Condition

Nonalcoholic Fatty Liver Disease (NAFLD)

Nonalcoholic fatty liver disease is a buildup of fat in the liver without heavy drinking, often tied to insulin resistance and obesity, that can progress to inflammation and scarring. Berberine and vitamin E have the strongest supplement evidence, and in trials of tesamorelin, liver fat fell by more than a third. Those tesamorelin trials were in people with HIV, so the results may not apply more broadly.

Sources: PMID 31611038; PMID 24911133

Updated 30 September 2026
How we grade
6 studies cited
Nonalcoholic Fatty Liver Disease (NAFLD) protocol

Supplements studied: 26
Medicines and peptides: 1
Graded outcomes: 29
Trials: 20
People studied: 39,518

Evidence by supplement

Strong
Moderate
Limited
Very limited

26 supplements

Vitamin D

Vitamin D: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Blood glucose Small Improvement	Improves (the measure goes down)	Small effect	2 studies	1 person
Studies that measured blood glucose Effect of vitamin D3 supplementation on vascular and metabolic health of vitamin D-deficient overweight and obese children: a randomized clinical trial.Am J Clin Nutr · PMID 31950134 The impact of vitamin D supplementation on glycemic control and lipid metabolism in polycystic ovary syndrome: a systematic review of randomized controlled trials.BMC Endocr Disord · PMID 40259331
	Insulin	Changes; see studies		3 studies	1 person
Studies that measured insulin Effects of vitamin D and calcium supplementation on pancreatic β cell function, insulin sensitivity, and glycemia in adults at high risk of diabetes: the Calcium and Vitamin D for Diabetes Mellitus (CaDDM) randomized controlled trialAm J Clin Nutr · PMID 21715514 Efficacy of vitamin D supplementation on glycaemic control in type 2 diabetes: An updated systematic review and meta-analysis of randomized controlled trials.Diabetes Obes Metab · PMID 39355942 Vitamin D Supplementation Affects the Beck Depression Inventory, Insulin Resistance, and Biomarkers of Oxidative Stress in Patients with Major Depressive Disorder: A Randomized, Controlled Clinical TrialJ Nutr · PMID 26609167
	Low-density lipoprotein (LDL)	Improves (the measure goes down)		3 studies	1 person
Studies that measured low-density lipoprotein (ldl) Vitamin D3 supplementation does not modify cardiovascular risk profile of adults with inadequate vitamin D statusEur J Nutr · 2015 · PMID 26621634 The effect of vitamin D supplementation on clinical symptoms and metabolic profiles in patients with endometriosisGynecol Endocrinol · PMID 33508990 Vitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markersAm J Clin Nutr · PMID 19321573
	Weight	Improves (the measure goes down)		2 studies	1 person
Studies that measured weight Can Vitamin D supplementation enhance the effectiveness of exercise-induced weight loss in overweight or obese adults? Evidence from integrated transcriptomic and meta-analysisFront Nutr · PMID 41098796 Effect of vitamin D supplementation on body composition, lipid profile, and glycemic indices in patients with obesity-associated metabolic syndrome: a systematic review and meta-analysis.Diabetol Metab Syndr · PMID 40682197
	HbA1c	Improves (the measure goes down)		1 study	1 person
Studies that measured hba1c Association of A1C levels with vitamin D status in U.S. adults: data from the National Health and Nutrition Examination SurveyDiabetes Care · 2010 · PMID 20215453
	Insulin Resistance	Improves (the measure goes down)		1 study	1 person
	High-density lipoprotein (HDL)	Improves (the measure goes up)			1 person
	Total cholesterol	Improves (the measure goes down)			1 person
	Triglycerides	Improves (the measure goes down)			1 person
	Waist circumference	Improves (the measure goes down)			1 person

Black seed

Black seed: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	C-Reactive Protein (CRP) Small Decrease	Improves (the measure goes down)	Small effect	1 study	727 people
Studies that measured c-reactive protein (crp) The effect of Nigella sativa (black seed) on biomarkers of inflammation and oxidative stress: an updated systematic review and meta-analysis of randomized controlled trials.Inflammopharmacology · PMID 37036558
	Interleukin 6	Changes; see studies			156 people
	Oxidative Stress Biomarkers	Changes; see studies			591 people
	Superoxide Dismutase Activity	Improves (the measure goes up)			364 people
	TNF-Alpha	Changes; see studies			307 people
	Total Antioxidant Capacity (TAC)	Improves (the measure goes up)			480 people

