The liver is the engine of the human body. It is basically composed of 2 types of cells (a cell is the basic building block of the human body)   hepatocytes (liver cells) and cholangiocytes (bile duct cells). It also has other supporting tissue and their respective cells. The hepatocytes are by far the most numerous cell type, not surprisingly tumours (otherwise called mass or lump.  Tumor  means lump in Latin), of this cell form the majority of abnormal growths in the liver. Abnormal growths can be benign (that is, they do not grow rapidly, spread to other parts of the organ or to other parts of the body) or malignant (grow rapidly, spread to other parts of the organ and to other parts of the body, i.e. cancer). These abnormal growths from liver cells are Focal nodular hyperplasia (FNH), Adenomas (the benign variety) and hepatocellular cancer (otherwise called Hepatoma/HCC, the cancerous type). What we need to recognize is that certain adenomas can turn into HCC, over a period of time. The other type of growths in the liver are those that have originated elsewhere in the body and spread to the liver, for example a growth of the breast spreading to the liver. These are in fact the commonest tumours of the liver. I will discuss these at a later date.

Benign growths of the liver

Common benign growths are Haemangiomas, FNH and Adenoma. Most of these are identified when a scan is performed as investigation for some other problem. Accurate diagnosis of the nature of these lumps is important to determine the type of treatment needed. This can be ascertained by a carefully selected scan like an Ultrasound, CT scan or an MRI. The technology of these scans is continuing to evolve and get better year on year. There are different types of Ultrasound, CT and MRI scans with different applications, based on whether contrast is used or not, the different phases of scanning, the type of MRI scanning sequence etc. Therefore, these scans although commonly available and used very frequently, need to be performed under the supervision of a team involving Liver doctors and radiologist who is well versed in the diagnosis of liver lumps, for accurate diagnosis without the need for unnecessary tests (Box 1).

Haemangiomas are by far the commonest. It is estimated that 5% of the adult population harbor this lump in their livers! They occur in both sexes and at all ages but are commonest between 30 to 50 years in women. Most of them are small, less than 4-5 cms in diameter and are are identified on Ultrasound. MRI and its various applications is the scan of choice for accurate diagnosis. This is crucial as most of them do not need treatment.

Focal Nodular Hyperplasia (FNH) are the second most common liver lumps. They are usually single and small (less than 4 cms) and occur in women between 35   50 years of age. About 2.5-3% of population harbor this lump in their livers. Special MRI techniques using special contrast agents is diagnostic and the findings are quite distinct from haemangiomas. Again treatment is not recommended apart from selected circumstances. Assessment in a dedicated Liver team is recommended for accurate diagnosis and a proper management plan to be formulated.

Hepatic adenomas (Hepatocellular adenoma, HCA) are rare lumps and occur in 0.2 to 0.3% of the population, again occurring mostly in young women during their reproductive period. They are again solitary and most usually 3-4 ms in diameter.

There are a couple characteristics which make this lump different from the previous 2, there is a strong relation between hormones the development of HCA and some of these HCA can turn into the malignant Hepatocellular carcinoma (HCC). Therefore, accurate characterization and diagnosis of these HCA is essential. Sometimes biopsy of the lump, molecular and genetic tests maybe necessary to determine if the HCA has a high chance of progressing to HCC. Imaging tests are generally adequate, contrast MRI Liver and its different techniques is accurate in diagnosing HCA and sub-typing it, however CT and contrast-enhanced Ultrasound is sometimes necessary along with MRI.

Generally, a HCA in a male is recommended for surgical resection. While in women, discontinuation of the OCP pill/ any other such hormone is recommended for a period of 6 months, if the HCA does not have any worrying features and size is less than 5 cms. IF HCA is larger than 5 cms and has features suggestive of a high risk for change to HCC, surgery is advised. Again these decisions have to be made as a part of a Multi-disciplinary team (Box 1)

Malignant growths beginning within the Liver

As mentioned earlier, usually malignant growths which are seen in the liver spread to it from elsewhere in the body. Hepatocellular cancer/Hepatoma (HCC) is the commonest malignant tumour beginning within the liver, as apposed to those that spread to the liver from elsewhere. It occurs between 40-70 years of age and occurs commonly in men. It is estimated that 17000 new patients develop this tumour every year in India. The vast majority (> 80%) of these develop in patients who have chronic liver disease (cirrhosis). Importantly the number of HCC cases is increasing year on year as cirrhosis due to fatty liver disease, Hepatitis B (3% of Indian population carry this virus, ie nearly 40 million individuals) and alcohol are continuing to increase in India. Nearly overall it is the 4th or 5th most common cause of cancer and the second most common cause of cancer-related death. This is continuing to increase too. We do not have a national policy in India to screen and diagnose these lumps in the liver at an early stage. Most patients present at a late stage when effective treatment is not possible.

