Supplements for Fatty Liver Disease: Which Ones Work? - Dr. Michael Ruscio, DC

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Supplements for Fatty Liver Disease: Which Ones Work?

Effective Ways to Fight a Fatty Liver Naturally

Key Takeaways:

  • Some of the best supplements to help reduce fat buildup in the liver are probiotics and certain herbal products like milk thistle and curcumin.
  • Exercise and a healthy diet are the more fundamental ways to reduce liver fat.
  • Action is important because a fatty liver is associated with diabetes and inflammation, and can lead to more serious liver problems if left unchecked.
  • If you improve your gut health, the likelihood is that your liver health will also improve as the two are closely related.

When good quality evidence linking probiotics with improvements in fatty liver disease crossed my path a few years ago I had to share it with my audience. Since then fatty liver has unfortunately become more common, with the pandemic creating a surge in both alcoholic and nonalcoholic fatty liver disease according to recent scientific news reports

In this article, we’ll bring the topic of fatty liver up to date and also look at dietary supplements for fatty liver more generally (i.e. not just probiotics). 



Potentially helpful supplements are:

  • Multi-strain probiotics
  • Silymarin
  • Curcumin
  • Cinnamon
  • Carnitine
  • Choline
  • Coenzyme Q10
  • Vitamin C
  • Vitamin D

Importantly, we’ll also cover the lifestyle factors that underlie the condition, and what you can do to turn things around.

First, let’s get up to speed with the basics.

What Actually Is a Fatty Liver?

Supplements for Fatty Liver Disease: Which Ones Work? - Non Alcoholic%20Fatty%20Liver%20Disease L

As the name suggests, a fatty liver is when excess fat (lipid) becomes deposited in the liver. This is a potentially worrying health issue because over time the excess fat can lead to inflammation, liver cell damage, and even permanent liver scarring.

Fatty liver is also associated with a doubling in risk of developing type 2 diabetes, irrespective of obesity and other risk factors [1]. However, you can take steps to treat it and reduce all these risks.

The two main types of fatty liver are:

  • Alcoholic fatty liver disease, also called alcoholic steatohepatitis, caused by consuming alcohol in excessive amounts, usually over several years.
  • Nonalcoholic fatty liver disease (NAFLD), which is not related to excess alcohol intake. NAFLD is also called hepatic steatosis [2, 3]. 

Here we are going to focus on the second of these two. NALFD has become more common as highly processed diets, sedentary lifestyles, and obesity have increased, but slimmer people can have fatty liver too

NAFLD is the term given to a fatty liver before it develops into full-blown or chronic liver disease. NASH, or non-alcoholic steatohepatitis, is the more advanced and severe form of fatty liver that is accompanied by inflammation and liver damage [2].

How Do I Know If I Have NAFLD?

NAFLD  affects around 25% of the US population [4] and usually causes no signs or symptoms. When it does, they may include [5]:    

  • Fatigue
  • Pain or discomfort in the upper right abdomen

You’ll only really know if you have a fatty liver if you have an ultrasound scan of your abdomen. But a liver function blood test can give a good idea. If this produces an abnormal result and you have other risk factors like obesity and poor diet (plus hepatitis has been ruled out), NAFLD is a likely diagnosis.

You Can Reverse a Fatty Liver

The good news is that early to mid-stage NAFLD, in which you have fat in your liver but little or no inflammation or liver cell damage, is totally reversible if you take action. 

Steps to prevent fatty liver disease progression and permanent liver injury include diet and exercise first and foremost, backed up with key supplements for fatty liver disease (the ones mentioned above, which we’ll go into more detail on below).

What Causes Nonalcoholic Fatty Liver Disease?

The primary causes of NAFLD are obesity and insulin resistance (when your body’s cells don’t respond well to the hormone insulin and your blood glucose runs high). Dietary drivers of these two conditions include excess calories and/or  too many processed carbohydrates and sugary foods [3, 6, 7, 8].

If you’re carrying more weight than is healthy, a good goal is to lose 10% of your total body weight, but even a loss of 3% to 5% can improve your liver health.

Being sedentary also increases your chance of developing a fatty liver.

