Your Checkup: Health Conversations for Motivated Patients
Ever leave the doctor’s office more confused than when you walked in? Your Checkup: Health Conversations for Motivated Patients is your health ally in a world full of fast appointments and even faster Google searches. Each week, a board certified family medicine physician and a pediatric nurse sit down to answer the questions your doctor didn’t have time to.
From understanding diabetes and depression to navigating obesity, high blood pressure, and everyday wellness—we make complex health topics simple, human, and actually useful. Whether you’re managing a condition, supporting a loved one, or just curious about your body, this podcast helps you get smart about your health without needing a medical degree.
Because better understanding leads to better care—and you deserve both.
Your Checkup: Health Conversations for Motivated Patients
75: Understanding Your Liver: From Function to Fatty Disease
Send us a message with this link, we would love to hear from you. Standard message rates may apply.
The liver performs vital functions including filtering toxins, producing proteins, storing energy, aiding digestion, and regulating cholesterol and hormones. Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) has become the most common chronic liver disease globally, affecting up to 38% of the population worldwide.
• The liver filters blood, breaks down alcohol and medications, produces proteins like albumin and clotting factors
• It stores energy as glycogen, vitamins, and minerals including iron
• The liver makes bile for digesting fats and helps regulate cholesterol and support immune function
• Common liver problems include fatty liver disease, alcohol use, viral infections, and medication toxicity
• MASLD (formerly non-alcoholic fatty liver disease) occurs when too much fat builds up in the liver
• MASH is a severe form of MASLD with inflammation and damage that can lead to fibrosis and cirrhosis
• Up to 38% of people worldwide have MASLD, with prevalence rising to 65% in those with type 2 diabetes
• 5-10% total body weight loss can help slow, stop or reverse liver injury from MASLD
• The FDA recently approved semaglutide (Wegovy) as the first specific medication for treating MASH
• Regular check-ups with blood tests can help detect liver problems before symptoms develop
Stay healthy, and if you're concerned about your liver health, speak with your healthcare provider about testing and treatment options.
Production and Content: Edward Delesky, MD & Nicole Aruffo, RN
Artwork: Olivia Pawlowski
Hi, welcome to your checkup. We are the patient education podcast, where we bring conversations from the doctor's office to your ears. On this podcast, we try to bring medicine closer to its patients. I'm Ed Delesky, a family medicine doctor in the Philadelphia area.
Nicole Aruffo, RN:And I'm Nicola Aruffo. I'm a nurse.
Edward Delesky, MD:And we are so excited you were able to join us here again today.
Nicole Aruffo, RN:Why are you looking at me like that?
Edward Delesky, MD:I don't know, you've had the giggles all day. You really have. The Emu Lemu commercial came on and the bass on the sound bar was like way too high and it was like and you just go, damn, it was like a really, it was like a bassy man's voice, damn. I was like, oh my God, you startled me. I was startled by the commercial and then I was startled by you, damn.
Nicole Aruffo, RN:I think I startled myself.
Edward Delesky, MD:And you were startled by a sound. You've had the giggles all day and then, like you know, I we woke up in this type of mood. I mean, if this was a visual podcast, you see that we're like wrapped in two blankets. I have like mother mary going on with the white blanket over my head right now. You have like bali sunglasses on right now.
Nicole Aruffo, RN:Yeah, I got CUNY sunglasses for Bali.
Edward Delesky, MD:And you're wrapped like a babushka in this, like teal fluffy blanket. Gravy is on the excuse me, gravy is on the stovetop. Got up early to do that. We're trying to get Jones to poop.
Nicole Aruffo, RN:Oh yeah, he's been sick. We took him to the doctor, though. Well, eddie did, because some of us had to go to work.
Edward Delesky, MD:oh wow, it's really bright in here without these sunglasses on the blinds are completely closed and they like, darken the room entirely no, but maybe the sunglasses are just that good. They're cute, right no, they're cute, I like them. Yeah, I like them, they're cute bring them to bali with us yeah, we're um doing some like uh research on bali by watching real housewives of orange county during those episodes to try to understand what bali looks like. It. It's not helping me at.
Nicole Aruffo, RN:No, all they're doing is fighting in the hotel.
Edward Delesky, MD:Yeah, so that's not helpful One bit.
Nicole Aruffo, RN:But yeah, Ollie's been sick. He had a little stomach bug. Eddie took him to the doctor. He got little puppy fluids. He's so cute. He's improving though he is, he's better. He's pooping regularly, semi-regularly. So road to recovery.
Edward Delesky, MD:Road to recovery. I made burgers last night. You seemed to really like them.
Nicole Aruffo, RN:Yeah, that was a good burger You've been making. I feel like you've been sleeping on burger making and have been holding out on me.
