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Condition

Nonalcoholic Steatohepatitis (NASH)

NASH is a serious form of fatty liver disease in which fat buildup sparks inflammation and liver cell damage, driven by metabolic problems like insulin resistance rather than alcohol. Silymarin from milk thistle has the most reviewed research, and six studies found liver enzymes improved, with moderate evidence. Betaine showed a similar improvement, though that research was small, involving only 30 people.

Sources: PMID 28785154; PMID 33418491

Supplements studied
7
Graded outcomes
7
Trials
11
People studied
3,423

Evidence by supplement

  • Strong
  • Moderate
  • Limited
  • Very limited

7 supplements

Silymarin

Silymarin: outcomes studied for Nonalcoholic Steatohepatitis (NASH)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Liver Enzymes

Small Improvement

Improves (the measure goes down)Small effect6 studies437 people

Studies that measured liver enzymes

and 3 more on the Silymarin page

Total cholesterolImproves (the measure goes down)166 people
TriglyceridesImproves (the measure goes down)166 people

Betaine

Betaine: outcomes studied for Nonalcoholic Steatohepatitis (NASH)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Liver Enzymes

Small Improvement

Improves (the measure goes down)Small effect30 people
Liver FibrosisChanges; see studies1 study30 people

Studies that measured liver fibrosis

Liver FatChanges; see studies30 people

Synbiotics

  • Blood Pressure
  • Liver Enzymes: changes; see studies
  • Weight: improves
Synbiotics: outcomes studied for Nonalcoholic Steatohepatitis (NASH)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Blood Pressure

Mixed effect

319 people
Liver EnzymesChanges; see studies1 study957 people

Studies that measured liver enzymes

WeightImproves (the measure goes down)1 study701 people

Studies that measured weight

Body FatImproves (the measure goes down)227 people
C-Reactive Protein (CRP)Improves (the measure goes down)478 people
Liver FatImproves (the measure goes down)137 people
Liver FibrosisImproves (the measure goes down)238 people
TNF-AlphaImproves (the measure goes down)233 people
Total cholesterolImproves (the measure goes down)877 people
Waist circumferenceImproves (the measure goes down)316 people

L-Carnitine

  • Body Fat: improves
  • Muscle Mass: improves
  • Oxidative Stress Biomarkers: improves
L-Carnitine: outcomes studied for Nonalcoholic Steatohepatitis (NASH)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Body Fat

Small Decrease

Improves (the measure goes down)Small effect1 study71 people

Studies that measured body fat

Muscle MassImproves (the measure goes up)3 studies71 people

Studies that measured muscle mass

Oxidative Stress BiomarkersImproves (the measure goes down)3 studies72 people

Studies that measured oxidative stress biomarkers

Liver EnzymesChanges; see studies2 studies30 people

Studies that measured liver enzymes

TNF-AlphaImproves (the measure goes down)2 studies102 people

Studies that measured tnf-alpha

C-Reactive Protein (CRP)Improves (the measure goes down)1 study72 people
WeightImproves (the measure goes down)1 study71 people
Glycemic ControlImproves (the measure goes up)30 people
Transforming Growth Factor BetaImproves (the measure goes up)72 people
Waist circumferenceImproves (the measure goes down)71 people

Whey Protein

  • Anti-Oxidant Enzyme Profile: improves
  • Weight: improves
  • Glycemic Control: improves
Whey Protein: outcomes studied for Nonalcoholic Steatohepatitis (NASH)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Anti-Oxidant Enzyme Profile

Small Increase

Improves (the measure goes up)Small effect59 people
WeightImproves (the measure goes down)4 studies59 people

Studies that measured weight

and 1 more on the Whey Protein page

Glycemic ControlImproves (the measure goes up)1 study59 people

Studies that measured glycemic control

Liver EnzymesChanges; see studies59 people
Liver FatImproves (the measure goes down)59 people

Melatonin

  • Adiponectin: improves
  • Ghrelin: improves
  • Glycemic Control: improves
Melatonin: outcomes studied for Nonalcoholic Steatohepatitis (NASH)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Adiponectin

Small Increase

Improves (the measure goes up)Small effect16 people
GhrelinImproves (the measure goes up)1 study16 people

