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The prevalence of NAFLD exceeds 40% in the Americas
Global incidence and prevalence of nonalcoholic fatty liver disease [PMC10029957]
Non-Alcoholic Fatty Liver Disease (NAFLD) is a growing health concern that has risen rapidly in parallel to the increasing weight of the population. Nutritional supplements have emerged as a supportive tool for people with fatty liver disease. While they are not a cure-all, certain supplements can complement diet and lifestyle changes in managing NAFLD. This article explores how specific supplements, such as Omega-3 fatty acids, Vitamin E, and milk thistle, among others, can support liver health.
We explore the research behind each supplement and show how they can contribute to improved liver function, reduce inflammation, and assist in managing this increasingly common liver condition.
What Is NAFLD?
NAFLD was recently renamed to remove any stigma associated with alcohol. It will now be metabolic dysfunction-associated steatotic liver disease (MASLD). MASLD encompasses patients who have hepatic steatosis and have at least one of five cardiometabolic risk factors.
NAFLD/MASLD is a common condition characterized by the accumulation of excess fat in liver cells in individuals who consume little or no alcohol. It’s becoming increasingly common, partly due to rising obesity rates worldwide. NAFLD is often silent, with few or no symptoms, especially in the early stages. When symptoms do appear, they may include fatigue, pain or discomfort in the upper right abdomen, and sometimes swelling in the abdomen.
NAFLD/MASLD is primarily caused by a combination of lifestyle factors and genetics. The main risk factors include obesity, insulin resistance, type 2 diabetes, and high levels of fats, particularly triglycerides, in the blood. Poor eating habits, a sedentary lifestyle, and excessive calorie intake also contribute to its development.
While NAFLD/MASLD can be benign and not progress, it can sometimes evolve into a more serious condition known as non-alcoholic steatohepatitis (NASH), which involves inflammation and damage to liver cells, potentially leading to cirrhosis or liver cancer. Early detection and lifestyle modifications play a crucial role in managing NAFLD/MASLD and preventing its progression.
What Food and Lifestyle Factors Are Important For Managing Fatty Liver?
Managing Non-Alcoholic Fatty Liver Disease (NAFLD) effectively centers on weight loss. When a person loses weight, it directly reduces fat in the liver and decreases inflammation. Losing even a modest amount of weight can greatly improve liver health and function. Regular physical activity, such as brisk walking, cycling, or swimming, not only helps with weight loss but also improves overall liver function. Getting enough quality sleep is critical for weight management, as it helps regulate metabolism. Managing stress through techniques like yoga, meditation, or deep breathing is also important because chronic stress can lead to weight gain and worsen NAFLD.
Diet plays a critical role too. Avoiding alcohol is essential, as it can worsen liver damage. Sugary beverages, especially sodas with high fructose corn syrup can be very damaging to the liver by causing liver fat accumulation and causing further liver injury. By focusing on long-term weight management and dietary factors, people can greatly influence the progression of NAFLD.
Some studies have shown that coffee may have liver-protective effects and could be beneficial in managing NAFLD. [PMID: 27824642]
Iron Overload: A Critical Connection With NAFLD
Non-Alcoholic Fatty Liver Disease (NAFLD) can progress to a more severe form known as Non-Alcoholic Steatohepatitis (NASH), particularly under certain metabolic conditions. One such condition is Dysmetabolic Iron Overload Syndrome (DIOS), which is characterized by abnormal iron accumulation in the liver and other organs without a primary cause such as hereditary hemochromatosis.
DIOS may accelerate the progression of NAFLD to NASH by promoting oxidative stress and liver inflammation due to excess iron. This oxidative stress damages liver cells and can enhance the fibrotic processes that characterize NASH. Iron overload in the liver disrupts normal metabolic functions, potentially worsening insulin resistance—a key factor in the development and progression of NAFLD.
