From the Guidelines
Trimethylglycine (TMG) may be considered as a potential adjunctive treatment for fatty liver disease, but lifestyle modifications, including weight loss, regular exercise, and a Mediterranean-style diet, remain the primary approach to management. TMG, also known as betaine, has been shown to support liver function through its role in methylation processes and may help reduce fat accumulation in liver cells 1. However, the current evidence for TMG in the treatment of fatty liver disease is limited, and more research is needed to fully understand its effects.
Some key points to consider when using TMG for fatty liver disease include:
- Typical supplementation ranges from 500-2000 mg daily, divided into two doses with meals
- TMG may interact with certain medications, so medical supervision is recommended
- Lifestyle modifications, such as weight loss and regular exercise, are essential for managing fatty liver disease
- A Mediterranean-style diet, low in processed foods and sugars, is recommended for patients with fatty liver disease 1
It's also important to note that other micronutrients, such as vitamin E, have been shown to have antioxidant effects and may be beneficial in the treatment of fatty liver disease 1. However, the interactions between different vitamins and between vitamins and macro/micronutrients must be taken into consideration, and more research is needed to fully understand the effects of these micronutrients on fatty liver disease.
In terms of lifestyle modifications, the American Gastroenterological Association recommends a hypocaloric diet, regular physical activity, and avoidance of alcohol for patients with fatty liver disease 1. The Mediterranean diet, in particular, has been shown to be beneficial in reducing hepatic steatosis and improving liver enzyme levels 1. Overall, a comprehensive approach to managing fatty liver disease, including lifestyle modifications and potential adjunctive treatments like TMG, is recommended.
From the Research
Treatment Options for Fatty Liver Disease
- Fatty liver disease, also known as nonalcoholic fatty liver disease (NAFLD), is a common liver disease worldwide 2.
- There is no Food and Drug Association-approved medication for NAFLD patients, but some studies suggest that certain medications such as metformin, silymarin, pioglitazone, and vitamin E may be effective in treating NAFLD 2, 3, 4, 5.
Efficacy of Pioglitazone and Metformin
- Pioglitazone and metformin have been shown to be effective in reducing steatosis, inflammation, and ballooning, and improving liver markers in patients with NAFLD 3, 5.
- A randomized controlled clinical trial found that metformin and pioglitazone in combination with vitamin E decreased the sonography grade of fatty liver and improved liver enzymes in patients with NAFLD 5.
- However, another study found that metformin was more effective than pioglitazone in improving liver enzymes and sonography grade in patients with NAFLD 5.
Response to Pioglitazone in Patients with Type 2 Diabetes
- Pioglitazone has been shown to be effective in patients with NAFLD and type 2 diabetes, with significant reductions in liver fibrosis and improvements in insulin sensitivity 6.
- A prospective study found that pioglitazone was effective in patients with and without type 2 diabetes, but reduced liver fibrosis and increased adipose tissue insulin sensitivity at significantly greater levels in patients with type 2 diabetes 6.