Condition
Nonalcoholic Steatohepatitis (NASH)
NASH is a serious form of fatty liver disease in which fat buildup sparks inflammation and liver cell damage, driven by metabolic problems like insulin resistance rather than alcohol. Silymarin from milk thistle has the most reviewed research, and six studies found liver enzymes improved, with moderate evidence. Betaine showed a similar improvement, though that research was small, involving only 30 people.
Sources: PMID 28785154; PMID 33418491
- Supplements studied
- 7
- Graded outcomes
- 7
- Trials
- 11
- People studied
- 3,423
Evidence by supplement
- Strong
- Moderate
- Limited
- Very limited
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Liver Enzymes Small Improvement | Improves (the measure goes down) | Small effect | 6 studies | 437 people | ||
Studies that measured liver enzymes
| ||||||
| Total cholesterol | Improves (the measure goes down) | 166 people | ||||
| Triglycerides | Improves (the measure goes down) | 166 people | ||||
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Liver Enzymes Small Improvement | Improves (the measure goes down) | Small effect | 30 people | |||
| Liver Fibrosis | Changes; see studies | 1 study | 30 people | |||
Studies that measured liver fibrosis | ||||||
| Liver Fat | Changes; see studies | 30 people | ||||
Synbiotics
- Blood Pressure
- Liver Enzymes: changes; see studies
- Weight: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Blood Pressure Mixed effect | 319 people | |||||
| Liver Enzymes | Changes; see studies | 1 study | 957 people | |||
| Weight | Improves (the measure goes down) | 1 study | 701 people | |||
| Body Fat | Improves (the measure goes down) | 227 people | ||||
| C-Reactive Protein (CRP) | Improves (the measure goes down) | 478 people | ||||
| Liver Fat | Improves (the measure goes down) | 137 people | ||||
| Liver Fibrosis | Improves (the measure goes down) | 238 people | ||||
| TNF-Alpha | Improves (the measure goes down) | 233 people | ||||
| Total cholesterol | Improves (the measure goes down) | 877 people | ||||
| Waist circumference | Improves (the measure goes down) | 316 people | ||||
L-Carnitine
- Body Fat: improves
- Muscle Mass: improves
- Oxidative Stress Biomarkers: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Body Fat Small Decrease | Improves (the measure goes down) | Small effect | 1 study | 71 people | ||
Studies that measured body fat | ||||||
| Muscle Mass | Improves (the measure goes up) | 3 studies | 71 people | |||
Studies that measured muscle mass
| ||||||
| Oxidative Stress Biomarkers | Improves (the measure goes down) | 3 studies | 72 people | |||
Studies that measured oxidative stress biomarkers
| ||||||
| Liver Enzymes | Changes; see studies | 2 studies | 30 people | |||
Studies that measured liver enzymes | ||||||
| TNF-Alpha | Improves (the measure goes down) | 2 studies | 102 people | |||
Studies that measured tnf-alpha | ||||||
| C-Reactive Protein (CRP) | Improves (the measure goes down) | 1 study | 72 people | |||
| Weight | Improves (the measure goes down) | 1 study | 71 people | |||
| Glycemic Control | Improves (the measure goes up) | 30 people | ||||
| Transforming Growth Factor Beta | Improves (the measure goes up) | 72 people | ||||
| Waist circumference | Improves (the measure goes down) | 71 people | ||||
Whey Protein
- Anti-Oxidant Enzyme Profile: improves
- Weight: improves
- Glycemic Control: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Anti-Oxidant Enzyme Profile Small Increase | Improves (the measure goes up) | Small effect | 59 people | |||
| Weight | Improves (the measure goes down) | 4 studies | 59 people | |||
Studies that measured weight
| ||||||
| Glycemic Control | Improves (the measure goes up) | 1 study | 59 people | |||
Studies that measured glycemic control | ||||||
| Liver Enzymes | Changes; see studies | 59 people | ||||
| Liver Fat | Improves (the measure goes down) | 59 people | ||||
Melatonin
- Adiponectin: improves
- Ghrelin: improves
- Leptin: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Adiponectin Small Increase | Improves (the measure goes up) | Small effect | 16 people | |||
| Ghrelin | Improves (the measure goes up) | 1 study | 16 people | |||
| Leptin | Improves (the measure goes up) | 1 study | 16 people | |||
| Glycemic Control | Improves (the measure goes up) | 16 people | ||||
| Insulin | Changes; see studies | 16 people | ||||
| Liver Enzymes | Changes; see studies | 16 people | ||||
| Resistin | Improves (the measure goes up) | 16 people | ||||
Vitamin E
- Bilirubin
- Oxidative Stress Biomarkers: improves
- Total cholesterol: improves
| Grade | Outcome | Effect | Size | Studies | People | Studies list |
|---|---|---|---|---|---|---|
| Bilirubin No effect | NoneNo effect | 222 people | ||||
| Oxidative Stress Biomarkers | Improves (the measure goes down) | 3 studies | 43 people | |||
Studies that measured oxidative stress biomarkers
| ||||||
| Total cholesterol | Improves (the measure goes down) | 2 studies | 244 people | |||
