Surfing the MASH Tsunami

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Hepatologist and hepatology key opinion leader Naim Alkhouri joins Roger Green to remember his longstanding relationship with Stephen Harrison, announce his new role as Chief Academic Officer at Summit Clinical Research and share how, in this role, he will have exciting new avenues make an impact on many elements of MASH drug development and patient care. 

The conversation can be divided into two sections. In the first, Naim recounts his relationship with Stephen Harrison, beginning with his move to a different San Antonio clinical trial practice and continuing through his tenure at Arizona Liver Health, up until Stephen's untimely passing last April. He describes what it was like to work with Stephen, the man, and to learn from and share ideas with Stephen, the "visionary." 

Next, Naim announces that he has joined Summit Clinical Research as Chief Academic Officer. He describes the many aspects of his new role, from collaborating with Gail Hinkson, Mazen Noureddin and the rest of the Summit team in designing better clinical trials to the many kinds of medical education Summit can bring to various medical stakeholders. He describes the dramatic growth in the number of trial sites in the Summit network and additional growth he foresees. Like Gail Hinkson in the same episode, he discusses ways in which Alzheimer's drug development is similar to MASH. He also touches on obesity trials and the ways that Summit can help create more robust knowledge about obesity, not only through trials but also expert advisory boards. In the end, he makes a personal announcement that you will have to read to learn.

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Fatty Liver Alliance President Mike Betel joins Roger Green to discuss his recent completion of the 3rd Annual Glucose Challenge, an event every July where Mike wears a continuous glucose monitor (CGM) device for a month, conducts food experiments, tracks glucose levels and shares all results with his LinkedIn and FattyLiver.ca friends and followers. 

The conversation starts with Mike sharing the history of the Glucose Challenge. Over its first three years, it has evolved from a means to demonstrate the adverse effects of certain foods on human glucose levels into a shared lesson on how a patient (in this case, Mike) can maintain his blood glucose level between 75 and 140 mg/dl. 

During the episode, Mike shares some of the tricks he has learned to manage glucose more effectively. The most intriguing one? To manage post-prandial (after-meal) glucose levels, walk for "10, 15, 20, 30" minutes after each meal. An obvious and simple one many of us forget? "You don't have to finish everything put in front of you," and you shouldn't feel guilty about not finishing later. A cautionary note: weight loss via diet or drugs without exercise can lead to a greater loss in muscle or bone mass than in fat, but it does not take much in terms of formal exercise to maintain muscle and bone while dropping fat.

Mike also applauds ChatGPT and an array of consumer health devices for giving him the data and analytical support he needed to track key body metrics and know how to act upon them.

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This conversation is the third and final segment of SurfingMASH’s July discussion of #SLDThinkTank 2025. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include Dr. Kristina Curtis of Applied Behaviour Change, a UK-based consultancy. 

Louise begins this conversation by highlighting the low level of correct information (and, frequently, high level of passionately-held misinformation) that adults have about diet and her success in improving a family's behavior by educating parents about how to better help their children. Kristina replies that while knowledge and education are critical, they are not sufficient in themselves. She lists a variety of social or life priority factors that can also drive poor eating, from taking out fast food when too hungry to cook to not wanting to fight with one's children about eating their vegetables to comparing themselves to other, more obese friends or acquaintances.

Roger asks about the role politicians can play on these kinds of issues. Jörn observed that politicians at the Think Tank were motivated to act and thought about how to support better behavior. Louise noted that multi-metabolic programs with broad support can help many MASLD patients, even though MASLD is not in the stated goal for the program. Roger and Kristina note that politicians and government budget manager are motivated by short-term solutions with little thought to longer term consequences.

In the last part of this conversation, Roger asks the group to describe their reactions leavin the Think Tank in a single word. Louise and Kristina both choose "enlightened." Jörn chooses "inspiring" to describe Louise's comments and "motivating" to describe his own reaction. Listen to the conversation to hear the reasoning behind these word choices.