Edward Delesky, MD:On burger making, let me tell the good people. So we used regular beef, like like ground beef, but you do ground turkey. Uh, I didn't actually use the onion that it calls for. Um a third of a cup of breadcrumbs, a tablespoon of worcestershire, a tablespoon of dijon mustard, a teaspoon of paprika, which we didn't have. Half a teaspoon of garlic powder, teaspoon of kosher salt unless you have hypertension um half a tea I'm kidding. Half a teaspoon of fresh ground pepper and an egg. You mix that up and put it on the cast iron and you really liked it yeah, it was really delicious yeah, so that was good.
Edward Delesky, MD:Um, and then it is fantasy football season. I am am obsessed with fantasy football season my drafts and things like that. So I'm working on that on overtime.
Nicole Aruffo, RN:You're such a good fake football coach.
Edward Delesky, MD:Thank you. Yeah, the boy, I listen to podcasts about this, do relentless research. The boys in the locker room were assembling our team multiple teams and it's going to be fun. We're going to see where it goes and I think we're gonna put together a good squad this year. Make a good stretch run that's what football coaches say, I think.
Nicole Aruffo, RN:get the boys riled up in the locker room, you know.
Edward Delesky, MD:Yeah yeah, it's gonna be good. Um, I bought these shorts with yeah, underwear built in. Is that underwear?
Nicole Aruffo, RN:I mean, I don't know if that's like. I think it's just supposed to be like a compression short, but that's basically your underwear, Not to be weird.
Edward Delesky, MD:Yeah, well, it really brings it to a single use then, Not that, like, I mean, if you're wearing underwear, maybe you can like reuse a short if you're wearing it like lightly right. Yeah, I think so yeah, so that was fun. And then a handheld water bottle, because I'm seeing people run around and they're holding water and I will go like not far, far distances, but like reasonably far distances, and not have water, and I'm thirsty when I'm doing that stuff.
Nicole Aruffo, RN:How did your run feel today with your water?
Edward Delesky, MD:thank you. Um, you know it felt good today. I felt nice to be able to just run with it. It kind of just slides right on your hand so you don't have to change anything and it was good. I um probably ran about the same length, um exerted myself about the same amount, but it felt nice to have the water with me so I didn't have to be parched.
Nicole Aruffo, RN:Hydration.
Edward Delesky, MD:Yeah, hydration is key, a major key, if you will.
Nicole Aruffo, RN:And we got a new monitor. We had ourselves a little day yesterday.
Edward Delesky, MD:We did Well. I'm starting work soon and I wanted to be able to multitask and have two things up at once or just have a better display. And I am very pleased because previously I just used like do you have it up right now? Oh, yeah, yeah, I have the show notes right up on the oh, really the screen right now, yeah, wait, let me come look yeah, oh
Edward Delesky, MD:this looks great yeah, we got to get you one of these. Yeah, it's good, it's a good monitor and the guy helped us out. Um, they're making laptops these days that look pretty nice.
Nicole Aruffo, RN:Yeah, I think we should get some. I want one too.
Edward Delesky, MD:I have a lot of laptops. What are you going?
Nicole Aruffo, RN:to do with a laptop. I don't know what do people do with laptops?
Edward Delesky, MD:What you're going to do on your phone.
Nicole Aruffo, RN:Surf the web. I'll book our next vacation. That'll be nice, we've got to rack up the credit card points. Got to buy two laptops. We use all our points for our honeymoon.
Edward Delesky, MD:Got to rack them back up, as economical as it makes it sound. That's how that works, and then any other thoughts before we dive in here. I don't think so, okay, well, what are we going to talk about today, nick?
Nicole Aruffo, RN:Today we're talking about the liver, some metabolic liver disease and the new FDA approval for Wagovi, and all of that.
Edward Delesky, MD:Yeah, and today's information is grounded in consensus guidelines from the American Diabetes Association, systematic reviews and major clinical trials, putting all of this stuff together for you in what seems like three segments today. So before we dive into all of that, I really wanted to introduce the idea about what the liver does. I went out on threads the day we're recording this and I was like do you know what the liver does? And a sassy biology teacher of 30 years was like yes, comma, look it up. I taught biology for 30 years, which wasn't the intent of the post. It was to invite.
Nicole Aruffo, RN:It was a little literal.
Edward Delesky, MD:It was a little literal, it was to invite that it does a lot. The liver is very important. It is a large organ located in the upper right part of the abdomen, just below the ribs right there, and it has a ton of important jobs. Nick, why don't we go back and forth kind of reviewing what these important jobs are? I will kick us off. Okay, it mainly, or one major feature it has, is filtering and cleaning the blood, and by that I mean thinking of toxins. Certain medicines and drugs and other waste products from the blood get processed through the liver. It also helps break down alcohol and, like I mentioned, other medicines, before moving it to other parts of the body where it's easier to handle. What else does the liver do?
