Preventing and Reversing Fatty Liver Disease | 011

So for the past few episodes, we've been talking about the importance of better gut health and nutrition. And I promised to bring in a liver expert to talk about fatty liver disease, which has now become an epidemic in the global population. So I called my dear friend and colleague Kristin Kirkpatrick from the Cleveland Clinic who is widely considered to be one of the top dieticians in the United States. And Kristen's got such a great way of explaining this in simple terms, her two books, skinny liver and regenerative health really helped me to understand fatty liver disease better. But I want to start the conversation by diving into her personal story, because it's such a great example of listening to your it has to be me moments to get really clear about your calling, and what you want your contribution to be. And then we'll dive into getting all of the juice from her about fatty liver disease. Now, we had a little bit of a tech issue during the interview, and there's a bit of a delay. And so if you just hear that slight delay, that's what's going on, but I just wanted to keep the conversation exactly how it was because it's just so incredible. You know, when you meet somebody and you go, can this person really be this incredible? And then the more you get to know them, the more you realize me and they're even more incredible than I thought they were. So let's get the skinny from Kristin Kirkpatrick. Hi, I'm here with Kristin Kirkpatrick today. I'm so excited about this interview, I couldn't sleep because story is so incredible. And so many twists and turns to this incredible journey of being an award winning dietitian one of the best dietitians in the United States. I'm gonna say the world and coach and author of skinny liver and the follow up book regenerative health which man I love these books so much we're gonna dive in today. You know, Kristin, you would have seen her you know, she's, you know, a contributing writer for today.com. And you know, the New York Times interviews her she's been on the Dr. Oz Show, you know, the today's I mean, you name and tons of magazines, newspapers just goes on and on. And really influential in, in talking to people about health in America. So Kristin, thank you for joining me.

Oh, my gosh, Tess. Thank you, thank you. And I always think like, man, you, you impact so many lives. So it's just such an honor and a privilege for me to have just even a small piece of your world. So your audience, so thank you.

Gosh, you're being humble and kind Kristin, spoken several times in my SK 60. Community for my 60 Day reset, and the love looms large for Kristin. So, you know, you're such an authority and so incredibly knowledgeable. You know, as a dietitian, I'm just really interested in sharing a little bit about how your journey with foods started. Because your journey is such an interesting one. So I want to take everybody back to your childhood and your relationship with food as a child.

Yeah, it's so interesting. And I think you think about that, when you have your own kids, right? Because you look at their eating habits and you stop yourself when you're like, you can't leave the table until you eat all that. Right. And I think about that from my childhood. But I was an obese child's adolescence, I was you know, it's interesting. There's this symptom that you have that indicates that you're insulin resistance, or even type two diabetic and it almost looks like there's like velvet underneath your armpits. And it's this actual symptom that occurs. So I go to my primary care physician, my pediatrician, my yearly visit, and my arms are up and he said that, and he looks at that and he's like, oh, boy, okay, so then from there it was let's test your blood sugar and all of these things. And we find out that it's like, probably was very severely type of insulin resistance, not quite type two diabetic but major blood sugar problems. And that was kind of like, the big aha moment for my mother to say, gosh, we have to lose weight. Now you have to go see a dietitian, etc. So that was really the beginning of my journey. And I remember walking into this dieticians office, and she was like, in my mind, like a size two. I was not, right. So I kind of shut down a little bit, because I'm just like, oh, god, she's perfect. And she had asked me, she said, Well, what do you think we're doing wrong? And I thought it was really interesting, even at that young age that we're going to start with the What are you doing wrong? Implying that there's something wrong with what you're doing. And we can sum it up into one sentence. Right, which we can't we can't sum it up into one sentence. So I let her in on this dirty little secret that I used to go babysitting and I would take my money, get on my bike because then we could go bike anywhere and not worry about you know, safety. Get on my bike, go to the grocery store, come back and I have these little that'd be bars, and I would put them underneath my bed. And when I knew my parents were asleep, no one's watching, I take them out and I start eating that way. So clearly looking back, you know, clear anxiety and trying to cope with with the comfort of food, the comfort of of that without being judged, because it's the middle of the night. So I let her in on this, this little secret I have. And she said, Okay, well, gosh, yeah, that's a tough one. Let's just stop that say, and then we're going to, we're going to start to improve your eating habits. And I thought to myself, I've wanted to stop that for years. So I think I mean, you, this is not mind blowing for you to say, let's stop that bad habit. It's just like, I just have to go to class, why can't you do that? Right. So I think that was really the eye opener. For me. I felt like even though this person had such great intentions, was not understood. And the complexity behind why I was choosing certain foods was not understood. And until that's understood, you can't really change behavior, because you can't get to the root. And it was the first kind of introduction to, I really want to do something where I can understand people. And I can understand when someone says, I'm really struggling with this, or I can't stop eating this, I, I want to be able to say I've been there and I understood it. And not to say if you haven't been there that you are any less effective than I am, when you're in that patient setting. But I had the compassion that I felt like only someone who's been there could have. So that was

a real aha moment for you that propelled you forward, you know, through your teenage years. And then when you went to college, so tell us about that journey, where you really started to kind of form your ideas about food, how you wanted to move through the world, and then how that led to, you know, your college experience.