| Triglycerides | Improves (the measure goes down) | 2 studies | 244 people | |||
Studies that measured triglycerides | ||||||
| Cirrhosis Severity | Changes; see studies | 1 study | 239 people | |||
Studies that measured cirrhosis severity | ||||||
| High-density lipoprotein (HDL) | Improves (the measure goes up) | 1 study | 222 people | |||
| Liver Enzymes | Improves (the measure goes down) | 1 study | 1,008 people | |||
| Liver Fat | Improves (the measure goes down) | 1 study | 1,008 people | |||
| Weight | Improves (the measure goes down) | 1 study | 244 people | |||
| Blood glucose | Improves (the measure goes down) | 222 people | ||||
| Glycemic Control | Improves (the measure goes up) | 239 people | ||||
| Liver Fibrosis | Improves (the measure goes down) | 1,008 people | ||||
| Low-density lipoprotein (LDL) | Improves (the measure goes down) | 222 people | ||||
| Serum TGF-β | Improves (the measure goes up) | 22 people | ||||
Key findings
- Liver EnzymesImproves (the measure goes down)
- Blood Pressure
- Body FatImproves (the measure goes down)
The Nonalcoholic Steatohepatitis (NASH) protocol
2 primary supplements · 6 supporting supplements
- Vitamin E800 IU daily (alpha-tocopherol)
- Milk Thistle (Silymarin)420–600 mg silymarin daily
Shop the evidence-backed picks
Support alongside medical care. These supplements are not a treatment for Nonalcoholic Steatohepatitis (NASH). 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 Steatohepatitis (NASH). Each opens third-party tested products for that supplement.
- Grade B
- Grade B
- Grade B
Links to Fullscript, iHerb or Thorne carry our referral, so we may earn a commission at no extra cost to you. Grades come from the research and never change based on what we earn. Fullscript asks for a free account before it shows its catalog and prices. Full disclosure
Studies cited
100 studies from PubMed
- The efficacy of probiotics, prebiotics, and synbiotics on anxiety, depression, and sleep: a systematic review and meta-analysis of randomized controlled trials.
- Long-term effect of betaine on risk factors associated with the metabolic syndrome in healthy subjects
- The effect of low doses of betaine on plasma homocysteine in healthy volunteers
- Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study
- Influence of betaine consumption on strenuous running and sprinting in a hot environment
- Effect of betaine supplementation on cycling sprint performance
- Betaine supplementation enhances anabolic endocrine and Akt signaling in response to acute bouts of exercise
- Effect of betaine supplementation on power performance and fatigue
- Effect of 15 days of betaine ingestion on concentric and eccentric force outputs during isokinetic exercise
- Creatine but not betaine supplementation increases muscle phosphorylcreatine content and strength performance
- The effects of chronic betaine supplementation on exercise performance, skeletal muscle oxygen saturation and associated biochemical parameters in resistance trained men
- Ergogenic effects of betaine supplementation on strength and power performance
- Betaine supplementation lowers plasma homocysteine in healthy men and women
- Betaine supplementation decreases plasma homocysteine concentrations but does not affect body weight, body composition, or resting energy expenditure in human subjects
- Orally administered betaine has an acute and dose-dependent effect on serum betaine and plasma homocysteine concentrations in healthy humans
- Betaine supplementation and plasma homocysteine in healthy volunteers
- Dietary and supplementary betaine: effects on betaine and homocysteine concentrations in males
- Betaine for nonalcoholic fatty liver disease: results of a randomized placebo-controlled trial
- Evaluation of the clinical efficacy of a betaine-containing mouthwash and an intraoral device for the treatment of dry mouth
- Safety and effectiveness of topical dry mouth products containing olive oil, betaine, and xylitol in reducing xerostomia for polypharmacy-induced dry mouth
- Betaine-containing toothpaste relieves subjective symptoms of dry mouth
- Effects of a betaine-containing toothpaste on subjective symptoms of dry mouth: a randomized clinical trial
- L-carnitine ameliorated fasting-induced fatigue, hunger, and metabolic abnormalities in patients with metabolic syndrome: a randomized controlled study
- L-Carnitine's Effect on the Biomarkers of Metabolic Syndrome: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
- Ameliorating hypertension and insulin resistance in subjects at increased cardiovascular risk: effects of acetyl-L-carnitine therapy
- Comparative study to evaluate the effect of l-carnitine plus glimepiride versus glimepiride alone on insulin resistance in type 2 diabetic patients
- Effects of simvastatin and carnitine versus simvastatin on lipoprotein(a) and apoprotein(a) in type 2 diabetes mellitus
- Comparison between orlistat plus l-carnitine and orlistat alone on inflammation parameters in obese diabetic patients