Studies that measured ghrelin

Glycemic ControlImproves (the measure goes up)16 people
InsulinChanges; see studies16 people
Leptin
Liver EnzymesChanges; see studies16 people
ResistinImproves (the measure goes up)16 people

Vitamin E

  • Bilirubin
  • Oxidative Stress Biomarkers: improves
  • Total cholesterol: improves
Vitamin E: outcomes studied for Nonalcoholic Steatohepatitis (NASH)
GradeOutcomeEffectSizeStudiesPeopleStudies list
Bilirubin

No effect

NoneNo effect222 people
Oxidative Stress BiomarkersImproves (the measure goes down)3 studies43 people

Studies that measured oxidative stress biomarkers

Total cholesterolImproves (the measure goes down)2 studies244 people

Studies that measured total cholesterol

TriglyceridesImproves (the measure goes down)2 studies244 people

Studies that measured triglycerides

Cirrhosis SeverityChanges; see studies1 study239 people

Studies that measured cirrhosis severity

High-density lipoprotein (HDL)Improves (the measure goes up)1 study222 people
Liver EnzymesImproves (the measure goes down)1 study1,008 people
Liver FatImproves (the measure goes down)1 study1,008 people
WeightImproves (the measure goes down)1 study244 people
Blood glucoseImproves (the measure goes down)222 people
Glycemic ControlImproves (the measure goes up)239 people
Liver FibrosisImproves (the measure goes down)1,008 people
Low-density lipoprotein (LDL)Improves (the measure goes down)222 people
Serum TGF-βImproves (the measure goes up)22 people

Key findings

  • Liver EnzymesSilymarinImproves (the measure goes down)
  • Blood PressureSynbiotics
  • Body FatL-CarnitineImproves (the measure goes down)

The Nonalcoholic Steatohepatitis (NASH) protocol

2 primary supplements · 6 supporting supplements

See the full protocol

Shop the evidence-backed picks

Support alongside medical care. These supplements are not a treatment for Nonalcoholic Steatohepatitis (NASH). 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 Nonalcoholic Steatohepatitis (NASH). Each opens the products we list for that supplement.

  • Grade B

Links to Fullscript, iHerb or Thorne carry our referral, so we may earn a commission at no extra cost to you. Grades come from the research and never change based on what we earn. Fullscript asks for a free account before it shows its catalog and prices. Full disclosure