Um, it's interesting, like I so it took me a long time to to try and lose the weight. And I think when people kind of hear my story to say, Oh, how long did it take you to lose the weight? And I always say, oh, gosh, probably like 1015 years. And then I always follow it up with, I'll let you know, when I figure out how to keep it off. Because losing it was actually the easy part. It was the day today of trying to change your relationship with food. That becomes really complex. I mean, from a weight loss perspective, it's, it's, it's not as simple as calories in calories out. But there is a lot of simplicity behind it. If you eat less if you move, especially when you're young, right? You're gonna have probably some success of weight loss. So, you know, I think like, when I went to college, when I was successful in losing weight, I almost wanted to abandon that part of it almost deny that that was part of who I was, I wanted to just probably act like I was always been and always this way and never struggled. So I kind of like pushed it into the back of my mind. And it was like, this kind of my personality tests where I'm, you know, I walked past something. I walked past a billboard in college, I saw that there was an ad for a White House intern. And I was like, wow, that looks cool. Because I went to college in DC. And I applied for it and never thought I would get it I interviewed and I got it. So I had this great opportunity of being able to work at the White House. I ended up working on the presidential campaign. I mean, it was like, the most amazing moments, those most amazing moments. I'll never forget it. And I don't regret it for one second. The point of this is that, like I took so many turns before I went back to that 16 year old girl that said, I want to understand people. I want to help people. You know, there's no greater turn than going against

you Lynne, what was your it has to be me moment, or it does not have to be a moment about being in the political world at the highest level like that. Yeah,

I think I really embraced the coolness of it. And I embraced that I felt I did feel that I was part of history. And that I was right. And I felt like I was meant to be there at that moment. But I don't think I ever felt like it was my calling. But it was a great, it was a great moment. At the time. I always just kept getting pushed back to the wellness perspective and trying to figure out what that looks like for me and how do I you know, how do I how do I take wellness and turn it into a career that not only is successful, but also lucrative? Because 20 years ago, I mean, you thought about Wellness and it's like, you know, you prep people reload, or do you volunteer at a gym? Or what do you do? Right? Like, it's not something you would think of in terms of what your career looks like, we've evolved considerably since then. So I think that was like the it had to be me moments where I just didn't feel like I was contributing to the world in the way I wanted to contribute. Yeah, just felt as if this isn't the right step. Okay, now I'm 23. But that's okay, let's, let's, let's kind of deep go to a deep dive and figure out what is the right step. And it wasn't 10 years last, it was, it was a great experience, but not not right. For me, you know, I tell my kids this all the time, you can go through so many different versions of yourself, eventually, you're gonna land on who you're meant to be. And sometimes you got to go through all those versions to figure it out. Right?

Let me go through some old versions of Kristen. So you, you get you then merged your interest in politics, your experience in politics, your interest in the health and wellness space, and then you will lobbying? Right you were working as a representative in DC. Tell me a little bit about that. And what you learned from that, and how that was the next evolution in you discovering.

It was the perfect, it was kind of a perfect combination. Right. So I applied for a position at the American Academy of dietetics, which is our trade organization, for dieticians. And it was because I was in DC, it was their lobbying arm. At the time, they were lobbying for something that was groundbreaking and dietetics, called M and T, or medical nutrition therapy. So it was the essential lobbying that was necessary in order to get reimbursements to see a dietitian in any kind of hospital setting. So before MMT, it was out of pocket or maybe maybe your your, you know, your individual insurance company might pay for a session. But this was a universal. So if you had certain diagnosis, things like that, you would have your insurance cover it. So it was so interesting to just be be able to kind of be in that world then, and work with lobbyists who I had never worked with before. And just look at, like what they were trying to achieve from the political standpoint. But really, ultimately, it came down to what we were doing was trying to get people of all walks of life to have access to see a dietitian, right. And that's really what it boils down to if insurance covers it, then anyone can see a dietitian. And we still need to improve MMT we need to open up more diagnosis for it. But we didn't have it at the time. And so it's great to be part of of that experience as well.

Yeah, and so but through that experience, again, you discovered this isn't quite what I want to be doing. I want to really in the doing of the helping people get healthy and that kind of stuff. So that's was that the next it has to be me moment for you where you went? I want to be a dietitian. Yes.

Yeah. So I was in grad school when I was doing that. And I was doing just a general wellness degree. So again, I did my undergrad that was political science and went into Okay, I'm going to do grad school, but I'm just going to do general wellness. And I sat with the head of the school who was a dietitian, and I still talk with her today. So get mentoring from her today. And I said, Well, what should I do next? And she said something that just never forget. She said, Well, you had this graduate degree, but you are nothing. Like you don't, you are not, you don't have a title, you just have a degree. So I would be something so I would be either an exercise physiologist or a dietitian. And that was the moment where I just went back to all those years all of those things that I tried to achieve and said, Okay, this is this is what I meant to do. It took me much longer than the average person to figure that out. But that's okay. Here I am. And then I had to go backwards to go to dietetic school because dietetic school back then was an undergraduate degree. So I have my grad I have my undergraduate degree, then I got a graduate degree. And now I'm going to go backwards and go back to college to be able to get all of the training and internship that I needed to be a dietitian.

Yeah, you know, you returned, right return I went

back to where I started your return.

And you know, sometimes returning is so powerful because we are returning with a different lens, different life experience, more or more brands, we have a different perspective, and then we hold that experience differently. So, you know, tell me a little bit about how you came into contact with the Cleveland Clinic wall You're in dietetic school because that's another it has to be me moment right where you are incredible mentor. I mean, your story to me is such a glorious example of every little piece dovetailing and leading you to the next moment. And I mean all lives like this right? But yours is,

to me is just so incredible. Can you

tell us about how you were a mature student? We had its benefits you had to work, right. So you were working and that's when you took the job at the Cleveland Clinic?

