Dr. Joseph Galati is a liver disease expert, speaker, radio host, entrepreneur, and author devoted to the care of patients with all facets of liver diseases, obesity, fatty liver, and related disorders. Since 2003, Dr. Galati has been a familiar voice on Texas radio airwaves, producing and hosting Your Health First every Sunday evening on the program’s flagship station, 740 KTRH in Houston.
Today, Dr. Galati joins the show to share what inspired him to specialize in the liver, the incredible leading-edge work he is doing in liver transplant medicine, and to debunk the stigma behind diseases such as hepatitis and cirrhosis.
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Listen to the episode here
Dr Joseph Galati – Your Health First: At The Leading Edge Of Liver Transplant Medicine
I’m joined by our guest, Dr. Joseph Galati. How are you, Dr. Galati?
I’m awesome and so happy to be here.
I am so happy and honored to have this world-renowned Liver Specialist with us. Thank you so much for taking the time. I know how busy you are.
Yes, I’ll say I am busy, but these kinds of activities really have to take priority to communicate with the public and interested healthcare professionals. It’s key. I think it behooves us all to make time.
It does. That’s right. We’re talking about a topic, the liver, obviously being a liver specialist. We run into that at J. Flowers Health Institute and working with the patient population that we do. It’s such an important part of our human being, of ourselves, of our human condition. First, I want to say that Dr. Galati’s practice, as a Liver Specialist of Texas and the Metabolic Liver Center, is devoted to the care of patients with all facets of liver diseases, obesity, fatty liver, and related disorders. Since 2003, Dr. Galati has been a familiar voice on Texas Radio Airwaves, producing and hosting Your Health First every Sunday evening on the program’s flagship station, 740 KTRH in Houston.
I tell people it’s the best one hour of the week. It really is fun.
Dr. Galati’s Background In Radio
That is so cool. Right before the show, you and I talked a little bit about how you got into radio, and it was such a great story. I would love for you to share a 50,000-foot overview of that.
I love telling this because it brings back such great memories of childhood. In brief, growing up in New York on Long Island, my mother was a radio fanatic. She had her battery-operated transistor radio. Every day we would come home from school, the radio was on with Bob Grant, a legendary host in the talk radio world, way before Rush Limbaugh in the 60s. We had to be quiet. We had to listen to the radio. Not so much that Mom was having a running commentary; it was like our quiet time. We were doing homework, and we were having a snack.
Mom was listening to the radio, and we got into listening to the radio, hearing the commercials and the other shows that would come on. It just got into my blood, in a sense, this whole radio thing. Also, with my cousins and friends, we were good kids, but we were mischievous in a sense, good, clean fun.
The local WABC radio was a music station. On Saturday night, we would listen to a call-in show, a request show, and we would throw our voices. We would make up these outlandish names. We were 10, 11, 12 years old. We would get onto the radio, and that empowered you to say, “I was on the radio.” It was just fun being able to communicate. It got into my DNA and allowed me to be a communicator, even at ten years old.
You bet. We could do, and I would love to do, an entire other show about the days gone by. We don’t do that anymore. We don’t sit around and listen to our mothers listen to the radio as children. We don’t go with our cousins and listen and call in to the radio stations anymore.
I think we do miss a little something of that, and not to sound like your parents or grandparents from the Depression era, but there is something very valuable in reflecting on how things were. Things were good, things were bad. There were lessons learned, and we should learn from our elders, in a sense.
There is something valuable in reflecting backward and seeing how things were good or bad.
As society fragments, many people don’t know their grandparents, their aunts and uncles, their cousins. They don’t know their family heritage, in a sense. You’re almost growing up in a vacuum, thinking the way it is here is all there is. This is it. I have no contribution, or it’s like cooking, you add spices and flavoring to the dish rather than serving a piece of meat with no flavor on it.
Exactly.
You have to add from the past.
Role Of Liver In The Body
We do a lot of that here with our patients as well, just looking back at childhood and the good parts of our lives and also the not-so-good parts. Thank you for sharing that. Let’s talk about the liver, your passion other than radio. Tell our audience, let’s start with the basics. Tell us about the liver.
