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#Ayurvedic treatment of fatty #liver – real world evidence: A #Thread
Overweight woman, early 40’s. Routine liver tests, mild enzyme abnormalities. Advised #ultrasound liver, showed grade 2 #fattyliver. GP advised vitaminE and #weightloss, review in 3mo
Patient and husband doubtful. Hears fatty liver disease can lead to #cirrhosis. Seeks advice from #Ayurvedic practitioner nearby #home since #Herbal #DRUGS = safe. Assures complete #cure through #Ayurveda. Prescribes multiple #medicines, advises almost all foods restriction.
Lets look at medicines. #tablet APFIL. Packet mentions ‘for liver #diseases’. Which liver disease? There is #alcohol related, #hepatitis B/C, #NAFLD, primary biliary #cholangitis and more causes. Nine #herbs extract combo - clinical #evidence on safety and benefit ❌
Patient sold #Physician sample. One herb, Picrorhiza kurroea mentioned in #Wikipedia as harvested to near extinction = most herbs 'actually' not obtainable = #mislabeling. None of the herbs shown to have clinical benefit in #liverdisease. Do check on #Google. Its that simple.
Punarnnavadi tablets, contains 10 herbs, used in #Inflammation, swelling. Vague, it can be used for #allergic cough to any #Cancer. So maybe in liver disease too, since every organ system this drug is "confirmed" to work on, is between the #mouth and anus. Not #Evidencebased
Next Kamiladi Gulika – tablets. Black, pellet shaped, VERY #SINISTER LOOKING. It was the worst smelling drug ever. A Google search showed ZERO results on this #Herbal drug. No idea what it is and what it does. Package has no details on contents, #safety or benefits. Nothing
Next, a series of powders. I checked on how they matched up for fatty liver treatment (searched on #scientific resources). Found #advertised uses for flatulence, anorexia, menstrual cramps, epilepsy, urinary problems and scrotal swelling (!!!!) not fatty liver. #MedTwitter
Anyway, patient on all Ayurvedic drugs as advised. Liver tests between, elevations in enzymes along with worsening of certain parameters. But assured that everything takes time to heal. ‘THE AYURVEDIC #Doctor SPENDS #Time WITH THE PATIENT, LISTENING’. Very #important.
6 to 7 months into the #Ayurveda, itching starts, the skin darkens. There is loss of appetite, loss of weight, general fatigue. 8th month, swelling of the legs and abdomen. The liver tests show near normal liver enzymes, ALP high, but #jaundice. #MedEd #MedTwitter
She comes to our unit, referred by a Physician. #examinations reveal fluid in abdomen. Water pills take care of that. Severe muscle wasting and #nutritional status pathetic. After a long discussion, further nutritional optimization, a #CT scan and liver #biopsy were done.
#Liverbiopsy findings were out of this #world. There is multiacinar #necrosis – meaning areas in the liver where there is complete loss of liver #cells. Few liver cells remain as ‘islands’ here and there (red marked). But no fatty liver disease (steatosis). #GITwitter
CT Scan = very striking. Large area of the liver enlarged extensively, looked like a big #tumor. But biopsy from large ‘tumor’ looking area = bunch of regenerating liver cells! Liver took care of itself during the ongoing herbal assault, preventing clinical liver failure.
Final #diagnosis – Fatty liver converted to severe chronic #herbaldrug induced liver injury impending #liverfailure. Look on the bright side. No fattyliver! Because nothing much left of the liver to become fatty, thereby proving real world evidence of effective #Ayurvedic Rx
Spend time with your #patients, teach them good, real science in simple terms. “#Treat often, cure sometimes and #comfort always.”
#ayush #alternative #pseudoscience #EBM #radiology #pathology
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Keep Current with Abby Philips M.D., D.M. (Hepatology)

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