Hepatic Encephalopathy

Overview

Three supplements are indexed for hepatic encephalopathy (12 studies), all at WA 40 with low effect size and low evidence. L-Carnitine (6 studies) may improve some liver-related blood tests and reduce toxins but does not appear to reduce fatigue or improve quality of life; thinking skills may improve in some trials.

Acetyl-L-Carnitine (5 studies) did not improve quality of life or fatigue and has not been evaluated for survival or hospital use. Phosphatidylcholine (1 study) showed uncertain recovery effects, with possible mortality reduction in less severe liver failure.

Evidence remains limited across all three. See the evidence reviews below.

Effect graph

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Relevant supplements

Relevant supplements sorted by DEX Score.


L-Carnitine	★★★★★	Low
Acetyl-L-Carnitine	★★★★★	Low
Phosphatidylcholine	★★★★★	Low

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Studies

Find individual evidence reviews for supplements sorted by DEX Score.

3 supplements for rated at least stars. All purchase bands. No minimum star filter.

Acetyl-L-CarnitineView supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceHighTrustMedium

Evidence Review

Taking acetyl-L-carnitine by mouth does not seem to improve quality of life or reduce fatigue in people with brain problems caused by liver disease.
Studies have not looked at important outcomes like survival or hospital visits.
The available research is limited and may not be reliable.

Browse 5 studies1 meta-analysis

MetaAcetyl-L-carnitine for patients with hepatic encephalopathy2019n=398

A Cochrane review of 5 RCTs (398 patients) found insufficient evidence that acetyl-L-carnitine improves quality of life or fatigue in hepatic encephalopathy; all trials were at high risk of bias.

Effect: Benefit
Population: Patients with hepatic encephalopathy
Participants: 398

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MetaOral acetyl-L-carnitine treatment in hepatic encephalopathy: view of evidence-based medicine2013n=660

A meta-analysis of 7 RCTs (660 patients) with hepatic encephalopathy found acetyl-L-carnitine improved serum ammonia and number connection test completion time versus placebo.

Effect: Benefit
Population: Patients with hepatic encephalopathy
Participants: 660

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RCTAcetyl-L-carnitine improves cognitive functions in severe hepatic encephalopathy: a randomized and controlled clinical trial2011n=30

An RCT in 61 patients with severe hepatic encephalopathy found acetyl-L-carnitine 2 g twice daily for 90 days improved cognitive test scores and reduced ammonia versus placebo.

Effect: Benefit
Duration: 90 days
Dose: 2 g 2×/day
Population: Patients with hepatic encephalopathy
Participants: 30

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RCTAcetyl-L-carnitine reduces depression and improves quality of life in patients with minimal hepatic encephalopathy2011n=34

An RCT in 67 patients with minimal hepatic encephalopathy found acetyl-L-carnitine 4 g/day for 90 days improved quality of life, depression scores, and ammonia levels versus placebo.

Effect: Benefit
Duration: 90 days
Dose: 4 g/day
Population: Patients with hepatic encephalopathy
Participants: 34

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RCTOral acetyl-L-carnitine therapy reduces fatigue in overt hepatic encephalopathy: a randomized, double-blind, placebo-controlled study2011n=61

An RCT in 121 patients with overt hepatic encephalopathy found acetyl-L-carnitine 2 g twice daily for 90 days reduced fatigue severity and increased physical activity versus placebo.

Effect: Benefit
Duration: 90 days
Dose: 4 g/day
Population: Patients with hepatic encephalopathy
Participants: 61

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L-CarnitineView supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceHighTrustMedium

Evidence Review

Research shows that L-carnitine taken by mouth or injection can help improve some blood tests related to liver function and reduce toxins in people with liver-related brain problems (hepatic encephalopathy).
However, it does not seem to make patients feel less tired or improve their quality of life.
Some studies suggest it might help thinking skills, but more research is needed.