Yeah, so I ended up when I wanted to go to dietetic school, I ended up moving home from DC. So here I am going to leave DC I'm gonna go back to Cleveland, to go to dietetic school where I went to University of Akron. And it's interesting, I was thinking about what you were saying like kind of, you know, going full circle and coming back. I feel like had I gone to dietetic school right after, you know, right after high school, I would have had a totally different experience. So I go into dietetic school I am now 29 years old. I have a fiance completely different place in my life than most of the girls that I'm in dietetic school with, and it was all girls, there was not one guy in my class. And the first thing they tell us is like, well, you can't work. It's so grueling to do the internship and the classes for dietetics, you can't work. And I'm like, why I just got a mortgage. So I'm so sorry, why that happened. And I was able to get a position at Cleveland Clinic in cardiovascular genetics, and I worked there nights, weekends after school, just whenever I could. So again, I had this great opportunity to be at Cleveland Clinic, which is, you know, one of the the top medical institutions in the globe, and be in cardiovascular genetics. So I had this kind of this genetics education being provided that no one else in my class is being provided. Because I was in it, I was living it. And that's really what brought me to the clinic. And and as we were there within the clinic, we we got, I got a new CEO there. Toby Cosgrove, who was groundbreaking in his attention to wellness, no other CEO of a major medical institution really gave the care. And just the attention that Dr. Cosgrove did so he came in and said, I'm going to I'm going to create this institute type of format within the clinic. And we're going to have an institute just devoted to wellness. So at that point, I was applying to get kind of into the wellness area of Cleveland Clinic. I started with employee wellness, which I loved. And then from there, I met Dr. Roizen, he ended up being the chairman of the wellness Institute and he and he said, Hey, we're gonna start this new institute, you want to come be the dietician. So part of it was luck. I was in the right place at the right time. Maybe a little bit of persistence. I was constantly talking to him trying to discuss things with him, making connections with him, but Ulis

I'm sure you wound him and continue. You know, I mean, you've been there for almost 20 years now. Right?

Yeah. Yeah. So incredible, you know, long career.

Another thing I really love about your story, is this, this constant story of mentorship. Yeah, you're still in contact with one of your very first mentors, all these mentors along the way. And now you yourself and are an incredible mentor for young dieticians. Tell me a little bit about how how that factors into your view of the world, you know, really helping to support and elevate and celebrate others in their journey and really helping them to see what their potential is.

Yeah, I think it's so important because you know, number one, again, a lot of times we'll take on different things in our life, because we didn't have it. And so we take that on as a goal to give back what was not given to us. And so I felt like when I was in dietetic school, all of the the people that I was under in terms of like the internships, it was just kind of like and I get it now, as a dietitian, I get it. They were so busy, and they were on the clinical floor, they just didn't have time for you. So there wasn't a lot outside of your interaction with these dieticians during the internship. But then if you had one that kind of took you aside and was courageous enough to take the time to say, here's why you did this wrong. Not the one that said hey, this is great. Yeah, get a million This is great. Okay, this is great. We'll see you tomorrow. But the one that took the time to say here's why the what you put in the chart really is not going to work. Those are the ones you learned from. So that's really, it really kind of spoke to me I really wanted to work with other dietetic students. I've had men, I've had women, you know, of all walks of life, who can take what their passion is, because they all start with that they all start with, here's my passion, here's what I want to do, try and make them figure out how is it going to work for them, while still kind of doing things that are outside of the norm. Right doing things that are outside of the norm. So I think I really love that perspective of it. You know, I love just trying to like open your open the eyes to some of these interns. I have an intern right now who's she's great. She's an older intern, she's married, she has kids. So she's a different perspective than some of my other interns. And she's telling me what she wants to do. She's helping me put together this presentation. There's all these places that like, look good, but not great. And that's what I said, like, Here's how you make it great. Because, believe me, it's not just me being hard on you, you are going to get into the world. And if you want to present, your slides have to look engaging, and really good. And you got to be ready for that. So I just think there's benefit in being honest, and giving people some perspective that you have from so many years of experience that they couldn't possibly have, because they haven't been in the industry long enough.

Yeah. And also your life experience. Right. So you were engaged when you were going through this, and then you started your private practice, because you wanted to be at home as a young mom and be flexible to spend quality time with your with your sons, right? Yeah. So yeah. Not that it has to be mean moment where you just went, Okay, I got to change some things here. And I want to I it's good, but I need it to be great for my changing situation as a young mom. Right? Yeah, I

really wanted to, you know, I really wanted to get to a place where I could still work. But still, I always say like, when I'm thinking about working with new clients, I always say I take my kids to school every day, and I pick them up. And I just can't, I can't compromise outside of that. I mean, every once in a while, yes, I'll compromise outside of that. But for the most part, that's, that's really important to me, I want to get everything done while they're in school. So I can be present and within school. So I think sometimes the only way to do that is to kind of go out on a limb and build your own business, because then your own boss. I mean, if you're working for someone else, they'll control your schedule, they'll tell you when you're coming in when you're going. So that was really important. And I think there's so much, you know, you know, but there's so much risk and fear and to going off on your own and building something, right. It's just so much

exhilarating, if your view never changes. Right, right, able to do it the way that you want to do it. There is it there's such joy and value and peace in that, you know, for me, anyway, tell me about how that changed things for you, you know, opening up that practice and consulting with people in a different way than you had been at Cleveland Clinic. You're you're interpreting data, right? That's one of the things that what you had said to me, when we first spoke ages ago, you went, I'm simply interpreting data, right? So you're used to interpreting science data. And then obviously, as a human being as a woman, we're interpreting all of that anecdotal, you know, non, you know, physical data. When you say it's scary, and you're starting something, you know, for people listening, going, Oh, I'm thinking of going out on a limb and taking a big risk and leaving my high paying secure job to go start my own thing. What was some of those data points that we can't put on a spreadsheet for you? You talked about it earlier, where you knew this wasn't my calling, I'm not going to work in politics. This doesn't feel quite me. And you were telling, you're telling your sons about this. You got to go through many iterations. When you decided, you know, it has to be me right now. I got to make some changes. I'm going to start this business. What was some of the things that you said to yourself just so we can steal some of these things from you? Yeah.