Berberine

Blood glucose: improves
HbA1c: improves
Total cholesterol: improves

Berberine: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Blood glucose Large Improvement	Improves (the measure goes down)	Large effect		2,897 people
	HbA1c	Improves (the measure goes down)		5 studies	1,156 people
Studies that measured hba1c The Effect of Berberine on Metabolic Profiles in Type 2 Diabetic Patients: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsOxid Med Cell Longev · PMID 34956436 Berberine in the treatment of type 2 diabetes mellitus: a systemic review and meta-analysisEvid Based Complement Alternat Med · PMID 23118793 Treatment of type 2 diabetes and dyslipidemia with the natural plant alkaloid berberineJ Clin Endocrinol Metab · PMID 18397984 and 2 more on the Berberine page
	Total cholesterol	Improves (the measure goes down)		3 studies	2,804 people
Studies that measured total cholesterol Overall and Sex-Specific Effect of Berberine for the Treatment of Dyslipidemia in Adults: A Systematic Review and Meta-Analysis of Randomized Placebo-Controlled Trials.Drugs · PMID 36941490 Efficacy and safety of berberine for several cardiovascular diseases: A systematic review and meta-analysis of randomized controlled trials.Phytomedicine · PMID 36805484 The Effect of Berberine on Reproduction and Metabolism in Women with Polycystic Ovary Syndrome: A Systematic Review and Meta-Analysis of Randomized Control Trials.Evid Based Complement Alternat Med · PMID 31915452
	Glycemic Control	Improves (the measure goes up)		2 studies	184 people
Studies that measured glycemic control Efficacy of Berberine in Patients with Non-Alcoholic Fatty Liver DiseasePLoS One · PMID 26252777 Effect of berberine administration on metabolic syndrome, insulin sensitivity, and insulin secretionMetab Syndr Relat Disord · PMID 23808999
	High-density lipoprotein (HDL)	Improves (the measure goes up)		2 studies	2,784 people
Studies that measured high-density lipoprotein (hdl) Effects of berberine on lipid profile in subjects with low cardiovascular riskExpert Opin Biol Ther · 2013 · PMID 23441841 The effects of berberine supplementation on cardiovascular risk factors in adults: A systematic review and dose-response meta-analysis.Front Nutr · PMID 36313096
	Triglycerides	Improves (the measure goes down)		1 study	3,004 people
	Blood Pressure	Improves (the measure goes down)			1,426 people
	Insulin	Changes; see studies			1,138 people
	Insulin Resistance	Improves (the measure goes down)			1,119 people
	Liver Enzymes	Changes; see studies			184 people
	Liver Fat	Improves (the measure goes down)			184 people
	Low-density lipoprotein (LDL)	Improves (the measure goes down)			2,824 people

