The liver is the body’s largest gland and metabolises almost all nutrients. Disturbances in liver lipid metabolism, caused by various underlying factors, can lead to fatty liver. When it is associated with heavy alcohol use, the condition is called alcohol associated liver disease. But when this buildup of fat (steatosis) is not associated with heavy alcohol use, it is referred to as Non Alcoholic Fatty Liver Disease (NAFLD). It is an umbrella term for a range of liver conditions characterised by steatosis. One of these conditions is Non Alcoholic Steatohepatitis (NASH), in which fat accumulation is accompanied by inflammation and liver cell injury. In this blog, we will look at how NAFLD differs from NASH, what these changes mean for liver health, and non-alcoholic fatty liver disease Ayurveda treatment.
What Is the Difference Between NAFLD and NASH?
NAFLD has two variants: Non-Alcoholic Fatty Liver (NAFL) or Metabolic Dysfunction-Associated Steatotic Liver (MASL) and Non Alcoholic Steatohepatitis (NASH) or Metabolic Dysfunction-Associated Steatohepatitis (MASH). A fatty liver occurs when excess fat builds up in liver cells without serious inflammation. It may cause pain because the liver enlarges.
While simple fatty liver generally has a more favourable course, Non Alcoholic Steatohepatitis (NASH) is a more serious and life-threatening form of the condition. It involves fat accumulation along with inflammation (hepatitis) and liver cell injury. In some cases, this may be accompanied by varying degrees of fibrosis. Over time, advanced fibrosis may progress to cirrhosis, resulting in scarring and, in some cases, irreversible liver damage.
What Causes Fatty Liver Disease?
NAFLD is more commonly seen in people with the following conditions:
- Obesity, particularly excess abdominal fat.
- Prediabetes (insulin resistance) and Type 2 diabetes, with studies suggesting that one-third to two-thirds of people with the condition have NAFLD.
- Hypertension, hyperlipidaemia & metabolic syndrome.
- Some medicines, including calcium channel blockers
- Poor lifestyle, including an unhealthy diet which includes junk food, soft drinks, Avyayama (lack of physical activity), weight loss and poor sleep
Symptoms and Diagnosis: What Should You Look For?
NAFLD & NASH are called silent diseases because they hardly show signs or symptoms, especially in the initial stages. Doctors usually detect them on routine blood tests. Patients may present with abdominal heaviness and distention, increased or decreased appetite, constipation or diarrhoea, and malaise in the first stage. This distention can be compared with Ajirna, or indigestion, in Ayurveda. When NAFLD progresses to the next stage, the clinical picture of NASH is similar to persistent Amlapitta (Gastro-oesophageal Reflux Disease), where the patient has sour belching, burning sensation in the chest and abdomen, distention of the abdomen, tastelessness and loose stools. The patient may pass stools frequently without proper digestion, as in Grahani (IBS or Sprue). When the condition progresses to Fibrosis and Cirrhosis, systemic features suggestive of more serious liver disorders such as Pandu (Anaemia, Fatigue), Kamala (yellowish sclera, skin & urine), and Raktapitta (haematemesis) will be more evident.
Understanding Fatty Liver Through Ayurveda
From an Ayurvedic perspective, NAFLD can be understood as a Santarpanajanya Vyadhi (overnourishment disease). Nidana (aetiology) and Samprapti (pathogenesis) are similar to Sthaulya (obesity). The main pathology is an imbalance of Agni (digestive fire) due to intake of Vidahi and Abhishyandi Ahara (irritating and channel-obstructing food) and a faulty lifestyle, leading to the formation of Apakva Anna Rasa (improperly formed digestive end product). This causes Kapha Dosha vitiation and improper formation and deposition of Meda (fat tissue) in Yakrit (liver), resulting in fatty liver. Kapha imbalance causes Srotorodha (blockage of channels), along with Vata imbalance. Pitta aggravation leads to inflammatory changes in the hepatocytes, and the condition may proceed to the next stage, i.e. NASH. Further aggravation of Vata can cause Dhatu Paaka and fibrosis, which can progress to more serious conditions like cirrhosis and other metabolic complications.
How Does Ayurveda Approach NAFLD and NASH?
Ayurvedic treatment for NAFLD includes Agnideepana (Stimulation of digestive fire), Rookshana (Drying and pacification of Kapha and Meda), and Srotoshodhana (Removal of channel blockages). When Fatty Liver progresses to the next stage and Dhatus get involved, NASH Ayurveda treatment should focus on Prasadana of Rasa and Rakta and Yakritshothahara (reducing hepatic inflammation).
Nidana Parivarjana
Reduce your intake of fats and high-calorie foods that cause Kapha-medo dushti.
Apatarpana chikitsa
Along with avoidance of causative factors, changing a person’s diet based on their metabolic profile and helping them lose weight is one of the first steps. A diet of whole foods, lean proteins, and moderate physical activity can help achieve the desired body weight.
Shodhana
Panchakarma procedures such as Lekhaniya vasti or Virechana using Churnas and kashayas help in reducing excessive Dosha accumulation and Srotorodha. It also supports rasa and rakta prasadana (nourishing and improving the quality of Rasa Dhatu and Rakta Dhatu).
Samshamana
In the early stages, deepana-pachana, or carminative, herbs can help improve metabolism. Using katu-tikta (pungent and bitter) drugs helps reduce accumulated Ama in the hepatocytes. Herbs like Sharapunkha, Bhoomiamla, Katuki, Giloy, Vasa, Haritaki, and Pippali are commonly used but should be taken only under the guidance of an Ayurveda doctor. Since the liver is already compromised in NAFLD or NASH, consuming herbs without a prescription can worsen the condition.
Rasayana
Rasayana Chikitsa can also be adopted with herbs like Triphala, Shilajatu, Guggulu, etc., to help reduce fat accumulation and improve liver function under a doctor’s guidance.
Lifestyle changes
Eat freshly prepared food and avoid junk food, excessive sugary foods, and oily, fatty foods. A sedentary lifestyle, excessive daytime sleep, smoking and suppression of natural urges have to be avoided. Avoid alcohol and smoking.
Conclusion
Non alcoholic fatty liver disease Ayurveda treatment works the same way for everyone. The treatment plan depends on the person’s condition, how much the liver is affected, and any other health problems. It may include dietary changes, physical activity and chosen therapies under the advice of an Ayurveda physician. Fatty liver needs attention as it may remain undetected for a long time. Many people have no obvious symptoms and only find out on a routine scan or blood test. If it’s found early, you can identify contributing factors and take steps to address them. Regular follow-up and attention to metabolic health is as important as the fatty liver Ayurvedic treatment itself.
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