NMU – 174 Supplements Shown to Help Reverse Non-alcoholic Fatty Liver Disease
Lifestyle Medicine Update No 174 (September 22, 2020)
with Dr. James Meschino
Topic: Supplements Shown to Help Reverse Non-alcoholic Fatty Liver Disease
Sources: Diseases (2018); Antioxidants (2018); Diseases (2018)
In the previous Lifestyle Medicine Update,I explained that fatty liver problems not caused by excess alcohol consumption are primarily a result of eating too much refined sugar (especially sugary soft drinks or sodas), and/or the overconsumption of bad fats, such as saturated fat and trans-fats found in beef, pork, high-fat dairy products, creamy salad dressings, mayonnaise, cream sauces, deep-fried and breaded foods, to name some common offenders. Fatty liver problems are becoming more prevalent even in non-overweight and non-obese individuals, primarily due to these types of frequent food choices along with a sedentary lifestyle. Non-alcohol-induced fatty liver problems, usually diagnosed by the presence of high triglycerides and elevated liver enzymes on a standard blood test panel after a 12-hour fast, often lead to liver fibrosis and cirrhosis, which is a serious, life-threatening. Fatty liver problems also greatly increase the risk of developing primary liver cancer – hepatocellular carcinoma. So, identifying this condition in its early stage is important, which can be done by routine blood tests, as in the early stages it can be reversed through dietary and lifestyle strategies, as I explained in the previous update. There are no drugs that effectively reverse this condition. The treatment is lifestyle modification.
In addition to dietary changes and getting more endurance activity, several nutritional supplements have also shown impressive evidence in reversing fatty liver problems in human studies, which I will review for you today. The first supplement of importance is the herb Milk thistle. At least eight randomized human studies have shown that Milk thistle supplementation, standardized to high silymarin content (which is the active ingredient Milk thistle) has reversed key aspects of non-alcoholic fatty liver problems. The typical dosage is usually a minimum of 210 mg of silymarin (the active ingredient) per day. The second supplement is green tea extract (high in EGCG content – epigallocatechin-3-gallate). Various studies have shown that 500 mg of green tea extract per day has reversed key aspects of non-alcoholic fatty liver problems as well. The third supplement is curcumin (from the spice turmeric). Studies using 1,000 mg of curcumin per day have also shown that it reverses key aspects of non-alcoholic fatty liver problems. The fourth supplement is fish oil. At a daily dosage of 1,000 mg per day has also been shown to improve key aspects of non-alcoholic fatty liver problems. The fifth supplement is Coenzyme Q10. Animal studies have shown that it helps to reverse non-alcoholic fatty liver problems and one blinded human study showed that it reversed key aspects of fatty liver disease using a dosage of 100 mg per day. The sixth supplement is vitamin E, which has also shown good results in reversing this condition. However, the current guidelines suggest that it not be used to treat non-alcoholic fatty liver problems in patients that also have diabetes. The typical dosage is 800 IU per day. The combined effects of these supplements in reversing fatty liver problems is due to their proven ability to inhibit free radical damage within liver cells, block the synthesis of fat and cholesterol within liver cells, decrease the synthesis inflammatory agents (prostaglandins and cytokines) withing liver cells and inhibit other steps leading to fibrosis, cirrhosis, and primary liver cancer.
A modest approach to the use of these supplements in the complementary management of non-alcoholic fatty liver disease would be the use of k thistle, along with Green tea extract, Fish Oil, and curcumin. In cases where diabetes is not present the use of 800 IU of vitamin E can also be considered. However, every case is different, so you must check with your physician before using any of these supplements to help treat non-alcoholic fatty liver problems. Of course, the first step is to use dietary change and endurance activity to reverse this condition. The use of supplements may further enhance the benefits of these lifestyle changes, but supplements should not be used in place of dietary and physical activity strategies shown to prevent and reverse fatty liver problems.
I have included the references for this information in the text below.
1. Perumpail BJ et al. Potential therapeutic benefits of herbs and supplements in patients with NAFLD (non-alcoholic fatty liver degeneration). Diseases 2018; 6(3):80 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6165515/
2. El Hadi H et al. Vitamin E as a treatment for non-alcoholic fatty liver disease: Reality or Myth? Antioxidants (Basel) 2018; 7(1):12 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5789322/
3. Perrumpail BJ et al. The role of vitamin E in the treatment of NAFLD. Diseases 2018; 6(4):86 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6313719/
Eat Smart, Live Well, Look Great,
Dr. James Meschino