NMU 253 – Vitamin B12 and Folic Acid Supplements Shown to Reverse Fatty Liver Problems (NASH)

Nutrition/Natural Medicine Update No 253 (August 11, 2022)

with Dr. James Meschino

Topic: Vitamin B12 and Folic Acid Supplements Shown to Reverse Fatty Liver Problems (NASH)

Source: Journal of Hepatology (July 2022)

Twenty-five percent of the world’s population is currently afflicted with fatty liver disease that is not caused by alcohol consumption. Excess alcohol consumption can certainly cause fatty liver problems and life-threatening cirrhosis, but people who don’t drink alcohol or drink very little alcohol can still develop a serious fatty liver problem known as Non-alcoholic steatohepatitis (NASH), which has become a global problem in recent years. There is no doubt that this problem is tied to many global lifestyle trends such as the obesity epidemic, high consumption of fatty foods, and high consumption of sugary foods, accompanied by reduced physical activity and exercise. NASH is serious business for those who have it because it can progress to liver dysfunction, cirrhosis (a life-threatening condition), and it increases the risk of primary liver cancer – hepatocellular carcinoma, which is also on the increase worldwide and tied to the increased incidence of NASH. Eating less high fat animal fat foods and other fatty and fried foods is a good start to help to prevent and reverse NASH in its early stages. The same applies to watching your sugar intake and getting more endurance/aerobic exercise. Some supplements have also been shown to be helpful in reversing NASH, such as vitamin E (400-8000 IU per day) and other supplements that help to remove fat from the liver such as lecithin (high in choline) and trimethylglycine, which is also known as betaine).

But in July 2022, a study published in the Journal of Hepatology provided another piece of the puzzle that appears to be important in preventing and treating early-stage NASH. These researchers discovered that people with a progressive form of NASH often have high blood levels of homocysteine. In turn, the homocysteine damages certain enzymes and structures within liver cells, which facilitates the progression of NASH to more serious liver dysfunction and cirrhosis. But researchers found that Vitamin B12 and Folic acid (another B-vitamin) supplements lowered homocysteine levels and greatly improved liver function in mice who had homocysteine-induced NASH. The researchers used Vitamin B12 and Folic acid because in normal human metabolism these two vitamins recycle homocysteine back to methionine in our cells, including liver cells, which results in lower homocysteine levels, and in the case of these mice, it restored normal liver cell function. The researchers conclude that Vitamin B12 and Folic acid supplantation may be considered first-line therapy in the treatment of NASH, especially in patients with high homocysteine blood levels.

My advice is that everyone should have their liver enzymes checked annually by their doctor, as part of the standard blood profile, to see if they have NASH. There are no symptoms in the early stages, but elevated liver enzymes show up on blood tests. If your liver enzymes are high and indicate that NASH is present, then follow-up blood work should include a blood homocysteine test. If homocysteine is also elevated, then part of the treatment should include Vitamin B12 and Folic acid supplementation to lower homocysteine levels into the normal range. Elevated homocysteine is also a risk factor for heart attack, stroke, and Alzheimer’s disease, and it can make some mental health conditions worse, so it is worth knowing your homocysteine blood level for a number of reasons. The good news is that Vitamin B12 and Folic acid can often return homocysteine to the normal range if it is found to be high initially. Studies indicate that between 5 -30% of the population have homocysteine levels above 14 umol/L, which is considered high or elevated.  An excellent review of elevated homocysteine and its ties to cardiovascular disease and all-cause mortality appeared in 2015, which I have included in the references below. Typically, the dosages used to lower homocysteine include Vitamin B12 1,000 – 5,000 mcg per day, Folic acid – 1,000 mcg per day, as well as vitamin B6 – 50-100 mg per day.

I have included the references for this information in the text below.

References:

1. Tripathi M et al. Vitamin B12 and folate decrease inflammation and fibrosis in NASH by preventing syntaxin 17 homocyteinylation. Journal of Hepatology. July 8, 2022 https://www.journal-of-hepatology.eu/article/S0168-8278(22)02932-4/fulltext

2. Science Daily: B vitamins can potentially be used to treat advanced non-alcoholic fatty liver disease. August 5, 2022. https://www.journal-of-hepatology.eu/article/S0168-8278(22)02932-4/fulltext

3. Peng H et al. Elevated homocysteine levels and risk of cardiovascular and all-cause-mortality: a meta-analysis of prospective studies. J Zhejiang Univ Sci B. 2015; 16(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4288948/

Eat Smart, Live Well, Look Great,
Dr. Meschino