Resveratrol

Adiponectin: improves
Blood glucose: improves
C-Reactive Protein (CRP): improves

Resveratrol: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Adiponectin Small Increase	Improves (the measure goes up)	Small effect		285 people
	Blood glucose	Improves (the measure goes down)		7 studies	216 people
Studies that measured blood glucose Effect of resveratrol on glucose control and insulin sensitivity: a meta-analysis of 11 randomized controlled trials.Am J Clin Nutr · PMID 24695890 Resveratrol supplementation and type 2 diabetes: a systematic review and meta-analysisCrit Rev Food Sci Nutr · PMID 33480264 Influence of Age and Dose on the Effect of Resveratrol for Glycemic Control in Type 2 Diabetes Mellitus: Systematic Review and Meta-Analysis.Molecules · PMID 36014469 and 4 more on the Resveratrol page
	C-Reactive Protein (CRP)	Improves (the measure goes down)		3 studies	869 people
Studies that measured c-reactive protein (crp) Evidence-based nutritional and pharmacological interventions targeting chronic low-grade inflammation in middle-age and older adults: A systematic review and meta-analysis.Ageing Res Rev · PMID 29803716 Can resveratrol supplement change inflammatory mediators? A systematic review and meta-analysis on randomized clinical trials.Eur J Clin Nutr · PMID 30013206 The effects of resveratrol supplementation on biomarkers of inflammation and oxidative stress among patients with metabolic syndrome and related disorders: a systematic review and meta-analysis of randomized controlled trials.Food Funct · PMID 30426122
	Weight	Improves (the measure goes down)		3 studies	582 people
Studies that measured weight Resveratrol supplementation significantly influences obesity measures: a systematic review and dose-response meta-analysis of randomized controlled trials.Obes Rev · PMID 30515938 Efficacy of Resveratrol Supplementation on Glucose and Lipid Metabolism: A Meta-Analysis and Systematic ReviewFront Physiol · PMID 35431994 A Systematic Review and Meta-Analysis of Randomized Controlled Trials on the Impact of Resveratrol Supplementation on Anthropometric Indices in Patients With Type 2 Diabetes.Phytother Res · PMID 40842160
	Kidney Function	Improves (the measure goes up)		2 studies	135 people
Studies that measured kidney function Resveratrol may mildly improve renal function in the general adult population: A systematic review and meta-analysis of randomized controlled clinical trials.Nutr Res · PMID 36996691 Effects of resveratrol supplementation on renal function in adults: a systematic review and dose-response meta-analysis.Naunyn Schmiedebergs Arch Pharmacol · PMID 40580309
	Liver Enzymes	Changes; see studies		2 studies	216 people
	Total cholesterol	Improves (the measure goes down)		2 studies	863 people
	Vascular Function	Improves (the measure goes up)		2 studies	1,448 people
	Blood Pressure	Improves (the measure goes down)		1 study	156 people
	Glycemic Control	Improves (the measure goes up)		1 study	541 people
	Triglycerides	Improves (the measure goes down)		1 study	216 people
	Blood Urea Nitrogen (BUN)	Improves (the measure goes up)			894 people
	Body Fat	Improves (the measure goes down)			516 people
	Body Mass Index (BMI)	Improves (the measure goes down)			1,418 people
	HbA1c	Improves (the measure goes down)			444 people
	High-density lipoprotein (HDL)	Improves (the measure goes up)			793 people
	Insulin	Changes; see studies			2,474 people
	Insulin Resistance	Improves (the measure goes down)			156 people
	Interleukin 6	Improves (the measure goes down)			631 people
	Leptin	Improves (the measure goes up)			271 people
	Low-density lipoprotein (LDL)	Improves (the measure goes down)			791 people
	Serum Albumin	Improves (the measure goes up)			516 people
	Superoxide Dismutase Activity	Improves (the measure goes up)			118 people
	TNF-Alpha	Improves (the measure goes down)			483 people
	Uric Acid	Improves (the measure goes down)			353 people
	Waist circumference	Improves (the measure goes down)			335 people

Synbiotics

Blood Pressure
Body Fat
Liver Enzymes: changes; see studies

Synbiotics: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Blood Pressure Mixed effect				319 people
	Body Fat No effect		NoneNo effect		227 people
	Liver Enzymes	Changes; see studies		1 study	957 people
Studies that measured liver enzymes The effect of synbiotics on liver enzymes, obesity indices, blood pressure, lipid profile, and inflammation in patients with non-alcoholic fatty liver: A systematic review and meta-analysis of randomized controlled trials.Pharmacol Res · PMID 39241935
	Weight	Improves (the measure goes down)		1 study	701 people
Studies that measured weight Effect of synbiotics on the cardiovascular risk factors in patients with non-alcoholic fatty liver: a GRADE assessed systematic review and meta-analysis.BMC Gastroenterol · PMID 40419987
	Body Mass Index (BMI)	Improves (the measure goes down)			1,921 people
	C-Reactive Protein (CRP)	Improves (the measure goes down)			478 people
	High-density lipoprotein (HDL)	Improves (the measure goes up)			1 person
	Insulin Resistance	Improves (the measure goes down)			1,921 people
	Liver Fat	Improves (the measure goes down)			137 people
	Liver Fibrosis	Improves (the measure goes down)			238 people
	Low-density lipoprotein (LDL)	Improves (the measure goes down)			1 person
	TNF-Alpha	Improves (the measure goes down)			233 people
	Total cholesterol	Improves (the measure goes down)			877 people
	Triglycerides	Improves (the measure goes down)			1 person
	Waist circumference	Improves (the measure goes down)			316 people

L-Carnitine

Blood glucose: improves
High-density lipoprotein (HDL): improves
Total cholesterol: improves

