ABSTRACT
Fatty liver, also known as fatty liver disease (FLD), is a reversible condition where large vacuoles of triglyceride fat accumulate in liver cells via the process of steatosis (i.e. abnormal retention of lipids within a cell). The liver is the largest gland in the body situated below the diaphragm, on the right side of the abdomen and has many vital functions to perform for the body. It filters the blood coming from the digestive tract before it passes to the body. Other important functions of the liver are metabolism of carbohydrates, proteins, lipids and amino acids in the body; production of bile that help in breaking down the fat and detoxification of chemicals and drugs. Its other functions include producing blood clotting factors, storage of glucose and clearance of bilirubin. In this article we discuss about the major factor that affects the normal functioning of liver – Non Alcoholic liver disease.
INTRODUCTION
Fatty liver, also known as fatty liver disease (FLD), Despite having multiple causes, fatty liver can be considered a single disease that occurs worldwide in those with excessive alcohol intake and those who are obese (with or without effects of insulin resistance). The condition is also associated with other diseases that influence fat metabolism.
Nonalcoholic fatty liver disease (NAFLD) is a term used to describe the accumulation of fat in the liver of people who drink little or no alcohol. Nonalcoholic fatty liver disease is common and, for most people, causes no signs and symptoms and no complications. But in some people with nonalcoholic fatty liver disease, the fat that accumulates can cause inflammation and scarring in the liver. This more serious form of nonalcoholic fatty liver disease is sometimes called nonalcoholic steatohepatitis (NASH). At its most severe, nonalcoholic fatty liver disease can progress to cirrhosis, liver failure, or liver cancer. The disease often goes hand in hand with diabetes. According to latest research about 70 percent of people with type 2 diabetes have a fatty liver. Morphologically, it is difficult to distinguish alcoholic FLD from nonalcoholic FLD, and both show microvesicular and macrovesicular fatty changes at different stages.
AETIOLOGY
Exactly, is unknown. A fatty diet or overeating by itself never results in a fatty liver. The fat may come from increased absorption from the intestines or from elsewhere in the body. Some common causes of NAFLD are:
Metabolic syndromes - Apart from alcohol, there are many conditions that cause an imbalance in the body's metabolic capacity like Diabetes, High Hypertension, High blood cholesterols, Pregnancy, Glycogen storage disease, Congenital disorders like Wolman's disease, Congenital diseases like Wilson's disease, Weber-Christian disease, Galactosemia, Infections like tuberculosis and malaria.
Nutritional causes - Severe mal-nutrition, Obesity, Sudden rapid weight loss, Surgeries performed to reduce obesity - gastric bypass surgery, jejuno-ileal bypass, etc.
Drugs – Corticosteroids, Valproic acids (used in epileptic patients), Medications for heart conditions like irregular heartbeats and high blood pressures e.g. amiodarone; diltiazem, Sedatives, Tamoxifen - used in treating breast cancer, Methotrexate, Anti-retroviral drugs (indinavir), Overdose of Vitamin A. In extreme cases, amiodarone and methotexate can cause cirrhosis.
Other - toxins from food stuffs like rancid peanuts - aflatoxins are extremely toxic, mushroom poisonings, phosphorus from environment
RISK FACTORS:
§ are obese
§ are an alcoholic
§ Suffer from high blood pressures which often fluctuate or are on long-term medications for the same.
§ Blood cholesterol levels are high.
TYPES OF NONALCOHOLIC FATTY LIVER DISEASE
Nonalcoholic fatty liver disease can take several forms — from harmless to life-threatening. Forms include:
Ø Nonalcoholic fatty liver. It's not normal for fat to build up in your liver, but it won't necessarily hurt you. In its simplest form, nonalcoholic fatty liver disease can cause excess liver fat, but no complications. This condition is thought to be very common.
Ø Nonalcoholic steatohepatitis. In a small number of people with fatty liver, the fat causes inflammation in the liver. This can impair the liver's ability to function and lead to complications.
