Fatty liver disease

Read in Hindi

fatty liver diseaseFatty liver simply means accumulation of fat in the liver. Normal, healthy liver has no fat. It is unclear where the fat comes from. It may be acquired from other parts of the body or the liver may be absorbing an increased amount of fat from the intestine. It could also be possible to explain fat accumulation, if the liver loses its ability to change fat into a form that can be eliminated.

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Types

Fatty liver disease can be divided into 2 types – alcohol related and non-alcohol related.

Alcoholic fatty liver disease: It is caused due to heavy alcohol drinking. Alcohol, in general, is bad for the liver because it diverts the liver from its major function of metabolising carbohydrates and providing glucose throughout the body. It destroys the liver cells resulting in fat deposits, causing alcoholic fatty liver disease. The fat in the liver can progressively cause inflammation and scarring of the liver, resulting in cirrhosis

Non-alcoholic fatty liver disease: There are 3 stages of non alcohol related fatty liver disease


  • Non-alcoholic fatty Liver (NAFL):  It is not as serious as other forms since it doesn’t lead to inflammation.

  • Non-alcoholic steato hepatitis (NASH): In this type, permanent liver damage can occur. The liver may enlarge and as the diseases progresses, the liver cells may get replaced by scar tissue causing cirrhosis. A person can also develop liver cancer and life-threatening conditions related to liver like liver failure.

  • Cirrhosis: Scarring of the liver tissue leads to cirrhosis.

Causes

Alcoholic fatty liver disease: It is caused by significant consumption of alcohol. Usually, consumption of greater than 21 units of alcohol/week in men and 14 units of alcohol/week in women, over a two year period is found to cause fatty liver. (One unit is equivalent to 10 ml of pure alcohol)

Non alcohol fatty liver disease: It is seen in patients who suffer with the following conditions in the absence of significant alcohol consumption:


  • Obesity

  • Type 2 diabetes

  • Insulin resistance

  • Hyperlipidemia

  • Hypothyroidism

  • Metabolic syndrome which requires the presence of 3 or more of the following features

    • Waist circumference greater than 102cm in men and 88 cm in women

    • Triglyceride level 150mg/dl or greater

    • High density lipoprotein (HDL ) cholesterol level less than 40mg/dl in men and less than 50mg/dl in women

    • Systolic blood pressure 130mm Hg or greater or diastolic pressure 85mm Hg or greater and

    • Fasting blood glucose level 110mg/dl or greater




Here are more causes and risk factors of liver disease

Risk Factors

While the specific cause of non-alcoholic fatty liver disease is not known, there are certain factors that increase the likelihood of this condition.


  • It tends to run in families and is often seen in middle-aged persons who are overweight or obese.

  • People with diabetes, insulin resistance, high levels of triglycerides and cholesterol are more likely to suffer from fatty liver.

  • Diseases such as inherited liver disease, some autoimmune conditions and viral hepatitis are other risk factors for fatty liver.

Symptoms

Fatty liver disease is a silent medical condition, which means there are usually no symptoms. In such cases, the disease is identified from routine health check up indicating fatty liver with ultrasound, CT scan or MRI of the abdomen. Patients should visit the doctor for further investigations even if they do not have any symptoms.

In case you experience the following symptoms, visit the doctor.


  • Fatigue

  • General feeling of being unwell

  • Right sided upper abdominal discomfort


As the disease progresses towards the advanced stages it can cause cirrhosis, where the following symptoms may be experienced:

  • Jaundice (yellowing of the skin)

  • Swelling of feet and abdomen

  • Vomiting blood

  • Bleeding from gums

  • Recurrent infections

  • Confusion

Diagnosis


  1. Blood test: Some liver enzymes act as markers which can be detected using liver function tests. Some liver enzymes such as SGOT (aspartate transaminase -AST) and SGPT (alanine transaminase- ALT) might be elevated. Blood tests exclude other causes of fatty liver including blood sugar, lipid profile and thyroid function tests. They also check for viral hepatitis B and C which co exist in some patients with fatty liver disease without producing any symptoms.

