Protocol · Digestive & Liver
Nonalcoholic Steatohepatitis (NASH) Protocol
Vitamin E and Milk Thistle (Silymarin) are the core of this stack, with 6 supporting supplements. Each row gives the amount the protocol lists and the grade our evidence database holds for that supplement in Nonalcoholic Steatohepatitis (NASH).
We are re-verifying the studies cited on protocol pages; only confirmed citations are shown.
The stack
8 supplements · 3 graded · 1 confirmed study
| Grade | Supplement | Amount listed | Why it’s in the stack | Evidence on file | Shop |
|---|---|---|---|---|---|
| Primary stackThe core of this protocol | |||||
| Vitamin E | Amount listed: 800 IU daily (alpha-tocopherol) | Potent antioxidant that reduces oxidative stress and inflammation in the liver; improves histology in NASH
| Grade D for Bilirubin222 people | ||
Confirmed studies for Vitamin E (titles as PubMed lists them) | |||||
| Milk Thistle (Silymarin) | Amount listed: 420–600 mg silymarin daily | Hepatoprotective flavonoid that reduces inflammation, oxidative stress, and may improve liver enzymes | Not graded yet | ||
| Supporting stackListed as additions to the core | |||||
| Omega-3 Fatty Acids | Amount listed: 2–4 g EPA/DHA daily | Reduces hepatic fat accumulation, inflammation, and improves lipid metabolism | Not graded yet | ||
| Betaine | Amount listed: 10–20 g daily in divided doses | Methyl donor that supports liver methylation pathways and may reduce hepatic fat accumulation
| Grade B for Liver Enzymes30 people | ||
| Probiotics/Synbiotics | Amount listed: Multi-strain formula with prebiotic fiber | Modulates gut-liver axis, reduces endotoxin translocation, and improves hepatic inflammation | Not graded yet | ||
| L-Carnitine | Amount listed: 1–2 g daily | Enhances fatty acid oxidation in the liver, reducing hepatic fat accumulation
| Grade C for Body Fat1 study · 71 people | ||
| Berberine | Amount listed: 500 mg 2–3 times daily | Activates AMPK, improves insulin sensitivity, reduces hepatic fat, and has anti-inflammatory effects | Not graded yet | ||
| Curcumin | Amount listed: 500–1,500 mg daily (enhanced absorption formula) | Anti-inflammatory and antioxidant that may improve liver enzymes and reduce hepatic fat | Not graded yet | ||
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 supplement in this protocol graded A or B. Each opens third-party tested products, matched to the dose above where we can.
- Grade B
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How this protocol works
In plain language
NASH (Nonalcoholic Steatohepatitis) is a serious form of fatty liver disease where fat accumulation in the liver causes inflammation and liver cell damage—not from alcohol, but from metabolic dysfunction. It can progress to cirrhosis and liver failure. NASH is closely linked to obesity, insulin resistance, and metabolic syndrome. While weight loss through diet and exercise is the most effective treatment, certain supplements can support liver health and reduce inflammation.
IMPORTANT: NASH can be a serious progressive disease. Work with a hepatologist or gastroenterologist. Weight loss of 7-10% of body weight significantly improves NASH—this is the most important intervention.
- Vitamin E is the best-studied supplement for NASH. The landmark PIVENS trial showed that 800 IU daily improved liver inflammation and resolved NASH in significantly more patients than placebo. It works by reducing oxidative stress, which is a key driver of liver damage in NASH. It's now recommended in treatment guidelines for non-diabetic NASH patients.
- Milk Thistle (Silymarin) has been used for liver conditions for decades. It protects liver cells, increases glutathione (the liver's main antioxidant), reduces inflammation, and may help regenerate liver tissue. Studies show it can improve liver enzymes and may help with liver histology when combined with other treatments.
- Omega-3 Fatty Acids help reduce the fat accumulation in the liver and have anti-inflammatory effects. They improve triglyceride levels and may help reduce liver fat content. Higher doses (2-4g) are typically needed for liver benefits.
- Betaine is a methyl donor that supports the liver's methylation pathways. It helps process fats and may reduce the accumulation of fat in the liver. Studies show improvements in liver enzymes and histology, though large trials are needed.
- Probiotics/Synbiotics address the gut-liver axis—there's a strong connection between gut bacteria and liver health. Dysbiosis (imbalanced gut bacteria) contributes to liver inflammation through bacterial products crossing into the bloodstream. Probiotics can reduce this 'endotoxemia' and improve liver inflammation.
- L-Carnitine helps transport fatty acids into mitochondria for burning. By improving fatty acid oxidation in the liver, it may help reduce hepatic fat accumulation.
- Berberine activates AMPK (the body's 'metabolic master switch'), improving insulin sensitivity and reducing hepatic fat. It has benefits similar to the diabetes drug metformin and can improve liver enzymes in NAFLD/NASH.
- Curcumin has potent anti-inflammatory and antioxidant effects. Studies show it can reduce liver enzymes and may help with liver fat content.
Expected timeline: Liver enzyme improvements: 8-12 weeks. Histological improvements: 6-12 months of consistent treatment. Weight loss remains the cornerstone—aim for 1-2 lbs/week.