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00:00:00 - Surf's Up: Episode 6.9
This conversation covers three topics. The first discusses the challenges of behavior change in dietary habits and ways governments can help, the second looks at what one can learn from wearing a CGM for 30 days, and the third celebrates the late Stephen Harrison while looking into the future of clinical trials and medical education. 

00:06:12 - Global Think-Tank on SLD Roundtable, Part 3
Behavior consultant Dr. Kristina Curtis joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss issues related to patient-centered care. This conversation starts by focusing on the unique challenges that come with changing dietary habits. Changing this behavior is so challenging because the issues are so complex. People lack education about healthy eating habits. Even when they do, the high-pressure world in which we live often makes it easier simply to offer children fast food. Even parents who know better might allow their children (or spouses, or selves) not to eat vegetables after a trying day. The panel proceeds to discuss steps politicians can take to encourage healthier living and lifestyles if they wish, and why some are easier to execute than others. Finally, the group shares why they felt "enlightened" when leaving the SLD, and perhaps a little less alone.

 00:21:34 - Newsmaker: Fatty Liver Alliance President Mike Betel

This interview with Fatty Liver Alliance President Mike Betel focuses on Year 3 of his 30-day Glucose Challenge. Mike wears a continuous glucose monitor (CGM) for the entire month of July and provides daily videos on LinkedIn and the Fatty Liver Alliance website discussing what he learned. The first year was dedicated to teaching the impact of eating badly and the second year was similar, but less egregious. This year, Mike, who is pre-diabetic, set the goal of keeping his glucose in a "normal" range of 70-140 mg/dl. He did so successfully 97-98% of the time over the month, and discusses some of the tricks he learned that help keep glucose in range over that time (HINT: walking 10-15 minutes after meals helps a lot!). He also shares hints about how to look at overall weight (it's the fat that matters, not simple weight), why it is not healthy to believe you must finish every bite of food put in front of you, and how all this relates to sleep and overall health. He also provides seeds for thought about ways manufacturers and providers might educate patients effectively on these issues. 

00:53:11 - Expert: Summit Clinical Research Chief Academic Officer Naim Alkhouri

This interview occurred in late April during our episode celebrating Stephen Harrison. Naim chose this interview to annouce that he was joining Summit as Chief Academic Officer. The first part of this discussion focuses on Stephen on two levels: the personal history between Naim and Stephen and the nature of the contributions Stephen has made to the science of MASH, and particularly clinical trial design. The second part of the interview discusses Naim's new role, the diffrent kinds of teaching, training and medical education he sees as pivotal to the future of MASLD and MASH therapies, and the other elements of his new role. While discuss the role, he shares several bright, challenging insights about when MASH-ville is heading. 

01:15:09 - Conclusion

The business report discusses vacations on the SurfingMASH team, upcoming episodes, and grateful notes from Ukrainian listeners. 

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This conversation is the fourth and final segment of SurfingMASH’s April discussion of drug development in memory of Stephen A. Harrison. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include hepatologist and key opinion leader Sven Francque. 

The discussion focuses on PPARs, genetic medicines, and other emerging drug classes while considering the idea that drug therapies can have an impact on the liver independent of their effect on fibrosis regression. It begins with Sven  discussing his experience as a lead investigator in clinical trials for the pan-PPAR agonist lanifibranor, whose Phase 3 trial is now fully recruited. Sven states that in addition to fibrosis regression, lanifibranor is likely to exhibit other pleiotropic effects, and notes that vascular changes start early in the fibrotic progression process. 

After Sven elaborates on these effects, Louise asks about the SCD-1 agent Aramchol. This leads to a discussion about the idea that over time, therapy will probably come to incorporate two separate modes of action, with one to treat the metabolic dysfunction and the other to treat specific effects in the liver or, as Jörn puts it, "combining weight-neutral and weight-reducing drugs." This evolves into a discussion of what Louise terms "personal-centric" medicine, or what patient advocate Mike Betel has previously described on SurfingMASH as "tailored medicine."

