Vitamins For Fatty Liver

Fatty liver disease

The liver is the largest gland in the body and the second largest human organ after the skin. Providing over 500 functions, and with one in ten people likely to have a problem with it during their lifetime, it’s important to treat it well. This article is about vitamins for fatty liver, but it also deals with what a fatty liver is and what can be done about it.

It’s all in the name(s)

Fatty liver disease is when there is an increased amount of fat in your liver.  Drinking excess alcohol can cause this; however, there is also Non-Alcoholic Fatty Liver Disease (NAFLD), which can be divided into Non-Alcoholic Fatty Liver (NAFL) and Non-Alcoholic Steatohepatitis (NASH).  The rise in cases mirrors rising obesity levels (with which it is closely associated), with NAFLD now estimated to affect 38% of the global population.¹

NAFL (the first stage of a fatty liver) is generally harmless, producing no symptoms, but has the potential to progress into NASH, where the liver is inflamed.  Most people with NAFL won’t get to this stage; however, it is more serious as the inflammation can cause damage to the liver in the form of fibrosis (think of it like scar tissue) and cirrhosis (an even worse stage of extreme scarring).  The other concern with NAFLD is its connection with something called metabolic syndrome – a combination of problems that leads to a higher risk of diabetes and heart disease.

Treatment

Currently, no medications are approved to treat a fatty liver, and only individuals matching a specific set of circumstances are recommended vitamin E supplements or a drug called pioglitazone. Instead, lifestyle changes are encouraged, and drugs that target associated conditions, such as those for high blood pressure, may be prescribed.  Weight loss remains the cornerstone of treatment, with a Mediterranean diet and moderate physical activity recommended.  Losing weight is one of the most effective things you can do to limit or even reverse the damage from a fatty liver – at the mild end of the condition.² Bariatric surgery may be advised in certain cases.

Vitamins and their role in liver health

With weight loss being somewhat of a challenge for several people for various reasons, any boost to improve liver health is welcome. Vitamins help keep our bodies working at their best, with each one being unique and known by a specific letter/name.  A deficiency of these vital nutrients can cause health problems and may even negatively affect the liver.³

The B vitamins help the liver do its job effectively, while vitamin C is an antioxidant that mops up harmful free radicals that can damage cells.⁴ A lack of vitamin D (the “sunshine” vitamin) has been linked with liver disease, and vitamin E shows the most promise in those with fatty liver.  Normal doses of vitamin A are not known to be associated with liver injury, but high doses can be toxic.^5,6

Vitamins for fatty liver

Vitamin E has been extensively studied in people with NAFLD and is the only one currently that may be recommended by healthcare professionals as an additional treatment for weight loss in some people.  That’s not to say the others have no effect, and vitamins for fatty liver may help manage it.  Here, we will go through them one by one.

Vitamin A

Vitamin A is one of the fat-soluble vitamins (along with D, E and K), and most of it is stored in the liver.  It is involved in lipolytic (breaking down of fat) and lipogenic (creation of fat) pathways and so may have a complex relationship with fat accumulation in NAFLD patients.⁷ The contradictions don’t end there: a review article from 2022 found studies had differing results on how the protein that transports vitamin A in the circulation, retinol-binding protein-4 (RBP4), affected NAFLD patients.⁸ Vitamin A does, however, have antioxidant properties, and deficiency has been seen with worsening NASH.

Vitamin B complex

There are 8 different types in the group.  Most research has focussed on 3 of the B vitamins and fatty liver disease: niacin, folate and B12.^9.10

• In a rat model of NAFLD, niacin was able to block a gain in liver weight, as well as protect against existing fatty livers.  Human trials have been mixed; results from one study showed improvement in liver fat levels while another didn’t (although it did improve other markers of general health).⁷ Long-term use of niacin has also been implicated in increased insulin resistance, which is one of the features of metabolic syndrome
• Vitamin B9, otherwise known as folate or folic acid, is important for cell metabolism (essential processes that help it to thrive), and when there is a problem with folate’s metabolism, then there may be knock-on effects on conditions associated with a fatty liver such as obesity, metabolic syndrome, and diabetes.¹⁰  It could also help protect the liver from damage, so supplementation may be a therapy in the future with more evidence
• One study found that low levels of vitamin B12 in the blood of patients with NAFLD were linked to a higher concentration of a liver protein, one of the markers of liver damage; however, another determined there was no difference between B12 levels in people with NAFLD compared with those without it.