I think the liver, first of all, is something a lot of people don’t know where it is. I’ll be examining them, and I’ll pull their gown up and be palpating around. They’re like, “What are you doing up there?” I’m like, “Well, that’s where your liver is.” “I thought it was down here somewhere.” That’s a big point, that people don’t even know where their liver is. If they have a pain on their side, they don’t know that it could be their liver. It could be their gallbladder. Their spleen is not down by their left kneecap.
The liver is the largest organ next to the skin. If you look at the skin as an organ, the unique thing about the liver is that it is involved in over 200 different biochemical reactions. It does a lot of stuff. We like to describe it as the manufacturing plant for the body. It makes stuff. It makes hormones. It makes testosterone. It makes cholesterol. It detoxifies your blood. It is absolutely vital. You cannot live without your liver. The other thing is the complexity of it. We have invented and created an artificial heart. We have invented an artificial kidney in the form of dialysis. We are yet to create an artificial liver.
It is just too complicated and complex. We’re getting there with a lot of gene therapy and things like that, 3D printing, but it is so complicated and complex that we can’t reproduce it. The liver is involved in everything, in a sense. The strength of our muscles is related to the liver, our cholesterol, and our immune function. Detoxifying everything we put in, good or bad, is related to the liver doing its thing. It is in everything. It’s in the middle of all the activity.
Everything we put in good or bad is related to the liver doing its thing.
Some of the diseases that we deal with, and the number one misunderstanding for everybody, involve two words that everybody gets freaked out about. Number one is hepatitis. We’ll be with a patient, and we’ll say, “James, you’ve got hepatitis.” It’s like, “I’m not a drug addict. I never did this. I don’t have tattoos. I never did anything bad. Didn’t do drugs.” Hepatitis is just inflammation of the liver.
Now, there are viral causes of hepatitis, which are potentially contagious, but you could get hepatitis, inflammation of the liver, from medication, from alcohol, from other genetic things that you’re born with. Before you have a meltdown when your doctor says you have hepatitis, it is important to ask what type of hepatitis it is. The other word is cirrhosis.
Many times, we have to have a conversation. We do blood work, testing, and biopsies, and the results come back and you have cirrhosis. Another meltdown situation. “I never drank. You’re calling me an alcoholic.” I’m like, “No, I didn’t say that. You’re saying that.” Cirrhosis is just the scarring of the liver. That’s it.
Alcohol, since we’re talking about alcohol, accounts for only about 49% of all cirrhosis, which means 50% is due to obesity and a fatty liver, hepatitis B, hepatitis C, autoimmune disease, too much copper, or too much iron in your blood. If you understand those two words—hepatitis, inflammation of the liver, and cirrhosis, scarring of the liver—you’re not automatically deemed an alcoholic, a bad person, or whatever. It comes down to the stigma, which we have talked about ad nauseam.
As a side note, I had a really nice lady who had hepatitis C. She contracted her hepatitis C from a horrible traumatic injury. She lost half of her right arm when she was about ten years old and received 100 units of blood back in the 1970s. She contracted hepatitis C, which was not diagnosed, and she developed cirrhosis. She’s seeing me for hep C and cirrhosis.
We were talking, and I said, “Where’s your family? Where’s your husband? Where’s your mom?” She replied, “I’m not telling them this.” I asked, “Well, why not?” She said, “Well, they’re going to think I’m a drug addict and an alcoholic.” I told her, “You are neither. You’ve never experimented with drugs. The hep C was from a blood transfusion when you were ten years old at John Sealy Hospital in Galveston. You have no arm. The cirrhosis is due to the hepatitis C. You don’t drink alcohol.” She said, “Now, if I told my coworkers, my friends, my family, they would have a negative look at me.”
