Suplmnt
Best supplements for Fatty Liver (NAFLD/MASLD and NASH) hero image
Best Supplements for Fatty Liver (NAFLD/MASLD and NASH)

Top 10 Evidence-Based Recommendations

Evidence Level: promising•Ranking methodology

We analyzed meta-analyses and the largest RCTs in fatty liver (NAFLD/MASLD and biopsy-proven NASH), prioritizing meaningful liver-fat loss (MRI/CT/ultrasound), histology where available, enzyme drops, safety, and practicality from >60 human trials. No fluff, no affiliate picks—just what moves the needle, fast and safely, with [^] citations throughout.

Quick Reference Card

1.Omega-3s (EPA/DHA)
2.Vitamin E (RRR-α-tocopherol)
3.Berberine
4.Delta-tocotrienols
5.L-Carnitine
6.Curcumin (enhanced)
Show all 10 supplements...
7.Probiotics/Synbiotics
8.Silymarin (milk thistle)
9.Phosphatidylcholine (choline)
10.Green tea catechins

Ranked Recommendations

#1Top Choice

The reliable fat-squeezer for your liver

Dose: 2–4 g/day EPA+DHA with meals for 12–24 weeks

Time to Effect: 8–12 weeks for liver fat; 4–8 weeks for triglycerides

How It Works

EPA/DHA lower hepatic VLDL production and de novo lipogenesis, improving triglyceride export and insulin signaling, which reduces intrahepatic fat stores. [10][12][14]

Evidence

Umbrella/meta-analyses of 15–22 RCTs show meaningful reductions in liver fat (imaging) and ALT/AST, with better lipids; histology changes are limited. Benefits seen in adults and kids. [10][11][12][15]

Best for:High triglycerides, MRI/ultrasound-proven steatosis, those wanting cardio-metabolic upside too

Caution:Fishy burps; mild antiplatelet effect—use caution with anticoagulants

Tip:Aim for products listing EPA and DHA milligrams (not just "fish oil"); triglyceride or re-esterified TG forms are well absorbed.

#2Strong Alternative

The only supplement with biopsy-proven NASH response

Dose: 800 IU/day RRR-α-tocopherol for 96 weeks (non-diabetic NASH)

Time to Effect: 24–48 weeks for histology; 8–12 weeks for enzymes

How It Works

Potent antioxidant dampening lipid peroxidation and inflammatory injury that drive ballooning and NASH activity. [1]

Evidence

The NIH PIVENS RCT showed 43% NASH improvement vs 19% placebo over 96 weeks (non-diabetic adults); fibrosis not improved. Not generalizable to diabetics. [1]

Best for:Biopsy-proven NASH without diabetes, under clinician guidance

Caution:Possible ↑ hemorrhagic stroke and prostate cancer risk signals in other populations; discuss risks/benefits and avoid mega-dosing unnecessarily. [9]

Tip:Use natural RRR-α-tocopherol; reassess need at 6–12 months with your clinician.

#3Worth Considering

The insulin-and-lipid fixer that trims liver fat

Dose: 500 mg three times daily with meals (1.5 g/day) for 12–16 weeks

Time to Effect: 4–8 weeks for enzymes and lipids; 12–16 weeks for liver fat

How It Works

Activates AMPK, curbing hepatic lipogenesis and improving insulin resistance; reduces de novo fat making in the liver. [18][21]

Evidence

Open-label RCT with MRI spectroscopy showed greater hepatic fat reduction vs lifestyle alone; meta-analysis of 6 RCTs found improvements in ALT, LDL, and glycemia. [20][22]

Best for:NAFLD with insulin resistance, prediabetes/T2D, atherogenic lipids

Caution:GI upset; may interact with CYP3A4/P-gp drugs and lower glucose—monitor if on hypoglycemics

Tip:Choose berberine HCl from reputable brands; split dosing tames GI effects.

Loading products...

