2 • Sep–Dec 2023 • Vol LXII • No. 5 E D I T O R I A L Dear Doctor, Type 2 diabetes mellitus (T2DM) is the most common endocrinal metabolic disorder that causes various liver abnormalities. The cover page article in this issue of Capsule focuses on the association between NAFLD and T2DM. An association between T2DM and male sexual health is discussed in The Latest in Medicine section. The Research at Himalaya section features excerpts of clinical studies that prove the efficacy of Diabecon in the management of T2DM. In addition, the section also features excerpts of clinical studies on the efficacy of Pilex in the management of hemorrhoids. The In Focus section covers an excerpt of a clinical study that evaluated the safety and efficacy of Florasante Capsule in the management of diarrhea-dominant irritable bowel syndrome. Furthermore, interesting facts on and tips to manage PCOS, a few Pranayama exercises to boost mental health, and many more informative articles are covered in this issue. Happy reading! — Editor Liv.52® DS (SYRUP, TABLET) Liv.52 is a hepatospecific formulation, from Himalaya Wellness Company, designed for the treatment and management of liver disorders. Liv.52 restores the metabolic efficiency of the liver by protecting the hepatic parenchyma and promoting hepatocellular regeneration. In nonalcoholic steatohepatitis (NASH) and liver diseases caused by diabetes, Liv.52 decreases the uptake of free fatty acids by hepatocytes, leading to a reduction of fat deposition in the hepatocytes; decreases DNA fragmentation through antioxidant activity, leading to lesser cell death; downregulates inflammatory mediators like tumor necrosis factor-α and interleukin-8 and upregulates cytoprotective peroxisome proliferator–activated receptor gamma, leading to a decrease in hepatic inflammation; increases urea and albumin secretion, suggesting cell proliferation; decreases alanine transaminase and aspartate transaminase levels, indicating normalization of biochemical parameters; and produces newer proteins responsible for the transportation of glucose into the cells, thus causing increased glucose uptake and reduction in insulin resistance. These actions synergistically help in preventing NASH and liver diseases caused by diabetes. result in the development of T2DM.7 T2DM contributes to the development of NAFLD through IR, oxidative stress, endoplasmic reticulum stress, and production of inflammatory cytokines (eg, TNF-α, IL-6).2,8 IR exacerbates NAFLD through increased accumulation of free fatty acids (FFAs) in the peripheral adipose tissue of the liver. The increased influx of FFAs results in subacute hepatic inflammation. This proinflammatory state leads to fatty infiltration in the hepatocytes through lipid peroxidation and mitochondrial membrane damage.2,8 The damage to the mitochondrial membrane worsens respiratory chain dysfunction and decreases synthesis of H+ ATPase enzyme. All of these lead to hepatocyte dysfunction in the process of FFA oxidation, resulting in excessive triglyceride deposition in the liver (fatty liver).1 The progression of NAFLD to NASH can be due to the glucotoxicity caused by glucose-induced IR, increased DNL, and hepatocellular dysfunction. Increased levels of intracellular and extracellular advanced glycation end products, which are formed by the nonenzymatic reaction between reducing sugars and proteins or lipids, lead to initiation and progression of NAFLD to NASH. Further, NASH in turn leads to cirrhosis and hepatocellular carcinoma through multiple mechanisms, including direct hepatocyte lipotoxicity and hepatocellular oxidative stress.1,2 Incorporating lifestyle changes such as following a balanced diet and regular physical activity can play a key role in the management of both the disease conditions.8 References 1. Wan Y, et al. J Cell Mol Med. 2016; 20(2):195–203. 2. Acierno C, et al. Explor Med. 2020; 1:287–306. 3. Gastaldelli A, et al. JHEP Rep. 2019; 1(4):312–328. 4. Suryawanshi NV, et al. Int J Health Clin Res. 2023;6(1):19–22. 5. Mare R, Sporea I. J Clin Med. 2022; 11(17):5223. 6. Xia M-F, et al. Front Pharmacol. 2019; 10:877. 7. Xiong X, Li X. Life Metabol. 2023; XX(XX):1–3. 8. Tomah S, et al. Clin Diabetes Endocrinol. 2020;6:9. FEEDBACK Please scan the QR code or visit the link below to submit your feedback and suggestions on Capsule. https://tinyurl.com/CapsuleFeedbackForm
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