Tag: fatty liver

ABSTRACT

In today’s world liver infections and fatty liver disease are major problems and fat accumulation in the liver due to excessive fat and excessive alcohol intake. Fatty liver has two aspects: alcoholic and non alcoholic aspects. NAFD is a type of fatty liver which does not occur due to heavy alcohol intake.NASH is a type of fatty liver which is not alcohol induced but damages liver cells and leads to cirrhosis of liver.Although it’s a curable disease, it may deteriorate over time because of negligence and lack of proper treatment.

INTRODUCTION

Fatty liver is a condition where excess fat builds up in the liver. Fatty liver disease is also known as hepatic steatosis and steatotic liver disease. It is normal for the liver to store some amount of fat but when fat build up is more than 10% of liver’s weight then it causes some serious complications like scarring of liver, liver cancer, and esophageal varices. There are different stages of fat accumulation. Grade1 is mild, grade 2 is moderate, grade 3 is severe, potentially leading to liver damage, scarring (fibrosis), and cirrhosis. Early detection and lifestyle changes are crucial for preventing progression.

FATTY LIVER DISEASE TYPES

There are mainly two types of fatty liver disease (FDL)

1. Metabolic dysfunction-associated steatotic liver disease (MASLD)

This type used to be called Nonalcoholic fatty liver disease (NAFLD). Obesity or metabolic disorders such as insulin resistance, dyslipidemia, central obesity, and hypertension will increase risk of getting it. Unlike the other main type, it is not caused by drinking alcohol. There are two forms of MASLD:

• Simple Fatty Liver: This means there is fat accumulation in the liver. But there is no inflammation or liver cell damage found. Usually it does not get worse or cause any problem.
• Metabolic dysfunction-associated steatohepatitis (MASH): This used to be known as nonalcoholic steatohepatitis (NASH). It’s the advanced stage of FLD and means you have inflammation in the liver. inflammation and the liver cell damage that happens with MASH can cause hepatic fibrosis and later on leads to liver cirrhosis. Hepatic fibrosis and liver cirrhosis are types of liver scarring and liver cancer.

2. Alcoholic-related fatty liver disease (ALD)

This type is caused by excess drinking of alcohol. It is less common and can be prevented by reduction in alcohol consumption. If a person keeps consuming alcohol then it can cause serious conditions like enlarged liver, alcoholic cirrhosis, alcoholic hepatitis.

CAUSES OF FATTY LIVER DISEASE

Fatty liver is commonly due to metabolic disorders (diabetes, hypertension, obesity, dyslipidemia). Some other reasons are:

• Alcohol
• Drugs like corticosteroids and some cancer drugs
• Malnutrition and weight loss
• HIV, Hepatitis C

SYMPTOMS

Fatty liver disease usually does not cause symptoms. Some people may have symptoms like:

• Tiredness
• Pain in right upper part of abdomen
• Weight loss

More commonly patients notice symptoms when FLD is processed into cirrhosis in the liver. Once cirrhosis is developed, patients have symptoms like:

• Nausea
• Excessive weight loss
• Jaundice
• Swelling in abdomen
• Swelling in legs, feet, or hands
• Bleeding (rectum, stomach)

COMPLICATIONS

Fatty liver can develop into hepatic fibrosis, cirrhosis and liver cancer. For people affected by NAFLD, the survival rate is 10 years for 80% of patients. Less than 10% people with cirrhotic alcoholic FLD will develop hepatocellular carcinoma. the most common type of primary liver cancer in adults, but up to 45% people with NASH without cirrhosis can develop hepatocellular carcinoma.

DIAGNOSIS

Most individuals are asymptomatic and it is not easily diagnosed. Medical history, physical examination, and tests are performed for the proper diagnosis.

Medical history and physical exam

• As part of the medical history, the doctor will ask about alcohol use, to find out whether fat in the liver is a sign of alcoholic fatty liver disease or nonalcoholic fatty liver (NAFLD). He or she will also ask which medicines you take, to try to determine whether a medicine is causing NAFLD.
• During physical examination, body weight and height are checked, and signs of fatty liver such as enlarged liver, jaundice-like symptoms, and signs of cirrhosis are checked.

Blood tests

• Liver function and liver tests to detect liver disease and damage. The cells in the liver have proteins called enzymes. When these cells are damaged, the enzymes leak into the bloodstream, where they can be measured. If the liver is damaged, the level of these enzymes will be higher than normal. The serum alanine transaminase (ALT) level is greater than the aspartate transaminase (AST) level in the nonalcoholic variant and the opposite in alcoholic FLD (AST:ALT more than 2:1).
• Fibrosis assessment tests, also known as FIB-4, to estimate the level of liver scarring (fibrosis). These blood tests result in an indirect score that estimates the level of liver scarring (fibrosis). Other blood tests show more direct markers of fibrosis.
• Lipid profile to measure blood fats, such as cholesterol and triglycerides. Other blood tests to rule out other causes of FLD like tests for hepatitis C and Wilson disease (a rare genetic condition).

