Nonalcoholic steatohepatitis (NASH)
Supplements studied for nonalcoholic steatohepatitis (NASH).
Overview
Evidence for NASH supplements is mostly low-rated. Melatonin (WA 40; low effect size, evidence, and trust) showed improved liver tests and insulin resistance in one small four-week trial. L-Carnitine (WA 52; low effect size, high evidence, medium trust) improved liver markers and weight in two small studies with diet or medications. Milk Thistle (WA 52; low effect size, high evidence, medium trust) has unclear benefit, with inconsistent effects on liver tissue and scarring.
N-Acetyl Cysteine (NAC) (WA 32; very low effect size, low evidence, medium trust) reduced inflammation markers in one pre-surgery study but did not change body size. Whey Protein (WA 36; low effect size, low evidence, very low trust) lowered liver enzymes in one uncontrolled study. The heatmap and evidence reviews below provide trial-level detail.
Effect graph
Relevant supplements
Relevant supplements sorted by DEX Score.
| Milk Thistle | ★★★★★ | Low |
| L-Carnitine | ★★★★★ | Low |
| Melatonin | ★★★★★ | Low |
| Whey Protein | ★★★★★ | Low |
| N-Acetyl Cysteine (NAC) | ★★★★★ | Very Low / None |
Studies
Find individual evidence reviews for supplements sorted by DEX Score.
5 supplements for and rated at least stars. All purchase bands. No minimum star filter.
L-CarnitineView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- Two small studies in people with fatty liver disease (NASH) found that taking L-carnitine daily can improve liver health markers and lower body weight when combined with a specific diet or medications.
- One study showed improved liver function with 1 gram of L-carnitine twice daily and a special diet.
- Another study found that 10 mL of L-carnitine twice daily along with a cholesterol-lowering drug and low-calorie diet helped reduce weight and improve liver and blood sugar levels.
Browse 9 studies·2 meta-analyses
RCTThe efficacy of L-carnitine in patients with nonalcoholic steatohepatitis and concomitant obesity2023n=90
In 90 obese patients with NASH, 90 days of L-carnitine plus simvastatin and diet significantly reduced cholesterol, triglycerides, LDL, atherogenic index, and insulin resistance versus standard therapy alone.
- Effect
- Benefit
- Duration
- 90 days
- Dose
- 600 mg 3×/day
- Population
- NAFLD patients
- Participants
- 90
- Ages
- 30–50
RCTEffect of L-carnitine supplementation on lipid accumulation product and cardiovascular indices in women with overweight/obesity who have knee osteoarthritis: a randomized controlled trial2022n=76
In 76 overweight women with knee osteoarthritis, 12 weeks of L-carnitine 1,000 mg/day significantly reduced lipid accumulation product (−11.05 vs −5.82) but did not improve other cardiovascular risk indices versus placebo.
- Effect
- Benefit
- Duration
- 12 weeks
- Dose
- 1000 mg/day
- Population
- Women
- Participants
- 76
MetaBeneficial effects of l-carnitine supplementation for weight management in overweight and obese adults: An updated systematic review and dose-response meta-analysis of randomized controlled trials2020
A meta-analysis of 43 RCTs found L-carnitine significantly reduced body weight (−1.13 kg), BMI (−0.36), and fat mass (−1.16 kg), with greater effects in overweight/obese adults and when combined with lifestyle modifications.
- Effect
- Benefit
- Population
- Adults
MetaEffects of l-carnitine supplementation on weight loss and body composition: A systematic review and meta-analysis of 37 randomized controlled clinical trials with dose-response analysis2020n=2,292
A meta-analysis of 37 RCTs (2,292 participants) found L-carnitine supplementation modestly reduced body weight (−1.21 kg), BMI (−0.40), and fat mass (−2.08 kg), with maximum effect at ~2 g/day.