Nicole Aruffo, RN:The liver helps with making important proteins. It produces an important one like albumin, which keeps fluid in the bloodstream, helps with clotting factors and helps to stop you bleeding. Stop you bleeding. Stops your bleeding after an injury.
Edward Delesky, MD:Yeah, all extremely important stuff. Very easy for those things to go awry One simple organ doing all those complex things. What it also does is it helps store energy. Actually, the liver stores sugar, which can be broken up into smaller particles of usable energy, and releases them to the body when the body needs energy. It also stores other vitamins and minerals. Like it has a lot of stores of iron in there as well. What else is it good for?
Nicole Aruffo, RN:It helps us with digesting food. The liver makes bile, which is a yellow-green fluid that helps digest the fats in our food, and it's stored in the gallbladder and then released into the intestine when we need it.
Edward Delesky, MD:Yep, and the liver also helps regulate cholesterol and other hormones, so it's involved in managing the level. It's also involved in creating certain types of cholesterol. Cholesterol is like much more complicated we have episode 43, which discusses the other types of cholesterol to think about. But the liver also has an important job as it relates to cholesterol, and I'll just jump in here and finish out that it also helps support the immune system, so it also the liver itself can help remove bacteria and other germs from the blood in some smaller role than it has.
Edward Delesky, MD:So the way that various clinicians can help and check and see if the liver is okay is they have certain liver chemistries that they can look at to detect liver injury or disease, and these are ones that you may see on your own labs looking like ALT, ast, alkaline phosphatase, bilirubin and albumin, and so abnormalities in these may tip off that there's something to think about. But honestly that's like such a niche thing with you and your doctor to think about. But those are the labs that people most of the time look at. Nikki, can you take us through when things go awry, when these liver enzymes may be abnormal or they may not be? What are some common causes of liver problems?
Nicole Aruffo, RN:Some common causes of liver problems include fatty liver disease, alcohol use, viral infections such as hepatitis, some medicines and sometimes you can inherit different kind of liver conditions.
Edward Delesky, MD:Totally, and there's a lot of things that can obviously, as you mentioned, common and uncommon that can tickle the liver or really send it to go haywire. The liver is resilient, but sometimes people fly too close to the sun and the liver gets, you know, beat up a little bit too much. Many liver diseases don't cause symptoms at first, and so that's why getting your checkups and getting some blood tests can be important for people who are at higher risk. To highlight on your list right there fatty liver disease or otherwise, in medical language, metabolic dysfunction, associated steatotic liver disease. This is the thing that you may see as Masl-D is the thing that we talk about in the second segment today, becoming one of the most common causes of liver injury in our society today. So, so, unlike the end of the extreme, if the liver isn't working well, people can notice symptoms like yellowing of the eyes or skin, swelling in the belly or the legs, easy bruising and bleeding and overall feeling an intense set of fatigue, and so if you notice these, don't pass go, make sure you connect with your doctor.
Edward Delesky, MD:So, now that we have a broad overview of what the healthy liver does and general concepts, what we really wanted to dive into is MASLD, or the thing called metabolic dysfunction associated steatotic liver disease. It used to be called non-alcoholic fatty liver disease, but this new name has more of a patient first type of denotation when you're talking about it. So it's not so much like the person is the disease, it's that the person has this, and that's why the name is so long. It was a recent change in the last couple of years, so I'll kick us off here. The question remains is what is this? Well, masl-d is a or M-A-S-L-D is a common liver condition that occurs when too much fat builds up in the liver. This falls squarely in the bucket of visceral fat that fat that we're talking about. That builds up in the abdomen and it ends up usually being linked to things like being overweight or having obesity, type two diabetes, high blood pressure and high cholesterol. Nikki, can you key us in about why Masl-D is so important?
Nicole Aruffo, RN:Yes, it's actually the fastest growing cause of cirrhosis and liver cancer, which is not good. It's also linked to higher risks of heart disease and kidney problems.
