Protocol · Hepatic
Chronic Liver Disease Protocol
Silymarin (Milk Thistle) and S-Adenosyl-L-Methionine (SAMe) are the core of this stack, with 4 supporting supplements. Each row gives the amount the protocol lists and the grade our evidence database holds for that supplement in Chronic Liver Disease.
We are re-verifying the studies cited on protocol pages; only confirmed citations are shown.
The stack
6 supplements · none graded yet · 1 confirmed study
| Grade | Supplement | Amount listed | Why it’s in the stack | Evidence on file | Shop |
|---|---|---|---|---|---|
| Primary stackThe core of this protocol | |||||
| Silymarin (Milk Thistle) | Amount listed: 420 mg daily (standardized to 70–80% silymarin) | Flavonoid complex with hepatoprotective, antioxidant, and antifibrotic properties | Not graded yet | ||
| S-Adenosyl-L-Methionine (SAMe) | Amount listed: 1,200 mg daily in divided doses | Methyl donor that supports glutathione synthesis and hepatocyte membrane integrity | Not graded yet | ||
| Supporting stackListed as additions to the core | |||||
| N-Acetyl Cysteine (NAC) | Amount listed: 1,200–1,800 mg daily | Glutathione precursor that reduces oxidative stress and supports detoxification | Not graded yet | ||
| Vitamin E | Amount listed: 800 IU daily | Antioxidant that reduces lipid peroxidation; studied in NASH/NAFLD | Not graded yet | ||
Confirmed studies for Vitamin E (titles as PubMed lists them) | |||||
| Phosphatidylcholine | Amount listed: 1,800 mg daily | Essential phospholipid for hepatocyte membrane repair and bile secretion | Not graded yet | ||
| Zinc | Amount listed: 30–50 mg daily | Often deficient in liver disease; supports alcohol dehydrogenase and immune function | Not graded yet | ||
Shop this protocol
Support alongside medical care. These supplements are not a treatment for Chronic Liver Disease. If you are being treated for it, talk to your clinician before adding one: supplements can interact with medicines.
Each opens third-party tested products, matched to the dose above where we can.
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
How this protocol works
In plain language
Chronic liver disease involves ongoing inflammation, oxidative stress, and progressive scarring (fibrosis) that impairs the liver's ability to detoxify and metabolize. This protocol supports liver protection and regeneration.
- Milk thistle (silymarin) is the most studied liver supplement. It stabilizes hepatocyte membranes, increases glutathione levels, and has anti-inflammatory effects. Studies show it can improve liver enzymes and potentially slow fibrosis.
- SAMe is a natural compound involved in methylation and glutathione production. The liver normally makes SAMe, but this is impaired in liver disease. Supplementation supports detoxification pathways.
- NAC provides cysteine for glutathione synthesis—the liver's master antioxidant. It's used medically for acetaminophen overdose and supports general liver detoxification.
- Vitamin E (800 IU) is the only supplement with Level A evidence in NAFLD/NASH from the PIVENS trial, showing histological improvement.
- Phosphatidylcholine helps repair damaged cell membranes and supports bile flow.
- Zinc deficiency is common in liver disease and worsens outcomes.
Important: Work with your hepatologist. Avoid high-dose vitamin A, iron (unless deficient), and limit acetaminophen.
Expected timeline: Liver enzyme improvements may be seen in 8-12 weeks. Histological changes take 6-12 months.