Hepatitis B is a vaccine-preventable disease, there are good drugs to treat it and decrease the risk of cirrhosis and HCC in HBV patients, therefore it is important to test for this virus infection. The fatty liver disease can cause chronic liver damage and HCC, regular exercise and consuming a balanced diet can reduce the risk of fatty liver disease.

The usual mode of detection of these growths is when a scan is done for some other reason. Occasionally patients can develop pain in the abdomen or jaundice which leads to an investigation. The treatment of HCC depends on the extent of tumour, the extent of the chronic liver disease (the stage of cirrhosis) and the overall condition of the patient. These patients are best seen, assessed and treated in a team (Box 1) which specializes in the treatment of Liver disease.

The best treatment for HCC is surgery. However, this is suitable only for certain carefully selected patients. This can take the form of liver resection (where a portion of the liver with tumour is removed) or liver transplantation (where the whole liver is removed and a donated liver (full or partial) is replaced into the patient. Indeed surgical has excellent survival rates; more than 75% of patients survive for more than 5 years after resection or transplantation making treatment for these cancers one of the most satisfactory.

Other treatments which can be combined with surgery in selected patients or can be combined with patients not suitable for surgery are different types of Interventional radiological therapy   chemotherapy or radiotherapy delivered through fine catheters introduced into the blood vessels of the liver (TACE: Transarterial chemotherapy, TARE: Transarterial radiotherapy) and or heat energy delivered to the tumour area by means of carefully placed needles/probes (RFA: radiofrequency ablation, MWA: microwave ablation).

HCC is unique cancer as its treatment should be tailored to the patient, the treatments are varied and range from catheter-based non-invasive treatment to major surgery and transplantation. This necessitates that HCC patients are best managed in a multidisciplinary team which is highly skilled in and specializes in the management of liver diseases.

Box 1: A liver tumour multidisciplinary team   Integrated Liver Care team

The team should be one with expertise in the management of benign liver lesions and should include a Hepatologist, a Hepatobiliary & Transplant surgeon, Diagnostic and Interventional radiologists, Medical oncologist and a Pathologist.

Each member of the team must hold specific and relevant training, expertise and experience relevant to the management of benign liver lesions.

The team should be one with the skills required not only to appropriately manage these patients but also to manage the rare but known complications of diagnostic or therapeutic interventions.

The Increasing Problem Of Liver Tumours In India!

Cumin, also known as 'jeera' in the Indian subcontinent, is an ancient seed that has been prized for more than 3000 years. Ayurveda holds this spice in high regards and uses it for treating a host of health disorders including burning of excess fat.

Why are cumin seeds considered to aid in weight loss?

An effective detoxifier: Ayurveda considers the accumulation of toxins to cause weight gain and other medical conditions. While certain toxins are easily removed with water, fatty toxins stick to cells and disrupt cell metabolism resulting in weight gain. To detox such hard-to-remove toxins, cumin seeds are predominantly used in Ayurveda. The seeds remove excess kapha from the intestines and detox liver effectively.
Lowers cholesterol that aids in burning fat effectively: Black cumin is rich in phytosterols which are plant fats resembling cholesterol present in animal fats. When consumed, they limit the amount of cholesterol absorbed by the body. Taking a tablespoon of cumin seeds every day has been medically proven to lower the amount of cholesterol up to 10 percent and bad cholesterol up to 14 percent. This reduction in addition to the cholesterol-lowering measures that you may have adopted would be helpful in burning fat much faster. Taking about 2 grams of cumin seeds combined with light freehand or aerobic exercises can lead to subsequent weight loss in people who lead a sedentary lifestyle.
Lowers blood sugar levels and regulates metabolism: Any person with high blood sugar levels is aware that low insulin levels tend to create a craving for sweets and carbs while high insulin levels can cause extreme thirst and fatigue. Cumin seeds have been proven to lower the blood sugar levels. It lowers blood sugar levels by increasing insulin and glucose sensitivity. In this way, black cumin seeds can aid you to shed off extra pounds by improving the blood glucose levels as well as glucose absorption. In addition to all these benefits, black cumin seeds contain high amounts of oleic acid which is a fatty acid causing acceleration in the way in which the body burns fat.
Other benefits from cumin seeds: Constipation and indigestion are other common reasons for weight gain. An excellent source of fiber, antioxidants, and that has anti-flatulent properties, the cumin seeds can cure constipation, bloating and heaviness, thus, aiding in weight loss. Lack of sleep may also be causing weight gain. Cumin seeds can cure you of insomnia, thus. regulating your sleep pattern and metabolism.
Hence, cumin seeds are a simple and effective ayurvedic remedy for weight loss. Cumin seeds are more potent, and you can take a spoon of roasted or plain cumin seeds every day. Obese or normal, irrespective of your weight, taking cumin seeds regularly have quite a few benefits.

