FATTY LIVER (Hepatic steatosis)

   Fatty liver                         

Hepatic steatosis

28TH JULY 2023 WORLD HEPATITIS DAY 

“Why Indians need to fear a fatty liver”? Are you at risk? Yes/ No”  

"Liver is a master detoxifier"

Fatty liver disease is caused as a result of too much junk food and too little exercise.. Often there is no symptoms.  In advance stages, damage is similar to that caused by excessive alcohol. It can lead to scarring of liver, cirrhosis and liver failure .  Fatty liver, or hepatic steatosis, is a term that describes the buildup of fat in the liver. It's normal to have some fat in your liver, but too much can become a health problem.

Excess fat in the liver is a major contributor to India’s diabetic epidemic, which affects close to 70 million adults. Non-alcoholic fatty liver disease (NAFLD), affects one-third of India's urban population. NAFLD is closely related to insulin resistance and abnormal blood sugar metabolism. NAFLD is an early indicator of metabolic syndrome.

The guardian of the whole body is the liver. It is the inspector and the gatekeeper for the relationship between the gut and the rest of the body. Fatty liver is a reversible condition that can often be resolved with lifestyle modifications. In many cases, fatty liver has no symptoms. It doesn’t usually cause permanent damage unless it progresses. Most cases of fatty liver are detected in people between ages 40 and 60. More than 10 million cases in India per year are reported.

“Want to look young, keep your liver healthy”

Introduction

Excessive fat deposition in the liver is known as fatty liver. It causes inflammation of the hepatic cells and interferes with the normal liver functions. The liver is the second largest organ in the body, and it is vital for health. Healthy liver should contain no or some fat.

The liver produces bile, which helps in digestion and absorption of fats in our body. The livers functions are so important that it is imperative we maintain a healthy liver.

The function of a liver is to process everything we eat or drink and filter any harmful substances from the blood. This process is interrupted if too much fat is in the liver. Fatty liver is when fat accounts for more than 5 to 10 percent of your liver’s weight.

Fat in the liver disrupts metabolic pathways and affects the way the body breaks down glucose and uses energy. This leads to the affected person developing the metabolic syndrome, and raise the chances of developing diabetes, heart attacks and strokes.

Fatty liver develops when the body creates too much fat or cannot metabolize fat fast enough. The excess fat is stored in liver cells where it accumulates to form fatty liver disease. When enough fat builds up, it will cause the liver to swell. Eating a high-fat, high-sugar diet may not directly result in fatty liver, but it can contribute to it.

According to  Ayurveda, liver or Yakrit  (यकृत या जिगर या कलेजा ) is the seat of Pitta (metabolism) and Rakta (blood). In the liver, if Kapha and Medas (fat) exacerbate, it results in NAFLD. It affects Rakta Vaha Srotas (channels caring blood).

"Excessive of protein causes damage to liver."

Alcohol Intoxication
If a man drinks a tiny quantity of wine, he becomes like a ;

1. Parrot : He says the same things over and over again.
2. Tiger : If he drinks a little more , he becomes like a tiger. He doesn't speak. he roars.
3. Boar / Pig : And if he drinks still more, he becomes a boar, he lolls on a ground

                                    "A HEALTHY LIVER FOR HEALTHY BODY"

Stages of liver disease

Types of fatty liver:

1 . Non-alcoholic fatty liver disease: (NAFLD) or nonalcoholic steatohepatitis. It is caused when too much of fat is stored in liver cells. It is a potentially serious form of the disease, is marked by liver inflammation, which may progress to scarring and irreversible damage. At its most severe, non-alcoholic steatohepatitis can progress to cirrhosis and liver failure. In Indian population, it ranges from 9% to 35%. It can lead to carcinoma, chronic kidney disease and retinopathy.

2 . Alcoholic fatty liver: Fatty liver can also be caused by excess alcohol intake. The alcoholic fatty liver is the earliest stage of alcohol-related liver disease. Heavy drinking damages the liver, as a result, the liver cannot break down fats. Abstaining from alcohol will likely cause the fatty liver to subside. Within six weeks of not drinking alcohol, the fat will disappear. However, if excessive alcohol use continues, cirrhosis may develop.

3. Acute fatty liver of pregnancy (AFLP) is an uncommon but potentially fatal complication that occurs in the third trimester of pregnancy or early postpartum (after delivery) period.

4. Other causes certain medications, viral hepatitis, autoimmune metabolic or inherited liver diseases.

The main stages of NAFLD are:

1.    Simple fatty liver (steatosis): A large harmless buildup of fat in the liver cells that may only be diagnosed during a test carried out for another reason.