- Effect
- Benefit
- Dose
- 2000 mg/day
- Population
- Older adults
- Participants
- 2,292
RCTComparison between orlistat plus L-carnitine and orlistat alone on inflammation parameters in obese diabetic patients2011n=58
In 258 obese type 2 diabetic patients, 1 year of orlistat plus L-carnitine 2 g/day improved body weight, glycemic control, LDL, adiponectin, and inflammatory markers more than orlistat alone.
- Effect
- Benefit
- Duration
- 1 year
- Dose
- 120 mg 3×/day
- Population
- Diabetic patients
- Participants
- 58
RCTEffects of combination of sibutramine and L-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients2011
In 254 obese type 2 diabetic patients, 12 months of sibutramine plus L-carnitine 2 g/day improved body weight, HbA1c, insulin resistance, and inflammatory markers faster than sibutramine alone.
- Effect
- Benefit
- Duration
- 12 months
- Dose
- 2 g/day
- Population
- Diabetic patients
RCTL-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis--a randomized and controlled clinical trial2010
In NASH patients, L-carnitine 2 g/day for 24 weeks significantly improved liver enzymes, lipid profile, glucose, HOMA-IR, inflammatory markers, and histological scores versus diet alone.
- Effect
- Benefit
- Duration
- 24 weeks
- Dose
- 2 g/day
- Population
- Hepatitis patients
RCTOrlistat and L-carnitine compared to orlistat alone on insulin resistance in obese diabetic patients2010n=58
In 258 obese type 2 diabetic patients, 1 year of orlistat plus L-carnitine 2 g/day produced faster improvements in body weight, HbA1c, insulin resistance, and inflammatory markers than orlistat monotherapy.
- Effect
- Benefit
- Duration
- 12 months
- Dose
- 120 mg 3×/day
- Population
- Diabetic patients
- Participants
- 58
RCTL-Carnitine supplementation combined with aerobic training does not promote weight loss in moderately obese women2000n=18
In 36 moderately obese premenopausal women, 8 weeks of L-carnitine 4 g/day plus aerobic training did not reduce total body mass or fat mass compared with exercise plus placebo.
- Effect
- No Benefit
- Duration
- 8 weeks
- Dose
- 2 g 2×/day
- Population
- Women
- Participants
- 18
Milk ThistleView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- It is unclear if milk thistle helps people with nonalcoholic steatohepatitis (NASH), a serious form of fatty liver disease. Some studies suggest milk thistle may improve liver scarring in some patients, but overall it did not show clear improvement in liver tissue health. Sometimes milk thistle is combined with other supplements like vitamin E, which might help, but it is not certain if milk thistle alone is effective.
- Milk thistle may help lower some liver enzymes and improve certain blood fats, but it doesn’t seem to affect body weight or blood sugar control. More research is needed to understand if milk thistle benefits people with NASH specifically.
Browse 4 studies·2 meta-analyses
MetaComparative Efficacy of Drug Interventions on NAFLD Over 24 Weeks: A Traditional and Network Meta-Analysis of Randomized Controlled Trials2024
A traditional and network meta-analysis of 24-week NAFLD drug trials found several agents including herbal treatments improved liver enzymes and steatosis.
- Effect
- Benefit
- Duration
- 24 weeks
- Dose
- 25 mg/day
- Population
- Adults
MetaEffects of silymarin use on liver enzymes and metabolic factors in metabolic dysfunction-associated steatotic liver disease: a systematic review and meta-analysis2024
A meta-analysis found silymarin improved ALT, AST, liver stiffness, and metabolic markers in patients with metabolic dysfunction-associated steatotic liver disease.
- Effect
- Benefit
- Population
- Adults
RCTSilymarin in non-cirrhotics with non-alcoholic steatohepatitis: A randomized, double-blind, placebo controlled trial2019n=116
A 48-week double-blind RCT of 116 non-cirrhotic NASH patients found high-dose silymarin (1260–2100 mg/day) reduced NASH activity scores and improved liver enzymes.