Your Gut Health Influences Your Liver Health

Every time you eat, the absorbed nutrients (and toxins like alcohol and medications) get shunted from the gut to the liver via the portal vein. The liver then does a remarkable job of storing, processing, or detoxifying the incoming bloodstream. 

Once you understand this simple piece of physiology, it’s easy to understand how the metabolites produced by your gut bacteria (which pass to the liver) can have an important effect on the onset and progression of liver disease [9]. 

Put simply, an imbalanced gut microbiome can contribute to the progression or development of liver diseases, including NAFLD. This is more than just theoretical. For example: 

  • One recent review confirmed that conditions such as leaky gut, SIBO, and dysbiosis, can contribute to the progression and development of NAFLD [10]
  • Likewise, patients with NAFLD have been shown to have alterations in their gut microbiota [7]. 

Supplements for Fatty Liver: Probiotics

Likely because of their role in improving the health of the gut microbiota, research shows that probiotics (supplements of friendly bacteria) can help improve various facets of fatty liver disease and liver function.

For example:

  • A number of studies have found that probiotic supplementation reduces liver enzyme levels that are generally elevated in the liver function tests of people with NAFLD [11, 12]. 
  • Improved blood sugar, insulin levels, insulin resistance, total and LDL cholesterol levels, liver stiffness, and body mass index have also been found when using probiotics in several meta-analyses [13, 14, 15].
  • One meta-analysis found that taking probiotics for more than 3 months, and/or taking probiotics with three or more strains, can reduce BMI, which will benefit most people with NAFLD [12]. 

Going a step further, we’ve found that triple probiotic therapy (the use of all three primary probiotic categories) is especially effective for our patients. However, any probiotic is likely to be better than none. 

Supplements for Fatty Liver: Herbs, Vitamins, and More

Beyond probiotics, some other key supplements that can be taken to help flush the fat out of your liver faster are listed in the table below. I’ll outline some of the evidence for these supplements and indicate how much of each you may need to take. 

While there’s no reason you can’t take more than one of these supplements at the same time, they haven’t been studied in combination for reducing fat levels in the liver. It’s probably best to try one at a time, and see what works for you.

SupplementHow it May Help A Fatty LiverRecommended Dosage
Milk thistle (active ingredient silymarin)The findings from three comprehensive reviews showed that milk thistle significantly reduced liver enzyme levels in patients with NAFLD [16, 17, 18]280mg/day of milk thistle extract (standardized to 70-80% silymarin). A 4 –5 times higher dose spread out over the day can be used initially for a few weeks [19
Turmeric (active ingredient curcumin) Three systematic reviews and meta-analyses found that curcumin significantly reduced liver enzymes in NAFLD patients [16, 17, 20] One of these found that curcumin also helped improve metabolic syndrome (reducing BMI, triglycerides, total cholesterol, and insulin resistance) [16]500mg a day curcumin [21]
Cinnamon  Another herbal supplement documented to reduce elevated liver enzymes in people with fatty liver [17]. Additionally, a clinical trial found that cinnamon supplementation significantly improved insulin resistance, total cholesterol, LDL cholesterol, triglycerides, and GGT), and inflammation compared to placebo in NAFLD patients [22].750mg twice a day [22]
Carnitine  
Carnitine supplementation was found to significantly reduce insulin resistance, liver enzymes and triglycerides compared to placebo in NAFLD patients [23]. 15g per day [24]
Coenzyme Q10  One clinical trial found that CoQ10 supplementation significantly reduced liver enzymes, inflammation, and disease severity compared to placebo in NAFLD patients [25].100mg/day [25]
Vitamin D  One systematic review found that vitamin D helped reduce inflammation and cholesterol levels in NAFLD patients. However it did not have a significant effect on liver enzymes [26Uncertain, but probably 1000 iu/day minimum [26]
Vitamin C   A recent randomized controlled trial found that vitamin C supplements improved liver health and glucose metabolism in patients with NAFLD 1000mg per day had the best effect

Tocotrienols (part of the vitamin E family) have also been suggested as useful supplements for fatty liver disease. Here the evidence is somewhat mixed, however [27, 28, 29]. In general, the evidence seems to be moving away from high-dose vitamin E supplementation because of possible adverse effects such as increased hemorrhagic stroke risk [29].

