Condition
Hepatic Encephalopathy
Hepatic encephalopathy is brain dysfunction caused by liver disease, when a struggling liver can't clear toxins such as ammonia from the blood. The evidence is strongest for L-carnitine, where five studies found blood ammonia went down, while resveratrol, with moderate evidence, was linked to lower blood urea nitrogen. Those studies were small to moderate in size and tracked lab markers, so they say less about thinking or daily function.
Sources: PMID 30610762
- Supplements studied
- 2
- Graded outcomes
- 2
- Trials
- 7
- People studied
- 1,118
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 | 387 people | ||
| Hepatic Encephalopathy Symptoms | Improves (the measure goes down) | 5 studies | 493 people | |||
Studies that measured hepatic encephalopathy symptoms
| ||||||
| Cognition | Improves (the measure goes up) | 2 studies | 150 people | |||
| Depression Symptoms | Improves (the measure goes down) | 2 studies | 67 people | |||
| Liver Enzymes | Changes; see studies | 2 studies | 67 people | |||
Studies that measured liver enzymes | ||||||
| Attention | Improves (the measure goes up) | 1 study | 217 people | |||
| Anxiety Symptoms | Improves (the measure goes down) | 67 people | ||||
| Bilirubin | Changes; see studies | 67 people | ||||
| Cirrhosis Severity | Changes; see studies | 45 people | ||||
| Serum Albumin | Improves (the measure goes up) | 67 people | ||||
| Urea | Improves (the measure goes up) | 67 people | ||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Blood Urea Nitrogen (BUN) Small Decrease | Improves (the measure goes down) | Small effect | 894 people | |||
| Kidney Function | Improves (the measure goes up) | 2 studies | 135 people | |||
Studies that measured kidney function | ||||||
| Serum Albumin | Improves (the measure goes up) | 516 people | ||||
| Uric Acid | Improves (the measure goes down) | 353 people | ||||
Key findings
- AmmoniaImproves (the measure goes down)
- Blood Urea Nitrogen (BUN)Improves (the measure goes down)
The Hepatic Encephalopathy Support protocol
2 primary supplements · 5 supporting supplements
- L-Carnitine (LOLA alternative)1–2 g L-carnitine daily or 9–18 g LOLA daily
- Branched-Chain Amino Acids (BCAAs)0.25 g/kg/day or as directed
Shop the evidence-backed picks
Support alongside medical care. These supplements are not a treatment for Hepatic Encephalopathy. If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.
The supplements graded A or B for Hepatic Encephalopathy. Each opens the products we list for that supplement.
- Grade A
- Grade B
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Studies cited
100 studies from PubMed
- Resveratrol Blunts the Positive Effects of Exercise Training on Cardiovascular Health in Aged Men
- L-carnitine ameliorated fasting-induced fatigue, hunger, and metabolic abnormalities in patients with metabolic syndrome: a randomized controlled study
- L-Carnitine's Effect on the Biomarkers of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- Ameliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapy
- Comparative study to evaluate the effect of l-carnitine plus glimepiride versus glimepiride alone on insulin resistance in type 2 diabetic patients
- Effects of simvastatin and carnitine versus simvastatin on lipoprotein(a) and apoprotein(a) in type 2 diabetes mellitus
- Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patients
- Effects of combination of sibutramine and L-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients
- L-Carnitine supplementation reduces oxidized LDL cholesterol in patients with diabetes
- Effect of L-carnitine on plasma glycemic and lipidemic profile in patients with type II diabetes mellitus
- Effect of carnitine-orotate complex on glucose metabolism and fatty liver: a double-blind, placebo-controlled study
- Efficacy and tolerability of combined treatment with L-carnitine and simvastatin in lowering lipoprotein(a) serum levels in patients with type 2 diabetes mellitus
- Blood Pressure and Metabolic Effects of Acetyl-l-Carnitine in Type 2 Diabetes: DIABASI Randomized Controlled Trial
- The effects of oral L-carnitine treatment on blood lipid metabolism and the body fat content in the diabetic patient
- The effect of L-carnitine on plasma lipoprotein(a) levels in hypercholesterolemic patients with type 2 diabetes mellitus
- The effects of L-carnitine supplementation on cardiovascular risk factors in participants with impaired glucose tolerance and diabetes: a systematic review and dose-response meta-analysis.
- Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial
- Effect of oral L-carnitine administration on insulin sensitivity and lipid profile in type 2 diabetes mellitus patients
- The effects of L-carnitine supplementation on glycemic markers in adults: A systematic review and dose-response meta-analysis.
- L-carnitine improves glucose disposal in type 2 diabetic patients
- Caloric restriction and L-carnitine administration improves insulin sensitivity in patients with impaired glucose metabolism
- Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes
- Acetyl-l-carnitine versus placebo for migraine prophylaxis: A randomized, triple-blind, crossover study
- The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis
- Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta-analysis.
- Oral carnitine supplementation reduces body weight and insulin resistance in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial
- Effects of Carnitine Administration on Carotid Intima-media Thickness and Inflammatory Factors in Patients with Polycystic Ovary Syndrome: A Randomized, Double-blind, Placebo-controlled Trial
- Effects of L-carnitine supplementation for women with polycystic ovary syndrome: a systematic review and meta-analysis
- Effect of glycine propionyl-L-carnitine on aerobic and anaerobic exercise performance
- Influence of L-carnitine administration on maximal physical exercise
- Effects of nine weeks L-Carnitine supplementation on exercise performance, anaerobic power, and exercise-induced oxidative stress in resistance-trained males
- l-Carnitine l-tartrate supplementation favorably affects biochemical markers of recovery from physical exertion in middle-aged men and women
- Glycine propionyl-L-carnitine produces enhanced anaerobic work capacity with reduced lactate accumulation in resistance trained males
- Chronic oral ingestion of L-carnitine and carbohydrate increases muscle carnitine content and alters muscle fuel metabolism during exercise in humans
- The effect of oral supplementation with L-carnitine on maximum and submaximum exercise capacity
- Effect of intravenous L-carnitine on carnitine homeostasis and fuel metabolism during exercise in humans
- Effects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effort
- l-Carnitine Supplementation in Older Women. A Pilot Study on Aging Skeletal Muscle Mass and Function
- Effects of L-carnitine L-tartrate supplementation on muscle oxygenation responses to resistance exercise
- The effects of L-carnitine L-tartrate supplementation on hormonal responses to resistance exercise and recovery
- Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue
- Oxidative stress in response to aerobic and anaerobic power testing: influence of exercise training and carnitine supplementation
- Effect of L-carnitine on submaximal exercise metabolism after depletion of muscle glycogen
- Androgenic responses to resistance exercise: effects of feeding and L-carnitine
- Carbohydrate, protein, and fat metabolism during exercise after oral carnitine supplementation in humans
- Effects of four weeks L-carnitine L-tartrate ingestion on substrate utilization during prolonged exercise
- L -Carnitine and the recovery from exhaustive endurance exercise: a randomised, double-blind, placebo-controlled trial
- Effects of carnitine coingested caffeine on carnitine metabolism and endurance capacity in athletes
- Effects of L-carnitine supplementation on physical performance and energy metabolism of endurance-trained athletes: a double-blind crossover field study
- Clinical Effects of L-Carnitine Supplementation on Physical Performance in Healthy Subjects, the Key to Success in Rehabilitation: A Systematic Review and Meta-Analysis from the Rehabilitation Point of View.