I think what you said, really resonated with me that the view doesn't change when you're just in a large organization and it could still be very fulfilling. But when the view doesn't change, you can't necessarily grow So, what really helped for me? Yeah, so what I think like the data was really the challenges, the things I tried to put off, right. So even as a writer, I'm getting these assignments from my editor, and then looking at and being like, oh, god, okay, I gotta, I gotta write this, I'll do it tomorrow, or I'm gonna do it over the weekend, right, like, putting it off, and then finally getting into it. But when you are constantly putting together articles, or you're constantly looking for different clients from different areas of the food industry, you grow so tremendously, because you have to write I like, if I'm gonna write an article, I wrote an article. This was a few months ago, for the today's show, my editor asked me if I would write an article about the carnivore diet. And someone had said to me, like, I can't believe you took that assignment. Like, that's got to be the most unhealthy diet ever, right? And I was like, Yeah, but like, that doesn't matter. What mattered is that I took multiple days and comb through all the data. And now when someone says to me, what's your opinion on the carnivore diet? I can give them an evidence based answer, not just the opinion of oh, well, there's a lot of meat. So it's probably not good for you, right? So it forces you, it forces you to constantly be up on research. And I can't tell you how many clinical dietitians again, it's not to it's not to devalue them by any means. But I have many colleagues of mine that are clinical in the hospital, I could never do what they do. They're so good at it, that they're on autopilot. Like, you could get the most complex case, that case comes in, they know exactly what to do. Whereas I'd be like, Oh, I'm gonna kill this patient. If I get, like, I need, I need to step back and study, I need to go back to the rd exam. So they're really good, but they're on autopilot for just that one area of where their practices. So I think, when you take on different clients, when you take on different assignments, when you say, I'll do this, when you put your hand up and say, Okay, I'll take it on. And you know, it's going to be hard work, and you're not comfortable with it. That is when you grow. Because yes, then, you know, go back, and you can have a conversation where you could say, you know, you know that there was this study that came out a few months ago. And I would only know about that, because I just wrote about it. So I think I like getting into areas in my career that I don't have that comfort level. Because if I have that comfort level, I'll be on autopilot. And that's great. I'll coast and I know I'll do a great job. Because I know it's so well but it's the stuff that makes you uncomfortable where you you're forced to learn about something that you didn't know before.

Oh, yeah, I love that. I love that. So that's one of your yardsticks is pushing yourself wanting to grow, wanting to try new things, seeing what you're made of seeing what you know, because, you know, we're so many things that we didn't even dream that we we are or that were possible of being right until we stretch ourselves. So let's talk about this writing piece because you're such a prolific writer, and I've written so many articles, they're out there in so many different places. It's really impressive. Then you write your book, write your first book, skinny liver and then the follow up regenerative regenerative health, tell me how that came about why the lever out of all the things that you've written about and all the things that you're interested in and the important things that we need to talk about in health and nutrition. Why the sexy liver I love delivery so sexy. You know one of the things I love about your book is how you make it sexy, you make things and digest some of those medical books they're quite dry and boring and it's like okay, I learned a ton but oh gosh, let me go you know whenever you've got all these funny analogies in like in the liver to a superhero it's just such an interesting entertaining read whilst at the same time why is the liver so sexy?

Yeah, so interesting. I let me just say, I am also the first person to tell you I don't know something. Right? Like you got there's there's part of being successful. Yeah, I mean, part of being successful is is the humbleness of it right and that's a big thing. I try and teach the students that are with me the second you lose your your humbleness and your arrogance about your skills. That's it, and people will see right through it. I think for the liver when I decided to kind of get into this become an expert in this area. I too knew nothing about it, I really didn't, I just, my office was being flooded, flooded by people that would say I saw my doctor, he says I have something called fatty liver, there's no medication for it. And so here I am. And I would just I was lost to. So we just it was, it was so new in our world. And what I noticed was, there was no manual, there was no medication. Now, the there was this huge announcement about four days ago that the very first medication ever to treat, mash, which is the latter stages of non alcoholic fatty liver disease has been developed. So that but back then, even just two weeks ago, we didn't have that. So I really, it was a real opportunity to learn about this to help these patients. And as I just kept looking at this more and more, I realized, we need more information about it. And I do use the word sexy, because I remember when I was writing my first book, skinny liver, people were like, I should write a book and book a short book, right? So for the when people said, Oh, you're writing a book, what is it about? And I'd be like, you know, it's about the liver, like, I'd looked down. I'd be a little bit, I'd be a little bit embarrassed, you know, like, it's about like, you know, and so it was just kind of like, I had this kind of shame that I wasn't writing this, like, you know, really dynamic weight loss. But it ended up helping a lot of people. So you know, you got to see you have to keep that in mind as well. And that. Right. And that's what I love about, look, you know, the concept of your podcast, it had to be me, there was no one doing anything about the liver, nobody. And I just thought, Okay, well, it's not the most exciting organ, we don't talk about it that much. But you know what, I'm gonna attach my name to it, because no one else is doing it. And I really want to like help people. And then as we learn more, we realized that it's so closely tied to metabolic health to insulin resistance to you know, I was just putting a presentation today about menopause. So looking at the risk of fatty liver after you get into menopause. So it's just so pervasive, and it's so ignored. That I just felt like, gosh, there's so much we can learn as a community about really respecting this organ. And reversing some of the damage that we do to it. Yeah, I