For months, we would be taking care of her and having these conversations. “Have you told your mother? Have you told your coworkers? Where do they think you are for all these clinic appointments?” We never were able to break through to her. Again, in liver disease, the stigma actually prevents people from coming forward for the care they need. They’d rather sit at home concerned about what the neighbors are going to say than come forward and say, “I have a problem. Let me get it addressed.” There are therapies. There are people in centers around the country that could take care of it. Programs like this to break down the stigma. This is really what we are all about, as well as all that you do.
The stigma around liver disease prevents many from seeking help. It’s time to break the silence and get treated.
Becoming A Liver Specialist
I want to ask you real quick, how did you decide to become a physician, and what made you develop this passion for the liver?
Believe it or not, I truly wanted to be a doctor by the time I was in second grade. As a second grader, I had this crazy reaction to penicillin, and I pretty much stayed home three-quarters of second grade. I was homeschooled by my mother. I had to be on bed rest.
From penicillin?
Yes. I developed this. It wasn’t P, but it was some platelet clotting type thing. Now, my father’s whole career was in pharmaceutical sales. My mother was also in the medical field as an administrative assistant secretary. She worked for the president of Pfizer International as a young girl in New York. There was always this medical talk, magazines, and medical stuff. The year I was home in second grade, my father had a very simple basement office, and all of his work-related stuff was there.
The times that my mother would leave me alone or run to the store, I would go down to the basement and look through the Journal of the American Medical Association and all this stuff. I became completely enthralled with medical topics. I didn’t understand it, but I was just looking at the pictures, and it really stuck with me. All through grade school, high school, and college, this was all I wanted to do. As far as deciding on liver disease, when I was right at the end of my internship in New York City, there was a young boy, probably about sixteen years old. His mother was a Jamaican immigrant, and he had liver failure from some autoimmune virus. He was in liver failure and in our ICU. I was taking care of him.
The funny thing was I was in one of the largest hospitals in the country, and there was no liver expert. There were gastroenterologists and people who dabbled in liver disease, but there was nobody who was an authority on how to manage this kid. At that time, liver transplants were starting to become more widespread around the country. This was 1988. This was my patient, and he was getting more and more sick. In discussions, I really felt that this kid’s only route to survival was to get a liver transplant.
They were uninsured, and the New York centers were not willing to take them. I called the University of Pittsburgh, which at the time was one of the pioneers in liver transplants under Dr. Tom Starzl. I called them up and told them who I was. I was just a resident. It was July of 1988, and I was in the first weeks of my residency. I told them I had this young boy who was in liver failure, detailed all the complications, and said I thought he needed a liver transplant.
I faxed the paperwork to them. They looked at it, and their simple words were, “If you can get him here, we’ll evaluate him for transplant.” The operative words were “get him here.” New York City to Pittsburgh is not a car ride, a bus ride, or a taxi ride. We would have to fly. Plus, this kid was in the ICU. I don’t know all the details, but it took me about three days to go to the library, look at old newspaper articles, and find an angel pilot. Somebody who would fly us from New York to Pittsburgh for free. I found somebody. I called him up, and he said, “Yes, I have a small Cessna. It’s a four-seater. I fly out of Teterboro Airport in New Jersey.”
I asked, “When could we do this?” He said, “My first opening would be, let’s say Thursday.” I had about a three-day lead. I talked to my attending, and he said, “Okay, fine. That’s a good idea.” I talked to the mother, and she was on board. I was talking to the social worker at Pittsburgh, everything was aligned. Now, I had to figure out how to get the kid from the hospital to Teterboro, which was about a 35-minute ride.
I took a collection from the nurses, medical students, and my fellow residents, about $25. I hailed a gypsy cab. A gypsy cab in New York is not one of the yellow medallion cabs. It’s the equivalent of a car service or Uber in a sense. It’s just some dude with a Cadillac. I went to the curb, flagged down a gypsy cab, and said, “We got to go to Teterboro.” I knew it was about $25, $30, whatever. The driver said, “I’ll do it.”
I went back to the ICU. We had to disconnect this kid from intensive care leads. He had a nasogastric tube in his nose, and he had a central line. This would never, ever, ever even be considered. It’d be malpractice. We disconnected the kid, put him in a wheelchair, and everyone wheeled him to the curb. The gypsy cab was there.