1 Tablespoon Of Cumin - Know How It Can Work Wonders!

Fatty liver is a condition where excess fat is deposited on this organ. Also called as steatosis, this condition happens when more than 5- 10 percent of the weight of the liver is made up of fat.

Fatty liver is a common condition among people. A study from coastal regions of India found ~ 25% of healthy persons had patients had fatty liver on ultrasound.

It can occur at all ages including childhood, highest prevalence is in 40 50 year age group. Prevalence more in patient who are obese and in diabetic patients.

Types of Fatty Liver

1 Alcoholic fatty liver: This condition occurs when there is a heavy consumption of alcohol. Gastroenterologists recommend abstention from alcohol for this condition to subside. If the patient continues to consume alcohol, then liver cirrhosis may develop.

2 Non alcoholic fatty liver (NAFL): One may develop a fatty liver even if one is not an alcoholic. The liver in some cases is unable to process the fat in cells causing them to build-up on the organ.

When more than 10% of the liver is made of fat then this condition is called Non Alcoholic Fatty Liver (NAFL).

Non alcoholic steatohepatitis (NASH): When fatty liver is associated with inflammation in liver patient is said to be having Non alcoholic steatohepatitis. NASH is a more advanced stage of NAFLD, and has a higher risk of progressing to liver cirrhosis or hepatocellular carcinoma (HCC). These condition display symptoms like jaundice, vomiting, nausea, loss of appetite and abdominal pain. Blood test (LFT) shows raised enzymes level. Approx 5-8% of the Indian population has NASH. Consult a doctor if you are experiencing any of these symptoms.

3 Fatty liver during pregnancy: Occurring mainly in the third trimester, the symptoms of this condition are vomiting, nausea, pain the right part of the abdomen and jaundice.

Symptoms

During the early stages (fatty liver) of the disease, patients usually have no symptoms directly related to liver disease. However, people may experience a vague abdominal discomfort. If their liver is inflamed (NASH) then they may display symptoms of poor appetite, weight loss, pain in the abdomen and disorientation.

What causes fatty liver?

The most common cause of fatty liver is alcoholism. When the human liver is unable to metabolize fat fast enough or when there is an excess accumulation of fat on the liver cells then the liver becomes fatty. However, intake of high-fat foods may not result in a fatty liver.

Predisposing factor:

1 Diabetes mellitus

2 Obesity or being overweight

3 Hyperlipidemia or the condition where there are high levels of fat in the blood

4 Genetic reasons

5 Rapid loss of weight

6 Drugs: Aspirin, steroids, tamoxifen, tetracycline etc. cause side effects which also leads to fatty liver

7 Nutritional status (eg, overnutrition, severe malnutrition, total parenteral nutrition [TPN], or starvation diet)

8 Other health problems (eg, Hepatitis C infection, celiac sprue and Wilson disease)

Know More About Fatty Liver!

With the growing market for organic products, there is a widespread confusion on which product to choose. The same dilemma holds good in selecting the type of bread. White bread or Brown Bread? People are not sure which one to eat to stay healthy. A few quick facts about the two types of bread and which one should be consumed to stay healthy, are given below

White Bread
White bread is made out of refined wheat flour that has nothing to offer for the body. During the process of making white bread, the bran and wheat germ is removed from the wheat flour and Potassium Bromate, Benzoyl Peroxide or Chlorine Dioxide gas are used for bleaching to generate the whiteness. Potassium Bromate is highly dangerous if consumed in large doses. Chlorine dioxide is also used as a pesticide and is considered hazardous to the environment. When a large amount of white bread is consumed, the refined carbohydrates generate high levels of insulin thus, resulting in higher chances of weight gain. In spite of being globally popular, white bread is highly unhealthy for your body. It is completely devoid of nutrients and it is as harmful as table sugar for the digestive system.

Brown Bread
The American Academy of Pediatrics has revealed that whole wheat brown bread is rich in nutrients compared to the white bread. One major factor contributing to the above-mentioned fact is the amount of fiber present in whole wheat brown bread. The increased fiber content slows down the digestion process and thereby, reduces the effect on blood sugar and production of insulin. Other nutrients that are present in brown bread include vitamin B6, E, Folic acid, Zing, Copper and Manganese. Brown bread has lesser amount of calcium as compared with brown bread. Many manufacturers claim that they produce brown bread with the same amount of calcium as in white bread. Whole wheat bread contains Phytonutrient also called as plant lignans that have been observed to protect against heart diseases and breast cancer.