2.    Non-alcoholic steatohepatitis (NASH): A more serious form of NAFLD, where the liver becomes inflamed.

3.    Fibrosis: Where persistent inflammation causes scar tissue around the liver and nearby blood vessels, but the liver is still able to function normally.

4.    Cirrhosis: The most severe stage, occurring after years of inflammation, where the liver shrinks and becomes scarred and lumpy, this damage is permanent and can lead to liver failure (where your liver stops working properly) and liver cancer. It takes years to develop cirrhosis.

Cause

●    Adopting sedentary lifestyle

●    Excessive consumption of refined carbohydrates, saturated fats, protein from meat

●    Low in fresh fruits, vegetables and whole grain.

●    Excess abdominal fat / Obesity

●    Diet high in simple carbohydrates  and unhealthy fats is highly toxic for liver.  When body has too much fat your metabolism does not work well. Fat is then stored in liver cells leading to a fatty liver condition.

●    Hyperlipidemia or high level of fat in the blood, low good ‘HDL’ cholesterol.

●    High blood pressure

●    High fasting blood sugar

●    Insulin resistance, it means your cells don’t respond to insulin the way they should. As a result, an excessive amount of fat ends up in the liver.

●    Hepatitis C infection

●    Medication- Drugs like steroids, aspirin, tetracycline, tamoxifen and cancer drugs.

●    Genetic inheritance
*    Increased alcohol consumption resulting in fat build up, inflammation and scarring of liver.
*    Smoking aggravates liver damages.

Risk factors

●    Excessive abdominal obesity

●    High blood cholesterol

●    High blood pressure

●    Type 2 diabetes

●    Viral hepatitis

●    A diet rich in carbohydrates

●    Saturated fats found in food from animal sources such as meats, butter, cream and cheese

●    Trans fats are found in vanaspati oils and processed foods unless they are otherwise labelled.

●    PCOS (Polycystic Ovarian Syndrome)
*    A corporate job.

“People with NAFLD must get tested for diabetes”

Sign & Symptoms

●    Pain and swelling in upper right side of the abdomen (due to enlarged liver)

●    Fatigue, Loss of appetite, nausea, vomiting.
●    Itching all over the body.

●    Ascites or swelling in your belly

●    Jaundice that is the yellow coloration of skin and eyes.

●    Dyspepsia or Indigestion

●    Weight loss with no clear reason

●    Bloating of abdomen

●   Secondary Palmar erythema (alcoholic)

Palmar Erythema

"Sometimes the only symptom is abdominal pain".

Complication

●    Leads to cirrhosis

●    Scarring of liver

●    Permanent damage

●  Nerve damage (neuropathy) with symptoms of numbness, pain and weakness in the hand, feet and leg, kidney damage, erectile dysfunction, retinopathy (vision loss) and hypoglycemia.

●    A potentially life-threatening condition triggered by delayed or skipped meals, high dose of diabetes medicines and too much of alcohol.
TIP : Waist circumference should ideally be less than half of a person's height

Diagnosis

●    Physical examination if your liver is inflamed, your doctor can detect it by examining your abdomen for an enlarged liver.

●    Get a  Liver function test- ( SGPT) to know if your liver has additional fat accumulation. it
will show mild elevation of liver enzymes. This is a preventive step and can be done for the whole family at least once a year.

●    Ultrasound Abdominal : detect abnormal fat deposits in the liver.

●    CT scans showing accumulation of fat in the liver

●    Fibro Scan

●    Liver biopsy
●    Weight
●    BMI : Body mass index

The good news is that fatty liver can be reversed at the “fatty” stage by cutting simple carbohydrates like bread,  sugar and eating more fruits, vegetables and proteins.

                       "In the early stages ,corrective lifestyle changes can reverse the damage".

Lifestyle

Simple ways for liver detoxification

●    Relaxation-  Our body is subjected to lots of pressure and exertion. Slowing down is a must for liver detoxification.

●    Take a break from mental work - stretch, breath and walk. Practicing yoga, taking up hobbies is a great way to shift the mind to be relaxed.

●    Drink adequate water

●  Liver detox should be carried out at the commencement of the spring season. It helps in removing toxins accumulated in the body during winter.

●    Sound sleep is very vital for detox to happen.

●   Emotions - It is important to express emotions like anger and jealousy. Suppression of these emotions is potentially toxic as harmful chemicals.

●    Fasting once a week reduces the burden on the liver and helps to decongest it.

●    Massage is deeply detoxifying to both superficial and deep tissues and organs.

●    Eating healthy food is important; one should avoid overeating.
●    Go for outdoor sports.
●    Prefer home cooked food.
●   Systematic weight loss plan or treatment is essential.
●   If possible consume alcohol within limits or quit alcohol, and quit smoking.
●  Diabetic patients need to maintain ideal blood sugar levels.  A proper diet and regular exercise will help diabetes keep their liver healthy.

