A Vitamin to help Non Alcoholic Fatty Liver

What is it?

Non Alcoholic Fatty Liver Disease (NAFLD) is a condition when excess fat is stored in the liver, the cause of which is not related to the consumption of alcohol. This condition appears in two forms:​1​

  1. Simple Fatty Liver (NAFL), when there is fat in the liver, in the relative absence of inflammation or damage to liver cells. This condition does not usually progress to cause further deterioration, damage or complications.
  2. Non Alcoholic Steatohepatitis (NASH), when alongside fat in the liver, inflammation and cell damage is also observed.

These two conditions have been known to transform into one another.​2​

Who is at risk?

While the precise causes of some people developing one or the other condition isn’t known, NAFLD is common in people with the following conditions. This isn’t the complete list of causes/risk factors. There are others too. Please visit the references for further details. Symptoms aren’t usually felt, and if so, include fatigue and discomfort in the upper right side of the abdomen. ​3​

  • Obesity
  • Insulin resistance
  • High triglycerides, high total cholesterol, high LDL or low HDL
  • Metabolic syndrome
  • Type 2 Diabetes
  • Possible genetic predisposition
  • The risk factors for NASH, include all of the above, plus hypertension.

The Benefits

There is repeated mention of the use of Vitamin E, across papers on the subject, as therapeutic for both NAFL and NASH. Here’s a summary of findings.

  • Vitamin E reduces oxidative stress in NAFL/NASH livers, by retrieving free radicals.​2​
  • Treatment with Vitamin E has been shown to be beneficial, alongside the consumption of Omega-3 polyunsaturated fatty acids. ​4​
  • Vitamin E was shown to have beneficial effects in children. ​5,6​
  • Vitamin E at a dose of 800 IU/d for 96 weeks was associated with various improvements in the condition.​7​
  • Antioxidant therapies, such as vitamin E, improve NASH. ​8–17​
  • Vitamin E supplementation decreases liver fat content as well as fibrosis. ​18​
  • Vitamin E therapy has shown to reduce histological evidence of hepatic steatosis and associated with the clinical resolution of steatohepatitis in adult NAFLD patients. ​19​
  • Vitamin E and Vitamin C could avoid the progression of NAFLD. ​20​

The Doubts

Please also note that the some studies also mention:

  • The safety of long term use of Vitamin E has not been confirmed.
  • Has no effect on the condition’s features of insulin resistance.
  • The mechanism, especially concerning malignant tumour progression, and long-term outcomes are not clear.
  • It isn’t beneficial. (EASL, AISF)
  • Recommended for the use of Vitamin E for non-diabetic patients
  • This nutrient can benefit both diabetics and non-diabetics with the condition.
  • Does not appear to affect the extent or severity of hepatic fibrosis once it is established.

Conclusion

I’d speak with my doctor and chart a strategy for the inclusion of Vitamin E supplementation, keeping the doubts and negatives in mind as well as discussing them in detail.

