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Last modified on December 11th, 2020
Non-alcoholic fatty liver disease, or NAFLD, is a common liver problem. The number of people with NALFD is rising across the world, including in America. Experts estimate that between 30 and 40% of American adults and up to 10% of American children have the disorder. Although there is no cure for NAFLD, and no FDA-approved medications for the disease, certain supplements may help to treat it. We have read through recent medical journals to find the most recent information on which supplements have the best data behind them to bring you the top 6 best supplements to treat NAFLD.
What is NAFLD?
NAFLD refers to the buildup of extra fat in the cells of the liver. A fatty liver is often linked to alcohol use, leading to a condition called alcoholic fatty liver disease. However, in NAFLD, the fatty liver is not due to excessive drinking. Doctors do not think that having fat in the liver in and of itself is dangerous in most cases. However, over time, a simple fatty liver may progress to other, more dangerous, liver conditions.
What causes NAFLD?
- Obesity, especially in people who have a large waist
- Diabetes or prediabetes
- High cholesterol
- High triglycerides
- High blood pressure
- Poor diet
- Rapid weight loss
- Gastric bypass surgery
- Some medicines like:
o Amiodarone, sold under the brand names Nexterone and Pacerone: a drug used in the heart rhythm problem atrial fibrillation
o Diltiazem, sold under the brand name Cardizem: a drug used for blood pressure
o Steroids: drugs taken for conditions like inflammatory disease
o Antiretrovirals: drugs taken to fight HIV and AIDS
o Methotrexate, sold under the brand name Trexall: a drug used for cancer and certain other conditions like rheumatoid arthritis
o Estrogens: a hormone used by women for birth control and postmenopausal symptoms
o Tamoxifen, sold under the brand name Soltamox: a drug used for breast cancer
o Valproic acid, sold under the brand name Depakote: a drug used for seizures and some mood problems like depression and bipolar disorder
Other factors are linked to NAFLD. Although the condition can occur at any age, it is more likely to develop as people get older. Certain ethnicities are also linked to the development of NAFLD. People of Hispanic and non-Hispanic white origin are more likely to develop NAFLD than people of African-American or Asian origin.
What are the symptoms of NAFLD?
Most people have no symptoms from NAFLD. However, when symptoms occur, they may lead to you feeling:
- More tired than usual
- Pain in the upper right part of the abdomen
Because the disease rarely has symptoms, people may not even know they have it until they have an abnormal blood test. Lab tests ordered by your doctor can help to show how well your liver is working. In NAFLD, some of these tests may indicate that there is a liver problem. Specifically, the liver enzymes alanine aminotransferase (ALT) and aspartate aminotransferase (AST) may have abnormal levels in NAFLD, leading your doctor to suspect a problem. Your doctor may then order additional imaging tests like an ultrasound, MRI or CT scan to help them diagnose NAFLD. It is important to note, however, that sometimes people can have NAFLD although their liver enzymes may be normal.
When a doctor diagnoses NAFLD, other conditions that can cause a fatty liver must first be ruled out. These include:
-Heavy alcohol use
-Autoimmune liver disease
-Metabolic liver disease
-Inherited liver disease
How is NAFLD treated?
Although no medications have been approved to treat NAFLD, the disease can be treated with a variety of strategies:
- Weight loss (for people who are overweight)
- Eating a low-salt, healthy diet
- Avoiding alcohol
- Keeping physically active
- Treating health conditions like diabetes, high blood pressure, high cholesterol and high triglycerides
- Getting vaccinated against liver diseases like hepatitis A and hepatitis B
What is the prognosis of NAFLD?
Most people do not go on to develop health problems from NAFLD. That said, studies have shown that people with NAFLD are more likely to develop cardiovascular disease than people without the disorder. In addition, in rare cases, people with NAFLD may progress to a more dangerous disease called nonalcoholic steatohepatitis, or NASH. This disorder is a type of NAFLD in which the liver is not only fatty, but also has cell damage and inflammation. Over time, this inflammation can lead to liver scarring, a condition called fibrosis. NASH can go on to cause cirrhosis, a potentially fatal condition where the liver has extensive scarring and can no longer work properly. NASH can also cause liver cancer, another potentially deadly condition.