Things to consider while buying Brown Bread
The declining demand for white bread has forced a lot of manufacturers to use caramel as a coloring agent to darken white to brown bread. So buyers need to carefully look for the ingredients mentioned in the packing to ensure that they are buying the right product. It is important to check the first ingredient to see whether it is whole wheat or whole meal flour. If the word "enriched" is used, it means that the same flour used for white bread is used. Look for the bread with the minimum ingredients to ensure that you get maximum nutrients and very little additives. Also, make sure the amount of the following ingredients are as given below; sodium should be lesser than 401mg, saturated fat should be 1gm and fiber needs to be 4gm per 2 slices of serving.

To conclude, when it comes to organic and fitness oriented scenarios, brown is always better than white.

White Vs Brown Bread - Which One Should You Eat ?

The liver is a vital organ within the body, which functions as a filter for the blood that comes from the digestive system. One of the conditions that afflict this organ is fatty liver, which occurs due to the accumulation of triglycerides within it. There could be multiple reasons behind this, such as alcoholism, obesity, pregnancy, hepatitis among many others. Homeopathy has some great treatments for fatty liver disease, depending on the cause.

1. Nux vomica: one of the major reason of developing a fatty liver is alcoholism. While drinking moderate amounts of alcohol isn't harmful, the tendency to drink very regularly will lead to fatty liver disease. In such cases you may feel pain in the abdomen, especially a few hours after eating. You may also suffer from constipation with cravings for fatty and spicy food. Nux vomica is thus prescribed in these conditions.

2. Phosphorus: fatty liver has many symptoms, which may manifest differently in different people. Many people complain about indigestion and sour belching. Your liver area may be painful and you may also vomit. You may constantly crave for foods such as ice-creams, juices and cold drinks. In such case, s you may feel weak after passing stool. Phosphorus is a great remedy in such cases.

3. Chelidonium: this is one of the best overall remedies for fatty liver. Some of the symptoms where chelidonium may work are as follows:
A) pain in upper right abdomen
B) enlargement of liver
C) constipation
D) jaundice along with fatty liver
E) feeling excessively weak
F) craving for hot drinks and hot foods

4. Calcarea carb: if you are obese or fairly overweight and suffer from fatty liver, calcarea carbonica can be very effective in treating the symptoms. Some of the symptoms exhibited by the patients where this medication is effective would be a yearning for eggs, profuse sweating and sensitivity to air if it's cold.

5. Lycopodium: this medication is very effective in treating fatty liver disease, especially if you suffer from gastric issues and acidity. You may have symptoms like, bloating of the stomach, burning of the esophagus when belching or burping and pain in the upper right abdomen. You may also exhibit cravings for hot drinks and sweets.

5 Homeopathic Remedies for Fatty Liver

Healthy living is the key to a happy life, there are plenty of ways to lead a healthy life. An effective one is to include kidney beans as a part of your diet because as per Ayurveda, legumes should be part of almost every meal of the day as they are a rich source of protein. Kidney beans as you must be aware is a type of bean that gets its name from its shape, which is like a kidney. These are readily found throughout the year both in dry as well as in canned form.

What health benefits do they offer?
With the help of the kidney beans, you can prepare many delicious dishes which you can enjoy and at the same time enjoy the health benefits as well. Kidney beans offer a lot of health benefits which are being discussed below.

Excellent source of fiber: Kidney beans are an excellent source of both soluble and insoluble fiber. Most importantly, the fiber present in the kidney beans helps in the lowering the level of cholesterol in the blood. According to Ayurveda, kidney beans are extremely helpful in the prevention of many disorders of the digestive system. It helps in keeping the digestive system absolutely clean and free of problems. In addition to this, the fiber content in kidney beans is extremely good for patients suffering from diabetes since it can keep the blood sugar under control.
Good source of energy: Kidney beans help in the replenishment of iron in the body which is the integral component of hemoglobin in the blood. The iron is the key enzyme for the production of energy and metabolism in the body. Thus, kidney beans are an excellent source of energy. Moreover, kidney beans also promote the slow burning of the complex carbohydrates thereby providing energy to the body while stabilizing the level of sugar in the blood. These beans are also a good source of the trace mineral manganese which acts as the vital cofactor in energy production in the body.
Good for heart and memory: Kidney beans contain significant amount magnesium and folate which helps in the lowering of homocysteine which reduces the risk of heart attack, peripheral vascular disease or stroke. The rich supply of magnesium in the kidney beans provide great benefits to our cardiovascular system. These beans are also rich in vitamin B1 or Thiamine which are extremely good for the brain cells and cognitive function.
Since kidney beans provide numerous such benefits, you can make it a part of your diet. In case you have a concern or query you can always consult an expert & get answers to your questions!

Kidney Beans (Rajmah) - Are They Good For Your Health?

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