Nutritional management strategies in the presence of both NAFLD and DIOS focus on controlling iron intake and enhancing iron regulation. This may involve reducing dietary sources of highly bioavailable iron, such as red meat, and increasing consumption of foods that inhibit iron absorption, such as those high in calcium and polyphenols. Antioxidant-rich foods, which can help combat oxidative stress, are also emphasized, including fruits, vegetables, and whole grains.
Moreover, professionals might recommend regular monitoring of iron levels in the body through blood tests and liver biopsies to tailor dietary interventions more effectively and prevent the progression from NAFLD to NASH. These measures aim to mitigate the impact of iron overload on liver health and slow the progression of liver disease in people with NAFLD and DIOS.
Read more in our article: DIOS (Dysmetabolic Iron Overload Syndrome): Its Connection to NAFLD and Insulin Resistance.
Hyperferritinemia is observed in one-third of patients with non-alcoholic fatty liver disease (NAFLD) and Metabolic Syndrome (MetS). The condition characterized by increased body iron stores associated with components of MetS has been defined as Dysmetabolic Iron Overload Syndrome (DIOS). DIOS represents the most frequent iron overload condition, since it is observed in 15% of patients with MetS and in half of those with NAFLD and its clinical presentation overlaps almost completely with that of dysmetabolic hyperferritinemia (DH). The pathogenetic mechanisms linking insulin resistance (IR), NAFLD and DIOS to iron overload are still debated.
Dysmetabolic Hyperferritinemia and Dysmetabolic Iron Overload Syndrome (DIOS): Two Related Conditions or Different Entities? [PMID: 32003680]
How Constipation Relates To NAFLD
An interesting aspect of NAFLD is its potential connection with chronic constipation, a common digestive issue that affects a significant portion of the population. Chronic constipation can lead to prolonged toxin exposure in the intestines, which may contribute to inflammation and metabolic changes affecting the liver.
Studies suggest that the systemic inflammation associated with long-term constipation might exacerbate insulin resistance and alter lipid metabolism, leading to increased fat storage in the liver. Additionally, constipation can affect the gut flora balance and intestinal barrier function, potentially increasing the influx of harmful substances to the liver and promoting fat accumulation.
Nutritional management for individuals experiencing both conditions focuses on dietary adjustments that promote regular bowel movements and reduce liver fat. Diets rich in fiber, adequate hydration, and balanced intake of healthy fats are recommended to aid bowel regularity and support liver health. Healthcare professionals also emphasize the importance of regular physical activity to enhance gastrointestinal and liver function.
What Nutritional Supplements Are Recommended For NAFLD/MASLD ?
- Omega-3 Fatty Acids: These fatty acids, found in fish oil, are effective in reducing liver fat and inflammation in NAFLD by modifying fat metabolism and suppressing pro-inflammatory processes in the liver. [PMC7551292]
- Milk Thistle (Silymarin): Milk thistle aids in reducing liver inflammation and damage due to its antioxidant properties, which help protect liver cells from toxins and support liver regeneration in NAFLD. [PMC9149185][PMC5728929]
- Multivitamin: [PMC9511103]
- Zinc: Zinc plays a critical role in liver health, and its supplementation can help in reducing liver damage in NAFLD by supporting antioxidant defense systems and improving immune function in the liver.
- Vitamin E: Acting as an antioxidant, Vitamin E helps in improving liver function in NAFLD by protecting liver cells from oxidative stress and may slow the progression of liver fibrosis, especially beneficial for those without diabetes.
- Selenium: As an antioxidant, selenium might help reduce oxidative stress and liver inflammation associated with NAFLD.
- Vitamin D: Some studies suggest that Vitamin D supplementation might improve liver health in NAFLD, especially since Vitamin D deficiency is common in individuals with this condition.
- B-Complex Vitamins: B vitamins, particularly B12 and folate, can support overall liver health and may aid in managing NAFLD, especially since some individuals with liver disease are deficient in these vitamins.