Doctors are not sure why some people go on to develop NASH. Overall, about 3 to 12% of American adults are estimated to have NASH. Doctors diagnose this condition using a liver biopsy, in which a small piece of liver tissue is removed to be tested. If the tissue contains only fat, the person may have simple NAFLD. However, if the sample contains fat as well as signs of inflammation and sometimes scarring, the person might have NASH. A liver biopsy is the only way to detect inflammation and, therefore, the only way NASH can be diagnosed. NASH treatment can involve options such as a liver transplant.
Can Supplements Help Treat NAFLD?
Some supplements and nutrients may help to treat NAFLD. However, because certain herbs can damage your liver, it is important to tell your doctor before you start to take any over the counter treatment for NAFLD.
Supplements with the best data for their use in NAFLD include:
- Silymarin: This chemical is one of the active ingredients in milk thistle and is one of the best-studied herbal supplements. It has been tested at doses of 150 to 450mg a day. Studies have shown that it improves the liver enzymes AST and ALT, which are often abnormal in NAFLD. Further, silymarin has been shown to make the liver less fatty, as proven on ultrasound. Doctors think it works in various ways, including by having antioxidant and anti-inflammatory effects.
- Curcumin: This chemical is the active ingredient in turmeric. It has been studied at doses ranging from 400 to 2000mg a day. Curcumin has been shown to reduce the amount of fat in the liver. It has also been shown to improve the levels of the liver enzymes AST and ALT. Some experts believe it might help prevent the progression of NAFLD to NASH due to these factors.
- Anthocyanins: These chemicals are found in supplements like grape seed extract. One study showed that anthocyanins at a dose of 400 mg improved liver enzymes in people with NAFLD.
- Berberine: This chemical is found in a variety of herbs like goldenseal. It has been studied at a dose of 500mg daily and was shown to improve lab values linked to fatty liver.
- Carnitine: Derived from amino acids, the chemicals which are the building blocks of life, carnitine improved liver enzymes in people with NAFLD after 3 months of use as well as overall liver function in people with NASH.
The Top 6 Supplements to treat NAFLD
We have looked into the clinical data and ingredients of some of the best-selling supplements for liver health on Amazon. The name of each supplement is linked to the product on Amazon. We have also included a description of why the supplement was one of our top-ranked choices.
Why we love it: Now’s Liver Refresh supplement contains a variety of ingredients shown to help NAFLD like silymarin 240mg (from milk thistle), grape seed extract (anthocyanins) 100mg, L-carnitine 50mg, berberine 30mg and turmeric (curcumin) 30mg.
The supplement also has a variety of other ingredients like schisandra extract to support general liver health.
Some ingredients, like N-acetyl cysteine and methionine, were included to help the body make a chemical called glutathione, a free radical scavenger to help reduce tissue damage. Other ingredients, like dandelion extract and the flavonoid scutellaria baicalensis, may have anti-inflammatory and antioxidant effects.
A serving size is 3 veggie capsules once daily. The capsules can be opened and sprinkled on food or in liquid if desired. The product is free of wheat, gluten, soy, milk, egg, fish, shellfish and tree nuts. Although the capsules are veggie caps, the product is not vegetarian-friendly as some ingredients like pancreatic enzymes are sourced from pigs.
Because the enzymes come from pigs, the product is also not kosher or halal. The product is packaged in the United States using ingredients possibly sourced from other parts of the world. It also is GMP certified and carries a label to this effect, meaning that the manufacturer meets the FDA’s criteria for Good Manufacturing Processes. Amazon users generally like this product, stating that their bloodwork showed that their liver had improved after taking it.
Some users stated that the capsules are a bit hard to swallow on their own and that it is easier to take them with a drink.
Why we love it: 1MD’s LiverMD supplement contains ingredients believed to help NAFLD as well as promoting liver health in general.
In terms of ingredients shown to help NAFLD, besides 3.5mg of a patented Vitamin E extract containing multiple forms of the vitamin, the product contains 80mg of a silybin-soy lecithin formulation (from silymarin, in milk thistle) that it claims to be 10 times more available to the body than other milk thistle products.
To promote overall liver health, the product also contains N-acetyl cysteine 800mg, which promotes the production of the antioxidant glutathione. It also contains the antioxidant alpha lipoic acid 100mg, as well as zinc 15mg and selenium 0.2mg to support detoxification.
