Around 30% of the world’s population is walking around with too much fat in their liver, and the overwhelming majority have no idea. In this episode I sit down with Prof Aleksander Krag, professor and department chair of gastroenterology and hepatology at Odense University Hospital and former Secretary General of the European Association for the Study of the Liver, to work out what that number actually means for you.
Steatotic liver disease is silent until it is not. By the time symptoms appear, the options narrow dramatically, and yet the disease is slow moving, largely reversible, and detectable with tests that already exist in most clinics. Aleksander’s argument is that the field has spent decades finding people far too late, and that the distance between a frightening headline statistic and a genuinely useful risk assessment comes down to one distinction: not fat, but scarring.
What we cover
- Why roughly a third of us have fat in our liver, and why that figure on its own is not the thing to be frightened of
- The difference between steatosis and fibrosis, and why only one of them predicts whether your liver will ever cause you trouble
- What happened when Aleksander’s team measured alcohol in the blood rather than asking people how much they drink, and why 38% of one group turned out to be in the wrong category
- The single measurement you can take at home that tracks liver risk better than almost anything else on a standard blood panel
- FIB-4, FibroScan, elastography, and ELF: which test does what, and which one to ask your GP for
- How far liver damage can be walked back, including early signals that even cirrhosis may be reversible
- Where semaglutide and resmetirom fit, what the FGF21 drugs might add, and why Aleksander thinks hepatology is about to look a lot like treating blood pressure
- Why he sees this as a policy problem as much as a personal one, from alcohol pricing and marketing to removing VAT from vegetables
This is one of those conversations that turns a vague background worry into a concrete next step. If you take one thing from it, make it the question Aleksander wants far more people to ask at their next check-up.
To connect with Prof Aleksander Krag, visit the Centre for Liver Research (FLASH) at the University of Southern Denmark, follow him on X, or find him on LinkedIn.
- The Liver Patient Doctors Missed for Years (00:00)
- 30% Have Fatty Liver and Don’t Know It (02:59)
- How a Failing Liver Affects Your Whole Body (06:45)
- MASLD, METALD and Alcohol Liver Disease Explained (11:18)
- The Blood Test That Reveals Real Alcohol Intake (17:46)
- Is There a Safe Amount of Alcohol? (20:37)
- How Liver Fat Progresses to Fibrosis (25:15)
- Where Does Liver Fat Actually Come From? (28:47)
- How Smoking, Coffee and Fructose Affect the Liver (35:24)
- Blood Tests and Waist Size for Liver Risk (40:01)
- FibroScan Explained and Who Should Be Screened (45:08)
- Can Liver Fibrosis and Cirrhosis Be Reversed? (51:03)
- How GLP-1s, Resmetirom and FGF21 Work (57:19)
- Best Diet to Reduce Liver Fat (01:02:19)
- Alcohol Pricing and Ultra-Processed Food Policy (01:09:01)
- How to Check Your Liver Health This Week (01:12:49)
Resources and links:
- Steatotic liver disease
- Alcohol-Related Liver Disease: A Review
- Implementing sustainable liver health in Europe: a second EASL-Lancet Commission
- Steatotic liver disease trajectory: A holistic EASL guidance on the multidisciplinary approach to screening and patient management
- EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD)
- Why is the size of your waist important?
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More about Aleksander Krag
Aleksander Krag, MD, PhD, MBA is Professor and Department Chair, Department of Gastroenterology and Hepatology Odense University Hospital, Director of Centre for Liver Research (FLASH) Odense University Hospital and DIAS Chair of Health Sciences, University of Southern Denmark. He also served as Vice-Secretary and then as Secretary General of European Association for the Study of Liver (EASL) 2021-2025. Aleksander Krag is involved in and hold leader positions in a number of large research collaborations in liver diseases, including being director of FLASH: Fibrosis Fatty Liver and Steatohepatitis Research Centre Odense, PI in MicrobLiver, Coordinator in the H2020 project GALAXY: Gut and Liver Axis in Alcoholic Liver Fibrosis and partner and PI in the H2020/Horizon Europe projects MicrobPredict, LiverScreen, The International Human Microbiome Action and LiverAIM and PI in the Center of Excellence Center for Functional Genomics and Tissue Plasticity.
His passion is research with focus on translational and clinical aspects of steatotic liver diseases (alcohol and non-alcohol related), liver fibrosis, complications to cirrhosis and microbiome. He is particularly interested in biomarker research throughout the full value chain from discovery to implementation and how omics and AI can be used in next generation biomarkers.