Studies cited

40 studies from PubMed

  1. Open-labeled pilot study of cysteine-rich whey protein isolate supplementation for nonalcoholic steatohepatitis patientsJ Gastroenterol Hepatol · PMID 19638084
  2. A whey-protein supplement increases fat loss and spares lean muscle in obese subjects: a randomized human clinical studyNutr Metab · PMID 18371214
  3. Efficacy and Safety of Whey Protein Supplements on Vital Sign and Physical Performance Among Athletes: A Network Meta-Analysis.Front Pharmacol · PMID 31068804
  4. Changes in antioxidant status and cardiovascular risk factors of overweight young men after six weeks supplementation of whey protein isolate and resistance trainingAppetite · PMID 22889987
  5. Effect of whey protein supplementation on weight and body composition indicators: A meta-analysis of randomized clinical trials.Clin Nutr ESPEN · PMID 35871954
  6. Vitamin E for people with non-alcoholic fatty liver disease.Cochrane Database Syst Rev · PMID 39412049
  7. Vitamin E and respiratory tract infections in elderly nursing home residents: a randomized controlled trialJAMA · PMID 15315997
  8. Megavitamin E supplementation in manAm J Clin Nutr · PMID 803000
  9. Study on the effect of megavitamin E supplementation in manAm J Clin Nutr · PMID 347918
  10. Vitamin E improves serum markers and histology in adults with metabolic dysfunction-associated steatotic liver disease: Systematic review and meta-analysis.J Gastroenterol Hepatol · PMID 39150005
  11. Long-term (>=2 yr) efficacy of vitamin E for non-alcoholic steatohepatitisHepatogastroenterology · PMID 23933938
  12. Plasma transforming growth factor-beta1 level and efficacy of alpha-tocopherol in patients with non-alcoholic steatohepatitis: a pilot studyAliment Pharmacol Ther · PMID 11564008
  13. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitisN Engl J Med · PMID 20427778
  14. Assessment of the safety of supplementation with different amounts of vitamin E in healthy older adultsAm J Clin Nutr · PMID 9701188
  15. Dose dependent elevation of plasma tocotrienol levels and its effect on arterial compliance, plasma total antioxidant status, and lipid profile in healthy humans supplemented with tocotrienol rich vitamin EJ Nutr Sci Vitaminol · PMID 17330512
  16. Effects of vitamin E on lipid peroxidation in healthy personsJAMA · PMID 11231747
  17. The relationship between dose of vitamin E and suppression of oxidative stress in humansFree Radic Biol Med · PMID 17936185
  18. Effect of synbiotics on the cardiovascular risk factors in patients with non-alcoholic fatty liver: a GRADE assessed systematic review and meta-analysis.BMC Gastroenterol · PMID 40419987
  19. The effect of synbiotics on liver enzymes, obesity indices, blood pressure, lipid profile, and inflammation in patients with non-alcoholic fatty liver: A systematic review and meta-analysis of randomized controlled trials.Pharmacol Res · PMID 39241935
  20. Effects and tolerance of silymarin (milk thistle) in chronic hepatitis C virus infection patients: a meta-analysis of randomized controlled trials.Biomed Res Int · PMID 25247194
  21. An updated systematic review with meta-analysis for the clinical evidence of silymarin.Forsch Komplementmed · PMID 18334810
  22. Effect of Medicinal Plants and Natural Products on Liver Enzymes in Non-alcoholic Fatty Liver Patients in Iran: A Systematic Review and Meta-Analysis.Int J Prev Med · PMID 35958359
  23. The therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease: A meta-analysis (PRISMA) of randomized control trialsMedicine · PMID 29245314
  24. Impact of Silymarin in individuals with nonalcoholic fatty liver disease: A systematic review and meta-analysisNutrition · PMID 33418491
  25. Effect of silymarin on biochemical indicators in patients with liver disease: Systematic review with meta-analysis.World J Gastroenterol · PMID 28785154
  26. Plasma insulin, leptin, adiponectin, resistin, ghrelin, and melatonin in nonalcoholic steatohepatitis patients treated with melatoninJ Pineal Res · PMID 22804755
  27. L-Carnitine treatment reduces severity of physical and mental fatigue and increases cognitive functions in centenarians: a randomized and controlled clinical trialAm J Clin Nutr · PMID 18065594
  28. Effects of carnitine supplementation on liver aminotransferase enzymes: A systematic review and meta-analysis of randomized controlled clinical trialsIndian J Gastroenterol · PMID 31828538
  29. Data from a randomized and controlled trial of LCarnitine prescription for the treatment for Non- Alcoholic Fatty Liver DiseaseBioinformation · PMID 25352725
  30. L-Carnitine supplementation combined with aerobic training does not promote weight loss in moderately obese womenInt J Sport Nutr Exerc Metab · PMID 10861338
  31. The effect of l-carnitine on fat oxidation, protein turnover, and body composition in slightly overweight subjectsMetabolism · PMID 15281008
  32. Effects of carnitine supplementation on flow-mediated dilation and vascular inflammatory responses to a high-fat meal in healthy young adultsAm J Cardiol · PMID 18993165
  33. L-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis--a randomized and controlled clinical trialAm J Gastroenterol · PMID 20068559
  34. Glycine propionyl-L-carnitine modulates lipid peroxidation and nitric oxide in human subjectsInt J Vitam Nutr Res · PMID 20209464
  35. 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 menJ Int Soc Sports Nutr · PMID 20459623
  36. Single dose administration of L-carnitine improves antioxidant activities in healthy subjectsTohoku J Exp Med · PMID 21701126
  37. Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigueDrugs Aging · PMID 12875611
  38. l-Carnitine Supplementation in Older Women. A Pilot Study on Aging Skeletal Muscle Mass and FunctionNutrients · PMID 29473908
  39. L-carnitine ameliorated fasting-induced fatigue, hunger, and metabolic abnormalities in patients with metabolic syndrome: a randomized controlled studyNutr J · PMID 25424121
  40. Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot studyAm J Gastroenterol · PMID 11569700

Supplement stack for Nonalcoholic Steatohepatitis (NASH)