mean, I just love the name of of your your follow up book regenerative health, because the liver can regenerate. It's so what what was some of the things that really surprised you, when you really started to delve into this about the labor that we really need to know about and specifically about non alcoholic fatty liver disease? You know, we think that it's about fat, you know, and they thought it was vulgar. And then you realized, now it's about metabolic health. Can you just talk about that? Because we all need to know about this. It is just so incredibly fundamental to our health. What do you want to know about this?

I think and or we think it's about booze, right? We think, Okay, well, if I don't drink, nothing's going to happen. I'll be fine. Because you know, I don't drink alcohol, right. So there's all these misconceptions. And I do think there's some shame associated with it. I didn't realize that until I started working with Dr. Han Na, who's a hepatologist. And he said that when he would, people would come into his office, and he would say, hey, you know, we ran these tests, you have non alcoholic fatty liver disease? They'd be like, I don't drink that much. What are you talking about? Right? Like, they would be very defensive on the, you know, oh, but I don't drink. So there was also shame, the stigma of any alcohol disease we initially go to, you're an alcoholic. Right. So I think that's kind of important piece number one. What we know is that the liver plays a gigantic role, a huge role in blood sugar management, in terms of storing blood sugar in terms of releasing it when it senses that the body needs it. And then it can be also very involved in mismanagement. So when you have someone like my 16 year old self that has insulin resistance, what happens is that the liver becomes very overwhelmed with the ability to manage blood sugar. And when it doesn't understand what to do with the blood sugar, that blood sugar essentially turns into fats within the liver. And then it kind of creates this cascade of inflammation. So we do know that insulin resistance really any component of metabolic syndrome, can lead to non alcoholic fatty liver disease. So when we think about what do people need to know, what should people know? It's not about weights. It's about where are you carrying? Your weight? So the weight that you do have, where are you carrying it? And then number two, do you have any component of metabolic syndrome? So those are like the big things, we really wanted to tackle that, you know, we have to take away the stigma that if you're fat, then you're unhealthy. And that's just not the case. We have plenty of people whose whose metabolic numbers look really good, but they're struggling with weight, and they need to lose weight. But it has nothing to do with their health. Maybe they want to lose weight for other reasons. So I just think the most important thing to recognize is that this is impacting so many people. And the liver is so amazing and so resilient, that it's going to take such a punch before it gives you any sign that you got it. And sometimes, you know, you'll be in the latter stages, once that happens. So it's this call to action to not forget about really, you know, the most important organs in the body that are keeping you alive. And that's essentially what this organ is doing. And that's why it's sexy. Sexy.

Zach's inner regenerates like a superhero. It's incredible. One of the things that I found so interesting about regenerative health was just really helping people understand what metabolism is, and what metabolic health is and the bio individual component of that story. So can you just talk us through the different kinds of the different metabolic types? Because and if you do not have a copy of regenerative health, I'm telling you, it is such a great read. I read it in one day, because I was laughing, it was so entertaining. But just because it was a page turner, from the sense of I need to know this. Oh, okay. Now we know this about liver disease. I mean, it just, it's just the knowledge that you put out there in this book, it was it was such a huge learning curve for me. So thank you so much. And I know for so many people in our cubicle. Yeah. Yeah. Incredible. So what are the four? What are the metabolic types?

Um, so we created metabolic types to really kind of put people in areas to think about, okay, what is my risk? And based on my risk, and what are some of the interventions I should think about? So we really broke it down into four different types. So if you were someone who has a normal waist circumference, but your metabolic numbers are a little bit off, then that's type number one, the next type would be that your metabolic numbers are perfectly fine. But your waist circumference is a little too high. Right? Then you have your waist circumference is fine, your metabolic numbers are fine. So for the people in that camp, if you're like, Okay, well, I don't have any risk, that's more going to be associated with if you have the genetics that are associated. So we pulled, we found a lot of data showing that if your mom had non alcoholic fatty liver disease, or even insulin resistance, or gestational diabetes, while she carried you, you're much more prone to develop it yourself, even if those numbers aren't there. And then of course, we have people high waist circumference. So for a female, it's going to be over 35, a male over 40. And then some metabolic numbers on your hemoglobin a one C, your triglycerides, your blood pressure. That's really kind of how we we broke it down. So there's kind of one intervention that we would suggest for someone who just has the genetic risk factors, doesn't have anything to make them from a pathophysiology more likely to develop this all the way to someone who waist circumference how your metabolic numbers are not good. There's different kinds of planning. But I was I was so hesitant on putting any plan in the book because I didn't want people to think this is about deprivation, I now need to be on a diet. So that was really that's always the challenge, right? How do you communicate, these are some dietary interventions, not diets, but dietary interventions that have been tested in research to reverse non alcoholic fatty liver disease, versus here's the diet you should go on. So what we tried to communicate is you can kind of go in and out of any of these plans. The goal was just to open your eyes to it and give you enough recipe snacks, things like that to get you on your own to be able to go forward with reversing that condition. And just to empower people

with the knowledge and power right and that is what these two books do. Right? So they to me, they're like little little salt and pepper shakers in terms of your your little manual for how you can love on your liver. What is summer The main things that we should be doing to love on our liver to make sure that not only we reverse non alcoholic fatty liver disease if we indeed get the diagnosis, but we go into proactive prevention status where we are not going to develop it.