L-Carnitine: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Blood glucose Small Improvement	Improves (the measure goes down)	Small effect	5 studies	60 people
Studies that measured blood glucose L-Carnitine's Effect on the Biomarkers of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsNutrients · PMID 32932644 Ameliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapyHypertension · PMID 19620516 Effects of exercise intensity and altered substrate availability on cardiovascular and metabolic responses to exercise after oral carnitine supplementation in athletesInt J Sport Nutr Exerc Metab · PMID 21813919 and 2 more on the L-Carnitine page
	High-density lipoprotein (HDL)	Improves (the measure goes up)		12 studies	204 people
Studies that measured high-density lipoprotein (hdl) Comparative study to evaluate the effect of l-carnitine plus glimepiride versus glimepiride alone on insulin resistance in type 2 diabetic patientsDiabetes Metab Syndr · PMID 30641691 Effects of simvastatin and carnitine versus simvastatin on lipoprotein(a) and apoprotein(a) in type 2 diabetes mellitusExpert Opin Pharmacother · PMID 19618992 Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patientsFundam Clin Pharmacol · PMID 21077943 and 9 more on the L-Carnitine page
	Total cholesterol	Improves (the measure goes down)		6 studies	604 people
Studies that measured total cholesterol Effect of oral L-carnitine administration on insulin sensitivity and lipid profile in type 2 diabetes mellitus patientsAnn Nutr Metab · PMID 18714152 Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta-analysis.Clin Endocrinol · PMID 36746677 Oral carnitine supplementation reduces body weight and insulin resistance in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trialClin Endocrinol · PMID 26666519 and 3 more on the L-Carnitine page
	Triglycerides	Improves (the measure goes down)		4 studies	604 people
Studies that measured triglycerides The effects of L-carnitine supplementation on cardiovascular risk factors in participants with impaired glucose tolerance and diabetes: a systematic review and dose-response meta-analysis.Diabetol Metab Syndr · PMID 39085907 Effects of combined treatment with simvastatin and L-carnitine on triglyceride levels in diabetic patients with hyperlipidaemiaClin Drug Investig · PMID 23315432 Effects of L-carnitine supplementation on lipid profiles in patients with coronary artery diseaseLipids Health Dis · PMID 27317162 and 1 more on the L-Carnitine page
	Liver Enzymes	Changes; see studies		2 studies	406 people
Studies that measured liver enzymes Data from a randomized and controlled trial of LCarnitine prescription for the treatment for Non- Alcoholic Fatty Liver DiseaseBioinformation · PMID 25352725 Effects of carnitine supplementation on liver aminotransferase enzymes: A systematic review and meta-analysis of randomized controlled clinical trialsIndian J Gastroenterol · PMID 31828538
	Body Mass Index (BMI)	Improves (the measure goes down)		1 study	417 people
	C-Reactive Protein (CRP)	Improves (the measure goes down)		1 study	123 people
	HbA1c	Improves (the measure goes down)		1 study	60 people
	Weight	Improves (the measure goes down)		1 study	291 people
	Liver Fat	Improves (the measure goes down)			80 people
	Low-density lipoprotein (LDL)	Improves (the measure goes down)			204 people
	Waist circumference	Improves (the measure goes down)			211 people

Niacin (Vitamin B3)

Apolipoprotein B: improves
Insulin: changes; see studies
Blood glucose: improves

Niacin (Vitamin B3): outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Apolipoprotein B Small Improvement	Improves (the measure goes down)	Small effect	3 studies	27 people
Studies that measured apolipoprotein b Niacin, but not gemfibrozil, selectively increases LP-AI, a cardioprotective subfraction of HDL, in patients with low HDL cholesterolArterioscler Thromb Vasc Biol · PMID 11701466 Effect of fenofibrate and niacin on intrahepatic triglyceride content, very low-density lipoprotein kinetics, and insulin action in obese subjects with nonalcoholic fatty liver diseaseJ Clin Endocrinol Metab · PMID 20371660 Effects of niacin on apo A1 and B levels: a systematic review and meta-analysis of randomised controlled trials.Br J Nutr · PMID 38112076
	Insulin	Changes; see studies		2 studies	27 people
Studies that measured insulin Impaired beta-cell function in human aging: response to nicotinic acid-induced insulin resistanceJ Clin Endocrinol Metab · PMID 16757523 Relationship between Changes in Plasma Adiponectin Concentration and Insulin Sensitivity after Niacin TherapyCardiorenal Med · PMID 22969777
	Blood glucose	Improves (the measure goes down)		1 study	27 people
Studies that measured blood glucose Short-term effects of extended-release niacin with and without the addition of laropiprant on endothelial function in individuals with low HDL-C: a randomized, controlled crossover trialClin Ther · PMID 24768191
	Body Fat	Improves (the measure goes down)			27 people
	Glycemic Control	Improves (the measure goes up)			27 people
	Triglycerides	Improves (the measure goes down)			27 people
	vLDL-C	Improves (the measure goes down)			27 people
	Weight	Improves (the measure goes down)			27 people