The rest of the conversation predominantly lists other classes of drugs, "safe" mitochondrial uncouplers, genetic medicines, and others. Roger inquires about the FASN inhibitors, which are entering Phase 3 clinical trials. Jörn says that the data appears positive and unique. That said, he and Sven agree we need more data.

Louise sounds the closing note for this roundtable by discussing our co-founder, Stephen Harrison, and the energy and enthusiasm he brought to the entire drug development process. The group agrees that Stephen's impact continues to be felt through the MASLD community, even as he is missed by us all.

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Global Liver Institute President and CEO Larry Holden joins Roger Green to discuss recent Washington political and regulatory activities, their potential impact on the liver community, and ways we can respond.

Larry starts by acknowledging that we are in for "dark times" under the current administration and describes some current government actions that are causing major setbacks, as well as others that have the potential to do so. Specifically, he details the challenges caused by budget cuts, reallocation of funds away from major universities, staff reductions and, along with them, a loss of expertise in technical areas where knowledge and experience are pivotal.

Without minimizing these challenges, Larry proceeds to suggest actions that individuals and organizations can take to reduce losses to the greatest extent possible — and even create some "wins" — for people living with liver disease. He describes tactics for giving legislators something they value (mainly publicity and contacts) to build a relationship, gain access and create a sympathetic ear for liver community messages. 

The conversation itself shifts back and forth between some of the current challenges and the steps advocates can take to mitigate losses and, whenever possible, achieve "wins." Sometimes discouraging, sometimes educational, this is an essential conversation for all current and potential advocates for liver patients to hear.

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This conversation is the second segment of  SurfingMASH's coverage of the Global Think Tank on Steatotic Liver Diseases (#SLDThinkTank2025) held in Barcelona in June.  It focuses on the kinds of feedback most likely to produce successful behavioral interventions.

The conversation begins with Jörn discussing the Liver Screen Study, a "very ambitious effort" that starts with 30,000 members of the general European population, narrows down to a subgroup with liver disease, and then provides these individuals with information about MASLD and how to manage it, ultimately evaluating its impact. Many of these people did not know about liver disease before being informed they had it, and many changed their behavior as a result. Jörn links this to the EASL Amsterdam activity discussed last week in 6.7.1 and 6.7.2.   

Louise relates a story of speaking with Laurent Sandrin, Chairman of Echosens and inventor of FibroScan, who was "blown away by the reaction" to making FibroScans available and promoting this fact. Louise explained to Laurent that from her vantage point, FibroScan is "more than just the physical diagnostic. It has the power to engage populations," and, for many, provide the information and motivation they need to change behavior. Kristina describes how we can provide "biofeedback" like this, along with other behavioral strategies, to produce sustainable behavior change, which is far harder for an individual than simply reacting to a medical scare. She describes a model she deploys, the "Combi" model, which integrates an array of informational, motivational and behavioral items into an integrated, individualized approach. 

The conversation shifts to focus on environmental factors that work against long-term change. For someone with alcohol use disorder, this might be a family member who continues to consume large quantities of alcohol frequently. For someone living with obesity, it might be a favorite high-calorie dish...or even simply food advertising.

In the final part of this conversation, Jörn states that the Think Tank steering committee invited politicians to help them understand why certain kinds of interventions — such as taxing medically harmful goods or limiting advertising — might be socially valuable, even if unpopular. The group discussed some governmental tactics that are effective and others that are not.

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00:00 - Surf's Up, Season 6 Episode 8
The conversation addresses three issues that are distinct, yet each is pivotal to the future of MASLD and MASH therapies. The first, from the Global Think-Tank on Steatotic Liver Disease, considers how personal and digital approaches can be combined to form the most effective strategy for patient management. In the second, Global Liver Institute President and CEO Larry Holden joins Roger Green to discuss the new challenges in Washington stemming from the Trump Administration and RFK Jr. The final section is the conclusion of our recent drug development roundtable, examining drug classes we did not previously discuss, along with a thought on where combination therapy is likely to lead. 

