s and 40s, like start prioritizing your wellness because and it's hard those are the hard years. You're career building, you're having your families, you're establishing, you know your community. So you know it can be hard but you can somehow socialize your wellness and combine them. You'll do better, you know, and that might reduce that visceral weight gain that happens. That's all insulin resistance. So it's strength training, protein intake optimizing, getting good sleep and minimizing the alcohol. I think those are really the important things as I talk to women who's going into perimenopause to optimize their wellness.

Michele Folan:

Almost every episode now alcohol comes up and it's an unpopular topic. I say it all the time. You know I'm getting eye rolls right now. I know I can just imagine. When you and I first spoke back at episode 87, we realized at that time that Canada had much more strict guidelines around alcohol than the United States did. And then Surgeon General came out with their new recommendation, basically saying in the United States that no amount of alcohol is safe and linked to seven cancers. Blah, blah, blah. So it took a while for the US to catch up to Canada on that one. But I tell my clients look, I'm not the person delivering the no fun news, right? I'm not saying you can never have a drink, but you really need to think about long-term health and also how you're going to feel the next day, because we don't handle alcohol as well as we did when we were younger and you had explained to me the reason why that is. Sure it's a few reasons.

Supriya Joshi, MD:

So, first of all, as we get older, we have less amount of alcohol dehydrogenase, the enzyme that metabolizes the alcohol. So you have less of that, so you're not metabolizing it, it's still sitting in your bloodstream, so it lasts longer. And then, as you also know, over the age of 30, we all start to lose a percent of muscle mass per year, and that goes up in each decade. And when we have less muscle mass we have overall less body water, because they're tied together and so now when the alcohol is in there, it's more concentrated. So the effects of alcohol are just amplified in women, and especially as we get older. So that's the main reason, and I'm sure menopause plays a role too with estrogen.

Michele Folan:

We're just blaming it on estrogen and menopause.

Supriya Joshi, MD:

But those are the main reasons. It's related to our muscle mass and our metabolism and for some people, yeah, they're on medications. I can then interact with it as well.

Michele Folan:

Yeah, so it's a lot of things, but you're not imagining it. Let's just put it that way. No, it's real. I would love to know how your own health habits have changed over the years.

Supriya Joshi, MD:

I would say, paying way more attention to my protein intake in the last few years, like I don't think I really thought much about protein before I was. You know I definitely have been paying attention to being more. You know my diet is more akin to a Mediterranean diet. I keep my bread intake low, my refined carbs are low and, yeah, I do have treats. So I don't live in a food prison, but my daily habits have been that way for a long time. But more recently, as I was mentioning just more protein, I'm trying to get 30 grams a meal and it is hard, so I'm not a big eater either, so that's hard to do and not having late night snacking. That's been an on purpose thing to change because I again want to optimize my sleep and that'll be the main one.

Supriya Joshi, MD:

I've always exercised regularly, so that's not been a new change. But I have shifted what I do and that is I was probably like you I've seen your posts. Like I used to run cardio, cardio queen, all the time, right, but now we're actively strength training. I just started working out with the personal trainers. I could do heavier things using, doing a squat rack and using the bells in the gym, because I don't have that stuff at home, so it's been fantastic using different ways to strengthen muscle groups.

Michele Folan:

Oh, I love this. This is great, and this is coming from a doctor, which I love because I think there's so much to learn. Because you live it every day, you see the long-term benefits of really taking care of yourself. Is there one self-care non-negotiable that you have?

Supriya Joshi, MD:

I try to do yoga. I love hot yoga, so I try to do that at least once a week. I used to have a lot more time years ago when I would do more of it, but now I just I have to fit it in with all my spring training. It's hard to do it all in a week. You can't take care of your family. But yeah, I try to. I think a non-negotiable means I have to get to the hot yoga studio at least once a week.

Michele Folan:

Yeah, the yoga thing I got to try to be better about doing yoga, especially in the hot yoga.

Supriya Joshi, MD:

There's also a benefit to sauna right, and our sauna at home just broke, which is not ideal, but you get that heat shock protein activation in the sauna. So go to a class and try it the first couple of classes. The first class is really hard because you're just sweating, you're drenched, but you feel so good when it's done.

Michele Folan:

You know doing the sauna. I'm very intrigued about that and I've thought about joining the gym up the street because I know they have a sauna, because I want to try that. Go for it. It's so relaxing. Yeah, it's been ages since I've been in a sauna. All right, Dr Supriya Joshi, where can the listeners find you? Sure, they can find me.

Supriya Joshi, MD:

I have a website. I'm wwwliverhealthmd. com, so I finally launched my website literally two weeks ago. So, and then my handles on TikTok and Instagram are exactly the same liverhealthmd. That's where people can find me, and on my website I've got webinars, information and you follow me. I'll be happy to send you some information to help you improve your liver health.

Michele Folan:

Wonderful, Dr Supriya Joshi, thank you for being a guest today. Thank you for having me. Hey, thanks for tuning in. Please rate and review the show where you listen to the podcast, and did you know that Asking for a Friend is available now to listen on YouTube? You can subscribe to the podcast there as well. Your support is appreciated and it helps others find the show. Thank you.