Endowed professor @UCSF. NIH-funded liver & transplant clinician-scientist. Integrative health practitioner/physician nutritionist.
San Francisco, CA
Joined March 2026
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#FoodIsMedicine for pts with MASLD
We just need to figure out how to deliver that information effectively. 👇 study offers us a scalable way.
This is what #IntegrativeHepatology is all about. Supporting whole-person health thru the lifestyle-enhanced conventional medicine.
Original Article
Reduced risk of liver-related events among patients receiving individualized nutrition-focused remote care in the United States
Athinarayanan et al.
#LiverX
journals.lww.com/hep/fulltex…
A pt with at-risk MASH asked re: taking a MVI. Answer: no. Gen pop data show no clear benefit.
On GLP-1 and not getting enough? Don’t add a pill. Lower the dose or stop. The drug should serve your health, not undermine it.
Real food, not pills.
integrativehepatology.ucsf.e…
MELD tells us how sick the liver is. The #LiverFrailtyIndex tells us how sick the patient is.
But LFI needs an in-person exam.
New in @LTxJournal: the Lab-LFI. 7 proteins, c-stat 0.80 for predicting frailty in cirrhosis.
Read it here: ovid.com/jnls/lt/fulltext/10…
Great thought piece by @ebtapper and @IanARowe
No question that clinical practice guidelines need to be anchored by the evidence. But sometimes we just need them to standardize COMMON SENSE. How do we balance these needs?
What counts as evidence? Hepatologists have learned to thrive in data deserts. So how can we square the standards of Cochrane and GRADE with the data that we have? And should we?
Ian and I in @FrontGastro_BMJ : fg.bmj.com/content/flgastro/…
Fangirling over @umichmedicine Hepatology & LTx, home of the world’s best liver docs!
Honored to be invited by the great Dr. Anna Lok for the Sheila Sherlock visiting professorship. #GoBlue (❤️ @zingermans)
@ebtapper @NikMazumder_MD @pummy92 @RobertFontanaMD @HPB_Txp_Surg
Jen Lai retweeted
Heading to #TLM26 in Denver? UCSF authors are on 78 abstracts: 16 orals, 62 posters and 30 invited and moderator roles across Nov 5–8. Come find the @UCSFLiverCenter team! #AASLD #LiverTwitter
1/New in @Nature : sugar intake alone had no association with the gut microbiome.
Sugar intake PLUS broad-spectrum antibiotics did.
Anyone caring for pts with cirrhosis should read this
nature.com/articles/s41586-0…
3/ And among pts eating more sugar than the median, every extra day of abx ➡ ~12% higher risk of death.
The biggest contributors? Nutritional shakes and sports drinks. Added, not naturally occurring, sugars.
Enterococcus faecium expanded the most as diversity fell.
4/ This raises ⏰ for pts w/ AD/ACLF, where empiric abx =SOC. What is the effect of diet—like sugar-dense supplements/tube feeds—on infection, incl E faecium?
This is a potentially modifiable variable in plain sight. We need more studies of #foodasmedicine in cirrhosis care
How you know Dr. Tapper is the smartest doctor in the world 👇
I recommended huevos rancheros
theeducatedpatient.com/view/…
Agree with @ebtapper! Preventive care in cirrhosis is no longer an afterthought.
Worth noting: dietitian-guided nutrition and structured exercise now sit alongside carvedilol and HCC surveillance.
Proud to be part of this @AmCollegeGastro initiative.
Now is the best time in the history of cirrhosis care. And it will only get better.
This week we release the first set of guidelines on preventive care in cirrhosis in @AmJGastro @AmCollegeGastro
Open access: ovid.com/jnls/ajg/fulltext/1…
🎉 to @berkeleydoc, new EIC of @AGA_GIHN. A brilliant GI/IBD clinician-scientist w/ a nutrition focus. "What should I eat?" is the 1st question pts w/ GI conditions ask, yet is one of the most understudied. Excited to see what he will do w/ @AmerGastroAssn 's official newspaper!
Meet your new @AGA_GIHN editor in chief Berkeley N. Limketkai, MD, PhD! @berkeleydoc is the director of clinical research for the UCLA Center for IBD at #UCLAGI. He brings an engineer’s eye and a methodologist’s rigor to GI & Hepatology News.
👉news.gastro.org/issues/2026/…
I brought my kids to mtgs too. The pace changes, but your ambition doesn't have to.
🎉💪 to @Bealoquebea (+partner) for showing us how to bring what we love—professional & personal—together.
👉 Dr. Gros's site ibd-eii.com/ for practical summaries on IBD evidence
Perhaps the youngest attendee at this year’s @geteccu meeting, at just two months old 🤍
It has been wonderful to connect and work with such brilliant people. But even more special has been proving to myself that, when you have the greatest support by your side (my husband) you can continue pursuing what you are passionate about, even if the pace needs to be a little different for a while
I talked with @EatingWell about what a liver-friendly morning looks like. 3 simple habits you can sustain, all things I tell my own pts.
eatingwell.com/morning-habit…
Jen Lai retweeted
📑 Micronutrient deficiencies are common among patients awaiting LT (Zn, Vitamins A/D/E/B12, and Selenium)‼️
🚨#Selenium deficiency independently associated with a 2.5x ⬆️ odds of #Frailty❕
#LiverX #OpenAccess
journals.lww.com/hepcomm/ful…
Is rifaximin the new PPI of cirrhosis? It's a great therapeutic when it's indicated, but 👇 is a great reminder that we need to remember to stop it when it's no longer needed.
What are the indications of RIFAXIMIN in cirrhosis ?
Don’t overuse it, since it can favor bacterial resistance.
@PoseElisa shows it here:
#IMTLD2026
1/I couldn't agree with you more. Frailty matters.
Important work by @Fran_cesca0206 and team: #LiverFrailtyIndex is assoc with 2.2x ⬆️ mortality in inpts. Also assoc with ⬆️ ICU days and LOS.
Confirms multictr work by @serperm and @YucaSpice 10.1002/lt.26100
📑 Frailty matters 💪
🚨Among hospitalized 🏥 patients with decompensated #cirrhosis, physical #frailty was the strongest predictor of early mortality ☠️ ❕
#LiverX #OpenAccess
journals.lww.com/hepcomm/ful…
3/Next up: understanding whether frailty, assessed in INPATIENTS with cirrhosis + AD/ACLF, is assoc w/ POST-LT outcomes.
Stay tuned for the answer from our NIDDK-funded FrAILT Study. Read-out in Nov 2027.
@elizabeth_verna @YucaSpice @MattKappus @DanielaLadnerMD @DanielGanger
4/In the meantime, lots of tools to incorporate frailty into your practice/research:
1️⃣ #LiverFrailtyIndex in ambulatory pts, clinic
2️⃣ AM-PAC in hospitalized pts 10.1097/TP.0000000000005855
3️⃣ Cirr-admin frailty index (CAFI) 10.1097/LVT.0000000000000856
Frailty matters. 💪