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11 Best Supplements for Fatty Liver (and 2 Better Solutions)

Written by Dr. Michael Ruscio, DC on January 21, 2025

Written by Dr. Michael Ruscio, DC on January 21, 2025 — Reviewed by Kellie Blake

• What is Fatty Liver?|
• What Causes NAFLD?|
• Supplements for Fatty Liver Disease|
• Adopting a Healthy Lifestyle|

The liver is a complex organ, and liver dysfunction can be complex as well. Understanding the root causes of liver dysfunction beyond the effects of alcohol can equip you with the information you need to make lifestyle decisions that positively impact your liver. Specifically, how to prevent nonalcoholic fatty liver disease, or NAFLD. 

Since the COVID-19 pandemic, we’ve seen an upward tick in the occurrence of NAFLD. If your healthcare provider has diagnosed you with strained liver health or NAFLD, lifestyle changes and supplements for fatty liver can help improve your health and wellness. 

Let’s take a look at what nonalcoholic fatty liver disease is, which supplements can support your liver, and what lifestyle modifications are necessary to get yourself on the right track.

What Is Fatty Liver Disease?

As the name suggests, fatty liver disease occurs when too much fat accumulates on the liver. A fatty liver is a worrisome health issue because, over time, it can lead to liver inflammation, liver cell damage, and even permanent liver scarring (cirrhosis).

Fatty liver disease is also associated with a high risk of developing Type 2 diabetes, obesity, polycystic ovarian syndrome, and a number of other diseases 1 2. However, you can take steps to treat it and reduce these risks.

The two main types of fatty liver disease are:

• Alcoholic fatty liver disease—also called alcoholic steatohepatitis—is caused by drinking too much alcohol, usually over a long period of time (several years) 2.
• Nonalcoholic Fatty Liver Disease (NAFLD) is a chronic liver disease characterized by fat accumulation in the liver (aka hepatic steatosis) when no other causes of liver fat—like alcohol, medications, or genetic disorders—are present 1.

NAFLD is the focus of this article. It used to be called metabolic dysfunction-associated liver disease because it’s closely linked to things like metabolic syndrome and Type 2 diabetes. 

The most common form of liver disease in the world 3, NAFLD occurs in around 20–30% of people in western countries and 80–90% of obese adults 1. 

Understanding what causes NAFLD and what you can do about it if you’ve been diagnosed are vital to helping you improve your liver health.

What Causes Nonalcoholic Fatty Liver Disease?

NAFLD has become more common as highly processed diets, sedentary lifestyles, and obesity have increased, but this condition is not reserved for people carrying too much weight. Much like Type 2 diabetes, slimmer people can have a fatty liver, too.

The primary driver of NAFLD is overeating. Other contributors include 1 4: 

• Obesity
• Insulin resistance
• Sedentary lifestyle
• Genetics
• Too many carbohydrates in the diet 
• Other conditions such as Wilson’s disease or celiac disease
• Exposure to inorganic arsenic 
• Too much fructose in the diet

If your lipid profile (a blood test measuring fat in the blood) shows that you have signs of NAFLD, consider it a warning. It’s kind of like when a doctor tells someone they are prediabetic.

It’s much easier to get liver health under control before reaching full-blown chronic liver disease, much like it’s easier to reverse prediabetes than Type 2 diabetes. 

If untreated, NAFLD can lead to a more serious and advanced liver condition called nonalcoholic steatohepatitis, or NASH. NASH is far more inflammatory and can cause permanent liver damage 2.

NASH can progress to 2:

• Liver fibrosis (light scarring)
• Cirrhosis (chronic liver damage, including severe scarring and hardening of the liver)
• Hepatocellular carcinoma (liver cancer) 

How COVID-19 Impacts NAFLD

We’ve learned that the coronavirus can influence the progression of NAFLD and directly harm liver cells 5. Both diseases share inflammatory pathways, which means that chronic conditions and post-COVID effects could be worse if you have a compromised liver.

On the lifestyle front, it stands to reason that the increased isolation that resulted from the pandemic may have led to an increase in unhealthy habits, such as eating more processed foods or moving your body less. Post-pandemic, it’s important to take stock of anything that might have changed for the worse regarding your eating habits, exercise habits, and the way you engage with the world.

How Do You Know if You Have NAFLD?

NAFLD affects around 25% of Americans 6. While most people with NAFLD don’t feel anything strange, others may notice a few early signs and symptoms, such as 1: 

• Fatigue
• Sharp or dull aching in the upper right abdomen
• Unusual thirst
• Abdominal bloating
• Sleep disturbances

Unfortunately, these symptoms can be easy to overlook because they overlap with so many other conditions. It’s always a good idea to have regular checkups with a doctor, who can order blood tests to keep an eye on your organs.