- Magnesium: A 16-week study found that L-carnitine (2 gr) combined with magnesium (150 mg) supplementation led to a reduction in liver enzymes, insulin levels, lipid profile, and liver stiffness.
- Curcumin: Found in turmeric, curcumin is known for its anti-inflammatory and antioxidant properties. It may help reduce liver inflammation and oxidative stress in NAFLD. [PMID: 33861434]
- Berberine: This compound, found in several plants, is believed to improve insulin resistance and reduce fat buildup in the liver, which can be beneficial in NAFLD. [PMC4947506]
- Green Tea Extract: Rich in antioxidants, particularly catechins, green tea extract may help reduce liver fat accumulation and inflammation in NAFLD. [ PMC8949532]
- L-Carnitine: This supplement may help reduce liver fat and improve liver function in NAFLD by helping in the metabolism of fatty acids. [PMC10148537]
- Taurine: This amino acid is believed to have hepatoprotective effects, potentially reducing liver inflammation and oxidative stress in humans [PMID: 36314323] and animal models of NAFLD. [PMID: 21126079]
- Coenzyme Q10 (CoQ10): Known for its antioxidant properties, CoQ10 may help reduce oxidative stress in the liver, which is beneficial for NAFLD management. [PMC10261764]
- Probiotics: The intestinal flora is closely related to the pathogenesis of nonalcoholic fatty liver disease (NAFLD). These beneficial bacteria enhance liver function in NAFLD patients by restoring balance to the gut microbiome, which can positively impact liver health by reducing gut-derived toxins and inflammation. [PMC9875992]
Dietary supplements are not designed to diagnose, treat, cure, or prevent any disease. This article aims to offer valuable insights into which nutritional supplements have undergone scientific study and shown promise in supporting specific health conditions. We break down the research, so you can work with your medical providers to make informed decisions about adding supplements to your health regimen. For personalized advice tailored to your needs, we recommend consulting with a registered dietitian in addition to your primary care provider.
Check with your physician when adding supplements. While supplements are generally safe for most people, do not add nutritional supplements without your physician’s specific approval if you are pregnant or nursing, are undergoing cancer treatment, have a history of organ transplant, liver or kidney disease, or take medications that interact with supplements.
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Are Supplements Safe?
Omega-3 Fatty Acids, Multivitamins, Milk Thistle (Silymarin), Probiotics, Curcumin, Berberine, N-Acetyl Cysteine (NAC), Alpha-Lipoic Acid, Green Tea Extract, Resveratrol, Vitamin D, L-Carnitine, Taurine, B-Complex Vitamins, Coenzyme Q10 (CoQ10), and Dandelion Root are generally safe for use in the context of managing Non-Alcoholic Fatty Liver Disease (NAFLD)/Metabolic Associated Fatty Liver Disease (MAFLD). When used in recommended dosages and under medical guidance, these supplements are known to be well-tolerated with minimal side effects. It’s important to note that they are not substitutes for medical treatment but can be used as part of a broader health management plan.
Medication Interactions:
- Blood Thinners (Anticoagulants): Omega-3 Fatty Acids can enhance the blood-thinning effect and increase bleeding risk, while Green Tea Extract, containing vitamin K, can counteract the effects of blood thinners, and Ginkgo Biloba is known to increase the risk of bleeding.
- Diabetes Medications: Berberine and Alpha-Lipoic Acid can both lower blood sugar, possibly requiring adjustments in diabetes medication, and Ginseng can also affect blood sugar levels and interact with diabetes medications.
- Blood Pressure Medications: Licorice Root can elevate blood pressure and interfere with these medications, and Omega-3 Fatty Acids can potentially lower blood pressure, enhancing the effects of these drugs.
- Immunosuppressants: Echinacea can stimulate the immune system and may interfere with the action of immunosuppressants, and Astragalus might counteract the effects of these medications. Probiotics also interact with the immune system by affecting gut health.
