It is unsettling when the political warfare that has gripped our country in recent years spills out of the halls of Washington threatening vast change.  As a patient community, we are concerned about what the changing times mean for us as many of the details can represent life and death for us.  The politicians and the other clickbait artists search for triggers that can generate a viral message, constantly driving our concerns.  I thought it might be useful to take a step back and consider where we stand today.

Akero just announced the results of its phase 2b Symmetry clinical trial of its FGF21 analog for F4 cirrhosis due to NASH/MASH and those results are just super.  There is a long way to go but we may be seeing the first real evidence of direct treatment for advanced fibrotic disease.

Coffee, should it be part of an effort to manage liver disease?

There is lots of talk about alternative therapy for what ails you since drugs are limited and expensive.  We all manage our day to day with only occasional contact with our docs and much depends on what we consume.

Passing milestones, like a year or a birthday, often lead one to reflect on life or the passage of time.  As I look back at my life, the metaphor that comes to mind is that of water.

The holidays are a difficult time for managing your diet.  Navigating the day to day challenge of what to eat is difficult for most of us, but it is easier if you understand how things work.  That gives you a way to evaluate the advice and the choices that you deal with when choosing what to eat.

A key premise of our approach to food is to try to minimize the amount of work the liver has to do.  It is capable of a vast array of chemical tasks, but when it is ill the best strategy is to be kind to it and to ask it to do as little work as possible.

Comparing Rezdiffra with Wegovy and Mounjaro In the context of NAFLD/NASH (MASLD/MASH)

Understanding how these very different drugs work in the context of steatotic liver disease

At the end of 2024 there are three drugs available for patients dealing with obesity and its consequences for liver disease.  Resmetirom marketed as Rezdiffra (Madrigal) is a liver specific drug and Semaglutide marketed as Wegovy (Novo Nordisk) and Tirzepatide marketed as Mounjaro by (Eli Lilly) are both focused on weight loss outside the liver. 

GLP-1 Weight Loss Drugs: A Guide to Novo Nordisk and Eli Lilly’s Innovations 

In the world of weight loss and diabetes management, GLP-1 receptor agonists have become a game-changer. These medications, originally developed for type 2 diabetes, are now widely used for effective weight loss. Two pharmaceutical giants, Novo Nordisk and Eli Lilly, have emerged as leaders in this space, offering groundbreaking drugs that redefine how obesity and metabolic disorders are treated. 

This guide explores the key aspects of GLP-1 drugs, focusing on the contributions of Novo Nordisk and Eli Lilly, their mechanisms of action, benefits, market trends, and the future of these transformative medications. 

The 2024 edition of our Care Survey is ready.  It gives a view of how patients experience liver disease over time, and how contact with medical care evolves.  We are beginning to see changes in patient care that are encouraging as the education efforts of patients and physicians begin to show results. I invite you to click on the image below and take a look at the report.

Madrigal recently released their 3rd quarter financial report.  They said they were very pleased and the invester community loved it pushing the Madrigal stock price up dramatically.  Take a look at this summary.

PPAR -- Peroxisome proliferator-activated receptor

Lanifibranor by Inventiva leads the way

Wayne, you must be crazy to think I'll read something that starts out like that!!!

Be calm, I promise, it will make sense and if liver disease interests you this will be worth your time.

The approval of the HistoSonics Edison system for liver cancer recently was surprisingly low key.  This is a quite remarkable advancement in the treatment of liver cancer.  HCC is one of the leading cancers and is increasing very rapidly in our liver community.

The Edison system liquifies tumors using focused ultrasound so no complicated internal therapies or surgeries.  To look at the company information use this link.

HistoSonics website

The promise of DNA guided care has been a long time coming but we are on the brink of practical application. I've had a keen interest in DNA so I decided to get my genome sequenced and to see what I could learn. I wanted to know if it could help me manage my health.

There are a few suppliers of sequencing and they fall into two types.  One version analyzes a catalog of short sequences called SNPS that have known interpretations and lend themselves to genealogy such as Ancestry and 23andME.  The other does a whole genome sequence and captures all of the DNA data which is a huge amount of information, much of which isn't really well understood yet, but it is research grade.

I haven't written about diet in some time and things have improved a bit for some people, but we have the next crop of victims of these crummy liver diseases on board so a little information from the real world might be of value.

First, there is no cleanse, superfood, magic pill, talisman, or faith healer that will fix your liver.  Beware of Dr Google as he might kill you after he takes your money. There are a few things that help some people marginally, but  generally they just service hope.

When you are in a whirlpool you can't see the form of the beast and you only experience the local effect. AI is an information whirlpool drawing us ever more rapidly into a vortex whose ultimate consequence is unknown.

The concept of the "information singularity" is associated with the futurist Ray Kurzweil. In  "The Singularity Is Near," published in 2005 Kurzweil discussed the idea of a point in the future where technological growth becomes uncontrollable and irreversible, leading to profound changes in human civilization due to advancements in artificial intelligence and information technology.

Living with HIV comes with unique challenges, and understanding MASH (metabolic dysfunction-associated steatohepatitis) is crucial for those affected. Join us on Thursday, August 15, 2024, from 10:00 am to 11:00 am EDT for an informative and interactive webinar featuring Dr. Meena Bansal, System Chief of the Division of Liver Diseases at Mount Sinai Health System and Director of the MASLD/MASH Center of Excellence at Mount Sinai in New York.

Madrigal today released their first report of results following FDA approval of Rezdiffra for the treatment of NASH, in conjunction with diet and exercise, in March. Their results are on track according to company forecasts but there is much left to do.  Here are some key points.

The approval of Madrigal's Rezdiffra earlier this year was an important step for patients but we have a long way to go for robust therapy. Happily, research continues and there are important phase 3 trials underway from Akero Therapeutics (Efruxifermin) and 89Bio, (Pegozafermin) targeting FGF21.  These are interesting  as they more directly address fibrosis and are being tested for F4 patients which could be important as Rezdiffra is only approved for F2/F3.

Monday afternoon my wife and I will kill a dear member of our family.

Mercy killing, a difficult concept.  What do you do when the body fails, there is no hope for recovery and only a lingering and painful death will be the result?

I appreciate that I have achieved remission with my cancer and I was thinking about the fact that my liver, even though I have cirrhosis, managed all of the chemo drugs I've had pretty successfully.  In our patient groups we often see people who die quickly when a second problem appears. 

The Fatty Liver Foundation is very focused on NAFLD/NASH and how to manage it as patients.  A much broader need is coping with the challenges of life in the context of chronic illness.  The ordinary things of life like having food or shelter often become a problem for chronically ill people.  We have created a new program called The Wellness League designed to help people find the services they need beyond just medical.  A key tool is our SEARCH function.  I invite you to check that out and become member of thewellnessleague.organd I would love it if you would consider joining our Sharing Journeys project.  Your personal experience will help future patients learn about the patient journey.