The Proof with Simon Hill
The Proof with Simon Hill

The Liver Disease 30% of Us Have and Never Feel | Prof Aleksander Krag

September 14, 2026

AI Summary

5 min read

The Silent Epidemic: How 30% of Us Have Liver Disease and Don't Know It

Professor Aleksander Krag, a hepatologist and former president of the European Association for the Study of the Liver, opens with a story that drives his work: a patient named Henry. Henry had steatotic liver disease for 15 to 20 years, but the healthcare system missed it until he reached an advanced stage with cancer. He was too sick for a transplant, and Krag couldn't save him. Henry had a family and could have lived another 20 or 30 years. That experience shifted Krag's focus from treating end-stage disease to prevention and early detection. "I want to see a future where we find Henry 10 or 15 years earlier," he says.

What Steatotic Liver Disease Actually Is

Around 30% of the global population has steatotic liver disease—excess fat making up more than 5% of the liver's weight. The condition was renamed in 2023 to remove the stigmatizing word "fatty" and the confusing "non-alcoholic" label. Now it's called steatotic liver disease, an umbrella term with subtypes based on what drives the fat accumulation.

Continue reading the full summary in the app — free to try.

Read Full Summary →

Free • No credit card required

Listen to Audio Summary Open in App

What you'll learn

  • 1 (00:20) **The "Henry" Problem** - Why one patient drives Prof Krag's shift from end-stage care to early detection
  • 2 (03:26) **The Silent Epidemic** - 30% of the global population has steatotic liver disease and most have no idea
  • 3 (04:52) **The Two New Breakthrough Drugs** - After 20 years of searching, two medications are now FDA and EMA approved
  • 4 (05:50) **How Reversible Is Liver Disease?** - Even advanced fibrosis can be reversed, contrary to old medical teaching
  • 5 (10:45) **Liver Disease and Heart Attack Risk** - The strong association between steatotic liver disease and cardiovascular disease
  • 6 (13:14) **The New Nomenclature** - Why "fatty liver" was renamed and what the three subtypes actually mean
  • 7 (19:03) **The Alcohol Underestimation Problem** - Self-reported drinking hides how much alcohol actually drives liver disease

+ Full timestamped outline available in the app

Show Notes

Around 30% of the world's population has too much fat in their liver, and almost none of them know it. Liver disease stays silent until it is very advanced, which is exactly why so many people are found too late.

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 separate the frightening headline number from the thing that actually determines risk. It is not the fat. It is the scarring, and there is a simple test that can tell you whether you have any.

What we cover

  • Why a third of us have fat in our liver, and why that alone is not the thing to worry about
  • Steatosis versus fibrosis, and why only scarring predicts clinical liver disease
  • What blood-based alcohol biomarkers revealed about self-reported drinking
  • The single home measurement that tracks liver risk best
  • FIB-4, FibroScan, elastography, and ELF, explained plainly
  • How reversible liver damage really is, and where semaglutide and resmetirom fit
  • The policy levers Aleksander argues would prevent more disease than any clinic can

If you have ever wondered whether your drinking, your waistline, or your last set of liver enzymes is worth acting on, this conversation gives you a clear place to start.

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.

If this episode was useful, please leave a rating and review on Apple Podcasts or Spotify. It genuinely helps more people find the show.

Want to support the show?

The best way to support the show is to use the products and services offered by our sponsors. To check them out and enjoy great savings, visit theproof.com/friends. You can also support the show by leaving a review on the Apple Podcast app and sharing your favourite episodes with friends and family.

This episode is brought to you by:

38TERA

Consider 38TERA's DMN prebiotic supplement a daily multivitamin for your gut. Formulated by yours truly and gastroenterologist Dr Will Bulsiewicz. Use code THEPROOF for a discount at checkout.

38Tera ships to the United States, Australia, and New Zealand.

Function Health

Take charge of your health with advanced blood testing and personalised insights. Function Health offers a practical way to track key health markers such as cholesterol, blood sugar, and more. Learn

The Proof with Simon Hill

More from this podcast

The Proof with Simon Hill →