Home Remedies For Nonalcoholic Fatty Liver Disease

Nonalcoholic fatty liver disease (NAFLD) is the third most common cause of liver transplantation in the United States (behind alcoholism and hepatitis C), but I believe in the next 10 to 20 years it will take over the number one spot unless the obesity epidemic is reversed. The good news is that lifestyle changes, especially weight loss, are very effective, and often they’re the first line of treatment. 

For many people these changes are inexpensive (especially compared to drugs and medical care) and easy to make. 

When it comes to combating this disease, doctors need to be more open to trying several different types of therapies, including a variety of dietary supplements, to reduce liver enzymes and damage. The truth is, supplements work as well as most prescription drugs, if not better in some cases, and they can be taken with pharmaceuticals as well.

What is Nonalcoholic Fatty Liver Disease?

Nonalcoholic fatty liver disease is exactly what it sounds like: Fat gets deposited within and around the liver due to a poor diet, excess calories, and some bad luck (some people are more susceptible due to a family history). 

So when you gain weight, it’s not just showing up on your belly, backside, or arms; it’s also impacting your organs. The liver is a particularly dangerous spot for this to happen because the extra fat affects its ability to function normally, and this organ is responsible for so many things in the body—from immunity to cholesterol regulation to digestion. If NAFLD is left untreated, it can progress to nonalcoholic steatohepatitis, or NASH (steato means fat, and although hepatitis is a disease, it really just means inflammation of the liver). 

This occurs when the fat accumulation becomes so pervasive that liver cells start dying and the liver becomes scarred (fibrotic), leaving it unable to carry out its normal functions, which can lead to cirrhosis, liver failure, cancer, and the need for a transplant.

Here’s the really shocking news: About one in three adults in the United States has NAFLD, and about one in 20 has NASH! Even worse, experts believe one in 10 children now has it, too. 

That one-in-three stat should sound familiar because it’s the approximate rate of obesity in the United States as well. See the connection? The risk of NAFLD rises as body weight increases. About 67 percent of people with a body mass index (BMI) of 30 or higher and more than 90 percent of individuals with a BMI greater than 39 (considered morbidly obese) have NAFLD. The condition is so tied to obesity that many physicians, including myself, now consider NAFLD as one of the factors contributing to metabolic syndrome, a constellation of health problems that includes increased waist size (abdominal obesity), high triglycerides, low good cholesterol (HDL), high blood pressure, and high blood glucose or insulin resistance. Metabolic syndrome increases your risk of cardiovascular disease, diabetes, and cancer.

Most people with NAFLD don’t have any symptoms, but elevated ALT and AST liver enzymes on a blood test are a tip-off that something’s affecting liver function. 

Some patients will complain of fatigue and right upper quadrant pain or a feeling of fullness in that spot, though, and as many as 50 percent of patients will have an enlarged liver due to the extra fat. If your doctor suspects NAFLD or NASH, she will likely conduct a NAFLD fibrosis score (which looks at your age, BMI, liver enzymes, and other blood test results; you can even do it yourself online) or order an ultrasound, CT scan, or MRI. In severe cases, a biopsy may be needed.

Home Remedies For Nonalcoholic Fatty Liver Disease

1. Vitamin E (as d-alpha-tocopherol or RRR-alpha- tocopherol) 800 IU a day

Also known as the natural form of vitamin E, d-alpha was tested in a large clinical trial known as PIVENS (Pioglitazone versus Vitamin E versus Placebo for the Treatment of Nondiabetic Patients with Nonalcoholic Steatohepatitis). 

The 2-year study compared the drug pioglitazone (30 milligrams per day), vitamin E (800 IU once a day), and a placebo in nondiabetic NASH patients who did not have cirrhosis. Get this: Researchers were looking for a two-point improvement in subjects’ conditions (based on a clinical rating system), which occurred in 34 percent of the drug group, 19 percent of the placebo group, and 43 percent of the vitamin E group. Both the drug and vitamin E also reduced liver enzymes, liver fat, and inflammation (there was no improvement in fibrosis).

This is a classic example of why dietary supplements should be a specialty in medicine and not a part-time job or hobby! Vitamin E supplements are never recommended for anything today, and that is generally appropriate because of the increased risk of prostate cancer they cause in some men (at 400 IU daily). (In the PIVENS trial, the side effect rate was similar to a placebo and there was no increased risk of more serious problems with vitamin E.) 