- Effect
- No Benefit
- Duration
- 48 weeks
- Dose
- 1260–2100 mg/day
- Population
- Adults
- Participants
- 116
- Ages
- 18+
RCTA Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis2017n=50
A 48-week multicenter RCT of 50 NASH patients found silymarin did not significantly improve NASH histologic resolution versus placebo, though liver enzymes improved.
- Effect
- No Benefit
- Duration
- 48 weeks
- Dose
- 700 mg/day
- Population
- Adults
- Participants
- 50
MelatoninView supplement →
Reconsider purchase·★★★★★
How we scored this▸
- In a small study of people with fatty liver disease (NASH), taking melatonin 10 mg daily for 4 weeks improved liver tests, lowered insulin resistance, and raised certain hormones related to metabolism.
- These early results are promising, but larger studies are needed before melatonin can be recommended as a treatment.
Browse 1 study
Controlled trialPlasma insulin, leptin, adiponectin, resistin, ghrelin, and melatonin in nonalcoholic steatohepatitis patients treated with melatonin2012n=16
In 16 NASH patients, melatonin 10 mg/day for 28 days improved liver enzymes and adipokine profiles versus baseline.
- Effect
- Benefit
- Duration
- 28 days
- Dose
- 10 mg/day
- Population
- NASH patients
- Participants
- 16
Whey ProteinView supplement →
Do not purchase·★★★★★
How we scored this▸
- It is not clear if whey protein helps with nonalcoholic steatohepatitis (NASH), a type of fatty liver disease.
- One small study found that taking 20 grams of whey protein daily for 12 weeks lowered liver enzymes, which suggests better liver health.
- The whey protein also reduced liver fat and improved antioxidants in the blood.
- However, since there was no comparison group, more research is needed to be sure about these effects.
Browse 1 study
Open-labelOpen-labeled pilot study of cysteine-rich whey protein isolate supplementation for nonalcoholic steatohepatitis patients2009n=38
In an open-label trial of 38 participants, 20 g/day, for 12 weeks, the results support the role of oxidative stress in the pathogenesis of this disease.
- Effect
- Benefit
- Duration
- 12 weeks
- Dose
- 20 g/day
- Population
- Patients
- Participants
- 38
- Avg age
- ~48
N-Acetyl Cysteine (NAC)View supplement →
Do not purchase·★★★★★
How we scored this▸
- A study in obese adults about to have weight-loss surgery found that taking N-acetylcysteine (NAC) 600 mg daily for 4 weeks helped reduce signs of aging and inflammation in belly fat tissue.
- It also lowered inflammation in the body and improved blood sugar and insulin levels.
- NAC did not change body size or cholesterol levels.
Browse 1 study
RCTN-ACETYLCYSTEINE AND/OR URSODEOXYCHOLIC ACID ASSOCIATED WITH METFORMIN IN NON-ALCOHOLIC STEATOHEPATITIS: AN OPEN-LABEL MULTICENTER RANDOMIZED CONTROLLED TRIAL2019n=26
A 48-week open-label RCT of 53 NASH patients found adding NAC and/or UDCA to metformin did not significantly improve histologic or biochemical endpoints versus metformin alone.
- Effect
- No Benefit
- Duration
- 48 weeks
- Dose
- 1500 mg/day
- Population
- Patients with NASH
- Participants
- 26
- Avg age
- ~54
Evidence visualised
Same ratings as above, aggregated so you can see coverage and imbalance.
| Supplement | DEX | Studies | Meta-analyses | Share |
|---|---|---|---|---|
| L-Carnitine | ★★★★★52% | 9 | 2 | 56% |
| Milk Thistle | ★★★★★52% | 4 | 2 | 25% |
| Melatonin | ★★★★★40% | 1 | 0 | 6% |
| N-Acetyl Cysteine (NAC) | ★★★★★32% | 1 | 0 | 6% |
| Whey Protein | ★★★★★36% | 1 | 0 | 6% |