Condition
Cirrhosis
Cirrhosis is advanced scarring of the liver, left by long-term damage from alcohol, viral hepatitis, or fatty liver disease, which leaves the organ less able to filter blood and make proteins. Among supplements, L-carnitine has some of the better-supported findings, and in five studies blood ammonia went down, a toxin that builds up when the liver struggles. Those studies were small, covering only 76 people, so the evidence is moderate at best.
Sources: PMID 30610762
- Supplements studied
- 4
- Graded outcomes
- 2
- Trials
- 5
- People studied
- 728
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Ammonia Moderate Decrease | Improves (the measure goes down) | Moderate effect | 5 studies | 76 people | ||
| Hepatic Encephalopathy Symptoms | Improves (the measure goes down) | 5 studies | 31 people | |||
Studies that measured hepatic encephalopathy symptoms
| ||||||
| Cramps | Improves (the measure goes down) | 1 study | 42 people | |||
Studies that measured cramps | ||||||
| Cirrhosis Severity | Changes; see studies | 45 people | ||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Blood Pressure Small Improvement | Improves (the measure goes down) | Small effect | 10 studies | 22 people | ||
Studies that measured blood pressure
| ||||||
| Heart Rate | Improves (the measure goes down) | 22 people | ||||
| Hepatic Venous Pressure Gradient | Improves (the measure goes up) | 22 people | ||||
| Portal Hypertension Signs | Improves (the measure goes down) | 22 people | ||||
Silymarin
- Liver Enzymes: changes; see studies
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Liver Enzymes | Changes; see studies | 6 studies | 564 people | |||
Studies that measured liver enzymes
| ||||||
TUDCA
- Liver Enzymes: changes; see studies
- High-density lipoprotein (HDL): worsens
- Total cholesterol: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Liver Enzymes | Changes; see studies | 4 studies | 24 people | |||
Studies that measured liver enzymes
| ||||||
| High-density lipoprotein (HDL) Small Detriment | Worsens (the measure goes down) | Small effect | 24 people | |||
| Total cholesterol | Improves (the measure goes down) | 24 people | ||||
Key findings
- AmmoniaImproves (the measure goes down)
- Blood PressureImproves (the measure goes down)
The Cirrhosis Adjunctive Support protocol
2 primary supplements · 7 supporting supplements
- L-Carnitine1–2 g twice daily
- Branched-Chain Amino Acids (BCAAs)5–15 g daily in divided doses
Shop the evidence-backed picks
Support alongside medical care. These supplements are not a treatment for Cirrhosis. If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.
The supplement graded A or B for Cirrhosis. Each opens the products we list for that supplement.
- Grade B
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Studies cited
31 studies from PubMed
- A multicenter, randomized, double-blind trial comparing the efficacy and safety of TUDCA and UDCA in Chinese patients with primary biliary cholangitis.
- Ursodeoxycholic and tauro-ursodeoxycholic acids for the treatment of primary biliary cirrhosis: a pilot crossover study.
- Tauroursodeoxycholic acid for treatment of primary biliary cirrhosis. A dose-response study.
- Tauroursodeoxycholic acid for the treatment of HCV-related chronic hepatitis: a multicenter placebo-controlled study
- Effects and tolerance of silymarin (milk thistle) in chronic hepatitis C virus infection patients: a meta-analysis of randomized controlled trials.
- An updated systematic review with meta-analysis for the clinical evidence of silymarin.
- Effect of Medicinal Plants and Natural Products on Liver Enzymes in Non-alcoholic Fatty Liver Patients in Iran: A Systematic Review and Meta-Analysis.
- The therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease: A meta-analysis (PRISMA) of randomized control trials
- Impact of Silymarin in individuals with nonalcoholic fatty liver disease: A systematic review and meta-analysis
- Effect of silymarin on biochemical indicators in patients with liver disease: Systematic review with meta-analysis.
- The short-term effect of flavonoid-rich dark chocolate on retinal vessel diameter in glaucoma patients and age-matched controls
- Postprandial effects of dark chocolate on portal hypertension in patients with cirrhosis: results of a phase 2, double-blind, randomized controlled trial
- Effect of cocoa products on blood pressure: systematic review and meta-analysis.
- Dark chocolate for children's blood pressure: randomised trial
- Dark chocolate or tomato extract for prehypertension: a randomised controlled trial
- Effect of cocoa on blood pressure
- Effect of dark chocolate on nitric oxide serum levels and blood pressure in prehypertension subjects
- Blood pressure and endothelial function in healthy, pregnant women after acute and daily consumption of flavanol-rich chocolate: a pilot, randomized controlled trial
- Characterisation of hypertensive patients with improved endothelial function after dark chocolate consumption
- Safety and efficacy of cocoa flavanol intake in healthy adults: a randomized, controlled, double-masked trial
- L-carnitine Reduces Muscle Cramps in Patients With Cirrhosis
- Efficacy of L-carnitine in reducing hyperammonaemia and improving neuropsychological test performance in patients with hepatic cirrhosis : results of a randomised trial
- Effects of L-carnitine in patients with hepatic encephalopathy
- L-Carnitine for the Treatment of Overt Hepatic Encephalopathy in Patients with Advanced Liver Cirrhosis
- Acetyl-L-carnitine for patients with hepatic encephalopathy
- L-Carnitine in the treatment of mild or moderate hepatic encephalopathy
- Oral acetyl-L-carnitine therapy reduces fatigue in overt hepatic encephalopathy: a randomized, double-blind, placebo-controlled study
- Acetyl-L-carnitine reduces depression and improves quality of life in patients with minimal hepatic encephalopathy
- Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial
- Acetyl-L-carnitine treatment in minimal hepatic encephalopathy
- Carbohydrate, protein, and fat metabolism during exercise after oral carnitine supplementation in humans