Probiotics

Blood glucose: improves
HbA1c: improves
Insulin Resistance: improves

Probiotics: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Blood glucose Small Improvement	Improves (the measure goes down)	Small effect	1 study	899 people
Studies that measured blood glucose Effects of probiotics supplementation on glycemic profile in adults with type 2 diabetes mellitus: A grade-assessed systematic review and dose-response meta-analysis of randomized controlled trials.Clin Nutr ESPEN · PMID 39349104
	HbA1c	Improves (the measure goes down)		2 studies	899 people
Studies that measured hba1c The effects of probiotic supplementation on cardiometabolic health in patients with prediabetes: a systematic review, meta-analysis, and GRADE assessment.Front Nutr · 2025 · PMID 40959695 Probiotics Supplementation for Improving Glucolipid Parameters in Individuals with Prediabetes: A Systematic Review and Meta-Analysis of Randomized Trials.Probiotics Antimicrob Proteins · PMID 39806201
	Insulin Resistance	Improves (the measure goes down)		1 study	2,820 people
Studies that measured insulin resistance The effects of probiotics supplements on metabolic indices and clinical signs in patients with diabetic retinopathy, a randomized double blind clinical trial.J Diabetes Metab Disord · PMID 38932908
	Total cholesterol	Improves (the measure goes down)		1 study	2,820 people
Studies that measured total cholesterol The effect of probiotic consumption on lipid profile, glycemic index, inflammatory markers, and liver function in NAFLD patients: A systematic review and meta-analysis of randomized controlled trials.J Diabetes Complications · PMID 38968867
	Body Mass Index (BMI)	Improves (the measure goes down)			1,921 people
	High-density lipoprotein (HDL)	Improves (the measure goes up)			2,820 people
	Insulin	Changes; see studies			899 people
	Liver Enzymes	Changes; see studies			2,820 people
	Liver Fat	Improves (the measure goes down)			1,921 people
	Liver Fibrosis	Improves (the measure goes down)			1,921 people
	Low-density lipoprotein (LDL)	Improves (the measure goes down)			2,820 people
	TNF-Alpha	Improves (the measure goes down)			899 people
	Triglycerides	Improves (the measure goes down)			2,820 people

Artichoke Extract

Liver Enzymes: improves
Triglycerides: changes; see studies

Artichoke Extract: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Liver Enzymes Moderate Improvement	Improves (the measure goes down)	Moderate effect		2,509 people
	Triglycerides	Changes; see studies		3 studies	2,509 people
Studies that measured triglycerides Effects of artichoke leaf extract supplementation or artichoke juice consumption on lipid profile: A systematic review and dose-response meta-analysis of randomized controlled trialsPhytother Res · PMID 34569671 Artichoke leaf extract for treating hypercholesterolaemia.Cochrane Database Syst Rev · PMID 23543518 Effects of different natural products in patients with non-alcoholic fatty liver disease-A network meta-analysis of randomized controlled trials.Phytother Res · PMID 38886838

Jiaogulan

Glycemic Control: improves
Uric Acid: improves
Insulin: changes; see studies

Jiaogulan: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Glycemic Control Moderate Improvement	Improves (the measure goes up)	Moderate effect		56 people
	Uric Acid	Improves (the measure goes down)		1 study	56 people
Studies that measured uric acid The add-on effects of Gynostemma pentaphyllum on nonalcoholic fatty liver diseaseAltern Ther Health Med · PMID 16708768
	Insulin	Changes; see studies			56 people
	Liver Enzymes	Changes; see studies			56 people
	Weight	Improves (the measure goes down)			56 people

Spirulina

Hemoglobin: improves
Low-density lipoprotein (LDL): improves
Total cholesterol: improves