As liver disease progresses, more severe symptoms will arise. For example, signs and symptoms of NASH-associated cirrhosis, end-stage liver disease, or liver cancer (hepatocellular carcinoma) include 1:

• Nausea
• Vomiting
• Yellowing of the skin or eyes (jaundice)
• Itching
• Fluid buildup in the abdomen that causes swelling (ascites)
• Poor memory
• Easy bleeding
• Loss of appetite
• Liver enlargement
• Red or purple marks on the skin that look like a spider (spider angiomas)
• Redness on the palms
• Swollen veins in the abdomen (caput medusae)
• Development of breasts in males
• Thickened skin in the palm of the hand that pulls one or more fingers toward the palm (Dupuytren’s contracture)
• Tiny spots of bleeding under the skin (petechiae)

You’ll only really know if you have a fatty liver if a doctor takes a sample of your liver, but many choose to avoid that invasive procedure and rely on other measurements instead. For example, an ultrasound or CT scan can give a sense of whether your liver is struggling, especially if your liver enzyme levels are abnormal 1. 

A liver function blood test can show if biomarkers like the liver enzymes ALT or AST are abnormal. If they are and if you have other risk factors like obesity, Type 2 diabetes, and a poor diet—but hepatitis has been ruled out—NAFLD is a likely diagnosis.

Can You Reverse Nonalcoholic Fatty Liver Disease?

The good news is that early- to mid-stage NAFLD is reversible if you’re ready and able to make the necessary lifestyle changes. For example, if you’re carrying more weight than is healthy, a good goal is to lose 7–10% of your total body weight, but even losing 3–5% can improve your liver health 1.

Being sedentary also increases your chance of developing a fatty liver, so moving your body is critical. 

Steps to prevent fatty liver disease progression and permanent liver injury include:

1. Eat a healthy diet and exercise regularly.
2. Support your liver with supplements for fatty liver disease.

There is currently no approved drug therapy for NAFLD 4 7, but the following medications could help boost progress in some cases 1 8:

• Metformin
• Statins
• Orlistat
• Sibutramine
• Pioglitazone

11 Supplements for Fatty Liver Disease

Although a healthy diet and regular exercise are your best bet for treating NAFLD, these 11 dietary supplements can support the liver and help treat nonalcoholic fatty liver disease. 

High-quality research from meta-analyses (studies that investigate many studies) and randomized controlled trials (the top tier of human clinical trials) shows that probiotics, herbs, vitamins, and other healthy compounds can benefit people with NAFLD.

1. Probiotics

Every time we eat, the absorbed nutrients (and toxins like alcohol and certain chemicals in medications) get sent through the portal vein from the gut to the liver for further processing. This relationship is called the gut-liver axis. The liver then stores, filters, and if necessary, detoxifies the contents and sends clean nutrients to the rest of the body. 

Meanwhile, our gut bacteria make substances called metabolites that are good for the liver 9. These reach the liver through the portal vein, too. 

An imbalanced gut microbiome can contribute to liver diseases, including NAFLD. This is more than just theoretical. For example: 

• Conditions such as leaky gut, SIBO, and dysbiosis may contribute to NAFLD 10.
• Likewise, patients with NAFLD have unhealthy alterations in their gut microbiota 4. 

Taking measures to support the gut and its living microorganisms may help prevent or reverse liver disease 11. That’s where probiotics come in.

Research shows that probiotics (supplements containing healthy bacteria and fungi) can help improve various facets of fatty liver disease and liver function. This is likely because they improve the health of the gut microbiome.

Here are some studies to prove it:

• Probiotics can improve blood sugar, insulin levels, insulin sensitivity, cholesterol levels, liver stiffness, and body mass index in people with NAFLD 12.
• Probiotic supplementation can reduce liver enzyme levels that are typically elevated in the liver function tests of people with NAFLD 13. 
• When it comes to the type of probiotics, taking up to three strains for several months may be the best probiotic approach for reducing liver enzymes, cholesterol, and BMI in people with NAFLD 14. 

Echoing that last bullet, at the clinic we’ve found that combining three powerful probiotic categories is especially effective for our clients. Our triple probiotic therapy approach includes:

• A blend of Lactobacillus and Bifidobacterium species
• The probiotic yeast Saccharomyces boulardii
• Soil-based Bacillus species of probiotics

We coach our clients to take probiotics every day for 2–3 months and assess their progress.