The product contains trace amounts of soy and is therefore not appropriate for people with soy allergies. However, the product is preservative-free, gluten-free and sugar-free. It is also vegan and, therefore, appropriate for vegetarians.
The recommended dosing of the product is 1 capsule twice daily with a meal and a glass of water.
The capsules can be opened if desired. Amazon users like this product, saying that it is easy to swallow.
Why we love it: The Jarrow Formulas Milk Thistle product keeps it simple. Milk thistle (silymarin) has some of the most robust data supporting its use in NAFLD, so Jarrow keeps its product focused on that one ingredient.
As such, the product contains only milk thistle 150mg: no more, no less. The recommended dose is 1 veggie capsule once daily. The capsules can be opened if desired. The product is safe for people sensitive to gluten, as it is gluten-free. Amazon users like this product, saying that it is easy to swallow.
One user with NAFLD said that his bloodwork showed that his liver had gotten healthier after taking this product.
Why we love it: Naturenetics LiverSmart uses a patented process to make sure its most active ingredient for NAFLD, milk thistle, meets its specifications.
According to the manufacturer, the milk thistle is hand-picked in Europe and undergoes temperature-controlled pressing and cooling.
The product contains a specific ratio of 6 different silymarins from milk thistle in the product, which are then verified by independent lab testing to ensure at least 145mg of silymarin per dose.
The product also contains a mix of dandelion root, artichoke leaf, yellow dock root, protease and beet root to support liver health. The recommended dose is 1 capsule twice daily with meals. The capsules can be opened if desired. The product is cruelty-free, vegan and is, therefore vegetarian-friendly.
It is also free of soy, wheat, gluten and lactose. It is also non-GMO and is manufactured in the United States with globally-sourced ingredients.
Amazon users like this product, some stating that their blood work showed their liver function improved after taking it.
Why we love it: Nature’s Nutrition Liver Cleanse contains multiple ingredients to support liver health.
The product contains 200mg of milk thistle extract (silymarin), which has evidence supporting its use in NAFLD. It also contains 30mg of zinc to support detoxification, as well as beet root, artichoke, chanca pedra, dandelion, chicory, yarrow, jujube seed and a proprietary blend of other agents to support liver health.
The serving size is 2 veggie capsules once daily 20 to 30 minutes before a meal with 8 ounces of water. The capsules can be opened if desired. The product carries a GMP label, meaning that it complies with the FDA’s current Good Manufacturing Practices. It is also non-GMO and is made in the United States.
The product contains no gluten or sugar. The manufacturer states that its products are tested in a third-party lab.
Amazon users generally like this product, with several users stating that their bloodwork showed that their liver had improved after taking it.
Why we love it: Most products available for liver health and NAFLD on Amazon come in a capsule formulation.
For those who have problems swallowing capsules, Go Nutrients Liver Edge is an alternative. This product comes as a liquid which can be administered with a dropper. The dose of the product is one-quarter of a teaspoon, or 25 to 30 drops, 1 to 3 times daily.
The product contains a proprietary blend of ingredients like milk thistle seed (silymarin) and turmeric root (curcumin) which have evidence of benefit in NAFLD. The blend also contains other agents to support liver health like dandelion root, chicory root, artichoke leaf, gentian root and wormwood leaf.
A downside of the product is that the exact dose of each component is not made public, due to the blend being proprietary. The product includes a label that their manufacturer is NSF Certified. This means that NSF International, a public health and safety organization, certifies that the product complies with the FDA’s current Good Manufacturing Practices. The product is non-GMO and contains no preservatives.
Instead of artificial sweeteners, the product is sweetened with vegetable glycerin. It is vegan-friendly and appropriate for vegetarians. It contains no alcohol, gluten, soy or dairy. The product is also made in the United States. Amazon users like this product, saying that their bloodwork showed it seemed to help improve their liver.
It can be surprising to learn that you have NAFLD, especially if you do not have symptoms. Although there is no cure for the condition, and no prescription medications, it can be treated in a variety of ways.
Making healthy food choices, losing weight, and making sure you get enough physical activity are important for treating the disease. Your doctor may help you decide if supplements are right for you.
Some supplements, especially those containing silymarins from milk thistle, may also help improve the health of your liver if you have NAFLD.