So I would say like number one, we, of course, we're gonna think about food, because I'm a dietitian, but I would say sleep is really important. And a lot of times, we kind of minimize the importance that sleep has. So if we're not sleeping, well, we're not gonna be able to eat well. So that's kind of I always mentioned sleep first, because sleep is really makes a huge perspective here getting consistent sleep, which again, I didn't really recognize this until I started researching this, I was your typical, I would have a normal bedtime and wake up and then on the weekend, I would sleep in. And so now we know from the data that if your sleep is more consistent, you're not sleeping in on the weekend, you're still setting that alarm for 6am, that is more prone to better eating habits is more prone to better health. So, you know, really keeping that consistency. So I think that's really important. I think, from a dietary perspective, just having more color, just get more color in your diet, and you get more color in your diet, you're getting more fiber in your diet. So I think that's really important. Depending on where you are with the condition, if you're a little ladder within the stages, drinking less does help. I mean, I can't tell you at least half my patients started having a glass or two or three of wine every night during the pandemic. And then all of a sudden, they're up 30 pounds. And it was the alcohol it was for sure the alcohol. So really kind of looking at alcohol, just taking a deeper look into it, and saying, Okay, what, where's my alcohol status? And can I bring that down a little bit, that will always help as well. I love this concept of natural movements, which we see in the Blue Zones, right? I always say like, people in the Blue Zones, they don't go to a gym, they don't have a personal trainer, all those things are fine. But they have natural movements, they go from one place to another and they're walking. So I think like, I try and stick with more high level, get more color, make sure you're getting consistently natural movements. Those are really important perspectives. It's not always easy, I have plenty of patients that will just be addicted to ultra processed foods. And it's no different from me being told just have less of them. Because they have those addictive properties. So sometimes we have to go a little deeper and start really on a baby steps approach and not just say, Okay, I'm going to have a color is not going to sleep better. So really kind of if you had to give it a hierarchy, what could you do this month? Is it just I can have I can have two vegetables this month. And that's all I can do. But taking the time to figure out what can I do right now, as opposed to? What are the 20 things I could do for better wellness right now you're never going to sustain that?

What was the thing that surprised you the most when you were working on this book, doing the research looking at the data, interpreting it continuing to see patients asking your patients working in the real world? What was the thing that surprised you the most about this?

I think the thing that surprised me the most was number one, how many people have it. And not not that that alone was surprising. But what was surprising alongside it was the asymptomatic nature of it. So all these people have it. It's like one in four. So if you go and you walk out to the grocery store, one out of every four people you pass has it probably don't know it. And because there's no symptoms. Statistic well, and the latest data test really does have they really think those numbers are low. So we think it's probably closer to 30% globally, of individuals that have it. It's very much in line with type two diabetes and insulin resistance. So again, diagnosed versus undiagnosed status. Oh, absolutely. It is an epidemic. It is an epidemic. And it is the it's also the the the number one reason why someone is more likely to get a liver transplant. It's not it's not cancer, it's not liver cancer. It's like so this is like kind of gained the status of if we look at the rationale from a medical perspective of transplantation. Most of the reasons why people have a liver transplant is because they have gone from the early stages into cirrhosis. And the liver is no longer working. And it's it's so ironic because I have so many patients that will say they'll shoot me an email and they'll be like, hey, what do you think about this cleanse? Like, what do you think right? And I'm always tell them like, just take the money you spend on this cleanse and just go go buy yourself some better food. So we just again, like, we have to embrace research. And so that that was like the surprising thing that so many people have it, but they don't know it. And when you think about blood pressure, so many people assign it to it being the silent killer. Well, we know that phrase, we've heard it, we've seen it written, blood pressure's a silent killer, you don't have a symptom. But it puts you at risk for stroke and heart attack, etc. We don't have a similar phrase for the liver. But truly the condition is a silent killer, because it goes to a level at some point if you don't reverse it, where the liver is no longer functioning, and the only solution is transplantation. That's way down the line. But it's, it's still a possibility. We see it all the time. Yeah, you talked earlier

about how the liver is so magical and incredible. And so resilient was the word that you use, which I love, that it can take years for chronic symptoms to develop, which we don't want to get to that place. Right. So if we've got all these people all of it, you know, so many people want in for you're at the grocery store, one of us got it. How do we know that we haven't? And how do we get diagnosed? What how do we get tested? What does it need to do to make to what's going on with the liver? Right?

Well, as cliche as it sounds, number one is just seeing your physician every year, because most physicians will run a just a normal liver function tests, it's usually part of your just your regular bloodwork. So that's kind of number one, if your liver enzymes are off by any means, then they might look at other things. Or they might look at other things and then decide to run your liver enzymes. So they might say, oh, you know what, your blood sugar's a little high. And I noticed your waist circumference is a little high, we're going to run a liver panel test just to see what's going on. So typically, you're diagnosed from that perspective. Some physicians will take an ultrasound to actually look at how much fat is in liver to see the staging perspective of it. And then very rarely, you'll see a biopsy be part of that diagnostic approach, but usually ultrasound and then just liver enzymes. So when do you start seeing symptoms, you might not see symptoms until you start getting more scarring. So that's one thing I say like, you know, when you when you cut your finger, all the white blood cells go rushing there, it swells. And over time it heals. What happens in the liver is you're essentially cutting your finger within the liver, the bott the liver is trying to heal itself, it's not being successful. And so it just continues to draw this scar tissue. And it's just not healing. So it's scar tissue, scar tissue, scar tissue. And then that scar tissue and the fat replaced healthy liver cells. So once you start getting to that, once we first we refer to as, as fibrosis, or we get into Nash, once we start getting into those stages, then you could start having more fatigue. Once you start really going in, you could have itchy skin, you, you know, you might even have a little bit of like your brain is not working correctly, because the liver can't break down ammonia from protein. So if you can't convert and break down, then let's go into the brain. And you're like people are like, what's going on this person? is out of it out of nowhere? What is it? Right. And it could be that the liver function is just not really working at that point. So, you know, there's a lot of a lot of the early symptoms are very nonspecific. I mean, I don't I don't know one woman that is not fatigued, the majority of time so