Imaging tests

• USG, CT scan, MRI are suggested. These imaging tests show fat accumulation in the liver but do not tell if it is a simple type of fatty liver disease or MASH. There are some tests that can show whether it is fibrosis by measuring the stiffness of the liver. When liver cells die, they’re replaced by scar tissue, which is stiff. The stiffer the liver is, the more scarring it has.
• Transient elastography measures liver stiffness using a special ultrasound machine.
• Magnetic resonance elastography (MRE) combines ultrasound vibration frequency and MRI to create a visual map of stiffness throughout the liver.

Liver biopsy

It is considered the gold standard for diagnosing and assessing liver fibrosis. A liver biopsy can reveal a number of findings in fatty liver disease, including:

• Steatosis: A buildup of fat in the liver
• Inflammation: The presence of inflammation in the liver
• Fibrosis: The presence of fibrosis in the liver
• Hepatocyte Ballooning Degeneration: A key feature that distinguishes NASH from simple steatosis
• Megamitochondria: Round or needle-shaped mitochondria that are more common in hepatocytes with microvesicular steatosis
• Hepatic Siderosis: Mild iron deposition in periportal hepatocytes and/or pan-acinar reticulo-endothelial cells.

TREATMENT

Lifestyle changes can help in managing fatty liver at early stages and this includes:

• Avoid alcohol
• Weight loss: exercise, change in eating habits, and some medications like GLP1RA can help in reducing weight.
• Take medications to manage metabolic conditions: Take prescribed medicines to manage diabetes, cholesterol, and triglycerides (fat in the blood). You may also need to take vitamin E and thiazolidinediones.

AYURVEDIC OVERVIEW

According to ayurveda, the liver is the origin of pitta. Pitta regulates metabolic and biochemical functions of the body and maintains heat as pitta has hot and light characteristics Kapha has a cold and stabilized nature. When Kapha dosha rises above normal levels, it suppresses pitta and its function in supporting the liver. Therefore, it can be inferred from this correlation that fatty liver disease results from elevated Kapha dosha. Fatty liver means the presence of fat in the liver. It refers to Meda (fat) and Yakrit (liver). So in ayurveda it is termed as Medaja Yakrit Roga (fatty liver). NAFLD is called kaphaja yakrit dulludara. It is a most common complication of Udara Roga (abdominal disease).

Ranjaka pitta (fire that helps in production of blood), which turns Rasa Dhatu (plasma, interstitial fluids) into Rakta Dhatu (blood tissue) is based in Yakrit (liver). It is associated with Raktavahi (Blood vessels) and Mamsvahi Dhamni (arteries nourishing muscle tissue) and its Mulasthan (origin place) is Rakta Vaha srotas (channels that transport blood). Yakrit is closely linked to Rasa (plasma), Rakta (blood), Mamsa dhatu (muscle) and plays a significant role in Dhatu Parinama (essence of body tissues).

Samprapti (Etio-pathology)

Dushti of Annavaha (Channels that transport food), Udakvaha (channels that transport water), Rasa vaha (channel that carries circulatory fluids), Raktavaha (channels that transport blood), Medo vaha (channels that transport nutrients to body tissue) srotas etc. is caused by:

• High fat diet
• Sedentary lifestyle

Agnivikruti (disturbance in digestive fire) causes the creation of Apakva anna rasa (undigested food) which causes the vitiation of kapha dosha and uneven formation and deposition of fat in the liver. Agni Vikruti (disturbance in digestive fire) is caused by vitiated Vata.

Hepatocytes undergo inflammatory alteration when pitta is implicated in the pathophysiology and then this illness develops next stage NASH. When Vata is implicated then it develops fibrosis which leads to cirrhosis, ascites, hepatocellular carcinoma. Vitiation of samana vayu (balancing air), Apan Vayu, pachaka pitta (fire that digest food), Ranjaka pitta (fire that helps in production of blood), Kledaka kapha (moistening of food particle), rasa (plasma), Rakta (blood), Medo (fat) Dhatu and pureesha (body’ excretory product) are major variables involved in etiopathology of this disease.