2. Milk Thistle (active ingredient silymarin)

Milk thistle (Silybum marianum) is a plant people have used to treat various ailments for centuries. It has an active ingredient called silymarin, which can significantly reduce liver enzyme levels in patients with NAFLD 15 16 

Studies found beneficial effects when NAFLD patients took 94–2,100 mg of silymarin for 8 weeks to 4 years 15. Ask a healthcare provider to help you determine the right dose.

3. Curcumin

Curcumin is a polyphenol extracted from the spice turmeric (Curcuma longa). It has antioxidant and anti-inflammatory properties that can significantly reduce liver enzymes and improve metabolic health in NAFLD patients 15 17. 

In studies, people had benefits from taking 80–3,000 mg of curcumin for 8–12 weeks 15. Consult a healthcare provider to figure out the right dose for you.

4. Vitamin E

Vitamin E supplements can reduce liver enzymes, liver scarring, inflammation, fat deposits inside the liver, cholesterol, and fasting blood sugar in people with NAFLD 18. 

However, it’s important to check with a doctor if you’re considering high-dose vitamin E supplementation, which is anything above 66 mg/day. High doses of vitamin E can increase the risk of hemorrhagic stroke 19.

It’s best to get vitamin E from foods such as vegetable oils, nuts, seeds, spinach, and broccoli.

5. Omega-3 Fatty Acids

Omega-3 fatty acids are found in foods like fish and flaxseeds, and in fish oil supplements. Omega-3 supplements can reduce liver fat, triglycerides, total cholesterol, HDL cholesterol, and BMI in patients with NAFLD 20. 

Studies found benefits when people took 250–5,000 mg of supplemental omega-3s per day for 3–18 months, but check with a healthcare provider to determine the right dose for you.

6. Cinnamon  

Cinnamon is another herbal supplement that can reduce elevated liver enzymes in people with NAFLD 21. Cinnamon supplementation may also improve insulin resistance, cholesterol, triglycerides, and inflammation in NAFLD patients 22. 

Doses in studies were 1,000–1,500 mg of supplemental cinnamon per day for 4–24 weeks, but consult your doctor for help choosing the right dose.

7. Carnitine  

Carnitine is an amino acid made in the body to help transform food into energy. We can also get carnitine from red meat, poultry, fish, and dairy. Carnitine supplements can reduce insulin resistance, liver enzymes, and triglycerides in NAFLD patients 23. 

Studies found benefits from 300–2,000 mg of carnitine per day for 3–6 months. Please consult a healthcare provider to find an appropriate dose for you.

8. Berberine

Berberine is a plant compound with anti-inflammatory and anticancer properties. Berberine supplements can improve cholesterol, liver enzyme levels, and blood sugar in NAFLD patients 24. 

Studies found benefits from 300–500 mg of berberine for 12–16 weeks, but check with your healthcare provider for help choosing the right dose.

9. Green Tea

Green tea is very high in powerful antioxidants called polyphenols. Research shows that green tea can reduce liver enzymes in NAFLD patients 25. 

Beneficial doses of green tea extract in studies ranged from 300–1,500 mg/day, which is roughly 2–5 cups of green tea per day.

10. Vitamin D  

Vitamin D supplements may help reduce inflammation and cholesterol levels in NAFLD patients, but it doesn’t appear to affect their liver enzymes 25. 

It’s ideal to get most of our vitamin D from safely exposing our skin to the sun, but supplements can be helpful when it’s not possible to get enough sunshine. 

Studies found benefits from 2,000–7,000 IUs of vitamin D per day taken for 3 weeks to about 11 months. However, it’s important to get your levels checked by a healthcare provider before diving into high doses of vitamin D supplements.

11. Coenzyme Q10  

Coenzyme Q10 is an antioxidant made in the body to help cells grow and stay healthy. Taking 100 mg of CoQ10 every day for 3 months may reduce liver enzymes, inflammation, damage from free radicals, and disease severity in NAFLD patients 26. Check with your doctor to choose the best dose for you.

Before You Start Supplements for Fatty Liver

There’s no obvious reason you can’t take more than one of these supplements at the same time, but they haven’t been studied in combination. I usually recommend that my clients try one at a time to evaluate which are most effective. This approach is not only more scientific, it’s also the more economical way to go.

Although they can be helpful, supplements for fatty liver disease won’t make a lot of difference to your liver health or liver fat buildup on their own. But they can be very helpful as an addition to lifestyle modifications that will reduce excess weight, improve blood flow and nutrition, and optimize gut health. 