●  Main a healthy weight : since obesity leads to fatty liver disease, which has now become one of the top causes of liver problems.

Consume a balanced diet : Consume a balanced diet rich in protein and fibre, avoiding high calorie meals, saturated fats and refined carbs. 

●  Exercise for 30-40 minutes a day, five times a week.

Avoid alcohol consumption as it can lead to a spectrum of  liver problems ranging from fatty liver, cirrhosis and cancer.

●  Avoid hepatotoxic and alternative medicines since these can potentially cause liver damage.

●  Protect yourself against hepatitis B and C  by avoiding contaminated needles, illicit drugs and practicing safe sex.

●  Get vaccinated against hepatitis A & B

                                                                 Online portal www.liver.care

                                                                 "Consult a Gastroenterologist".

Exercise

●    Exercising at least 40  minutes each day. Exercises like walking, jogging, swimming, cycling are good for liver health.

Yoga

Halasana ( Plough Pose)

●   Ustrasana (the camel pose)

●    Sarvangasana (Shoulder Stand pose)

●    Naukasana (The boat pose)

●    Surya Namaskar These are a group of postures helps to keep the body and internal organs toned.

Pranayama

Kapalbhati

Kapal-  means forehead. Bhati- means light. So with this pranayama one becomes luminous and lustrous. In this normal inspiration and forceful expiration is done. In doing so, the abdominal area gets inward and outward movements. Kapalbhati is wonderful kriya for the health of the liver. It energies the Manipura chakra which is associated with the liver.

Bhastrika

Sit in comfortable asana. Breath in through both nostrils forcefully, till the lungs are full and the diaphragm is stretched. Then breathe out forcefully

Bhramari

Breath in till the lungs are full of air. Close the ears with the thumbs and eyes with the middle fingers. Press forehead with both the index fingers lightly close the eyes. Then press the eyes and nose bridge with remaining fingers. Concentrate on Ajna Chakra. Close the mouth. Begin slowly exhaling making a humming sound like a bee while reciting OM mentally.

Anuloma Viloma

Inhale through one nostril and exhale through other alternatively.

Mudra

Prithvi Mudra

●    Formation- Join the tip of ring finger with the tip of the thumb

Prana Mudra

Formation- The tip of little fingers and ring fingers are joined with the tips of the thumbs.

Sahaja Shankha Mudra

Formation- Join both the hands together interlocking the fingers and press the palms together. Apply a gentle pressure with both the thumbs by laying them parallel to each other on the index finger.

Effect- According to yoga physiology, all 10 main nerves get activated and the body becomes very strong with this Mudra

Benefit - It helps in digestion.

Poshana  Mudra (पोषण)

Poshana means the God of nourishment and hence this mudra is dedicated to the Sun, God. This Mudra is formed differently by each hand.

Benefit: This mudra has a relaxing effect on the solar plexus - the area of stomach, liver, spleen and gallbladder.

Warning : In non obese children, watch out for excessive central fat in the waist and abdominal region.

Marma

Nabhi marma It is located in the religion of umbilicus. Stimulation of this marma helps in digestion.

●    Stimulation: Sit in Vajrasana with the fist of right-hand press this marma and bend forward. Take a deep breath. The left hand should support right hand.

Meditation

●    Meditate on Manipura chakra which is located at the umbilicus.

                        

Diet

●    Choose healthier foods such as fresh fruits, vegetables, and whole grains.

●    Replace red meats with lean animal proteins such as chicken and fish.

●   Ghee is an important part of Ayurvedic cleansing. It lubricates the digestive tract and helps to facilitate the elimination process.

●    Increase fiber intake

●    Old rice, old barley mixed with wheat

●    Green gram, pigeon pea

●  Vegetables: long gourd, bottle gourd, round gourd, bitter gourd, ash gourd, radish, carrot , turnip, pumpkin

●    Fruits: Pomegranate, grapes, chikoo

“Liver is a powerhouse of an organ keeping it in good shape is important for maintaining health”

Avoid

●    Eliminate fatty foods and food high in sugar.

●   Avoid pitta enhancing food (these substances are found in oily and spicy food, alcohol, artificial flavors , preservatives and caffeine)

●    Avoid salty, sour and pungent taste.

●    Curd, cheese

●    Peanuts, dry fruits

●    Aerated drinks

●    Deep fried items

●    Non-vegetarian food

●    Alcohol, red meat, egg yolk, refined flour

●    Avoid junk food

●    Avoid saturated fats found in food from animal sources such as meat, buttercream and cheese. Trans fat is found in vanaspati oil and processed food also.