You can also obtain plenty of vitamin E from foods such as nuts, olive oil, and avocados.

Remember that although they can be really helpful, supplements for fatty liver disease are not going to make a lot of difference to your liver health or liver fat buildup on their own. However, they can be very helpful as part of a treatment protocol that also involves making changes to reduce excess weight, improve diet, and optimize gut health. 

Get Moving!

Let’s talk about exercise, which has been shown to reduce fat in the liver as well as improve fibrosis and more serious liver disease (NASH) [30, 31, 32].

If you haven’t done much physical activity lately, try not to feel intimidated, as it doesn’t take much movement to make a difference to liver health. Obviously, it’s great if you can work up to more intense workouts, but one study found that even low-volume, low-intensity aerobic exercise (regular short walks for example) can tweak liver fat levels downwards [33].

Anaerobic (resistance-based) exercises have also been shown to help a fatty liver [31], so if a muscle-focused weights session, pilates, or yoga class is more your thing, that will likely work to boost liver health too. 

For people with busy schedules, HIIT (high-intensity interval training) is another great option that helps reduce liver fat [30]. HIIT exercise isn’t for everyone as you have to work at very intense levels repeatedly, though for a shorter time overall. But if you are able to do it, HIIT can offer great bang for the buck both exercise and liver health-wise!

How to Improve Your Diet

If you have NAFLD, it’s a good idea to try to gradually lose any excess weight by reducing portion sizes, especially by cutting out the ultra-processed foods that are linked with weight gain [34]. Some specific changes to your diet that will help with fatty liver and liver health more generally [35]:

  • Increasing your intake of omega-3 fatty acids (e.g. from fish oil or oily fish such as salmon and mackerel, and nuts and seeds like walnuts, chia, and flaxseed), which may offer some protection against increased heart disease for people with NAFLD.
  • Switching to lower glycemic index carb sources such as veggies, fruits, and whole grains. These affect your blood glucose less than high-glycemic index foods, e.g. white bread, white rice, and potatoes.
  • Avoiding too many simple sugars, especially fructose 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.
  • Minimizing alcohol consumption, which can further damage your liver.
  • Drinking green tea. In one study, 12 weeks of consuming  700 ml (three 8-ounce cups) per day of catechin-rich green tea improved liver fat content and inflammation by reducing oxidative stress in patients with NAFLD [36]. This was only a small study though, so only make the switch to green tea if you like it! 
  • Be aware of any food sensitivities you may have. Sometimes even people with healthy diets can run into problems with their liver and gut health if they keep eating foods they are intolerant too. For example gluten can cause raised liver enzymes in people who can’t tolerate it [37]. An elimination diet will help you to identify your food sensitivities.

You can achieve the above changes with any sort of healthy, balanced diet framework (e.g. Mediterranean diet). Many of our patients tell us that a Paleo-style diet works best for helping them reach their health goals. Paleo is certainly a great option for dealing with a fatty liver, as key principles include cutting sugar and refined carbs while emphasizing non-processed foods such as vegetables, fruit, meats, poultry, fish, eggs, nuts, and seeds.

Supplements for Fatty Liver Disease: Which Ones Work? - Paleo%20Diet%20Landscape L

Intermittent fasting has also been linked with better liver health [38] and can work well when combined with a Paleo diet. The easiest way to experiment with intermittent fasting is to take a 16-hour break from food overnight — for example finishing eating at 6 pm and then not having breakfast until 10 am. This isn’t too onerous for many, but remember you should always do what suits you. 

Sometimes going without food for several hours can cause side effects such as low blood sugar and dizziness. People who shouldn’t do intermittent fasting include pregnant or breastfeeding women, those with severe chronic illness, and anyone under severe stress [39].

Supplements Are Just One Part of Treating a Fatty Liver

Overall, supplements are less important than dietary and lifestyle changes (weight loss and exercise) at tackling nonalcoholic fatty liver disease, but they can still play an important role. Probiotics are your first choice supplements for fatty liver as they can have a powerful influence on liver health via the gut-liver axis. However, milk thistle and other herbals known for their ability to reduce elevated liver enzymes in NAFLD patients are also useful.

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

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
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