- L-Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double-Blind Placebo-Controlled Study
- Effect of lysine, vitamin B(6), and carnitine supplementation on the lipid profile of male patients with hypertriglyceridemia: a 12-week, open-label, randomized, placebo-controlled trial
- L-carnitine infusion does not alleviate lipid-induced insulin resistance and metabolic inflexibility
- Effects of acute versus chronic L-carnitine L-tartrate supplementation on metabolic responses to steady state exercise in males and females
- Liver-Oriented Acute Metabolic Effects of A Low Dose of L-Carnitine under Fat-Mobilizing Conditions: Pilot Human Clinical Trial
- The effects of L-carnitine supplementation on glycemic control: a systematic review and meta-analysis of randomized controlled trials
- The effect of L-carnitine on inflammatory mediators: a systematic review and meta-analysis of randomized clinical trials
- Single dose administration of L-carnitine improves antioxidant activities in healthy subjects
- Comparison of pre-workout nitric oxide stimulating dietary supplements on skeletal muscle oxygen saturation, blood nitrate/nitrite, lipid peroxidation, and upper body exercise performance in resistance trained men
- Glycine propionyl-L-carnitine modulates lipid peroxidation and nitric oxide in human subjects
- L-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis--a randomized and controlled clinical trial
- Effects of carnitine supplementation on flow-mediated dilation and vascular inflammatory responses to a high-fat meal in healthy young adults
- The effect of l-carnitine on fat oxidation, protein turnover, and body composition in slightly overweight subjects
- Effects of exercise intensity and altered substrate availability on cardiovascular and metabolic responses to exercise after oral carnitine supplementation in athletes
- Safety measures of L-carnitine L-tartrate supplementation in healthy men
- Effects of oral L-carnitine supplementation on insulin sensitivity indices in response to glucose feeding in lean and overweight/obese males
- Glycine propionyl-L-carnitine increases plasma nitrate/nitrite in resistance trained men
- Effects of L-carnitine on oxidative stress responses in patients with renal disease
- Effects of L-carnitine supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials.
- Effects of combined treatment with simvastatin and L-carnitine on triglyceride levels in diabetic patients with hyperlipidaemia
- Effects of L-carnitine supplementation on lipid profiles in patients with coronary artery disease
- Effects of carnitine on thyroid hormone action
- L-carnitine improves the asthma control in children with moderate persistent asthma
- Carnitine supplementation improves metabolic flexibility and skeletal muscle acetylcarnitine formation in volunteers with impaired glucose tolerance: A randomised controlled trial
- The effects of L-carnitine supplementation on performance during interval swimming
- Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging
- Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy
- l-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility.
- Effects of L-carnitine administration on VO2max and the aerobic-anaerobic threshold in normoxia and acute hypoxia
- The effects of acute L-carnitine supplementation on endurance performance of athletes
- Acetyl-L-carnitine (ALC) in attention-deficit/hyperactivity disorder: a multi-site, placebo-controlled pilot trial
- Acetyl-L-carnitine as an adjunctive therapy in the treatment of attention-deficit/hyperactivity disorder in children and adolescents: a placebo-controlled trial
- Efficacy of carnitine in the treatment of children with attention-deficit hyperactivity disorder
- A double-blind, parallel, multicenter comparison of L-acetylcarnitine with placebo on the attention deficit hyperactivity disorder in fragile X syndrome boys
- L-Carnitine supplementation combined with aerobic training does not promote weight loss in moderately obese women
- Acetyl-L-carnitine treatment in minimal hepatic encephalopathy
- Acetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial
- Acetyl-L-carnitine reduces depression and improves quality of life in patients with minimal hepatic encephalopathy
- Oral acetyl-L-carnitine therapy reduces fatigue in overt hepatic encephalopathy: a randomized, double-blind, placebo-controlled study
- L-Carnitine in the treatment of mild or moderate hepatic encephalopathy
- Acetyl-L-carnitine for patients with hepatic encephalopathy
- L-Carnitine for the Treatment of Overt Hepatic Encephalopathy in Patients with Advanced Liver Cirrhosis
- Effects of L-carnitine in patients with hepatic encephalopathy
- Cinnoxicam and L-carnitine/acetyl-L-carnitine treatment for idiopathic and varicocele-associated oligoasthenospermia
- Does L-carnitine therapy add any extra benefit to standard inguinal varicocelectomy in terms of deoxyribonucleic acid damage or sperm quality factor indices: a randomized study
- Use of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trial
- Placebo-controlled double-blind randomized trial on the use of L-carnitine, L-acetylcarnitine, or combined L-carnitine and L-acetylcarnitine in men with idiopathic asthenozoospermia
- Use of carnitine therapy in selected cases of male factor infertility: a double-blind crossover trial
- Oral carnitine supplementation increases sperm motility in asthenozoospermic men with normal sperm phospholipid hydroperoxide glutathione peroxidase levels
- Safety and efficacy of clomiphene citrate and L-carnitine in idiopathic male infertility: a comparative study