Ø Nonalcoholic fatty liver disease-associated cirrhosis. Liver inflammation leads to scarring of the liver tissue. With time, scarring can become so severe that the liver no longer functions adequately (liver failure).
CLINICAL PRESENTATION
Mild Fatty liver is usually asymptomatic. It is detected incidentally during routine tests performed. However, some persons can have symptoms which are often vague like Malaise , Fatigue - even with moderate exertion, Fullness and heaviness in the abdomen, more in the right upper corner, Occasionally the liver maybe painful on pressure.
However, with fatty liver unchecked can progress into cirrhosis which is life-threatening.
DIAGNOSIS:
Commonly, the diagnosis is incidental. Some tests which identify the disorder are:-
§ Ultrasound (Ultrasonography): A painless, non-invasive test, when performed by an experienced personnel, it can accurately identify fatty liver. The liver size can be measured and this test can be valuable in grading the improvement.
§ Liver Function Tests: Abnormal levels of liver enzymes in the blood identify as well as provide a deeper understanding of the cause of fatty liver. This test also provides insight into the efficacy of treatment and the improvement to be expected.
§ Computed Tomography Scan (CT scan): non-invasive. Measures internal organs accurately and in detail by the use of X-rays.
§ MRI: Also non-invasive. Uses radio waves in a magnetic field to scan the structures of internal organs.
TIPS FOR PREVENTING AND TREATING NONALCOHOLIC FATTY LIVER DISEASE
· Lose weight, and exercise. Doctors often recommend weight loss as a first step for those newly diagnosed with fatty liver disease. The American Gastroenterological Association suggests weight loss of 10 percent or more for those with NASH. Aim for at least 30 minutes of exercise most days of the week. For instance, take the stairs instead of the elevator. Walk instead of taking short trips in your car. If you're trying to lose weight, you might find that more exercise is helpful. But if you don't already exercise regularly, get your doctor's OK first and start slowly.
· Improve your diet, even if you're having trouble losing weight. A healthful diet is considered key to a long and healthy life. It may be especially important for those with nonalcoholic fatty liver disease. Eat a healthy diet that's rich in fruits and vegetables. Reduce the amount of saturated fat in your diet and instead select healthy unsaturated fats, such as those found in fish, olive oil and nuts. Include whole grains in your diet, such as whole-wheat breads and brown rice.
· Consider a glass of wine. The prevailing advice for people with nonalcoholic fatty liver disease continues to be to avoid alcohol altogether. But a study published last year suggests an unconventional approach to preventing the condition. Researchers at the University of California-San Diego School of Medicine found that drinking a glass of wine a day may decrease the risk of nonalcoholic fatty liver disease. Study participants who reported drinking up to one glass of wine per day had their risk of liver disease cut in half, in comparison with those who drank no alcohol.
· Control cholesterol levels. Besides regular workouts, a healthy approach to avoid consumption of saturated fats in diet can reverse fatty liver. Cholesterol lowering medications used in adjunct to exercise can reverse fatty liver.
· Control Diabetes. Effective management of sugar levels with life-style changes, medications and insulin can stop further advancement of fatty liver into something serious like cirrhosis or liver failure.
MANAGEMENT
NATURAL TREATMENT
Certain natural remedies may be helpful in healing fatty liver when part of a personalized and well-rounded treatment plan. Before taking natural remedies, consult with medical doctor as well as a nutritionally and botanically trained health care professional.
Vitamin E is an antioxidant, meaning it protects against free radical damage. This can be especially helpful for the liver because free radicals form during the natural detoxification process. Vitamin E also supports the immune system and can help prevent fibrosis and cirrhosis, which are common complications of long-term fatty liver.
Turmeric is popular both as a culinary spice and for its medical properties. Turmeric, also known as Curcuma longa, is used in Chinese and Ayurvedic medicine to treat liver ailments, digestive problems and skin diseases. Turmeric has a strong antioxidant and anti-inflammatory properties. It protects liver cells against damage and reduces inflammation that results from fatty liver. Turmeric may be sprinkled on food as a spice or taken as a tincture or capsule.