Vitamin C

Vitamin C is a powerful antioxidant that helps ward off oxidative stress, a state where there is an imbalance between harmful free radicals and antioxidants. Studies show that oxidative stress can contribute to numerous diseases, including NAFLD. Low levels of vitamin C intake have been associated with more severe NAFLD, although the mechanisms with which it may protect the liver are unclear. As it has often been studied in combination with vitamin E supplementation, it’s hard to conclude its effectiveness on its own.¹¹

Vitamin D

Research has shown that low levels of vitamin D have been associated with NAFLD and liver damage in the form of fibrosis.  On the other hand, a meta-analysis, which is a study that looks at several smaller studies, found no direct association between low levels and a higher degree of liver scarring in NAFLD.¹²

Vitamin D helps regulate insulin sensitivity via receptors that can be found in the liver and other parts of the body and has functions in the immune system. Certain experiments have demonstrated that it has anti-inflammatory properties in animal and human fat cells, too.¹⁰ In mice models, findings suggested that vitamin D modulated the amount of fat in the liver after being fed a high-fat diet via a process called “autophagy”.⁷ 

Despite evidence of the potential benefits of vitamin D, the effects of supplementing those who have a fatty liver and are vitamin D deficient show inconsistent results,¹³ so further studies are needed to assess its role in NAFLD. Care should also be taken as excessive vitamin D can cause high calcium levels – a risk factor for NAFLD.¹⁰

Vitamin E

Vitamin E is another potent antioxidant and has the most evidence of benefit for certain individuals out of all the vitamins for fatty liver.

The American Association for the Study of Liver Diseases (AASLD) and the European Association for the Study of the Liver (EASL) both give recommendations for clinicians to consider Vitamin E for non-diabetic adults with biopsy-confirmed NASH and who are without cirrhosis.^14,15

A study called PIVENS showed that it reduced steatosis (fat in liver cells) and inflammation in patients with NASH but not fibrosis.¹⁶

In one review, vitamin E supplementation significantly improved fibrosis, liver enzymes and “NAFLD activity score” (NAS).¹⁷

There is some controversy over the safety of vitamin E, however, as it has been linked to a possible increased risk of prostate cancer as well as a type of stroke called a “haemorrhagic stroke”.¹⁷

Sources of liver-healthy vitamins

A well-balanced diet which includes a variety of fruits, vegetables, whole grains, lean proteins, and healthy fats can help ensure you get a good mix of vitamins and other essential nutrients.  Nuts, seeds, vegetable oils and green leafy vegetables like spinach are especially good for vitamin E. 

It is essential to talk with your healthcare professional or dietitian before making any changes to your diet if you have already received dietary advice.

Supplements

Silymarin, taken from milk thistle, is an antioxidant that has been investigated in patients with liver disease, including NAFLD.  Taken with vitamin E, results from studies suggest it can improve insulin resistance, liver damage and the markers of a fatty liver.¹⁸

Key points

• Fatty liver ranges in severity from a stage that generally doesn’t cause harm through to cirrhosis and is associated with being overweight or obese and other conditions such as diabetes.
• Deficiencies in certain vitamins have been seen in people with NAFLD, so it’s best to eat a balanced diet.
• Lifestyle changes, including diet, weight loss and exercise, are the main ways to manage the disease.
• Vitamin E is the only vitamin that may be recommended as a treatment; however, you should consult a healthcare professional before taking high-dose supplements.

Summary

Fatty liver disease, characterized by an accumulation of fat in the liver, has become increasingly prevalent, often linked to rising obesity levels. Lifestyle changes, such as weight loss through a Mediterranean diet and exercise, remain primary treatments, as there are no approved medications. Certain vitamins, particularly vitamin E, have shown promise in managing the condition, with studies indicating potential benefits in reducing inflammation and liver fat. 

However, caution is advised, as excessive supplementation can pose risks. Other vitamins, including A, B complex, C, and D, play roles in liver health but lack conclusive evidence for standalone treatment. Silymarin, derived from milk thistle, is being explored for its antioxidant properties in conjunction with vitamin E. Key points emphasize the importance of a balanced diet, lifestyle modifications, and consulting healthcare professionals before initiating any supplement regimen.