#4

Vitamin E's under-the-radar cousin with enzyme wins

Dose: 300 mg twice daily for 24 weeks

Time to Effect: 8–12 weeks for enzymes; 24 weeks for steatosis grade

How It Works

Antioxidant/anti-inflammatory effects distinct from tocopherols; modulates SREBP and NF-κB pathways tied to steatosis. [5]

Evidence

Placebo-controlled RCT (24 weeks) showed improvements in ALT/AST, inflammation markers, and ultrasound steatosis vs placebo. [5]

Best for:Those who can't take high-dose α-tocopherol but want redox support

Caution:Generally well tolerated; avoid stacking with high-dose α-tocopherol unless supervised

Tip:Annatto-derived δ-tocotrienol products typically provide the studied profile.

#5

Turns fat into fuel inside liver mitochondria

Dose: 1–2 g/day (adults) for 8–24 weeks

Time to Effect: 4–8 weeks for enzymes; 8–12 weeks for triglycerides

How It Works

Shuttles long-chain fatty acids into mitochondria, boosting β-oxidation and lowering hepatic fat accumulation. [2]

Evidence

Meta-analysis of 8 RCTs shows significant ALT/AST reductions and triglyceride benefits, with stronger effects in adults. [2]

Best for:Fatigue plus NAFLD, high triglycerides, those intolerant to fish oil

Caution:Fishy odor, mild GI upset

Tip:Acetyl-L-carnitine is also effective; take with meals to reduce GI issues.

#6

Inflammation down, enzymes down

Dose: 1000–1500 mg/day standardized curcuminoids with piperine/phospholipid for 8–12 weeks

Time to Effect: 4–8 weeks for enzymes; 8–12 weeks for ultrasound severity

How It Works

Inhibits NF-κB and lipogenesis genes, improving insulin resistance and oxidative stress that sustain steatosis. [3][4]

Evidence

Systematic reviews show reductions in ALT/AST and improved ultrasound severity; one well-controlled RCT with lifestyle found no between-group difference, highlighting heterogeneity. [3][6]

Best for:People prioritizing inflammation, enzymes, and metabolic markers

Caution:Gallbladder disease risk, anticoagulant interactions at high doses

Tip:Pick phytosomal or piperine-enhanced formulas; plain turmeric won't cut it.

#7

Fix the gut–liver axis to ease liver injury

Click to expand details...

#8

Solid for enzymes, mixed for histology

Click to expand details...

#9

Supports VLDL export—fat needs a ride out

Click to expand details...

#10

Antioxidant brew that lightens liver fat

Click to expand details...

Timeline Expectations

Fast Results

  • •Omega-3s (EPA/DHA): triglycerides and liver fat in 8–12 weeks. [10]
  • •Curcumin (enhanced): ALT/AST drops in 4–8 weeks. [3]
  • •Berberine: enzymes and glycemic markers by 4–8 weeks. [20]

Gradual Benefits

  • •Vitamin E (800 IU/day): NASH histology over 96 weeks. [1]
  • •Probiotics/Synbiotics: fibrosis indices over 3–6 months. [7]
  • •Silymarin: stiffness/enzymes over 3–6+ months. [25]

Combination Strategies

Metabolic Fix + Fat Out Stack

Components: Berberine 500 mg TID + Omega-3 EPA/DHA 2–4 g/day + L‑Carnitine 1–2 g/day

Targets the 3 biggest hepatic fat drivers—insulin resistance (berberine), triglyceride overflow (EPA/DHA), and sluggish β-oxidation (carnitine)—delivering additive drops in enzymes and liver fat. [10][12][20][2]

With meals: berberine 500 mg three times daily; fish oil split BID; L‑carnitine once or split BID. Run 12 weeks, recheck ALT/AST and ultrasound/MRI if available.

Inflammation & Stiffness Stack

Components: Curcumin 1000–1500 mg/day (enhanced) + Probiotic multi‑strain 10–20B CFU/day + Silymarin 420–700 mg/day

Curcumin and silymarin calm hepatocyte injury; probiotics reduce gut-derived inflammation and modestly improve fibrosis indices; together they address enzyme elevation and liver stiffness. [3][7][16][25]

Take curcumin and silymarin with food; probiotic daily for at least 12–24 weeks. Assess FibroScan (LSM) at baseline and ~6 months.