- Effects of combination of sibutramine and L-carnitine compared with sibutramine monotherapy on inflammatory parameters in diabetic patients
- L-Carnitine supplementation reduces oxidized LDL cholesterol in patients with diabetes
- Effect of L-carnitine on plasma glycemic and lipidemic profile in patients with type II diabetes mellitus
- Effect of carnitine-orotate complex on glucose metabolism and fatty liver: a double-blind, placebo-controlled study
- Efficacy and tolerability of combined treatment with L-carnitine and simvastatin in lowering lipoprotein(a) serum levels in patients with type 2 diabetes mellitus
- Blood Pressure and Metabolic Effects of Acetyl-l-Carnitine in Type 2 Diabetes: DIABASI Randomized Controlled Trial
- The effects of oral L-carnitine treatment on blood lipid metabolism and the body fat content in the diabetic patient
- The effect of L-carnitine on plasma lipoprotein(a) levels in hypercholesterolemic patients with type 2 diabetes mellitus
- 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.
- Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial
- Effect of oral L-carnitine administration on insulin sensitivity and lipid profile in type 2 diabetes mellitus patients
- The effects of L-carnitine supplementation on glycemic markers in adults: A systematic review and dose-response meta-analysis.
- L-carnitine improves glucose disposal in type 2 diabetic patients
- Caloric restriction and L-carnitine administration improves insulin sensitivity in patients with impaired glucose metabolism
- Preliminary observations on the use of propionyl-L-carnitine in combination with sildenafil in patients with erectile dysfunction and diabetes
- Acetyl-l-carnitine versus placebo for migraine prophylaxis: A randomized, triple-blind, crossover study
- The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis
- Effects of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with polycystic ovary syndrome: A systematic review and meta-analysis.
- Oral carnitine supplementation reduces body weight and insulin resistance in women with polycystic ovary syndrome: a randomized, double-blind, placebo-controlled trial
- Effects of Carnitine Administration on Carotid Intima-media Thickness and Inflammatory Factors in Patients with Polycystic Ovary Syndrome: A Randomized, Double-blind, Placebo-controlled Trial
- Effects of L-carnitine supplementation for women with polycystic ovary syndrome: a systematic review and meta-analysis
- Effect of glycine propionyl-L-carnitine on aerobic and anaerobic exercise performance
- Influence of L-carnitine administration on maximal physical exercise
- Effects of nine weeks L-Carnitine supplementation on exercise performance, anaerobic power, and exercise-induced oxidative stress in resistance-trained males
- l-Carnitine l-tartrate supplementation favorably affects biochemical markers of recovery from physical exertion in middle-aged men and women
- Glycine propionyl-L-carnitine produces enhanced anaerobic work capacity with reduced lactate accumulation in resistance trained males
- Chronic oral ingestion of L-carnitine and carbohydrate increases muscle carnitine content and alters muscle fuel metabolism during exercise in humans
- The effect of oral supplementation with L-carnitine on maximum and submaximum exercise capacity
- Effect of intravenous L-carnitine on carnitine homeostasis and fuel metabolism during exercise in humans
- Effects of prolonged L-carnitine administration on delayed muscle pain and CK release after eccentric effort
- l-Carnitine Supplementation in Older Women. A Pilot Study on Aging Skeletal Muscle Mass and Function
- Effects of L-carnitine L-tartrate supplementation on muscle oxygenation responses to resistance exercise
- The effects of L-carnitine L-tartrate supplementation on hormonal responses to resistance exercise and recovery
- Levocarnitine administration in elderly subjects with rapid muscle fatigue: effect on body composition, lipid profile and fatigue
- Oxidative stress in response to aerobic and anaerobic power testing: influence of exercise training and carnitine supplementation
- Effect of L-carnitine on submaximal exercise metabolism after depletion of muscle glycogen
- Androgenic responses to resistance exercise: effects of feeding and L-carnitine
- Carbohydrate, protein, and fat metabolism during exercise after oral carnitine supplementation in humans
- Effects of four weeks L-carnitine L-tartrate ingestion on substrate utilization during prolonged exercise
- L -Carnitine and the recovery from exhaustive endurance exercise: a randomised, double-blind, placebo-controlled trial
- Effects of carnitine coingested caffeine on carnitine metabolism and endurance capacity in athletes
- Effects of L-carnitine supplementation on physical performance and energy metabolism of endurance-trained athletes: a double-blind crossover field study
- Clinical Effects of L-Carnitine Supplementation on Physical Performance in Healthy Subjects, the Key to Success in Rehabilitation: A Systematic Review and Meta-Analysis from the Rehabilitation Point of View.
