Every St. Patrick’s Day the T-shirts come out. “Don’t worry, liver, you’ll be fine.”

Chantel Holz, CNP, has a two-word response to those. “Job security.”

Holz works in gastroenterology at Monument Health and has spent more than ten years specializing in liver disease. She sat down with Mark Houston on Doc Talk to talk about the organ most of us think about only when we’re joking about it.

The organ with a dozen day jobs

The liver detoxifies, which matters more every year given what we breathe, eat and swallow. It produces bile. It’s also a major production and transport center for cholesterol, which surprises most people who hear it for the first time.

And it’s quiet. That’s the part Holz wants people to sit with. “You can have absolutely no symptoms, even at advanced liver disease,” she said. “When you become symptomatic of the liver, it’s so far gone.”

Fatty liver by its new name

What used to be called non-alcoholic fatty liver disease now goes by metabolic associated liver disease. The name changed. The numbers got worse.

In westernized countries it’s the number one cause of liver disease, passing hepatitis B and C. Holz says it’s showing up in roughly one in every three to one in every four people. Obesity rates, diet and processed food are driving it.

Between ten and thirty percent of people with it develop scarring in the liver. Some reach cirrhosis, which is stage four scarring, a lumpy nodular liver replaced by scar tissue. Add moderate alcohol to that and the liver burns out faster.

The lab results that lie

For years the thinking was simple. Elevated liver enzymes meant risk, normal enzymes meant you were fine.

That turned out to be wrong. Holz says as many as forty percent of patients can have normal liver enzymes and still develop scarring. She’s seen charts where the labs looked clean for decades, and the patient walked in with cirrhosis.

Liver biopsies used to answer the question. They’re invasive, expensive and carry real risk, so they’ve largely been replaced by a FibroScan. It works like an ultrasound, sending a vibration through the liver and measuring how fast it travels through the tissue. The speed tells you about stiffness, and stiffness tells you about scarring.

Who should ask about it

Risk factors Holz watches for:

• BMI over 25, especially weight carried in the abdomen
• Visceral fat around the organs, which some people are genetically wired to store
• Insulin resistance or type 2 diabetes
• High triglycerides
• Polycystic ovarian syndrome
• Hypothyroidism
• Family history of liver disease

That last one carries more weight than people expect. Holz has treated patients with end-stage liver disease from fatty liver, and now treats their adult children.

Symptoms, when they show up at all, are vague. Fatigue. Sometimes a dull awareness in the upper right side, not painful, not tied to meals, that comes from the liver stretching its capsule.

Age isn’t the shield it used to be either. Her youngest transplant patient was 25. Pediatricians are calling her about adolescents with elevated enzymes and adult risk factors.

Skip the detox aisle

Ask Holz which liver supplement to buy and you’ll get a fast answer. Don’t.

She’s had patients walk into her clinic jaundiced from herbal supplements. Turmeric comes up first, marketed as an anti-inflammatory, linked to drug-induced liver injury in her practice. Lately she’s seeing damage from TikTok dewormer trends, including ivermectin, some of it formulated for horses.

“It’s not studied in humans,” she said. “We don’t know what’s safe.”

What actually helps

Fatty liver can be reversible, and the fixes aren’t exotic. Stick to the outer aisles of the grocery store. Cut the processed food and the high-fructose corn syrup. Put the phone down and move.

Treatment options have grown too. GLP-1 medications like Ozempic and Mounjaro help by hitting visceral fat, cholesterol and insulin resistance at once, and Holz says four more with additional liver benefits are in the pipeline. There’s now a first FDA-approved drug for fatty liver disease, one she helped study.

If you have risk factors, ask your primary care provider about screening. The whole point is catching this before it introduces itself.

“We don’t want that to sneak up on people,” Holz said.