But here’s a case where it can be helpful for people who have a potentially fatal disease with few remedies. In fact, current guidelines from the American Association for the Study of Liver Disease, American College of Gastroenterology, and American Gastroenterological Association recommend the use of vitamin E as first-line therapy in non-diabetic NASH without cirrhosis. Supplements like vitamin E should be treated like a drug. Only certain people qualify to take certain drugs (they’re not right for everyone), and the same holds true for vitamin E. You and your doctor should look at the research and your individual situation. It’s all about risk versus benefit.

2. Omega-3 fatty acids (EPA and DHA) 800 to 2,000 milligrams a day

There is some excitement about using fish oil—either in a more concentrated and expensive prescription or in supplement form—for NASH. (I think the supplement is better because it is cheaper, safe, and the quality control of most fish oil products right now is excellent.) Interestingly, a review of nine clinical studies using omega-3 supplements (involving 355 people with NAFLD) found an improvement in liver enzymes, especially AST, and a reduction in liver fat. Some of the studies used much higher doses than I’m comfortable with recommending, so stick to between 800 and 2,000 milligrams daily.

Fish oil does have side effects, including stomachache, increased ease of bleeding or bruising, fishy aftertaste, itching and rashes, and adverse blood sugar and LDL changes. You may have to play with dosages to find a level where side effects are tolerable or eliminated.

3. (tie) NAC (N-acetylcysteine) 1,200 milligrams a day

NAC increases production of an antioxidant called glutathione, which protects the liver. There has been some favorable clinical research showing a reduction in liver fat and fibrosis in NASH patients taking NAC, but another reason I’m recommending it is my (and my colleagues’) experience using it to treat liver damage from toxins, such as overuse of acetaminophen. In fact, emergency room doctors frequently use it to reduce damage to the liver from acetaminophen overdose.

3. (tie) Whey protein isolate 20 to 25 grams a day

Whey protein isolate (which you can buy as a powder or find in protein bars and other products) works similarly to NAC. Its high levels of cysteine may increase glutathione, which protects the liver. Some early studies show that just 20 grams per day for 3 months may help reduce elevated liver enzymes. But protein powder, specifically whey, may also work because it can help promote weight loss when used as part of a healthy diet and exercise program

High-protein diets are beneficial for weight loss because protein takes longer to digest (meaning you don’t get hungry as quickly as you do with simple carbs), and it helps you maintain or build muscle (if you’re resistance training) even while losing weight. The more muscle you have, the higher your metabolism is. Protein powders are one of the most concentrated forms of protein with the lowest amount of calories. Plant-based protein powders— such as soy protein isolate, pea, brown rice, and hemp—may help also, but they have not been as well studied for NAFLD (and the taste factor is still an issue—many of them taste like dirt!).

4. Betaine

Betaine (TMG or trimethylglycine), originally derived from sugar beets, may reduce liver enzymes at larger daily doses (up to 10 to 20 grams) in people with NASH. The results so far have been mixed; they were positive initially, but subsequent research wasn’t as good (there are just not enough studies yet). Regardless, it’s worth discussing with your physician.

What Supplements Are Useless For Treating Nonalcoholic Fatty Liver Disease?

The following supplements can potentially increase liver enzymes, so they should be avoided if you have NAFLD or NASH.

  • Chaparral leaf
  • Ephedra
  • Gentian
  • Germander
  • Kava
  • Red clover
  • Senna
  • Shark cartilage
  • Skullcap
  • Vitamin A (in excess, such as 25,000 IU or more a day)

Vitamin D

It’s completely overhyped for NAFLD due to misinterpretation of the research. Weight loss can benefit NAFLD patients, and when you lose weight, vitamin D levels go up. That doesn’t mean vitamin D is causing the weight loss. So don’t spend money on D if you haven’t been told you have low levels. Just lose weight!

Folic acid and vitamin C

These have both been used as treatments for NAFLD, but the research doesn’t show any benefit, so save your money.

What Supplements Are Suitable For Kids to Treat Nonalcoholic Fatty Liver Disease?

Thanks to skyrocketing rates of childhood obesity, NAFLD is the most common liver disease in children and adolescents in the United States. Of course, losing weight through diet and exercise is the best treatment option, but the most promising supplement that I’ve come across so far for kids is vitamin E. Although the biggest research trial (called Treatment of NAFLD in Children, or TONIC) didn’t find a statistically significant difference between a placebo, the diabetes drug metformin, and vitamin E, a daily 800 IU dose of vitamin E (d- alpha-tocopherol) did reduce liver enzymes (ALT) better than the others. After 96 weeks, 28 percent of the kids taking a placebo improved, 41 percent of those on metformin showed improvements, and 58 percent of the children on vitamin E got better.