SIGNS AND SYMPTOMS

1. Daurbalya (Weakness)
2. Arochaka (Anorexia)
3. Avipaka (Indigestion)
4. Varchograha (constipation)
5. Pain in kostha (abdomen) due to vata
6. Pipasa (thirst)
7. Agninasha (loss of digestive fire)

According to Acharya Charak

• Nila, Harit, Haridra (blue, green, yellow) coloured lines on the abdomen.
• Pale discoloration of skin (Kamla)

Pathya (To be consumed)

• Vegetables: carrot, beetroot, pumpkin, all green vegetables
• Milk Products: plant-based such as tofu, almond milk, soya milk
• Dry Fruits: almonds, walnuts, chia seeds, sunflower seeds (soaked overnight)
• Spices: fennel, turmeric, cumin, coriander, fenugreek, black pepper
• Oils/Fats: olive oil, rice bran oil, canola oil, cow’s ghee
• Juices: coconut water, pomegranate juice, beetroot juice, barley water

Apathya (Not to be consumed)

• Vegetables: cauliflower, eggplant, jackfruit, canned vegetables or vegetable soup
• Milk Products: avoid all kinds of dairy products
• Dry Fruits: cashews, peanuts, raisins, pistachios
• Oils: coconut oil, palm oil, hydrogenated oils
• Spices: red chilli, green chilli, table salt
• Fruits: coconut, banana, mango, dates
• Packed, processed, bakery foods

Treatment

In ayurveda dietary restriction, physical exercise, weight reduction are the first line treatment. Ayurveda has a potential remedies for fatty liver. Things to keep in mind while treating this disease are:

• Agni Vikruti (disturbance in digestive fire)
• Vitiation of kapha, meda
• Agni Deepana (enhancing digestive fire)
• Rookshana (drying therapy)
• Sroto Shodhan (cleansing of channels)
• Pacification of kapha, Meda, and Vata

This should be the first line of treatment. The careful use of Samshodhana, Samshamana, and ahara would help to reverse the fatty liver.

Shaman Chikitsa

In shaman chikitsa:

• Sharpunkha (Tephrosia purpurea)
• Bhoomi Amalaki (Phyllanthus niruri)
• Katuki (Picrorhiza kurroa)
• Guduchi (Tinospora cordifolia)
• Haritaki (Terminalia chebula)
• Pippali (Piper longum)

All these single herbs are useful in shaman Chikitsa (pacifying therapy).

Shodhan Chikitsa

Virechana: It is the best shodhana karma for fatty liver. It helps to eliminate excessive pitta dosha along with Vata and kapha. It is indicated in both sroto shodhan (cleansing of channels) and excess dosha buildup.

HERBAL REMEDIES FOR FATTY LIVER BY PLANET AYURVEDA

Planet Ayurveda is a GMP certified company that prepares 100% pure medications by following proper ayurvedic principles. Their products are natural and free from any kinds of additives, preservatives, chemicals, and fillers. For fatty liver, they have too many products but here we are talking about Fatty liver care pack. These products are totally safe and natural.

1. Yakrit Plihantak Churna
2. Livo Plan Syrup
3. Liver Detox Formula

PRODUCT DESCRIPTION

1. Yakrit Plihantak Churna

It is herbal powder that contains Bhumiamla (Phyllanthus niruri), Makoy (Solanum indicum), Katuki (Picrorhiza kurroa), Punarnava (Boerhavia diffusa), Kaasni (Cichorium intybus), Sharpunkha (Tephrosia purpurea), Kalmegh (Andrographis paniculata) and Bhringraj (Eclipta alba). This herbal powder is useful in liver anomalies and helps in treatment of cirrhosis, splenomegaly, fatty liver. Punarnava (Boerhavia diffusa) and some other herbs which are used in this formulation have characteristics like liver rejuvenation, anti-inflammatory, Choleretic Properties (stimulation of the production of bile from liver).

Dosage: 1 teaspoonful twice a day before meals with warm water.

2. Livo Plan Syrup

This is a herbal syrup that contains herbs such as Sharpunkha (Tephrosia purpurea), Kalmegh (Andrographis paniculata), Bhringraj (Eclipta alba), Shyonak (Oroxylum indicum), Rohitaka (Tecomella undulata), Bhumiamla (Phyllanthus niruri), Kasni (Cichorium intybus), Patol (Trichosanthes dioica), etc. These herbs regenerate the liver cells and protect the liver from toxins. It eliminates the toxins from the liver and provides a healthy liver function.

Dosage: 2 tsp twice a day after meals.

3. Liver Detox Formula

This herbal capsule preparation is prepared by using herbs like Punarnava (Boerhavia diffusa), Makoy (Solanum nigrum), Kutki (Picrorhiza kurroa) etc. This formulation is mainly used for liver disorders, it protects the liver against cell damage caused by free radicals due to its antioxidant, hepatoprotective properties. It can also help to provide relief in gas and abdominal discomfort. These herbs are very beneficial for balancing pitta dosha in the body.

Dosage: 1 capsule twice a day after meals with warm water.

CONCLUSION

Liver is the largest organ inside your body. It helps your body digest food, store energy, and remove poisons. Fatty liver disease is a condition in which fat builds up in your liver and if not treated properly, it can lead to scarring of the liver. Fatty liver can be cured by lifestyle modifications. In Allopathy only symptomatic management is done but Ayurveda has good management along with dietary & lifestyle modifications.