NASH (Doctor-Supervised) Stack

Components: Vitamin E 800 IU/day (non‑diabetic NASH) + Omega-3 EPA/DHA 2–4 g/day

Vitamin E is the only supplement with RCT histologic NASH improvement (non-diabetics); omega-3s layer on liver-fat and triglyceride reductions for cardiometabolic protection. [1][10][12]

Only if non‑diabetic and approved by your hepatology team. Take daily with meals; reassess at 6–12 months for continuation.

Shopping Guide

Form Matters

  • •Omega-3: choose EPA/DHA totals (≥1 g EPA+DHA per serving), re-esterified TG or triglyceride form absorbs well.
  • •Curcumin: phytosomal (Meriva) or with piperine for absorption; plain turmeric is weak.
  • •Silymarin: silybin-phosphatidylcholine (phytosome) boosts bioavailability.
  • •Probiotics: multi-strain Lactobacillus+Bifidobacterium with CFU listed at expiry, not manufacture.
  • •Vitamin E: natural RRR-α-tocopherol (not DL-) if used under medical guidance.

Quality Indicators

  • •IFOS/GOED or USP-verified fish oil; oxidation markers (peroxide/aniso) available on request.
  • •Botanicals standardized to actives (e.g., ≥95% curcuminoids; ≥70–80% silymarin).
  • •COAs showing heavy metals, microbes, and solvent residues—especially for green tea extracts.

Avoid

  • •'Liver detox' proprietary blends without exact milligrams.
  • •Mega-dose promises ('lose 50% liver fat in 2 weeks').
  • •No third-party testing (NSF, USP, Informed Choice) for oils and botanicals.
  • •Under-dosed berberine (<1000 mg/day total) or fish oil labeled only as '1000 mg fish oil' without EPA/DHA.

Overrated Options

These supplements are often marketed for Fatty Liver (NAFLD/MASLD and NASH) but have limited evidence:

Resveratrol

Multiple meta-analyses in NAFLD show trivial or no benefit on enzymes, fat, or lipids; some analyses even show worse LDL/TC vs placebo. [28][29][30][31]

Vitamin D (high-dose)

Mixed data; recent RCTs in NAFLD/T2D show biomarker shifts but inconsistent effects on liver fat/enzymes—insufficient to rank among top options. [23]

N‑acetylcysteine (NAC) alone

Evidence in NAFLD is limited and mixed; stronger data pertain to acute liver failure, not chronic fatty liver. Not a front-line NAFLD supplement. [32][33][35]

Important Considerations

Supplements support but don't cure fatty liver. Verify diagnoses (NAFLD vs alcoholic liver disease, viral hepatitis, autoimmune, drug-induced). If you have cirrhosis, are pregnant, on anticoagulants, or take multiple prescriptions, talk to your clinician first. Recheck ALT/AST in 8–12 weeks and consider imaging (FibroScan CAP/LSM, MRI-PDFF) to confirm response.

How we chose these supplements

Ranking emphasized outcomes patients feel/see: imaging-verified liver fat reduction, enzyme drops ≥5–10 IU/L, and histology where available. We prioritized randomized, placebo-controlled trials and meta-analyses and discounted small, open-label or biomarker-only studies. [1][10][12][16]

Common Questions

How fast can supplements reduce liver fat?

Most trials show changes by 8–12 weeks; histology-level NASH responses (vitamin E) take ~12–24 months. [1][10]

Which single supplement helps most people with fatty liver?

Omega-3 EPA/DHA—consistent imaging and enzyme improvements, plus cardiovascular benefits. [10][11]

Is vitamin E right for me?

Only consider 800 IU/day if you have biopsy-proven NASH and no diabetes, under medical supervision. [1]

Can I take berberine and fish oil together?

Yes—different mechanisms; the combo targets insulin resistance and triglyceride overflow. [10][20]

Do these replace diet and exercise?

No. All RCTs layered on lifestyle. Weight loss of 7–10% remains the biggest lever; supplements are add-ons.