●    Cutting simple carbohydrates like bread, sugar etc.

●    limiting or avoiding alcoholic beverages
●      Avoid sugary beverages including juices and glucose drinks.

Herbs

●   Raw Neem leaves are eaten to purify blood.
●     Ripe papaya should be eaten every day.
●    Picrorhiza kurroa or Katuki: It has deep cleansing action on the liver, supporting healthy liver function and proper flow of bile.

●   Aloe Vera: Peel the external skin and collect the fresh juice; this collected juice can be consumed internally 10- 20 ml of sugar candy/turmeric powder / or Triphala powder.

●    Phyllanthus amarus or Bhumyamalaki: Collect fresh whole plant, wash with water and crush into a soft paste. While crushing small quantity of milk can also be added. The paste is squeezed using a clean cotton cloth to obtain juice. This juice is consumed 30-50 ml on empty stomach.

●    Trichosanthes dioica root

●    Andrographis paniculata or Kalmegh: Collect fresh whole plant and crush into a soft paste. The paste can be consumed with little jaggery or boiled with water to get decoction. 50-100 ml of decoction tone consumed twice a day or use paste along with sugar/honey.

●    Root of piper longum

●    Tinospora cordifolia: Guduchi Fresh stem cuttings (minimum thickness of a pencil) measuring 2-3 inches, crushed and boiled in a cup of water, reduce to half of a volume. Consume 30-50 ml twice a day on empty stomach.

Home Remedies

●    Squeeze the juice of a ½ lemon in a glass of water. Drink it 2-3 times a day for several weeks.

●    Alternatively, add 2 to 3 chopped lemons to a jar of water. Drink this water at regular intervals.

●    Turmeric improves the body’s ability to digest fats so they do not accumulate in the liver. It also aids the liver detoxification process. Mix ¼ teaspoon of turmeric powder in 1-2 glasses of water and boil it. Drink it twice daily for a couple of weeks you can also mix ½ teaspoon of turmeric powder in a glass of warm milk and drink it once daily.

●    Green tea It improves liver functions. It helps block the amount of fat stored in the liver.

●    Add ½ teaspoon of licorice root to a cup of hot water. Cover and allow it to steep for 5-10 minutes. Strain, add a little honey and drink this tea two times a day.

●    Alternatively, mix together 1 teaspoon of licorice powder and 2 spoons of honey and have this once daily for several weeks.

●    According to Ayurveda both the papaya fruit and its seeds are effective treatments for the fatty liver disease.

●    Moreover, papaya aids in rapidly burning dietary fats, one of the main causes of fatty liver disease. Grind 5-6 dried papaya seeds and mix the powder with 1 tablespoon of fresh lemon juice. Take this two times a day for one month.

●    Eat a slice of ripe papaya with honey once daily.

●    Include raw papaya soup and salad in your diet.

●    Amla is another effective remedy for fatty liver disease. Its high antioxidant vitamin C content helps keep the liver functioning at optimal levels. It also helps get rid of harmful toxins from the liver. Moreover, Amla is good for people who have high blood cholesterol, high blood pressure or diabetes. You can eat 3 to 4 raw Amla daily or include the fruit in your cooking.

●    Alternatively, mix 1 teaspoon of Amla powder or juice in a glass of warm water and drink it twice daily.

Prevention

●    Drinking coffee without sugar also protects the liver

●    Healthy eating- 5 daily serving of food including fruits and vegetables.

●    Having a healthy weight

●    Cutting back on bad fats, processed foods,

●    Drinking alcoholic beverages in moderation.
●     The empty calories have to be cut ; candy ,chocolate,  , eat and fried removed from the diet.

                                                    "There is no pill to pop for NAFLD.

Treatment

●    Losing weight, exercise.

●    Keep blood sugar under control.

●    Reduce the number of calories you eat every day.
●    Decrease the amount of liver inflammation by antioxidants.

Ayurveda

●  The drugs/ formulation selected to treat NAFLD  should possess the following properties: predominant Tikta rasa with associated katu rasa (Bitter and pungent taste), Rukhsana (drying), Panchana (carminative), Shodhana (purification), Pitta virechana (expulsion of pitta), kaphagna alleviation of Kapha)

Formulations: Guduchi Swarasa, Triphala churna, Avitpathi churna, kanchanara Guggulu.

●    The good news is that fatty liver can be reversed at the “fatty” stage by cutting simple carbohydrates like bread, sugar and eating more fruits, vegetables and proteins.
"FIGHTING FIT"

Link: https://madhuchhandacdmo.blogspot.com/2018/01/fatty-liver-hepatic-steatosis.html

* Medicine as suggested above should only be taken under the consultation and supervision of registered medical practitioner.