Vitamin E deserves more credit (and research) here, especially since there are so few official treatments for kids with NAFLD, apart from lifestyle changes. Plus, five children in the placebo group developed diabetes while nobody in the vitamin E group did, and side effects of vitamin E were similar to the placebo. Daily doses between 400 to 1,200 IU have been found to improve liver enzymes, so talk with your child’s doctor about the appropriate dose.

What Lifestyle Changes Can Help With Nonalcoholic Fatty Liver Disease?

Heart healthy = liver healthy

Dietary changes that improve heart health (and help you lose weight) also benefit your liver. Increasing the consumption of polyunsaturated fats (such as omega-3 fatty acids), reducing sugar intake (including sodas and fruit juices), increasing your fiber intake (20 to 30 grams daily), reducing red meat and processed meats and fast foods, and increasing fish consumption can improve your liver enzymes.

Shrink your waistline

Weight loss and exercise are the most effective lifestyle changes you can make to improve NAFLD. These are the first things your doctor will tell you to do because they help reduce insulin resistance and visceral abdominal fat (the kind that settles around your organs, including your liver). Imaging studies have shown positive changes (reduced fat) in as little as 6 to 12 weeks of losing 1 or 2 pounds a week. (More rapid weight loss can sometimes make the condition temporarily worse, so be careful.) I have seen liver enzymes return to normal in individuals who have dropped 5 to 20 pounds or more. Even just exercising, without losing weight, will help reduce liver fat and improve the organ’s ability to repair itself. And don’t forget weight lifting: Adding lean muscle improves your metabolism and reduces fat.

Reduce your carbs

So far, there isn’t one particular eating plan that works better than others for NAFLD, but many doctors (myself included) like to recommend low-carbohydrate diets, especially for patients who have diabetes. Preliminary studies with the Mediterranean diet (high in vegetables, beans, fish, fruit, fiber, and “good” fats and low in meat and sugar) appear to show a benefit as well. Bottom line: Any reasonable, healthy program that helps you cut calories as well as lose weight and keep it off can be helpful.

Reduce or eliminate alcohol

Alcohol is toxic to the liver, and when it’s processed, it can damage liver tissue— especially if you drink in excess. Cutting back or quitting altogether can make a big difference, bringing those liver enzymes back to normal!

Go high octane

Are you ready for this one? Caffeinated coffee—two to three cups a day—may reduce the risk of NAFLD or NASH. Research over the past 20 years has suggested that consuming coffee can reduce the negative effects of toxic substances, like alcohol. The jury is still out over whether it’s the caffeine or other compounds in coffee (it’s high in antioxidants) that deliver the protective effect, so caffeine in general or decaf may not be beneficial.

Eat more choline

Some research suggests that diets higher in this B vitamin, which is found in all human cells, can improve liver function by reducing inflammation. The PIVENS study showed that it may even reduce scarring (fibrosis) in some individuals. The best way to get it is through diet, especially protein, such as chicken, eggs, turkey, fish, nuts, and seed oils.

What Else to Know About Treating Nonalcoholic Fatty Liver Disease?

Talk with your doctor about these drugs and supplements, which show some promise in treating certain aspects of NAFLD.

  • Metformin, a low-cost generic drug commonly used in people with diabetes, is not a standard treatment, but it has helped reduce liver enzymes slightly, and it may also help with weight loss and diabetes risk. It doesn’t reduce inflammation or the amount of fat in the liver, though.
  • Orlistat, an over-the-counter and prescription weight loss drug, could theoretically be beneficial if it helps a patient lose weight, but it’s controversial because there have been some reports of liver disease associated with its use. Two newer weight loss drugs approved by the FDA (lorcaserin and phenterminetopiramate) might also help.
  • Cholesterol-lowering drugs (statins) have appeared to be mostly safe when used for NAFLD, and they may help prevent further fatty deposits (such as triglycerides) in the liver.
  • Preliminary studies suggest that 140 milligrams per day of silymarin (milk thistle) might reduce liver enzymes (AST and ALT) in individuals with NASH, but this needs more research. If silymarin helps, it’s most likely going to show the most benefit early in the disease process.
  • Alpha-lipoic acid (ALA) is being studied for weight loss and improving glucose levels in people with diabetes, and since these two factors are often found in fatty liver disease, it’s likely that there would be some benefit for NAFLD. It has an excellent safety record, especially between 600 and 1,800 milligrams per day, so ask your doctor about it. Just divide the total into two or three separate doses and take it 30 minutes before meals (that’s how it was studied for weight loss).

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