Edward Delesky, MD:Yeah, it's extremely common and has been frustrating to treat until recently, when there are new medications available, both GLP-related and non-GLP-related. So the question comes in of like, how do you know if you have it? How do you know if you should get checked out? It is diagnosed by blood tests noticing those abnormal liver enzymes. Perhaps Someone may get an imaging study like an ultrasound or an MRI or some other imaging study, and it may, incidentally, come up and be noticed and in more rare cases, these days the gold standard is a liver biopsy, which sounds dramatic. It's not the easiest thing in the world and it's a little annoying, but less commonly used, but really, really, that's a really common thing to use to diagnose this. And in truth, when putting all of that together, to capture this diagnosis it requires liver fat, metabolic risk factors, like we talked about before, and ruling out other causes of liver injury, some of the most common ones being alcohol or hepatitis. You know what, since you always get this, I'll take this one, because you always end up talking about how things are treated and what I will say here is that lifestyle changes end up being the first thing to do. I kind of want to kick us off with a 5% to 10% total body weight loss can help. There is a lot of evidence that suggests that weight loss helps slow down, stop or even reduce and reverse the liver injury because of this, and so really sincerely take it into account that if you're thinking about your weight and your doctors mention, hey, you have some fat in your liver, that's a solution. I'm not proposing that it's easy, but that's something that could be done. And then you think about managing the other health problems like control blood sugar, control your cholesterol better and make sure that your blood pressure is under excellent control. So an interesting piece is that, specifically, there are no medications available for MASLD or the fatty liver, and that's specific because, while that's an umbrella term, underneath that umbrella there is a later stage, something called metabolic dysfunction associated steatohepatitis, which means that there's inflammation and damage and that there also can be scarring in the liver and potentially downstream cirrhosis, which is excess scarring in the liver, and liver cancer, potentially Soon.
Edward Delesky, MD:In our next segment we're going to talk about that delineation is important because there is a recent FDA approval for a GLP-1 medication, wagovi, to be approved to treat MASH or that long name that I said earlier. I am glad that we're spending so much time talking about this because this is so incredibly common. There is a recent New England Journal of Medicine review that came out August of 2025, which suggests that up to 38% of the population worldwide is affected by Masl-D, and that proportion of people is even higher in certain subgroups, like people who have type 2 diabetes, and that suggests that the prevalence of that, which is the number of people that have that in a population at any given time, could be about 65%. So this review suggests that now this is the most common chronic liver disease globally and is continuing to happen here more and more frequently. Okay, so can you, since we took a little step away from what mash is there, can you tell us and remind us what mash is?
Nicole Aruffo, RN:Mash is a severe form of the mass oldie, but with inflammation and actual damage to your liver, and this can lead to fibrosis, cirrhosis or cancer.
Edward Delesky, MD:So enter GLP-1 receptor agonists, and this is a brief summary review. These medicines were originally developed for type 2 diabetes and the management of the chronic disease of obesity, and they help people support blood sugar control and weight loss, and recently, in a trial, they were shown to improve liver health as well in MASH. All of this in totality being related to metabolic health and the management of metabolic dysfunction. And so the FDA approval comes on the back of semaglutide, a GLP-1 agonist for patients with MASH in a moderate or advanced fibrosis category. What that means for anyone out there is that certain tests done, or imaging studies done, to point you in the direction that it's a moderate to severe scarring in the liver and, of note, it's the first medication specifically approved for this condition. There is another medication approved for helping liver fibrosis is resmetiron. We won't be talking about that today, but that is another medication. The idea behind how they work is essentially to improve liver health and resolve inflammation. There is an evidence that it reduces the actual scarring in some patients, which is amazing. In addition, it helps support weight loss and improve blood sugar, cholesterol and heart risk factors, all in all being very helpful and approved. Here. Basically, what we're seeing is that they're going down the line, finding any obesity-related complication and trying to get FDA approval for these. Last year, we saw them approve ZepBound for sleep apnea and that's been very helpful, and now we're seeing Wagovi or semaglutide be approved for treatment of MASH. So, all in all, it's a really cool development that there is an extra tool in the toolbox to be more proactive and help people with this condition. This is something that's incredibly common, like we talked about earlier, and it should be taken so seriously. It's something to be proactive with and get checked out for. So hopefully this was helpful for anyone listening.
Edward Delesky, MD:Well, thank you for coming back to another episode of your Checkup. Hopefully you were able to learn something for yourself, a loved one or a neighbor. Check out our website. Come visit us on threads. I'm literally on there all the time. You can email us at yourcheckuppod at gmailcom. But, most importantly, stay healthy, my friends. Until next time. I'm Ed Dolesky. I'm Nicole Rufo. Thank you, goodbye, bye. This information may provide a brief overview of diagnosis, treatment and medications. It's not exhaustive and is a tool to help you understand potential options about your health. It doesn't cover all details about conditions, treatments or medications for a specific person. This is not medical advice or an attempt to substitute medical advice. You should contact a health care provider for personalized guidance based Thank you. In short, I'm not your doctor, I am not your nurse, and make sure you go get your own checkup with your own personal doctor.