Milk thistle is a well-known all-natural solution for the treatment of liver disorders. The active component perfectly located at the seed will be the phytochemical silymarin. Silymarin is often a flavonoid which helps bring about regeneration regarding harmed hard working liver tissue and also improves liver organ purpose.
Omega-3 essential fatty acids are located naturally within flax plant seeds, seed natural skin oils like flaxseed along with canola oils, bass oils as well as chilly water seafood like fish. Omega-3 essential fatty acids can have outstanding hard working liver health improvements, enhance the action involving insulin, as well as aid many individuals who are suffering through junk lean meats condition. In addition, Omega-3 fat lower swelling and pain some of those those who are experiencing any junk liver condition.
HOMOEOPATHIC MANAGEMENT
Homeopathy is one of the most popular holistic systems of medicine. The selection of remedy is based upon the theory of individualization and symptoms similarity by using holistic approach. This is the only way through which a state of complete health can be regained by removing all the sign and symptoms from which the patient is suffering. The aim of homeopathy is not only to treat fatty liver symptoms but to address its underlying cause and individual susceptibility. As far as therapeutic medication is concerned, several remedies are available to treat fatty liver symptoms that can be selected on the basis of cause, sensations and modalities of the complaints. For individualized remedy selection and treatment, the patient should consult a qualified homeopathic doctor in person. There are following remedies which are helpful in the treatment of fatty liver symptoms:
Arsenic Album, Nux Vomica, Chelidonium, Cardus m, Apocynum, Lycopodium, Sepia, Phosphorous, Digitalis, Bryonia, Helleborus Niger, Ferrum Met, kali Carb, Iris V, Natrum Carb and many other medicines.
Indicated Remedies | Indications |
Bryonia | When there are stitching pains in the right hypochondriac region, Bryonia is the first remedy to be thought of, though for these pains we have other remedies, such as Chelidonium and Kali carbonicum. Under Bryonia the liver is swollen, congested and inflamed; the pains in the hypochondriac region are worse from any motion, and better from lying on the right side, which lessens the motion of the parts when breathing. It is one of the chief remedies for jaundice brought on by a fit of anger. |
Mercurius | This remedy has much sensitiveness and dull pain in the region of the liver; the patient cannot lie on the right side. The liver is enlarged. The skin and conjunctiva are jaundiced. The stools are either clay-colored from absence of bile, or yellowish-green bilious stools passed with a great deal of tenesmus. There is a yellowish white coated tongue which takes the imprint of the teeth and there is a foetid breath, loss of appetite and depression of spirits. |
Podophyllum | The principal use of Podophyllum is in liver affections. Primarily, it induces a large flow of bile, and, secondarily, great torpidity, followed by jaundice. It is indicated in torpid or chronically congested liver, when diarrhea is present. The liver is swollen and sensitive, the face and eyes are yellow and there is a bad taste in the mouth. The tongue is coated white or yellow and the bile may form gall stones. |
Chelidonium | The liver symptoms of Chelidonium are very prominent. There is soreness and stitching pains in the region of the liver, but the keynote for this drug in hepatic diseases is a pain under the angle of the right shoulder blade, which may extend to the chest, stomach, or hypochondrium; there is swelling of the liver, chilliness, fever, jaundice, yellow coated tongue, bitter taste and a craving for acids and sour things, such as pickles and vinegar. |
Chionanthus Virginica | A prominent liver remedy. Hepatic derangements. Jaundice. Enlarged spleen. Jaundice with arrest of menses. Gallstones, Aching in umbilical region, griping. Sore; enlarged, with jaundice and constipation. Clay-colored stool, also soft, yellow and pasty. Tongue heavily coated. No appetite. Bilious colic. Hepatic region tender. Pancreatic disease and other glandular disorders. |