like, right, is that there's so many symptoms that could indicate that you have there's a problem with your metabolic health. There's issues with your liver that you might have non alcoholic fatty liver disease, what are some of the most common symptoms that we just take as oh, gee, it's just life. I'm just stressed. I'm just tired. I've just been busy this week that we continue to ignore. But that would indicate that we want to go to our doctor and have a conversation and say, Hey, listen, you know, my I need to get all my blood work done. And we need to go for that annual checkup. What are some of the most common early symptoms that we don't want to be ignoring?

Yeah, if I look at my patient base, which is you know, the majority I'd say 85% is female brain fog is a is a big one, right? So they'll just have brain fog, right. So what's what are some of the reasons why? And we'll kind of break down all of those, but it could be that could be fatty liver, especially if it's in conjunction with other things going on. Right. So brain fog, the fatigue, even something as simple as really challenging with sleeping, which you wouldn't think about that right. I mean, again, it can mimic so many other things. My patients that are Peri and postmenopausal. They struggle with sleep. So is it that we're going Going through that, or is it because we're having some challenges with the liver? You know, I think all of those things can be really the early symptoms, but they could also be assigned to so many other things. So that's why it's like, this is really a condition where the blood work is very telling. It's very telling. And it's, it's interesting. Like, I feel like since I wrote both of these books, I'm not a hepatologist, right, I'm not anywhere near where Dr. Ma is. But I've had people that have gone to their doctor, their liver enzymes are slightly elevated, and then they'll email me and say, like, oh, my gosh, my liver enzymes are elevated, like, and they never looked at it before. So just kind of like this awareness. Before even one symptom may occur, it might have, you know, it might have to do with the fact that their livers not clearing a medication that could increase liver enzymes, certain statins could increase liver enzymes. So sometimes it has nothing to do with fat in the liver. But our attention to it, I feel our goal is to increase it, just start thinking about it a little bit more. Oh, well, you

have achieved that goal in spectacular fashion, my friend. And I love you, with Dr. Han Na, because the just the clinical data, the research the the knowledge, the the breadth of experience between the two of you. It's such an incredible collaboration. So any liver regenerative health, you can get them wherever you get your books, online or at bookstores. Such great reads, thank you so much for fees

you Thank you.

What's your next it has to be mailed? What's something that's bubbling up in you right now, like from from writing these books, all the incredible work that you're doing? I just want to know what's next. Like, what do you feel is kind of churning around in there that that's calling to you at the moment,

I think, either we tend to, especially as we go through as we go through life, we tend to embrace more the things that are impacting people around us and ourselves. So I'm really just so interested in engaging with women that are going through perimenopause and menopause, that's kind of been something that I've been really interested in. Because it is such a challenge. It is biologically inevitable. Completely. So it's not like oh, you might get it. And then No, no, you're gonna get it, you're gonna get it. Um, so I think like as, as women, we just really need to kind of come together and have a conversation a little bit more about this, and even some of the opportunities that are surrounding this. And I fully admit that this was, you know, it's because I'm going through it myself, you know, it's interesting, I wrote, I asked my editor at The Today Show, I said, Can I write an article? Can I put some personal perspective on menopause. And she said, I love this right. And so I started the article by talking about last year, I was presenting at today's dietitian conference. And I said, right before I hit the stage, my pants, which were barely hanging on the button pops. And I was making a joke about how like it, like, if it flew in the right direction, you would have gotten a bruise it was going at such a high velocity. So I started talking about like, you know, it all started with this button popping incidence ad. And then it went into all the science and here's some things to talk about in the belly fat. And that's really what it was. emails about was women that were like, you know, what, my button pots, I was at a dinner and and then all, they were telling me their button popping stories, right? So it's just gonna like, and I just want to feel like when I was younger, that I wanted to embrace and help people that needed to lose weight. It was because I was going through it. And now that I am, you know, get it get into my 50s I'm going through this. I want to go back to that I want to go back to being vulnerable. And just telling people I am not perfect, my diet is by no means perfect. I have the demons from my childhood, believe me, I will never have a naughty bar in my house because I'll eat the box. I won't control myself. So it's just like, I want to take that from a menopause perspective and say we're all going to have this button popping experience. So how do we how do we embrace the body that we are now getting and focus on our health and focus on reducing the risks that come along with a loss of some of these hormones? So we're I feel foolish

enough to read that book. But I really love of how you recognize, taking up full circle from our conversation in the very beginning about not being seen or not seen, when you were that young girl, you know, using food to comfort, placate hide, where so many of us are doing that, I think we're a mixture of all of that, right? Yeah. And bringing that into your work and being able to see yourself and who you are today and what you're struggling with. And using that, and also being able to see your patients see people that you're interacting with on your book tour and stuff like that. What would you say to somebody that doesn't feel seen right now, by their practitioner, or by their friendship circle, you've really been able to navigate that space in a really beautiful way and hold space for others, what what would you say to somebody, right?

