From the Guidelines
Vitamin E (alpha-tocopherol) at a dose of 800 IU/day is the most clinically proven supplement to reduce oxidative stress, as evidenced by its significant improvement in liver histology and inflammation in patients with nonalcoholic steatohepatitis (NASH) 1.
Key Findings
- Vitamin E 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 1.
- The PIVENS study, a large-scale phase 3 trial, demonstrated that high-dose vitamin E (800 IU/day) produced significant improvement in liver histology and NASH resolution compared to placebo 1.
- However, long-term use of vitamin E carries safety concerns, including an increased risk of prostate cancer, hemorrhagic stroke, and mortality, highlighting the need for careful consideration and monitoring 1.
Recommendations
- Vitamin E (800 IU/day) is recommended for non-diabetic, non-cirrhotic patients with biopsy-confirmed NASH, due to its proven efficacy in reducing oxidative stress and improving liver histology 1.
- Patients should be informed of the potential risks and benefits of long-term vitamin E use, and regular monitoring is essential to minimize adverse effects.
- Other supplements, such as vitamin C, N-acetylcysteine, alpha-lipoic acid, coenzyme Q10, resveratrol, and curcumin, may also have antioxidant properties, but their efficacy in reducing oxidative stress is not as well-established as vitamin E in the context of NASH 1.
From the Research
Supplements to Reduce Oxidative Stress
The following supplements have been clinically probed to reduce oxidative stress:
- Glutathione and N-acetyl-cysteine (NAC) supplements, which have been shown to minimize oxidative stress and its downstream negative effects 2
- N-acetyl-cysteine (NAC) supplementation, which has been found to increase exercise performance and reduce oxidative stress in individuals with low levels of glutathione 3
- Vitamin E, which has been shown to rescue animal longevity and cellular oxidative stress in pre-clinical models of mitochondrial complex I disease 4
- Alpha-lipoic acid (ALA) and coenzyme Q10 (CoQ10) combination, which has been found to ameliorate experimental diabetic neuropathy by modulating oxidative stress and apoptosis 5
- N-acetylcysteine (NAC), which has been shown to have a well-established safety profile and remarkable antioxidant and anti-inflammatory capacity, making it a potential treatment for several diseases related to oxidative stress and inflammation 6
Key Findings
Some key findings from the studies include:
- NAC supplementation can restore baseline glutathione concentration, reduce systemic oxidative stress, and improve erythrocyte glutathione metabolism in individuals with low glutathione levels 3
- Vitamin E and NAC can fully rescue lifespan and healthspan in animal models of mitochondrial complex I disease 4
- ALA and CoQ10 combination can attenuate diabetic neuropathy-induced motor function deficiency, suppress oxidative stress, and prevent apoptosis and degeneration of dorsal root ganglion neurons 5
- NAC has been shown to increase the intracellular concentration of glutathione, reduce levels of tumor necrosis factor-alpha and interleukins, and suppress the activity of nuclear factor kappa B 6