
Alcoholic Liver Disease is one of the most common liver manifestations, caused due to the excess intake of alcohol. If a man consumes 75-100 ml/day and a woman consume 25 ml/day for longer duration, significantly increases the risk of Liver damage leading to Alcoholic Liver Disease. Women have a greater risk of developing Liver damage with the minimal amount of Alcohol. Our Liver does multiple functions in the body like production and secretion of bile, metabolism of the medicines, Macro-minerals such as Fats, Proteins and Carbohydrates, Metabolism of Ethanol, Glycogen storage, Excretion of Bilirubin, Cholesterol, etc.
When a person consumes Alcohol (Ethanol), 75% of it is absorbed in the intestines and reaches Liver where it is metabolised by the liver cells. 20% of the Alcohol directly enters the Bloodstream, where as 5% of it is excreted through saliva, urine and sweat, without getting metabolized. Absorption of Alcohol increases when consumed in empty stomach and delayed if consumed with food.
Metabolism of Alcohol
Alcohol is very corrosive in nature; it damages the whole oesophagus and stomach’s inner mucosal lining/layer. When it is absorbed into the bloodstream, it damages the Liver to such an extent that it loses all the normal functions. When Alcohol/Ethanol enters the liver, it is converted into acetaldehyde with the help of an enzyme alcohol dehydrogenase. Further, acetaldehyde is converted into acetate with the help of an enzyme names acetate dehydrogenase. Excess conversion and metabolism of ethanol in the liver, due to oxidative stress and other internal factors damaged by the ethanol, causes dysfunction of the Hepatocytes (Liver Cells), ultimately leading to the death of the liver cells.
Gradually, the liver starts to lose its function and becomes very week to fight against any hepatic illness ending up in different stages of liver failure.
SYMPTOMS OF ALCOHOLIC LIVER DISEASE:
Initially:
- Vomiting
- Stomach Pain
- Excess thirst
- Giddiness/Dizziness
- Muscle cramps
- Headache
- Fatigue
- Dehydration
In the later stage Person Experiences:
- Signs of Vit. B12 Deficiencies
- Severe Anaemia
- Pale Stools
- Generalised Body itching
- Jaundice (Yellowish discoloration of Sclera, Urine, Palms, and Skin)
- Signs of Liver Enlargement: palpable Liver
- Tremors
- Unsteadiness
- Reduced food intake
- Forgetfulness, Irritability, Insomnia, etc.
In further Stages Signs of Liver cell failure extends to a symptom like Ascites (Building up of fluid inside the peritoneal cavity)
- Dyspnoea (Breathlessness)
- Muscle Atrophy (loss of the muscle mass)
- Gynecomastia (Enlargement of Breast in both male and female, which is significantly seen in males)
- Testicular atrophy
- Oesophageal varices, Haemorrhoids
- Serious Disorders like Hepatic Encephalopathy, Wernicke’s Encephalopathy, Korsakoff’s Syndrome
Symptoms depend on the stages of liver damage.
STAGES OF LIVER DAMAGE:
- STAGE 1 – FATTY LIVER (Steatosis): Deposition of Fat in the Liver
- STAGE 2 – LIVER FIBROSIS: Formation of the Scar tissue
- STAGE 3 – LIVER CIRRHOSIS: Growth of connective tissue and liver cell damage.
RISK FACTORS:
- Quantity of Alcohol consumed per day
- Women > men (if consumed as per the quantity specified)
- Pattern of Drinking
- Genetic predisposition
- Infection – Post hepatic Infection/necrosis leading to Liver disease
- Hemochromatosis – a disease of iron overload
- Diet
AYURVEDIC PERSPECTIVE OF ALCOHOLIC LIVER DISEASE/Yakrit Viakara:
Ayurveda is the science of life, which is composed of three Doshas VATA, PITTA, and KAPHA – the three major components of the body. Saptha Dathu; RASA, RAKTA, MAMSA, MEDHA, ASTHI, MAJJA, SHUKRA, which are the major Tissues and Organs, and Three Guna – Different personalities or Qualities of a person RAJAS (Quality of Passion, Activity, Self-centredness, Individualization, egoism, self-Respect etc), TAMAS (Quality of imbalance, disordered, chaos, delusional, negativity, inactiveness etc), SATVIK (Quality of balance, harmony, Goodness, purity, etc).
Alcoholic Liver Diseases: Madhya Pana causing abnormal vitiation of the bodily components, leading to Yakrit Dosha and Yakritodara is the main understanding. Here Madya refers to Alcohol and Bodily components refer to Vata, Pitta, and Kapha, and Yakrit refers to the Liver. When a person consumes excess Madya (alcohol), which is very Vidahi (corrosive) in nature, it increases Pitta and Kapha dosha. Pitta Dosha is mainly involved in the function of Yakrit i.e., Liver. Because of the vitiated Kapha and Pitta, it causes impaired metabolism, it causes Yakrit Vriddhi (Enlargement of the liver), leading to Yakrit Dosha and ending up in Yakritodara (Cirrhosis and Ascites) leading to many above mentioned symptoms.
Madatyaya in other hand is referred to Acute Alcoholism, a condition where the immediate effect of excessive consumption of alcohol is observed. Symptoms include dizziness, irrelevant talking, state of excitement, excessive thirst, muscle cramps and also hampers the function of Rajas and Tamas.
TREATMENT OF YAKRITODARA/ALCOHOLIC LIVER DISEASE.
- The treatment protocol of Alcoholic Liver Disease is very wide. Starting with Snehapana, where the patient is advised to consume medicated ghee which controls the symptoms.
- Nitya Virechana: A mild form of Purgative therapy has shown promising results.
- Virechana: Classical, complete purgative therapy is adopted in case of detoxification.
- Basti Karma: An Enema therapy, that reduces the abdominal symptoms.
- Ksheera Pana: Consumption of Cow Milk is given utmost importance in Ayurveda to all Liver disorders’ patients, especially alcohol-related.
SINGLE DRUG USAGE IN ALCOHOLIC LIVER DISORDER:
- Pippali – Piper longum
- Haridra – Curcuma Longa
- Bhallataka – Samecarpus anacardium
- Ashwagandha – Withania somnifera
- Guduchi – Tinospora cardifolia
- Shilajitu – Asphaltum punjabianum
- Abhaya – Terminallia chebula
- Amalaki – Phyllanthus Emblica
- Shunti – Zingiber officinale
REFERANCES
- Anthony S, Joseph B Martin et al. Harrison’s principles of Internal Medicine. 19th ed. Vol 2.P2052
- Anthony S, Joseph B Martin et al. Harrison’s principles of Internal Medicine. 19th ed. Vol 2.P2058
- Agnivesha. Charaka Samhita.Yadavji Trikamji Acharya editor. 2014. Sutra Sthana.13thChapter.
- https://www.medicalnewstoday.com/articles/215638#risk-factors