Liver Support Supplements Lack Proven Benefits for Liver Disease
Liver support supplements do not have proven benefits for liver disease outcomes including mortality, morbidity, or quality of life based on current evidence. 1, 2
Evidence Assessment
- Multiple systematic reviews have assessed antioxidant supplements for liver diseases and found no significant effect on all-cause mortality or liver-related mortality 1, 2
- A Cochrane systematic review including 20 randomized trials with 1225 participants found no evidence to support or refute the use of antioxidant supplements in patients with liver disease 1
- Antioxidant supplements may actually increase liver enzyme activity, specifically gamma glutamyl transpeptidase, suggesting potential harm 1, 2
- The European Society for Clinical Nutrition and Metabolism (ESPEN) guidelines do not recommend specialized liver formulas, stating "Standard enteral formulas can be given, as there are no data regarding the value of a disease specific composition" 3
Nutritional Support in Liver Disease
- While nutritional therapy is recommended for patients with severe alcoholic hepatitis who cannot meet requirements through spontaneous food intake, this refers to standard nutritional support rather than specialized liver supplements 3
- ESPEN guidelines recommend standard enteral formulas for patients with acute liver failure, as there is no evidence that specialized formulas with branched-chain amino acids improve outcomes 3
- For patients with liver failure who cannot eat orally, the recommended approach is standard enteral nutrition via nasogastric/nasojejunal tube rather than specialized liver supplements 3
Specific Liver Support Interventions
- N-acetylcysteine is the only liver-supportive agent with strong evidence, but only for acetaminophen-induced acute liver failure 3, 4
- For non-acetaminophen acute liver failure, N-acetylcysteine should only be used in clinical trial settings 3
- Extracorporeal liver support systems have shown no clear effect on mortality in multiple systematic reviews and should only be used within clinical trials 3, 5
- Seven randomized controlled trials involving 415 patients with acute liver failure showed no significant improvement in survival with artificial liver support systems 5
Herbal and Antioxidant Supplements
- A review of herbal supplements for chronic liver disease found that while many trials suggest herbs can decrease serum transaminase levels, effects on hepatic histopathology and long-term survival are either poorly studied or show conflicting results 6
- Antioxidant supplements including beta-carotene, vitamin A, C, E, and selenium showed no significant effect on liver-related outcomes in systematic reviews 1, 2
- Some herbal supplements have been withdrawn from the market due to deleterious effects in patients with liver disease 6
Practical Recommendations
- Nutritional support for liver disease patients should focus on meeting caloric and protein requirements through standard nutrition rather than specialized liver supplements 3, 7
- For patients with severe alcoholic hepatitis, oral nutritional supplements should be used when patients cannot meet caloric requirements through normal food, but standard formulations are appropriate 3
- Patients should be cautioned about the use of herbal and antioxidant supplements for liver disease as they lack proven benefits and may have potential harms 1, 6
- Physicians should inquire about supplement use as many patients with chronic liver disease frequently use nutrition supplements and complementary/alternative medicine agents in addition to their traditional medicines 8
In conclusion, despite the widespread marketing and use of liver support supplements, current evidence does not support their efficacy in improving clinically important outcomes in liver disease.