Cholesterinum | For cancer of the liver. Obstinate hepatic engorgements. Burning pain in side; on walking holds his hand on side, hurts him so. Opacities of the vitreous. Jaundice; gallstones. |
Digitalis | When jaundice arises from cardiac diseases, Digitalis may be the remedy. There is no retention of bile, nor obstruction of the ducts, but the jaundice is due to the fact that the liver does not take from the blood the elements which go to form bile. There is present drowsiness, bitter taste, soreness , enlargement and bruised feeling in the region of the liver. |
Myrica cerifera | Myrica is an important liver remedy. There is first despondency and also jaundice due to imperfect formation of bile in the liver, and not to any obstruction, comparing here with Digitalis. There is dull headache, worse in the morning, the eyes have a dingy, dirty, yellowish hue, the tongue is coated yellow. |
Fel Tauri | Increases the duodenal secretion, emulsifies fats and increases the peristaltic action of the intestines. Liquefies bile and acts as a purgative and chologogue. Disordered digestion, Obstruction of gall ducts. Biliary calculi. Jaundice. |
Nux vomica | In liver affections occurring in those who have indulged to excess in alcoholic liquors, highly seasoned food, quinine, or in those who have abused themselves with purgatives, Nux is the first remedy to be thought of. The liver is swollen hard and sensitive to the touch and pressure of clothing is uncomfortable. The first remedy in cirrhosis of the liver. Colic may be present. |
Lycopodium | Lycopodium acts powerfully on the liver. The region of the liver is sensitive to the touch, and there is a feeling of tension in it, a feeling as if a cord were tied about the waist. Cirrhosis. The pains are dull and aching instead of sharp and lancinating, as under Chelidonium. Fulness in the stomach after eating a small quantity. |
Carduus marianus | This remedy is indicated in jaundice with dull headache, bitter taste, white tongue with red edges, nausea and vomiting of a greenish fluid. There is an uncomfortable fullness in the region of the liver, the stools are bilious and the urine golden yellow; there is sensitiveness in the epigastrium and right hypochondrium. Burnett regards a dark brownish patch over the lower part of the sternum as a useful hint for Carduus, and in such cases he observes that both the liver and heart are at fault. The presence of "liver spots seems to be a special indication for the remedy. |
Sulphur | Sulphur is suitable to chronic affections of the liver; it increases the flow of bile and there is much pain and soreness in the liver. Sulphur often completes the cure commenced by Nux. Liver complaints from abuse of mercury will oftentimes call for Sulphur. If the stools are colorless and if much jaundice or ascites be present Sulphur is contra-indicated. Lachesis, however, has jaundice, as do all snake poisons, and is useful in the enlarged livers of drunkards, with tenderness on pressure and throbbing in the right side. |
Phosphorus | Phosphorus is homoeopathic to fatty degeneration of the liver, with well marked soreness and jaundice. The stools are grayish white. Cirrhosis and atrophy may also call for Phosphorus. The jaundice is indicative of organic diseases, and the remedy is a useful one in malignant diseases of the liver. Digitalis has also been recommended in acute yellow atrophy. Jaundice accompanying pneumonia may also call for Phosphorus. |
Taraxacum | This is a decided liver remedy, and the indications are a mapped tongue and a bitter taste in the mouth, chilliness after eating, pain and soreness in the region of the liver and bilious diarrhoea. Kali bichromicum also has a mapped tongue. Yucca filamentosa has a pain going from the upper region of the liver to the back and a bad taste in the mouth. The stools are loose and bilious, accompanied with much flatus. |
CONCLUSION
Homoeopathy treats the person as a whole. It means that homoeopathic treatment focuses on the patient as a person, as well as his pathological condition. The homoeopathic medicines are selected after a full individualizing examination and case-analysis, which includes the medical history of the patient, physical and mental constitution etc. A miasmatic tendency (predisposition/susceptibility) is also often taken into account for the treatment of chronic conditions.
