There's a lot of noise out there when it comes to the best supplements or vitamins that can help fix your fatty liver or "detox" your liver, but which of these supplements are actually worth your money, or even safe to begin with?
.jpg "Best Supplements to Reverse Fatty Liver (Science-Backed)")
In this article, I'll give you a list of supplements that have good scientific evidence behind them, let you know who should and shouldn't be taking them, and, more importantly, go over important safety concerns to watch out for with each one.
I'm Dr. Leonid Kim. I am board-certified in Internal Medicine and Obesity Medicine, and I discuss the most up-to-date, evidence-based information on weight loss, metabolic health, and longevity. Let's get into it.
Curcumin (Turmeric)
The first supplement that has good evidence behind it is turmeric, or more specifically, curcumin, the active compound found in turmeric. Curcumin is effective in helping reverse fatty liver largely because it lowers blood sugar, improves insulin sensitivity, and corrects metabolic dysfunction, all of which are hallmarks of fatty liver disease.
Curcumin works by stimulating glucose uptake via GLUT4 transporters in fat and muscle cells, thereby clearing more circulating glucose from the bloodstream. It also regulates the AMPK pathway, the same pathway targeted by the common diabetes medication metformin, and it regulates the gene expression of glucose transporters in the pancreas, thereby stimulating natural insulin secretion.
A recent meta-analysis of nine randomized controlled trials, published in 2019, showed that curcumin supplementation significantly reduced liver markers such as ALT and AST, along with beneficial effects on metabolic parameters in patients with fatty liver.
Omega-3 Fatty Acids
The next supplement worth discussing is omega-3 fatty acids. Omega-3s, particularly EPA and DHA, can help reverse fatty liver in several ways. First, they reduce inflammation by lowering the production of pro-inflammatory cytokines, and inflammation is a major component of the disease process in fatty liver. Omega-3s can also help lower triglycerides and enhance fatty acid oxidation, thereby reducing fat accumulation in the liver.
A systematic review and meta-analysis of 11 randomized controlled studies showed that omega-3 supplementation significantly reduced liver markers and marginally reduced liver fat content.
There's an important caveat with omega-3s, though: the meta-analysis noted a dose-dependent trend, with greater improvement in fatty liver markers at higher doses of EPA or DHA.
That doesn't mean everyone should take higher doses, however, as several studies show that omega-3 supplementation, especially at higher doses, is associated with an increased risk of atrial fibrillation. This abnormal heart rhythm can lead to strokes and heart failure.
This is definitely a supplement worth discussing with your doctor, since it has clear benefits but also small, real risks, and both the risks and benefits increase with dose. With my patients, I generally don't recommend high doses of omega-3s unless someone is at very high risk for cardiac disease, in which case the benefits may outweigh the small risk of atrial fibrillation.
Outside of that, whether and how much to supplement really depends on your individual medical history and risk tolerance. I also always stress that most people don't need a supplement to get these benefits, and it's usually better to meet your omega-3 needs by eating foods like seafood, walnuts, and chia seeds.
Probiotics and Prebiotics
The next supplement to consider is a simple probiotic, as it's becoming increasingly evident that our gut microbiome plays a role in liver health, especially in fatty liver disease. Human studies have shown that people with biopsy-proven fatty liver disease have increased intestinal permeability compared to healthy individuals. That intestinal permeability allows gut bacteria to translocate, or move, into areas outside the gut, like the lymphatic system and the liver, which can trigger liver inflammation and eventually lead to NASH (non-alcoholic steatohepatitis), a more severe form of fatty liver disease.
An umbrella review of systematic reviews and meta-analyses, published in 2022, showed that probiotic supplementation was associated with improvements in liver markers such as ALT and GGT, and that probiotics appear to be safe, with no evidence of adverse events.
While we're on the topic of probiotics, it's important to focus not just on probiotics, the helpful gut bacteria we want to colonize our microbiome with, but also on prebiotics, non-digestible fibers that serve as food for the good bacteria and help them survive in the intestine. It's often not enough to take probiotics without also ensuring a good supply of prebiotics.
A small randomized controlled clinical trial in Brazil showed that a three-month synbiotic (a mixture of a probiotic and a prebiotic) treatment reduced the grade of hepatic steatosis and improved metabolic parameters associated with non-alcoholic steatohepatitis, including body weight, BMI, and waist circumference. You don't need a fancy synbiotic supplement, though; it's usually better to get the prebiotic component from natural foods like apples, bananas, oats, chickpeas, asparagus, and red kidney beans.
Choline
The next supplement worth discussing is choline, which has been gaining popularity as a treatment for fatty liver. A recent case-control study showed that people with high intakes of choline and betaine had an associated 81% reduction in hepatic steatosis. However, that was just a case-control study, and we still need more conclusive research to determine whether choline supplementation is actually beneficial for most people, not just those who are choline-deficient. We also don't have studies establishing at what dose choline is actually beneficial.