  2. Ultrasound of the abdomen: Ultrasound uses sound waves to detect structural abnormalities of the liver. A fatty liver will appear ‘echogenic,’ more dense than usual, when visualised through ultrasound.

  3. Fibroscan: It is a non-invasive test similar to ultrasound that gives valuable information about the liver and helps quantify the amount of fat and degree of scarring (fibrosis ) in the liver. It takes few minutes to perform, is painless and result is available immediately.

  4. Liver biopsy: It is performed by taking a tissue sample from the liver with the help of a biopsy needle. The test is invasive and can cause pain, bleeding and usually requires patient to remain in hospital for 6-8 hours for observation. It is done in selected group of patients where liver disease appears to have advanced with inflammation and scarring. However, in most cases this procedure can be avoided if fibroscan is available


Read more diagnostic tests of liver disease

Treatment

Treatment options include medication along with lifestyle and dietary changes.

Medication: Mostly for non-alcoholic fatty liver disease the treatment is given to control risk factors causing fatty liver. Medicines to control of diabetes, cholesterol , hypertension and hypothyroidism is required. In some cases, antioxidant medication such as Vitamin E can be prescribed.

Lifestyle measures:


  • Exercise:  Obese individuals should lose of 3-5 % of body weight for improving their liver condition. In advanced stages, greater weight loss up to 10% may be required. Therefore, regular exercise for at least 30-60 minutes/day (3- 5 days of the week) is recommended.



  • Diet: Avoid high carbohydrates and fats in diet. Increase protein intake, fibre, in the form of     fruits and vegetables.



  • Avoid alcohol:  In patients who do not have fatty  liver, the safe limits of alcohol consumption are as follows:

    • Men: Should not drink more than 21 units of alcohol/ week. Should not drink more than 4 units in one day

    • Women: Should not exceed 14 units of alcohol/week. Should not drink more than 3 units in one day.



Home Remedies

Unfortunately, modern medicine has no specific method of treatment for fatty liver. The focus is on dealing with underlying conditions such as obesity, diabetes or high cholesterol levels that have triggered the problem. Here are a few natural remedies that you can adopt to deal with fatty liver disease.


  • Regular physical exercise and a healthy diet can help you reach your ideal weight and this is one of the primary steps to deal with a fatty liver.

  • Include lots of vegetables, fruits and whole grains in your diet. Eat smaller meals at short intervals, avoiding food that is rich in carbohydrates and fats.

  • According to Ayurveda, fatty meat, fried and spicy food tends to produce heat and overstimulation and should be avoided by people with fatty liver. Instead, consume cooling substances and non-acidic fruits such as pomegranates, melons, pears and berries. Cook vegetables with light steaming and serve with a small amount of ghee.

Alternative Remedies

Certain Ayurvedic remedies are considered useful in dealing with fatty liver.

Triphala

One of the most effective liver-balancing remedies is Triphala. This, as the name indicates, is made up of 3 vital ingredients – Amalaki, Bibhitaki and Haritaki. This blend helps to detoxify the liver and stimulates the flow of bile and also has nutritional properties.

Kutki

Known as Kardi or Karwi in Hindi, Kutki is a bitter root of the plant Picrorhizakurroa that grows in the Himalayan regions. This herb has a strong action on maintaining liver functions, promoting the secretion and flow of bile and also ensures the enzymes in the liver function optimally.

Ginger

Although ginger is most well-known for its digestive properties, it also has strong anti-inflammatory and antioxidant actions. In recent times, laboratory studies on rats have shown ginger to have promising value in dealing with non-alcoholic fatty liver disease and this is believed to be because of the antioxidant action of ginger.

Kalmegh

Kalmegh, obtained from the plant Andrographispaniculata, is considered an effective remedy for liver problems. It is said to have the property of removing the toxins accumulated within the liver and thus, helps in improving liver function. Besides, it acts on the gall bladder and stimulates its functioning, preventing defects related to the storage of the bile secreted from the liver.

Prevention

Here are some expert tips to prevent the disease


  • Avoid alcohol

  • Exercise regularly

  • Eat a healthy diet

  • Get your liver function checked from a doctor who specialises in liver care, in case of any concerns.


Here are additional prevention tips for liver disease 

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