- L-Carnitine/Simvastatin Reduces Lipoprotein (a) Levels Compared with Simvastatin Monotherapy: A Randomized Double-Blind Placebo-Controlled Study
- Effect of lysine, vitamin B(6), and carnitine supplementation on the lipid profile of male patients with hypertriglyceridemia: a 12-week, open-label, randomized, placebo-controlled trial
- L-carnitine infusion does not alleviate lipid-induced insulin resistance and metabolic inflexibility
- Effects of acute versus chronic L-carnitine L-tartrate supplementation on metabolic responses to steady state exercise in males and females
- Liver-Oriented Acute Metabolic Effects of A Low Dose of L-Carnitine under Fat-Mobilizing Conditions: Pilot Human Clinical Trial
- The effects of L-carnitine supplementation on glycemic control: a systematic review and meta-analysis of randomized controlled trials
- The effect of L-carnitine on inflammatory mediators: a systematic review and meta-analysis of randomized clinical trials
- Single dose administration of L-carnitine improves antioxidant activities in healthy subjects
- Comparison of pre-workout nitric oxide stimulating dietary supplements on skeletal muscle oxygen saturation, blood nitrate/nitrite, lipid peroxidation, and upper body exercise performance in resistance trained men
- Glycine propionyl-L-carnitine modulates lipid peroxidation and nitric oxide in human subjects
- L-carnitine supplementation to diet: a new tool in treatment of nonalcoholic steatohepatitis--a randomized and controlled clinical trial
- Effects of carnitine supplementation on flow-mediated dilation and vascular inflammatory responses to a high-fat meal in healthy young adults
- The effect of l-carnitine on fat oxidation, protein turnover, and body composition in slightly overweight subjects
- Effects of exercise intensity and altered substrate availability on cardiovascular and metabolic responses to exercise after oral carnitine supplementation in athletes
- Safety measures of L-carnitine L-tartrate supplementation in healthy men
- Effects of oral L-carnitine supplementation on insulin sensitivity indices in response to glucose feeding in lean and overweight/obese males
- Glycine propionyl-L-carnitine increases plasma nitrate/nitrite in resistance trained men
- Effects of L-carnitine on oxidative stress responses in patients with renal disease
- Effects of L-carnitine supplementation on blood pressure: a systematic review and meta-analysis of randomized controlled trials.
- Effects of combined treatment with simvastatin and L-carnitine on triglyceride levels in diabetic patients with hyperlipidaemia
- Effects of L-carnitine supplementation on lipid profiles in patients with coronary artery disease
- Effects of carnitine on thyroid hormone action
- L-carnitine improves the asthma control in children with moderate persistent asthma
- Carnitine supplementation improves metabolic flexibility and skeletal muscle acetylcarnitine formation in volunteers with impaired glucose tolerance: A randomised controlled trial
- The effects of L-carnitine supplementation on performance during interval swimming
- Carnitine versus androgen administration in the treatment of sexual dysfunction, depressed mood, and fatigue associated with male aging
- Acetyl-L-carnitine plus propionyl-L-carnitine improve efficacy of sildenafil in treatment of erectile dysfunction after bilateral nerve-sparing radical retropubic prostatectomy
- l-carnitine and l-acetylcarnitine supplementation for idiopathic male infertility.
- Effects of L-carnitine administration on VO2max and the aerobic-anaerobic threshold in normoxia and acute hypoxia