From the Guidelines
Liver health supplements, such as Vitamin E, may offer benefits for those with certain liver conditions, particularly nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), but they should be approached with caution due to potential safety concerns. The use of Vitamin E (alpha-tocopherol) has been shown to decrease oxidative stress and improve liver inflammation in patients with NASH, with a significant improvement in liver histology compared to placebo (43% vs. 19%, P=0.001) in the PIVENS study 1. However, high doses of Vitamin E (>400 IU/day) have been associated with an increased risk of prostate cancer or hemorrhagic stroke, and may increase the mortality rate 1.
Key Benefits and Considerations
- Vitamin E may improve liver enzymes, steatosis, inflammation, and ballooning, and resolve steatohepatitis in patients with NASH 1
- The use of Vitamin E is associated with a significant improvement in liver histology compared to placebo in patients with NASH 1
- High doses of Vitamin E (>400 IU/day) may increase the risk of prostate cancer or hemorrhagic stroke, and may increase the mortality rate 1
- Lifestyle changes, such as limiting alcohol, maintaining a healthy weight, and eating a balanced diet, are more proven ways to support liver health
Recommendations
- Vitamin E may be considered as a treatment option for patients with biopsy-proven NASH, particularly those without diabetes mellitus, at a dose of 800 IU/day 1
- Patients should be closely monitored for potential safety concerns, such as prostate cancer or hemorrhagic stroke, and the benefits and risks of Vitamin E treatment should be carefully weighed 1
- Lifestyle changes, such as limiting alcohol, maintaining a healthy weight, and eating a balanced diet, should be recommended as the primary approach to supporting liver health.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Liver Health Supplements
The benefits of liver health supplements can be understood by examining the effects of various compounds on liver function.
- Silymarin, an extract of milk thistle, has been shown to improve liver function in patients with non-alcoholic fatty liver disease (NAFLD) when combined with vitamin E 2.
- The combination of silymarin, vitamin C, vitamin E, coenzyme Q10, and selenomethionine has also been found to be effective in improving liver enzymes and blood lipid profiles in NAFLD patients 3.
- Ursodeoxycholic acid, a hydrophilic bile acid, has been shown to reduce biochemical markers of cholestasis and hepatocellular damage in patients with chronic liver diseases, including primary biliary cirrhosis and primary sclerosing cholangitis 4, 5.
- However, the effectiveness of ursodeoxycholic acid in cystic fibrosis-related liver disease is still uncertain, with insufficient evidence to justify its routine use 6.
Key Findings
- Silymarin plus vitamin E can ameliorate liver function tests and non-invasive NAFLD indexes in patients with NAFLD 2.
- The combination of silymarin, vitamin C, vitamin E, coenzyme Q10, and selenomethionine can improve liver enzymes, lipid profiles, and ultrasonographic results in NAFLD patients 3.
- Ursodeoxycholic acid can improve liver function indices in chronic liver diseases, but its effectiveness in cystic fibrosis-related liver disease is uncertain 4, 5, 6.