We’re off to Teterboro. I didn’t know what the pilot looked like. It was me, the kid, and the mother. We showed up at Teterboro, and the pilot’s name was Bob. I asked, “Is Bob here?” “Hey, are you Joe?” You’re ten minutes out. I’m looking at this kid who is in bad shape. Bob had a Cessna four-seater, and I’m thinking, at any moment, this kid could bleed, hemorrhage, or go into shock. This is a two-and-a-half-hour flight, puttering over to Pittsburgh.
We stick this kid in the back with his mother. I’m up front with the pilot. We take off, and I am saying a Hail Mary, asking, “Jesus, just get me to the airport.” I arranged for an ambulance waiting for us at the airport. We all huddled into the ambulance, even the pilot. The pilot parks the plane and says, “Come on, let’s have lunch.” They admitted the kid, and he went off to the ICU.
The pilot and I went to the gift shop of the hospital. I was eating a tuna melt, and I was literally in what I can only describe as PTSD. I was in shell shock. It was 12:00, and I was sitting in Pittsburgh. This kid was going to the ICU and was probably going to get transplanted within 36 hours. I’m sitting there with this guy that I didn’t know, and we had just pulled off the impossible. “Eat your sandwich, have a Coke and a smile,” I thought, “we’re going back to Brooklyn.” At that point, I truly decided I was going to commit myself to liver disease. That was it. It was July of 1988.
What was the outcome?
Liver Transplant Patient
The kid got transplanted within two days, but unfortunately, back in 1988, we did not have good antiviral therapy for something called CMV, cytomegalovirus. CMV is typically either under control because the person’s immune system is okay, or the donor liver transmits it, and he died within about a month of cytomegalovirus.
Gosh, that’s too bad.
Yeah, but what a life-changing experience for you. I said, I’m all in for liver, and that was it.
How did you end up in Houston?
From Brooklyn, at Kings County State University of New York, where I did my medicine training, I went to the University of Nebraska, next to Pittsburgh, which was probably the premier liver program. A number of the people I was training with were recruited a few years before me to head up the first liver program in Houston, the Texas Medical Center. This was from 1991 through 1993.
They started recruiting. One person left. He recruited one of his buddies and her buddies, and within a period of about three years, several people I was training with from the University of Nebraska were at UT Houston here in the Texas Medical Center. My wife and I had plans of going back to the Metro New York area to please our parents and our brothers and sisters. We were coming back.
Coming home.
We thought we’d go to Omaha for a few years, but we’d be back. However, it was so attractive to come to Houston to be with friends and colleagues on a journey of something totally new. We decided to come here in 1994.
Your practice has become, if not the top, then one of the top liver transplant programs in the United States. Tell us about how many transplants you’ve done and how you’re leading in transplant medicine.
Let’s say from the early ’90s to the present day, I’m currently at Houston Methodist Hospital. It’s a question of talent and investment of effort, materials, and money into the infrastructure. The infrastructure includes not only the nuts and bolts and surgical instruments but also the human power. You need the know-how on the research side, the medical side, in medical liver disease, hepatology as we call it, the surgeons, radiology, pathology, immunology, and basic science researchers. I feel Houston Methodist has not just outspent but also recruited the right players.
The New York Yankees, I think, have the highest payroll, and look what happened to them. It’s not just about throwing more money at an idea, but over the last ten years, Houston Methodist Hospital has essentially become the number one or number two liver transplant program, depending on the month and different volumes. It’s a Herculean effort to go from the lower third to the top, beating out household names like Cornell, Mount Sinai, UCLA, Chicago, and Miami. We can say, “Here we are, we’ve done it, and it’s been hard work. It’s been a joy. We’ve saved a lot of lives, and it’s something all of us can look back on and say, ‘I was part of that.’”
Not only are you one of the world’s leading liver transplant specialists, not only are you an amazing talk show host, but you’re also an author.