- Chemotherapy Drugs: Green Tea Extract’s antioxidants can potentially interfere with the effectiveness of certain chemotherapy drugs, and Turmeric/Curcumin can interfere with the metabolism of some chemotherapy drugs.
- Statins (Cholesterol-Lowering Medications): Coenzyme Q10 (CoQ10) levels can be reduced by statins, and Niacin (Vitamin B3), when taken with statins, can increase the risk of muscle pain and damage.
It’s important to consult with a healthcare professional because interactions can vary based on individual health conditions and medication dosages.
Supplement Interactions:
- Omega-3 Fatty Acids: May increase the risk of bleeding when taken with supplements that have blood-thinning properties, like Ginkgo biloba or high-dose vitamin E.
- Milk Thistle (Silymarin): May change the effectiveness of supplements metabolized by the liver, such as Glucosamine.
- Curcumin: May enhance the blood-thinning effects of supplements like Omega-3 fatty acids or vitamin E.
- Berberine: Can interact with supplements that lower blood sugar levels, like cinnamon, potentially leading to hypoglycemia.
- N-Acetyl Cysteine (NAC): May interact with nitrate supplements, affecting blood vessel dilation.
- Alpha-Lipoic Acid: Can lower blood sugar levels and may interact with other supplements that have similar effects.
- Green Tea Extract: Contains caffeine and can interact with other stimulant supplements, possibly leading to increased heart rate and blood pressure.
- Resveratrol: May enhance the blood-thinning effects of supplements like Omega-3 fatty acids or vitamin E.
- L-Carnitine: Can interact with anticoagulant supplements, potentially enhancing their effects.
- Coenzyme Q10 (CoQ10): Statins can reduce CoQ10 levels in the body, and CoQ10 supplements can interact with blood-thinning supplements, affecting their efficacy.
The Fasting Mimicking Diet For Fatty Liver
Intermittent fasting is shown to improve liver function markers and promote weight loss in adults with fatty liver. [PMC10552959, PMID: 36343094]. An alternative option is the “fasting mimicking diet”, a 5 day low calorie, low protein, high nutrient density diet. Read more in our full article: ProLon: The Easy Way To Get the Benefits of Fasting.
The fasting-mimicking diet (FMD) mimics the effects of traditional fasting while still providing essential nutrients.The FMD state encourages the body to use up stored fats, which can directly help in reducing liver fat accumulation and promotes the removal of damaged cells and tissues, a process known as autophagy, which can improve liver function and reduce inflammation. By periodically implementing FMD, it helps in resetting the body’s metabolic processes, which is crucial in managing conditions like NAFLD where metabolism is significantly disrupted. This approach, therefore, offers a strategic and manageable way to address the underlying causes of NAFLD, improving liver health and overall metabolic function. [PMC6816332]
A recent study in a mouse model of fatty liver disease explored whether a fasting-mimicking diet (FMD), which involves intermittent calorie restriction, could help manage NAFLD. This special diet is low in carbohydrates and protein but high in dietary fibers. Not only did the diet help reduce obesity and improve blood sugar control, but it reduced the buildup of fat in the liver and decreased signs of liver inflammation. Additionally, gene analysis showed that the diet increased the liver’s ability to break down fats. Researchers concluded that intermittent use of the FMD can be effective in improving NAFLD. It works by enhancing the breakdown of fats in body fat and boosting the liver’s capacity to process and get rid of fats. Researchers concluded that FMD could be a promising approach for managing fatty liver disease. [PMID: 34632700]
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Food First!
Although this article discusses supplements in detail, don’t forget that we are absolutely committed to the “Food First” approach to nutrition. When it comes to your health, the totality of your eating habits far surpasses the impact of individual nutrients or any single supplement you consume. Even though this article doesn’t delve into the broader picture of your overall diet, it’s crucial to keep this element at the forefront of our minds. Your food needs to provide all the vitamins, minerals, fiber, and phytochemicals to nourish your body systems down to the cellular level.