Um, you know, I would say that, you know, number one, you have to really kind of develop, not so much the word confidence isn't the right word, but you have to develop kind of this appreciation for your body, the changing of your body. And then look at how it impacts your y as you move through life. You know, our y's change throughout life, when we're young, our Y is I want to look great in my wedding dress. And when you get into your 40s and 50s. It's like, okay, my why is I don't want to get dementia like my mother got, or I don't want to get cancer, right? So our y's change. So I always encourage people, like, look at their why. And it's interesting. And we're just talking about if you're not seen by your doctor, I can't tell you how many of my patients have emailed me and said, I really want to get on a GLP one agonists I want to get on ozempic, I asked my doctor, my doctor is not going to put me on it. And he made me feel shameful for it. So it's just kind of like, like, okay, so how do we take that information? And really kind of break down? Is this something you want to do? And how do we speak with the right health practitioner to figure out if that's what you want to do? You know, we give so much importance, if we have a great doctor, it's great. But sometimes we give so much importance to one person who we've worked with. There's a whole world of health practitioners that might be better, right? Not to say leave are doctors but really connecting with someone who just speaks your language and can sit down and have a conversation with you, as opposed to just say, this drugs not right for you? Right? So I think like, we are evolving as a society, especially because some of these drugs, and I think that we need to look at how do all the things that the medical world has provided to us? How does it relate to us? Our why and our path of longevity? Right? What does that look like for us, but it starts with kind of looking at your own worth before having to accept worth that others give you?

Yeah, you know, one of the conversations you and I had a while back, and I've never forgotten that you were talking about when you chase the money, it never ends well for you. Everybody, because what you know, we define success, everyone's got their own definition of success, but often it's tied to how much money you make, or your status or recognition or whatever. And I just I love that you're always tying it back to the why. Right? What is your like, for me the impact I want to make? What do I want to do with my life, the version of me going back to what you're teaching your children now. So you know, let's close with that. Because it's such a, it's such a beautiful thing. If somebody's out there right now struggling to know which version of themselves they want to put out today, or that they want to be today or struggling to find that or just start that thing they're dreaming about? What's what's the big thing that you ask yourself?

So I think, you know, I think what people should ask themselves what what they should look at is number one, there could be multiple versions of yourself that you have even in one in one moment, right? You don't just have to be a mom, you don't just have to be a great dietician. You can you can, you can be a great dietician, one week and a subpar mom. And then the next week, you're a great mom, and a mediocre dietitian. So I think we're going to constantly evolve. There's never going to be this constant of what is perfect today and tomorrow and the next day. So I think I think that's really important. We oftentimes don't do it, you know, just our previous conversation about like chasing the money or chasing the recognition, really kind of stopping and asking yourself what creates happiness in me, and oftentimes it's not It's an award it's not money. And we know from studies that that doesn't create happiness. So what creates fulfillment, what creates happiness? You know, really kind of having the courage to look at that. Sometimes having more time creates happiness versus working your butt off for money and feeling miserable every moment, right? So I just think, like, we often hear this cliche that we need to give our kids experiences and not things and, and for a lot of reasons that that is true. But we also need to do that for ourself as well. And I think we fall into, like, we just we give that advice to kids, we're gonna give you experience those things, and you're gonna grow because of it. But then we like we don't do it ourselves. So really kind of taking that step back and saying, Okay, what, what is the experience I want my life to have? Because that ultimately is what leads to better wellness chasing a number on the scale chasing a certain salary. I haven't had a patient yet that says, They reached it. And they found, you know, Nirvana. There was something missing. So we have to figure out what that piece is before we can chase anything else.

I feel like a sunflower. It's like Thank you.

It's great.

Thank you so much, Kristen, for joining me. Oh, what a beautiful conversation. Kristen, and Kristen. And you can get a copy of skinny liver and regenerative health please, such great reads. I will put everything about Kristin on our website at it has to be made.com and also in the show notes. Kristen, I just cannot wait to see what you're gonna do next.

You to test I love you. I adore you. So thank you. It's such an honor and privilege. Thank you so much. always an

honor and privilege. My friend love you. I will talk to you soon. Wow, what an eye opening conversation, you know, the relationship between blood sugar and fatty liver disease and the importance of understanding your metabolic type. And those statistics of over one in four people actually up to 30% of the global population having fatty liver disease and many people not knowing it, that was alarming. So please go and get your annual blood work done and your checkup with your doctor and arm yourself with the knowledge to know if you have fatty liver disease. And know that there's hope that you can reverse it with some simple food and lifestyle strategies so that you don't get to the end stages of liver disease. So definitely get a copy of Christian's book skinny liver and regenerative health because they really help you to understand this topic and give you some really tangible strategies to love on your liver. Some of my other key takeaways from this conversation were at the beginning where she was talking about giving yourself permission to try different things in order to get clear about what your calling is, what you want your contribution to be. And also, knowing your worth, instead of just accepting the worth that others give you. And finding a practitioner that gets to know you, that understand you in order to help you chart your unique path to longevity, and also anchoring yourself to your why. What do you want your experience to be in your life? Instead of just blindly chasing the numbers on the scale or the numbers in your blood work? You know, listening to your it has to be me. What do you want your life to look like? So I want to know what your key takeaways are. So join our community and leave a review on Apple podcasts. I'll be looking forward to reading your comments