Spirulina: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	Hemoglobin Small Increase	Improves (the measure goes up)	Small effect		15 people
	Low-density lipoprotein (LDL)	Improves (the measure goes down)		5 studies	18 people
Studies that measured low-density lipoprotein (ldl) Effects of spirulina and wakame consumption on intestinal cholesterol absorption and serum lipid concentrations in non-hypercholesterolemic adult men and womenEur J Nutr · 2020 · PMID 31388739 The influence of obesity on the effects of spirulina supplementation in the human metabolic response of Korean elderlyNutr Res Pract · PMID 27478549 Hepatoprotective effects of Spirulina maxima in patients with non-alcoholic fatty liver disease: a case seriesJ Med Case Rep · PMID 20370930 and 2 more on the Spirulina page
	Total cholesterol	Improves (the measure goes down)		5 studies	18 people
Studies that measured total cholesterol The effects of spirulina on glycemic control and serum lipoproteins in patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trialsPhytother Res · PMID 31359513 Hypolipidemic Effect of Arthrospira ( Spirulina) maxima Supplementation and a Systematic Physical Exercise Program in Overweight and Obese Men: A Double-Blind, Randomized, and Crossover Controlled TrialMar Drugs · PMID 31067674 The effects of Spirulina Platensis on anthropometric indices, appetite, lipid profile and serum vascular endothelial growth factor (VEGF) in obese individuals: a randomized double blinded placebo controlled trialBMC Complement Altern Med · PMID 28431534 and 2 more on the Spirulina page
	Triglycerides	Improves (the measure goes down)		1 study	18 people
Studies that measured triglycerides Effect of Spirulina maxima on postprandial lipemia in young runners: a preliminary reportJ Med Food · 2012 · PMID 22738038
	Weight	Improves (the measure goes down)		1 study	15 people
Studies that measured weight Effects of spirulina supplementation on body composition in adults: a GRADE-assessed and dose-response meta-analysis of RCTs.Nutr Metab · PMID 40528207
	High-density lipoprotein (HDL)	Improves (the measure goes up)			18 people
	Insulin Resistance	Improves (the measure goes down)			15 people
	Liver Enzymes	Changes; see studies			18 people
	Liver Fat	Improves (the measure goes down)			3 people

Citrulline

C-Reactive Protein (CRP): improves
Liver Fibrosis: improves
Liver Fat: improves

Citrulline: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People
	C-Reactive Protein (CRP) Small Decrease	Improves (the measure goes down)	Small effect		50 people
	Liver Fibrosis	Improves (the measure goes down)		1 study	50 people
Studies that measured liver fibrosis Inflammatory markers response to citrulline supplementation in patients with non-alcoholic fatty liver disease: a randomized, double blind, placebo-controlled, clinical trialBMC Res Notes · PMID 30767788
	Liver Fat	Improves (the measure goes down)			50 people
	NF-kB Activity	Improves (the measure goes down)			50 people
	TNF-Alpha	Improves (the measure goes down)			50 people

Brown Seaweed Extract

Blood Pressure: improves
C-Reactive Protein (CRP): improves
Liver Enzymes: improves

Brown Seaweed Extract: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Blood Pressure Small Improvement	Improves (the measure goes down)	Small effect		151 people
C-Reactive Protein (CRP) Small Decrease	Improves (the measure goes down)	Small effect		151 people
Liver Enzymes Improvement	Improves (the measure goes down)		1 study	151 people
Liver Fat Improvement	Improves (the measure goes down)			151 people
Metabolic Rate	Improves (the measure goes up)			151 people
Triglycerides	Changes; see studies			151 people
Weight	Changes; see studies			151 people

Curcumin

Blood glucose: improves
Triglycerides: improves
Low-density lipoprotein (LDL): improves

Curcumin: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Blood glucose Small Improvement	Improves (the measure goes down)	Small effect	18 studies	284 people
Triglycerides	Improves (the measure goes down)		9 studies	2,142 people
Low-density lipoprotein (LDL)	Improves (the measure goes down)		5 studies	2,226 people
Weight	Improves (the measure goes down)		5 studies	362 people
Total cholesterol	Improves (the measure goes down)		4 studies	613 people
Liver Enzymes	Changes; see studies		3 studies	792 people
Blood Pressure	Improves (the measure goes down)		2 studies	84 people
Insulin	Changes; see studies		2 studies	232 people
Uric Acid	Improves (the measure goes down)		2 studies	102 people
Interleukin 6	Improves (the measure goes down)		1 study	84 people
Liver Fat	Improves (the measure goes down)		1 study	234 people
Body Fat	Improves (the measure goes down)			84 people
Body Mass Index (BMI)	Improves (the measure goes down)			650 people
C-Reactive Protein (CRP)	Improves (the measure goes down)			84 people
Glycemic Control	Improves (the measure goes up)			284 people
HbA1c	Improves (the measure goes down)			186 people
High-density lipoprotein (HDL)	Improves (the measure goes up)			2,142 people
Insulin Resistance	Improves (the measure goes down)			1,908 people
Leptin	Improves (the measure goes up)			46 people
Liver Fibrosis	Improves (the measure goes down)			132 people
TNF-Alpha	Improves (the measure goes down)			84 people
Waist circumference	Improves (the measure goes down)			164 people