Yes. This book, Eating Yourself Sick: How To Stop Obesity, Fatty Liver, And Diabetes From Killing You And Your Family, let’s talk about it because, obviously, nutrition and food play a large part in liver health. Right, so that book came out after we had cured Hepatitis C. Hepatitis C, from the day I started, let’s say in residency in the 1980s through the mid-2010s or so, that’s a fair amount of time, was everywhere, and we were going through various drug regimens and research. Some worked, some didn’t, and then we hit a home run with a medicine called Harvoni.
We went from a very dismal 40% to 50% cure rate over a year, putting people through hell with these interferon shots, it was a disaster, to, “Here, take this pill, and you have better than a 90% treatment rate in just several weeks with no side effects.” Everybody was treated, and those patients were gone. It’s still around with the opioid epidemic, prescription drug abuse, crack, and whatever, making a bit of a resurgence in the younger generation, but we have a good answer for that.
In that space, fatty liver filled the void, in a sense. I look back at patients I knew 30 years ago, old dictations of letters from 1995, talking about fatty liver. We didn’t quite understand what it was all about, but it was there. Now, we focus our attention on fatty liver, and there are about 80 to 100 million people in the United States with fatty liver.
A third of the population.
Fatty liver is the leading cause of cirrhosis and chronic hepatitis and the leading disease for liver transplants. You’ve got a lifestyle problem being treated with a liver transplant, which is expensive, not always available, and high risk. Eat better. Just learn what the hell you’re eating. This was my reflection on how, as a society, we’re eating ourselves sick.
Fatty liver is the leading cause of cirrhosis and liver transplants. It’s a lifestyle problem we can address with better eating habits.
Obesity. When people say, “I’m big-boned,” no, you’re not big-boned. You’re just making bad choices. Are there people with genetic and hormonal issues? Yes., but that’s probably a very small minority. Most of the obesity we’re seeing is due to bad choices and not really understanding the foods they’re eating, like fast food. I’m sure when you were growing up, going to a fast-food place required getting in the car and driving for miles. It was a rarity. Now, I could walk out of here and see twenty fast-food places.
People aren’t learning how to cook and eat. We’re not eating as a family. The disintegration of the nuclear family, how old-fashioned is that? We don’t sit at home with our family and friends to eat and break bread.
No, we’re too busy.
You’re going out, or you think, “What the hell, I’ll pick something up.” That’s all contributing to this. We’re eating ourselves sick.
This is an amazing book. I can’t wait to read it. Thank you for bringing it. Thank you for being here.
Stigma Of Alcohol
Is there anything else you want to tell our audience about liver disease? So much of what we do with our patients and clients is in the alcohol realm. The stigma of alcohol carries through every facet of their life, especially when it comes time for a liver transplant. Unfortunately, a percentage of individuals with alcohol use disorder, alcoholism, get to the point where they are late for intervention. It wasn’t identified. They were hiding in the shadows, embarrassed. They don’t want to say, “I have a problem.” They get to the point where they are dying of liver failure.
A percent of individuals who have alcohol use disorder are often late for intervention. Most of them are hiding in the shadows in embarrassment.
Of course, a liver transplant is an option. There is something that’s been around since the earliest days of transplant called the six-month rule, which basically says if you have alcohol use disorder, you are an alcoholic, you have cirrhosis, bad boy, you have to sit in time out for six months while you go to recovery. Abstinence, you get a sponsor, and you work your way through a twelve-step program. You have proof of abstinence, then come back and talk to us. We’ll talk about a transplant.
I’ve even heard up to two years.
Yes. It started off as the six-month rule. People say, “Dr. So-and-so at this center said twelve months.” I’m like, “Where did twelve months come from? Six months isn’t bad enough?” He or she is just making this up. Two years is made up. There’s very little scientific data that says if you’re abstinent for six months, that will predict what the next six months or the next year will be like. We’re afraid that if we do a transplant on you, you will relapse, which could be bad.