Food choices, rather than supplements, are the most critical factors for a healthy gut microbiome. These trillions of tiny inhabitants in your gut affect your brain waves; they orchestrate your immune system. They possess the power to create molecules that can switch genes on or off and are even capable of synthesizing neurotransmitters. Opting for organic foods and steering clear of plastic packaging (including those labeled BPA-free) is a smart move to limit toxin exposure. The sum of all these parts leads to a powerful conclusion: the ultimate key to your health lies in the quality and balance of the food you consume. Supplements are secondary.
What To Eat
What Lab Tests Might Be Helpful In Managing NAFLD / MASLD?
Liver Function Tests (LFTs) and blood sugar tests, including Hemoglobin A1c (HbA1c), are really important for understanding and managing fatty liver disease. LFTs check for certain enzymes in your liver, mainly ALT and AST. If these are high, it could mean there’s some inflammation or damage in your liver, which often happens with NAFLD. By regularly checking these enzymes, doctors can see how the disease is progressing and whether the treatments are working.
Then there are blood sugar tests, including fasting glucose and HbA1c. These are important because NAFLD is often linked to problems with blood sugar control, like in diabetes or metabolic syndrome. Basically, these tests show how well your body is managing its blood sugar levels. For people with NAFLD, keeping an eye on blood sugar is crucial because problems with blood sugar control can make the liver condition worse.
Most of these can be accessed directly through NutriScape Labs.
- Serum Ferritin: Elevated ferritin levels can indicate excess iron stores, making this test a primary marker for iron overload. This test measures the amount of ferritin in the blood, which is a protein that stores iron. Serum Ferritin can be ordered directly through our NutriScape Labs affiliate link.
- C-Reactive Protein (CRP): CRP measures inflammation in the body. Since DIOS can be associated with inflammatory states, these markers can be useful for an overall health assessment. C-Reactive Protein can be ordered online through our NutriScape Labs affiliate link.
- Liver Function Tests: These tests, including alanine transaminase (ALT), aspartate transaminase (AST), alkaline phosphatase (ALP), and bilirubin, help assess liver health. Iron overload can lead to liver damage, making these tests crucial in monitoring the liver’s condition. A Liver Panel can be ordered online through our NutriScape Labs affiliate link.
To Sum It Up
A wide array of supplements have been researched for their benefit in fatty liver disease. The best results have been found with Omega-3 Fatty Acids, Multivitamins, Milk Thistle, Probiotics, Curcumin, Berberine, N-Acetyl Cysteine, Alpha-Lipoic Acid, Green Tea Extract, Resveratrol, Vitamin D, L-Carnitine, Taurine, and Coenzyme Q10. Although it might not be financially feasible to supplement with all of these, they each provide benefit.
Each of these supplements brings unique properties to the table, ranging from anti-inflammatory and antioxidant effects to liver support and metabolic health improvements. While these supplements can be beneficial, it’s crucial to remember that they should complement, not replace, traditional medical treatments and a healthy lifestyle. One of the most critical issues in fatty liver disease in weight loss. A dietitian can offer personalized counseling in this area that can help a person avoid the diet roller coaster and manage their weight with a long-term, health focused approach.
This Article is Not a Substitute for Medical Advice
Dietary supplements are not designed to diagnose, treat, cure, or prevent any disease. The Supplement Sciences website seeks to provide comprehensive access to the most relevant supplement information along with convenient online ordering. We do not provide medical advice and cannot guarantee that every product suggested is completely without risk. Since each person is unique in their health history and medication use, it is important to discuss supplements with your personal physician. Specifically, pregnant women and individuals being treated for cancer or liver or kidney problems must consult their physician about every nutritional supplement they plan to take. People taking medications for the treatment of HIV or with a history of organ transplant must not take supplements without consulting with their physician.