Vitamin E

All-Cause Mortality
Liver Enzymes: improves
Liver Fat: improves

Vitamin E: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
All-Cause Mortality No effect		NoneNo effect	2 studies	351 people
Liver Enzymes	Improves (the measure goes down)		1 study	708 people
Liver Fat	Improves (the measure goes down)		1 study	1,008 people
Liver Fibrosis	Improves (the measure goes down)			1,008 people

S-adenosylmethionine

Bilirubin
Liver Enzymes: changes; see studies
Liver Fibrosis: improves

S-adenosylmethionine: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Bilirubin No effect		NoneNo effect	1 study	37 people
Liver Enzymes	Changes; see studies		1 study	37 people
Liver Fibrosis	Improves (the measure goes down)		1 study	37 people

Chlorella

Blood glucose
Blood Pressure: improves
Body Mass Index (BMI): improves

Chlorella: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Blood glucose No effect		NoneNo effect	1 study	255 people
Blood Pressure	Improves (the measure goes down)		3 studies	797 people
Body Mass Index (BMI)	Improves (the measure goes down)			797 people
High-density lipoprotein (HDL)	Improves (the measure goes up)			797 people
Low-density lipoprotein (LDL)	Improves (the measure goes down)			797 people
Total cholesterol	Improves (the measure goes down)			797 people
Triglycerides	Improves (the measure goes down)			797 people

Fish Oil

Adiponectin
Triglycerides: improves
High-density lipoprotein (HDL): improves

Fish Oil: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Adiponectin No effect		NoneNo effect		104 people
Triglycerides	Improves (the measure goes down)		24 studies	475 people
High-density lipoprotein (HDL)	Improves (the measure goes up)		7 studies	439 people
Weight	Improves (the measure goes down)		7 studies	60 people
Insulin	Changes; see studies		4 studies	321 people
TNF-Alpha	Improves (the measure goes down)		2 studies	298 people
Insulin Resistance	Improves (the measure goes down)		1 study	439 people
Low-density lipoprotein (LDL)	Improves (the measure goes down)		1 study	225 people
Blood glucose	Improves (the measure goes down)			145 people
Body Mass Index (BMI)	Improves (the measure goes down)			275 people
Glycemic Control	Improves (the measure goes up)			60 people
Liver Enzymes	Changes; see studies			441 people
Liver Fat	Improves (the measure goes down)			60 people
Total cholesterol	Improves (the measure goes down)			225 people
Uric Acid	Improves (the measure goes down)			298 people
Waist circumference	Improves (the measure goes down)			292 people

Chromium

Glutathione (GSH)
Oxidative Stress Biomarkers: improves
Superoxide Dismutase Activity: improves

Chromium: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Glutathione (GSH) No effect		NoneNo effect		550 people
Oxidative Stress Biomarkers	Improves (the measure goes down)		2 studies	550 people
Superoxide Dismutase Activity	Improves (the measure goes up)			550 people
Total Antioxidant Capacity (TAC)	Improves (the measure goes up)			550 people

Prebiotics

Body Mass Index (BMI)
High-density lipoprotein (HDL): improves
Insulin Resistance: improves

Prebiotics: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	People
Body Mass Index (BMI) No effect		NoneNo effect	1,921 people
High-density lipoprotein (HDL)	Improves (the measure goes up)		1,921 people
Insulin Resistance	Improves (the measure goes down)		1,921 people
Liver Enzymes	Changes; see studies		1,921 people
Low-density lipoprotein (LDL)	Improves (the measure goes down)		1,921 people
Total cholesterol	Improves (the measure goes down)		1,921 people
Triglycerides	Improves (the measure goes down)		1,921 people