The Better Fix: Adopt a Healthier Lifestyle 

Whether you’re working with a conventional doctor or a more holistic healthcare provider, lifestyle changes are the cornerstone treatment for NAFLD 1. The two lifestyle changes that help the most are eating a healthy, whole-foods diet and moving your body on a regular basis.

Eating Better for Your Liver and Losing Weight

If you have NAFLD, dietary improvements that reduce ultra-processed foods and sugars and increase nutrients will have far-reaching effects. If you carry extra weight, then losing weight should also be part of your liver improvement strategy. 

Reducing portion sizes may be part of that, but just starting with changes in food quality should help kickstart weight loss and liver fat reduction. For example, cutting out ultra-processed foods and replacing them with whole foods will naturally reduce calorie intake and help remove fat from the liver 27. 

Other dietary changes that will help support liver health include 28:

• Increase your intake of omega-3 fatty acids by eating oily fish, such as salmon and mackerel, and flaxseeds, chia seeds, and walnuts. 
• Switch to carbs with a lower glycemic index, such as veggies, fruits, and whole grains. These help stabilize blood glucose more than high-glycemic index foods like white bread, white rice, corn, and potatoes.
• Reduce simple sugars, especially high-fructose corn syrup, which is found in sweets, sauces, dressings, cookies, flavored yogurt, sodas, sports drinks, sweetened tea, and juices. Sucrose (table sugar), is another big source of fructose.
• Minimize or eliminate alcohol, which damages the liver.
• Drink green tea if you like the taste—it can reduce liver enzymes 25. 
• Be careful with any food sensitivities you may have. Sometimes even people with healthy diets can run into problems with their gut health if they keep eating foods they don’t tolerate well. For example, an intolerance to gluten, dairy, fermentable sugars called FODMAPs, or histamines may throw off gut microbes and give rise to leaky gut, which can contribute to NAFLD 10. An elimination diet can help you identify your food sensitivities.

You can achieve the above changes with a healthy, balanced diet framework, such as the Mediterranean diet or the Paleo diet: 

• The popular and well-studied Mediterranean diet may actually lessen liver stiffness even though it doesn’t seem to affect liver enzymes in people with NAFLD 29. 
• There isn’t much research on how a Paleo diet affects NAFLD, but one randomized controlled trial showed it was great for weight loss and metabolic health, both of which are important for many people with NAFLD (30).

In the clinic, we find that a Paleo diet is a great option for improving gut health and losing weight, which can help reverse a fatty liver. The key principles of a Paleo diet include cutting processed foods, dairy, legumes, and grains while emphasizing fresh, whole foods such as vegetables, fruit, meats, poultry, fish, eggs, nuts, seeds, and healthy fats.

Intermittent fasting has also been linked with better liver health 31 and can work well when combined with a Paleo diet. 

Perhaps the easiest way to experiment with intermittent fasting is to take a 16-hour break from food overnight—for example, finishing dinner at 6 pm and then not having breakfast until 10 am. This isn’t too difficult for many, but talk to your healthcare provider before you start a program like this.

Sometimes going without food for several hours can cause side effects, such as low blood sugar, dizziness, and irritability. Intermittent fasting isn’t recommended for pregnant or breastfeeding people, very old or very young people, or anyone with a compromised immune system 32.

Moving Your Body More

Along with a healthy diet, exercise can help improve the liver of patients with NAFLD. In the absence of a healthy diet, exercise can’t have much of a positive effect on liver fat, liver scarring, or disease activity in NAFLD patients 33. But when paired with a healthy diet, a weekly combo of aerobic exercise and strength training is a powerhouse for improving liver health (and overall health) in people with nonalcoholic fatty liver disease 34. 

If you haven’t done much physical activity lately, it’s important to start small and begin building a habit. Even moderate daily movement, like a 10-minute walk, can have a positive impact on liver health.

A Holistic Approach to Addressing Fatty Liver

Overall, certain supplements can give the liver extra support as you incorporate dietary changes and exercise to tackle nonalcoholic fatty liver disease. 

Probiotic supplements can have a powerful influence on liver health via the gut-liver axis and are typically the first supplement I recommend for my clients. Milk thistle and other herbs, vitamins, and healthy compounds can reduce liver enzymes or improve metabolic health in NAFLD patients.

You can dive deeper into diet and gut health—and how these affect many areas of your well-being, including liver health—in my book, Healthy Gut, Healthy You. Or, if you want to work through your health issues on an individual basis with a functional medicine and gut health specialist, you can get in touch with us at the Ruscio Institute for Functional Medicine.