Browse 6 studies1 meta-analysis

RCTAdditional L-Carnitine Reduced the Risk of Hospitalization in Patients with Overt Hepatic Encephalopathy on Rifaximin2022n=42

In 42 cirrhosis patients with prior HE, adding oral L-carnitine 200 mg/day reduced HE recurrence and hospitalization risk versus standard care over 12 weeks.

Effect: Benefit
Duration: 12 weeks
Dose: 200 mg/day
Population: Patients with hepatic encephalopathy
Participants: 42

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RCTEffect of L-carnitine on quality of life in covert hepatic encephalopathy: a randomized, double-blind, placebo-controlled study2022n=150

A 24-week, multi-centre, double-blind RCT in 150 patients with covert hepatic encephalopathy receiving 2 g/day L-carnitine or placebo found no significant difference in MELD score or overall quality of life between groups, although some improvement in PHES scores in the treatment arm was seen.

Effect: No Benefit
Duration: 24 weeks
Dose: 2 g/day
Population: Cirrhosis patients
Participants: 150

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MetaEffect of L-carnitine on liver enzymes and biochemical factors in hepatic encephalopathy: A systematic review and meta-analysis2019n=779

A meta-analysis of 779 hepatic encephalopathy patients found L-carnitine lowered ammonia and AST but did not significantly change bilirubin, BUN, or creatinine versus control.

Effect: Benefit
Dose: 4000 mg/day
Population: Patients with hepatic encephalopathy
Participants: 779

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RCTEffects of L-carnitine in patients with hepatic encephalopathy2005n=50

In 50 HE patients, L-carnitine 2 g twice daily improved mental status and ammonia handling versus baseline over the treatment period.

Effect: Benefit
Dose: 2 g 2×/day
Population: Hepatitis patients
Participants: 50

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RCTL-Carnitine in the treatment of mild or moderate hepatic encephalopathy2003n=120

In 120 cirrhotic patients with mild-to-moderate HE, L-carnitine 2 g twice daily for 60 days improved mental status and ammonia versus baseline.

Effect: Benefit
Duration: 60 days
Dose: 2 g 2×/day
Population: Cirrhosis patients
Participants: 120

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Controlled trialEffect of L-carnitine upon ammonia tolerance test in cirrhotic patients1990

In cirrhotic patients, L-carnitine before an ammonium challenge test improved psychomotor performance versus baseline in a controlled evaluation.

Effect: Benefit
Population: Cirrhosis patients

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PhosphatidylcholineView supplement →

Reconsider purchase★★★★★

How we scored this

Effect SizeLowEvidenceLowTrustMedium

Evidence Review

It is uncertain whether phosphatidylcholine helps people recover from brain problems caused by liver failure.
Some studies show it does not improve recovery but may help reduce deaths in patients with less severe (subacute) liver failure.
More research is needed.

Browse 1 study

RCTA pilot study of polyunsaturated phosphatidyl choline in fulminant and subacute hepatic failure1998

In fulminant and subacute hepatic failure, polyunsaturated phosphatidylcholine 350 mg three times daily for 6–8 weeks sped encephalopathy recovery and lowered mortality versus control.

Effect: Benefit
Duration: 6–8 weeks
Dose: 350 mg/day
Population: Patients with hepatic failure

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Evidence visualised

Same ratings as above, aggregated so you can see coverage and imbalance.

Purchase-guidance distribution

How many supplements fall in each purchase band

Effect-size distribution

How large the reported benefits tend to be

Study distribution across 3 supplements for hepatic encephalopathy (12 studies total).
Supplement	DEX	Studies	Meta-analyses	Share
L-Carnitine	★★★★★52%	6	1	50%
Acetyl-L-Carnitine	★★★★★52%	5	1	42%
Phosphatidylcholine	★★★★★44%	1	0	8%

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Overview

Effect graph

Relevant supplements

Studies

Evidence visualised

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