Sources

  1. 1.
    Pioglitazone, Vitamin E, or Placebo for Nonalcoholic Steatohepatitis (PIVENS) (2010) [link]
  2. 2.
    Efficacy and safety of carnitine supplementation on NAFLD: systematic review and meta-analysis (2023) [link]
  3. 3.
    Curcumin as adjuvant treatment in NAFLD: systematic review and meta-analysis (2022) [link]
  4. 4.
    The effects of curcumin on metabolic parameters in NAFLD: meta-analysis of RCTs (2018) [link]
  5. 5.
    Delta‑tocotrienol in NAFLD: randomized, placebo-controlled trial (24 weeks) (2020) [link]
  6. 6.
    Curcumin and inflammation in NAFLD: randomized, placebo-controlled trial (2019) [link]
  7. 7.
    Probiotics, prebiotics, synbiotics in NAFLD: systematic review and meta-analysis (to March 2024) (2024) [link]
  8. 8.
    Silybin-phosphatidylcholine + vitamin E in NAFLD: randomized controlled trial (2012) [link]
  9. 9.
    Low‑dose vitamin E in MASH—news summary referencing RCTs and safety debates (2025) [link]
  10. 10.
    Omega‑3 PUFA supplementation in NAFLD: systematic review and meta-analysis (22 RCTs) (2020) [link]
  11. 11.
    Omega‑3 PUFAs umbrella systematic review and meta‑analysis (to 2022) (2023) [link]
  12. 12.
    Effectiveness of Omega‑3 PUFAs in NAFLD: systematic review and meta-analysis (2018–2023) (2023) [link]
  13. 13.
    A randomized trial of silymarin for NASH (48 weeks, high-dose) (2017) [link]
  14. 14.
    Intervention studies of long-chain omega‑3s in NAFLD (MRI/MRS) (2018) [link]
  15. 15.
    DHA in pediatric NAFLD: randomized, placebo-controlled trial (2015) [link]
  16. 16.
    Impact of silymarin in NAFLD: systematic review and meta-analysis (2021) [link]
  17. 17.
    Administration of silymarin in NAFLD/NASH: systematic review and meta-analysis (2024) [link]
  18. 18.
    Berberine improves glucogenesis and lipid metabolism in NAFLD (mechanistic) (2017) [link]
  19. 19.
    Berberine global modulation of hepatic mRNA/lncRNA in NAFLD (2015) [link]
  20. 20.
    Berberine in NAFLD—randomized, parallel, open-label MRI trial (16 weeks) (2015) [link]
  21. 21.
    Colesevelam increased liver fat by MRI-PDFF in NASH (negative control) (2012) [link]
  22. 22.
    Meta-analysis of berberine in NAFLD (6 RCTs) (2016) [link]
  23. 23.
    High‑dose cholecalciferol in NAFLD with T2D: randomized, placebo-controlled (2023) [link]
  24. 24.
    Phosphatidylcholine in NAFLD: randomized controlled study (12 weeks) (2024) [link]
  25. 25.
    Silymarin decreases liver stiffness in MASLD: randomized, double-blind trial (24 weeks) (2024) [link]
  26. 26.
    Green tea high‑catechin beverage in NAFLD: double‑blind RCT (12 weeks) (2013) [link]
  27. 27.
    Systematic review: green tea catechins in NAFLD (2022) [link]
  28. 28.
    Resveratrol supplementation in NAFLD: meta-analysis (7 RCTs) (2020) [link]
  29. 29.
    Resveratrol in NAFLD: systematic review and meta-analysis (4 RCTs) (2017) [link]
  30. 30.
    Efficacy of resveratrol—meta-analysis noting ↑ LDL/TC vs placebo (2016) [link]
  31. 31.
    Umbrella review of resveratrol meta-analyses in T2D/MetS/NAFLD (2021) [link]
  32. 32.
    NAC in non‑APAP acute liver failure: updated meta-analysis (2021) [link]
  33. 33.
    NAC in non‑APAP ALF: RCT meta-analysis (no overall benefit) (2024) [link]
  34. 34.
    NAC+Metformin±UDCA in biopsy‑proven NASH (open-label RCT) (2019) [link]
  35. 35.
    NAC in cirrhosis (non‑NAFLD specific): mixed biomarkers (2023) [link]

This content is for informational purposes only and is not medical advice. Always consult healthcare providers before starting supplements. We cite research but errors may exist. Report an error