00:04:57 - Global Think-Tank on SLD Roundtable, Part 2
Behavior consultant Dr. Kristina Curtis joins Jörn Schattenberg, Louise Campbell and Roger Green to discuss issues related to patient-centered care. This discussion focuses on the elements of successful behavior change and the importance of real-time, actionable feedback. The group discusses the interplay of diagnostic test feedback, real-time personal exchanges and AI-based algorithms in what Kristina terms a "hybrid therapy."

00:18:39 - Newsmaker: Larry Holden
GLI President and CEO Larry Holden addresses two issues related to current goings-on in Washington. First, he acknowledges that we are in for "dark times" under the current administration, and describes some of the decisions and challenges we face. Second, he suggests what individuals and organizations can do to create the best possible situation -- and even some "wins" -- for people living with liver disease. These suggestions reflect his experiences during a 30-year career on Capitol Hill, prior to his joining GLI.

00:46:15 - Drug Development Roundtable, Part 4
Sven Francque joins Jörn, Louise and Roger to share an up-to-date look at drug development. This discussion focuses on PPARs, genetic medicines, and other emerging drug classes. Sven uses the example of the pan-PPAR lanifibranor to explore the idea that drug therapies can have an impact on the liver independent of their effect on fibrosis regression. The group proceeds to discuss other emerging drugs in development and their modes of action. One theme: over time, we may see prescribers consider using different therapies to address metabolic vs. liver-specific effects, often in combination.

01:00:47 - Business Report
Thanks to our listeners, Jörn's vacation, Welcome Regeneron

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This conversation is the third segment of SurfingMASH’s April discussion of drug development in memory of Stephen A. Harrison. In addition to co-hosts Jörn Schattenberg, Louise Campbell and Roger Green, panelists include hepatologists and key opinion leaders Sven Francque and Naim Alkhouri. 

Louise starts the discussion by asking when a patient is metabolically and hepatically healthy instead of merely driving weight loss. She notes that basing therapy entirely on weight loss goals will breed failure and frustration while failing to address the actual pivotal goal of metabolic health. Sven agrees and notes how important this point is. Roger suggests that the benefit of weight loss is likely to become limited over time, which is why there is such excitement about GLP-glucagon combination therapies. Again, Sven concurs, noting that such knowledge and increasing drug class diversity will allow researchers to look at true, basic differences between agents instead of "small numerical differences."

Jörn notes the importance of NITs in addressing these kinds of issues. Scanning is an effective method for measuring changes in liver fat; however, the academic community has developed surrogate NITs for specific physiological activities. As Sven notes, there is still a great deal of work to do here. That said, Jörn cites examples of large, NIT-based projects like the VCTE Study Group that have sufficient sample size to start building definitions around kilopascal levels. Louise shares her strong concern that many TE operators are not trained adequately to appreciate subtle clues that would tell an expert how an individual scan was providing misleading results. She notes that the increased demand for scanning, in this case TE, is going to drive a watering down of the qualifications and the skill of the user and the supervision level..." The discussion winds down with Sven agreeing with Louise and stating the need for sequential testing and Jörn citing EASL guidelines in stating that practices should provide and manage high-quality care to the best of their abilities. 

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This week's newsmaker, Dutch Liver Patients Association President Jose Willemse, joins Roger Green to discuss the patient screening program at this year's EASL Congress, which took place in Amsterdam, and the general idea of what constitutes a patient-sensitive dialogue. 

Jose describes the phenomenal level of interest in the screening activity, in which hepatologists and APPs scanned 400 people per day for MASLD and MASH. Boosted by significant mass publicity in Amsterdam, the number of people seeking screening exceeded the 400/day quota, with some arriving in line hours before the scheduled start time and others traveling for hours to reach the site. Jose believes that with adequate publicity, efforts like these could be replicated around the world, but that the healthcare system lacks the necessary resources to do so. In terms of physician-patient dialogues, Jose emphasized the importance of sensitive yet frank conversations and helping patients appreciate the successes they are achieving.