What we’ve evolved to over the years is recognizing that some patients do very well with short-term sobriety. They were sober for 30 days and never drank again. How do you pick these people out? Here in Houston, we’ve taken the approach of evaluating everyone. It takes work, time, blood, sweat, and tears. We have to evaluate patients to try to determine their risk of relapse. We have taken a policy where, for the most part, we completely eliminate the six-month rule.
There are patients who may have recently consumed alcohol, but we still evaluate them for a transplant. They get on the list, but they’re too sick to go to therapy. The rigors you put your clients through, eight hours a day, they’re sick, confused, and malnourished. You can’t expect them to do this, but others would say, “Not my problem. You did this yourself, so suck it up.”
Go from there. We have taken the attitude of evaluating these high-risk patients, and there will always be high-risk cases. We have to, in a sense, set them aside, get them into treatment, and sort out any psychological and emotional issues. The hope is that after a successful transplant, as they get healthy, they enter an aggressive program. In many cases, it is an inpatient scenario or intensive outpatient, and we have had very good success.
Texas Medical Center
The word is if you are dealing with alcohol use disorder, alcoholism, or liver disease, and you’re being told you have to wait because “you did this to yourself,” remember this: heart disease, obesity, smoking, or uncontrolled diabetes—nobody says you did this to yourself when you go for a triple bypass. Uncle Bill needed a triple bypass, and nobody questions it. People with lung disease who smoke still get chemotherapy for their lung cancer. For those who get this message, reach out. There are centers, certainly here in Houston, and with your cooperation, we can partner. You have to partner the medical and surgical treatment with the recovery. That’s very optimistic for our ongoing collaboration.
I’ll say that the Texas Medical Center, founded back in 1962, was built on the concept of cross-institutional collaboration. That’s why we’ve become the largest medical center in the world.
One of the most, if not the most successful, leading hospital systems and medical centers in the world is because we collaborate with each other. Without that medical collaboration, we don’t see the successes that we see here. I appreciate that so much that we’re able to share patient information, of course, with the patient’s permission, and work together on these cases, instead of working in silos like we see across the world.
You look at other medical centers, and everybody is proud of their medical center, their medical school, their hospital. We’re blessed to have such great technology here in the United States. When you think about it, if you’re out in a city, wherever it is, their hospital, multiply that by ten within a two-mile or three-mile radius. You’ve got all these people concentrated here. There’s no place in the world like this.
Episode Wrap-Up
No, there’s not. When you fly into Houston, I always tell people that you look over and see these skyscrapers, and you think it’s downtown Houston. It’s really the Texas Medical Center. I would encourage everyone to go to tmc.edu to look at the statistics of what the Texas Medical Center does. Dr. Galati, how do people reach out to you and your practice?
The easiest way is Liver Specialist of Texas, or TexasLiver.com.
How about your radio show?
You can go to iHeart. TexasLiver.com has all the links to the radio show, the podcast, and of course, all the social media that we live and die by.
You’re a big social media star as well. I can’t thank you enough for being here. Thanks so much. Let’s do this again.
Absolutely. You do a tremendous service to the clients that you serve as well.
Thank you so much. Everyone out there, thank you for reading our show. You can also go to iHeart Radio, Spotify, Apple Podcasts, and everywhere else. We’re all out there understanding the human condition. Thank you for being here.
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I’d like to remind everyone that there are numerous platforms to find our show, YouTube, Apple Podcasts, SoundCloud, Spotify, Stitcher, and iHeart Radio. Please share this episode on social media or with someone you think it could help.
Absolutely.
We remind you also that a clear diagnosis is key to the most effective treatment possible.
Yes, it is.
See you next time.
Thanks again, Robin.
Thank you.
Important Links:
- Dr. Joseph Galati
- Eating Yourself Sick: How To Stop Obesity, Fatty Liver, And Diabetes From Killing You And Your Family
- YouTube – Understanding The Human Condition
- Apple Podcasts -Understanding The Human Condition
- SoundCloud – Understanding The Human Condition
- Spotify -Understanding The Human Condition
- iHeart Radio -Understanding The Human Condition