Fecal Transplant

Body Mass Index (BMI)
Insulin Resistance: improves
High-density lipoprotein (HDL): improves

Fecal Transplant: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Body Mass Index (BMI) No effect		NoneNo effect		1,921 people
Insulin Resistance	Improves (the measure goes down)		1 study	1,921 people
High-density lipoprotein (HDL)	Improves (the measure goes up)			1,921 people
Liver Enzymes	Changes; see studies			1,921 people
Liver Fibrosis	Improves (the measure goes down)			1,921 people
Low-density lipoprotein (LDL)	Improves (the measure goes down)			1,921 people
Total cholesterol	Improves (the measure goes down)			1,921 people
Triglycerides	Improves (the measure goes down)			1,921 people

Silymarin

Body Mass Index (BMI)
High-density lipoprotein (HDL)
Liver Enzymes: changes; see studies

Silymarin: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Body Mass Index (BMI) No effect		NoneNo effect		1,908 people
High-density lipoprotein (HDL) No effect		NoneNo effect		1,908 people
Liver Enzymes	Changes; see studies		6 studies	437 people
Insulin Resistance	Improves (the measure goes down)			1,908 people
Low-density lipoprotein (LDL)	Improves (the measure goes down)			1,908 people
Total cholesterol	Improves (the measure goes down)			166 people
Triglycerides	Improves (the measure goes down)			166 people

Betaine

Adiponectin
Liver Fibrosis: changes; see studies
Weight: changes; see studies

Betaine: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	Studies	People
Adiponectin No effect		NoneNo effect		34 people
Liver Fibrosis	Changes; see studies		1 study	34 people
Weight	Changes; see studies		1 study	34 people
Liver Enzymes	Changes; see studies			34 people
Liver Fat	Changes; see studies			34 people
TNF-Alpha	Changes; see studies			34 people

Panax Ginseng (Korean Ginseng)

Adiponectin
Fatigue Symptoms: improves
Liver Enzymes: changes; see studies

Panax Ginseng (Korean Ginseng): outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Outcome	Effect	Size	People
Adiponectin No effect		NoneNo effect	80 people
Fatigue Symptoms	Improves (the measure goes down)		80 people
Liver Enzymes	Changes; see studies		80 people

Zinc

Cirrhosis Severity: changes; see studies

Zinc: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People	Studies list
	Cirrhosis Severity	Changes; see studies		1 study	52 people

Green Coffee Extract

C-Reactive Protein (CRP): improves

Green Coffee Extract: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People	Studies list
	C-Reactive Protein (CRP)	Improves (the measure goes down)		1 study	265 people

Prescription medicines and peptides studied, for context

These are not supplements. Most need a prescription, and some are research compounds with no approved use. They are listed so the supplement evidence above can be read against them.

1 medicine or peptide

Tesamorelin

Liver Fat (NAFLD): improves
Liver Fibrosis Progression: improves

Tesamorelin: outcomes studied for Nonalcoholic Fatty Liver Disease (NAFLD)
Grade	Outcome	Effect	Size	Studies	People	Studies list
	Liver Fat (NAFLD) A randomized controlled trial showed 37% relative reduction in hepatic fat fraction from baseline, with 35% of tesamorelin patients achieving less than 5% liver fat versus 4% with placebo.	Improves (the measure goes down)	Large effect	6 studies
	Liver Fibrosis Progression Liver biopsies showed tesamorelin prevented progression of fibrosis over 12 months, with reductions in liver fat associated with reductions in fibrosis.	Improves (the measure goes down)	Moderate effect	6 studies

Key findings

Blood glucoseVitamin DImproves (the measure goes down)
C-Reactive Protein (CRP)Black seedImproves (the measure goes down)
AdiponectinResveratrolImproves (the measure goes up)

The Nonalcoholic Fatty Liver Disease (NAFLD) protocol

2 primary supplements · 5 supporting supplements

Berberine500 mg 2–3× daily with meals
Vitamin E800 IU daily (d-alpha-tocopherol)

See the full protocol

Shop the evidence-backed picks

Support alongside medical care. These supplements are not a treatment for Nonalcoholic Fatty Liver Disease (NAFLD). If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.

The supplements graded A or B for Nonalcoholic Fatty Liver Disease (NAFLD). Each opens third-party tested products for that supplement.

Grade B
Grade B
Grade B
Grade B
Grade B

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Studies cited

6 studies from PubMed