Until we get more data, I'd recommend getting enough choline through food, which means eating plenty of eggs (with the yolk), as well as lean meats, dairy, and seafood.
Berberine
Another supplement with decent evidence for fatty liver disease is berberine. Berberine is an alkaloid derivative isolated from several kinds of medicinal plants and has been used in Ayurvedic and Chinese medicine for thousands of years. A meta-analysis of six clinical trials, including over 500 patients, showed that berberine treatment improved liver function, blood glucose, and cholesterol in patients with fatty liver disease.
There are also animal studies, for what they're worth, showing that berberine can modulate the microbiome to increase GLP-1 levels in the body, the same mechanism behind diabetes and obesity drugs like semaglutide or tirzepatide.
Coenzyme Q10 (CoQ10)
The next supplement that looks promising, but doesn't have as much data behind it, is coenzyme Q10, or CoQ10. It's often used for its anti-inflammatory benefits, and as discussed, inflammation is a major factor in the development of fatty liver.
A small, double-masked, placebo-controlled randomized controlled trial of 44 participants assigned the treatment group to receive 100 mg of CoQ10 for 12 weeks, and this group showed significant decreases in liver markers such as ALT and GGT, as well as in inflammatory markers such as CRP and TNF-alpha. However, this was a very small trial, making it hard to extrapolate to larger populations. A recent meta-analysis of six studies showed significant improvements in liver markers, but only in specific subgroup analyses by intervention duration.
An important thing to keep in mind is that CoQ10 can interact with blood-thinning medications, so it's important to talk to your doctor before taking it.
Vitamin E
Lastly, let's talk about vitamin E, a natural antioxidant. An older randomized controlled trial showed that vitamin E at 800 international units per day was associated with a significantly higher rate of improvement in non-alcoholic steatohepatitis. A recent review of several meta-analyses and randomized controlled trials showed that vitamin E supplementation improved liver fibrosis, steatosis, and liver markers like ALT and AST.
With vitamin E, it's especially important to discuss use with your doctor, as higher doses have been associated with an increase in all-cause mortality, as well as an increase in the rate of prostate cancer. For this reason, vitamin E supplementation is generally only recommended for people with more advanced fatty liver disease. Talk to your doctor before starting vitamin E, since the right dose and formulation will depend on your individual needs.
A Note on Milk Thistle
I did not cover one common supplement that a lot of people take for liver health, milk thistle, because I've already covered it in a separate, dedicated article.
Conclusion
While there's no shortage of supplements marketed for fatty liver, only a handful, curcumin, omega-3 fatty acids, probiotics and prebiotics, choline, berberine, CoQ10, and vitamin E, have meaningful human evidence behind them, and each comes with its own dosing considerations and safety caveats. You do not need any of these supplements to fix fatty liver disease; most of these same benefits can be achieved by eating the right foods and treating food as your primary medicine. That said, for those looking to enhance and expedite their recovery, these supplements, used thoughtfully and in consultation with a doctor, may offer additional support.
FAQ
Do I need supplements to reverse fatty liver disease?
No. Most of the benefits discussed here can be achieved through diet and lifestyle changes alone. Supplements can enhance and potentially expedite recovery, but they aren't required to fix fatty liver disease.
Which supplement has the strongest evidence for fatty liver?
Curcumin, omega-3 fatty acids, probiotics/prebiotics, berberine, and vitamin E all have meta-analyses or randomized controlled trials supporting improvements in liver markers. Vitamin E in particular has shown benefits for more advanced disease (NASH), but comes with dosing risks that require medical supervision.
Are omega-3 supplements safe for everyone?
Not necessarily at high doses. While omega-3s can improve liver markers, higher doses have been associated with an increased risk of atrial fibrillation. The right dose depends on individual cardiovascular risk and should be discussed with a doctor.
What's the difference between probiotics, prebiotics, and synbiotics?
Probiotics are beneficial live bacteria; prebiotics are non-digestible fibers that feed those bacteria; and synbiotics combine both. Research suggests combining probiotics and prebiotics may be more effective than probiotics alone for improving fatty liver markers.
Is choline supplementation recommended for fatty liver?
The evidence is still preliminary, mostly from a case-control study. Rather than supplementing, it's currently recommended to get choline through foods like eggs (with yolk), lean meats, dairy, and seafood until more conclusive dosing data is available.
Is vitamin E safe to take for fatty liver?
Vitamin E has shown benefits for more advanced fatty liver disease (NASH), but higher doses have been linked to increased all-cause mortality and prostate cancer risk. It's generally reserved for more advanced cases and should only be used under a doctor's guidance.