Non-alcoholic fatty liver disease (NAFLD) is a growing epidemic in the U.S. and throughout the world. It is a condition characterized by lipid build up in the liver, and is the leading cause of abnormal liver enzymes.

Insulin resistance, diabetes, obesity, and metabolic syndrome are all major factors in the development of NAFLD, primarily driven by the excess intake of sugar. Long term hyperglycemia causes an increase in the synthesis of fatty acids and triglycerides in the liver, thus leading to fatty liver. The gut-liver axis plays a significant contribution as well. Gut dysbiosis and intestinal hyperpermeability lead to liver damage through proinflammatory responses.

At this time there are few guidelines for diagnostic and follow up methods for NAFLD, and limited proven treatment options. Previous research of pharmacological agents for this condition has yielded poor results.

In a new review published two weeks ago, researchers investigated the current findings of using various nutraceuticals for NAFLD, shedding light on the beneficial effects of such nutrients as milk thistle, vitamins D and E, omega-3 fatty acids, CoQ10, berberine and curcumin.

Milk thistle is a powerful antioxidant that has hepatoprotective properties with its anti-inflammatory, antifibrotic, and metabolic effects. It has been shown to improve insulin resistance and indirect markers of fatty liver after 3 months of treatment. Dosing in this review ranged from 150 mg/d up to 420 mg/d.

Numerous studies have demonstrated low polyunsaturated fat and the development of pathogenesis of NAFLD. In addition, supplementation with fish oil was associated with mitigating the disease process and improving lipid markers and insulin resistance in patients with NAFLD. Fish oil supplementation restores insulin sensitivity and exerts anti-inflammatory actions. In addition, fish oil significantly reduces liver enzymes. Dosing ranges have been studied between 1 to 4 grams per day.

Coenzyme Q10 is another antioxidant that has gained some recent attention in the management of NAFLD. A recent study demonstrated that 100 mg/d of CoQ10 for 3 weeks significantly reduced liver enzymes and hs-CRP, as well as improved adiponectin/leptin ratio.

Berberine, an alkaloid compound found in several plants commonly used in botanical and Chinese medicine, has been also shown to improve indirect markers for NALFD at doses ranging from 500 mg to 1500 mg/d.

Curcumin’s powerful antioxidant and anti-inflammatory properties also have been shown to be beneficial in NAFLD. Curcumin is an insulin-sensitizing agent shown to significantly improve the degree of hepatic steatosis by liver ultrasound at doses of 400 mg/d- 1000 mg/d over an 8 week period.

Furthermore, probiotics play a role in improving NAFLD. They restore the gastrointestinal barrier function, modulate the immune system, and inhibit the proliferation of harmful bacteria. Probiotics have been shown to reduce liver fat and improve liver enzymes. They are most likely effective by preventing bacterial translocation and reducing the effects of the intestinal microbiota on the liver.

It is essential to encourage a restricted carbohydrate diet and exercise to support weight loss in these individuals. They have established disease and higher nutrition demands than what could be obtained from the diet alone and, therefore, dietary supplements should be considered to help reduce the progression and improve liver function in patients with NAFLD.

By Michael Jurgelewicz, DC, DACBN, DCBCN, CNS

Source: Cicero A, Colletti A, et al. Nutraceutical approach to non-alcoholic fatty liver disease (NALFD): The available clinical evidence. Nutrients. 2018 Aug 23; 10(9).