References

  1. 1.
    NIDDK. Definition and Facts of NAFLD & NASH. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/. Published November 2016.
  2. 2.
    Tanaka N, Kimura T, Fujimori N, Nagaya T, Komatsu M, Tanaka E. Current status, problems, and perspectives of non-alcoholic fatty liver disease research. World J Gastroenterol. 2019;25(2):163-177. https://www.ncbi.nlm.nih.gov/pubmed/30670907.
  3. 3.
    NIDDK. Symptoms and Causes of NAFLD & NASH. National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/symptoms-causes. Published November 2016.
  4. 4.
    Schwenger K, Allard J. Clinical approaches to non-alcoholic fatty liver disease. World J Gastroenterol. 2014;20(7):1712-1723. doi:10.3748/wjg.v20.i7.1712
  5. 5.
    Hernandez-Rodas M, Valenzuela R, Videla L. Relevant Aspects of Nutritional and Dietary Interventions in Non-Alcoholic Fatty Liver Disease. Int J Mol Sci. 2015;16(10):25168-25198. doi:10.3390/ijms161025168
  6. 6.
    Clemente M, Mandato C, Poeta M, Vajro P. Pediatric non-alcoholic fatty liver disease: Recent solutions, unresolved issues, and future research directions. World J Gastroenterol. 2016;22(36):8078-8093. doi:10.3748/wjg.v22.i36.8078
  7. 7.
    Leoni S, Tovoli F, Napoli L, Serio I, Ferri S, Bolondi L. Current guidelines for the management of non-alcoholic fatty liver disease: A systematic review with comparative analysis. World J Gastroenterol. 2018;24(30):3361-3373. doi:10.3748/wjg.v24.i30.3361
  8. 8.
    Uchida D, Takaki A, Adachi T, Okada H. Beneficial and Paradoxical Roles of Anti-Oxidative Nutritional Support for Non-Alcoholic Fatty Liver Disease. Nutrients. 2018;10(8). doi:10.3390/nu10080977
  9. 9.
    Ullah R, Rauf N, Nabi G, et al. Role of Nutrition in the Pathogenesis and Prevention of Non-alcoholic Fatty Liver Disease: Recent Updates. Int J Biol Sci. 2019;15(2):265-276. doi:10.7150/ijbs.30121
  10. 10.
    Suárez M, Boqué N, Del B, Mayneris-Perxachs J, Arola L, Caimari A. Mediterranean Diet and Multi-Ingredient-Based Interventions for the Management of Non-Alcoholic Fatty Liver Disease. Nutrients. 2017;9(10). doi:10.3390/nu9101052
  11. 11.
    Yang J, Fernández-Galilea M, Martínez-Fernández L, et al. Oxidative Stress and Non-Alcoholic Fatty Liver Disease: Effects of Omega-3 Fatty Acid Supplementation. Nutrients. 2019;11(4). doi:10.3390/nu11040872
  12. 12.
    Machado M, Cortez-Pinto H. Non-alcoholic fatty liver disease: what the clinician needs to know. World J Gastroenterol. 2014;20(36):12956-12980. doi:10.3748/wjg.v20.i36.12956
  13. 13.
    Cicero A, Colletti A, Bellentani S. Nutraceutical Approach to Non-Alcoholic Fatty Liver Disease (NAFLD): The Available Clinical Evidence. Nutrients. 2018;10(9). doi:10.3390/nu10091153
  14. 14.
    Duseja A, Singh S, Saraswat V, et al. Non-alcoholic Fatty Liver Disease and Metabolic Syndrome-Position Paper of the Indian National Association for the Study of the Liver, Endocrine Society of India, Indian College of Cardiology and Indian Society of Gastroenterology. J Clin Exp Hepatol. 2015;5(1):51-68. doi:10.1016/j.jceh.2015.02.006
  15. 15.
    Benedict M, Zhang X. Non-alcoholic fatty liver disease: An expanded review. World J Hepatol. 2017;9(16):715-732. doi:10.4254/wjh.v9.i16.715
  16. 16.
    Lonardo A, Nascimbeni F, Maurantonio M, Marrazzo A, Rinaldi L, Adinolfi L. Nonalcoholic fatty liver disease: Evolving paradigms. World J Gastroenterol. 2017;23(36):6571-6592. doi:10.3748/wjg.v23.i36.6571
  17. 17.
    Leite N, Villela-Nogueira C, Cardoso C, Salles G. Non-alcoholic fatty liver disease and diabetes: from physiopathological interplay to diagnosis and treatment. World J Gastroenterol. 2014;20(26):8377-8392. doi:10.3748/wjg.v20.i26.8377
  18. 18.
    Yki-Järvinen H. Nutritional Modulation of Non-Alcoholic Fatty Liver Disease and Insulin Resistance. Nutrients. 2015;7(11):9127-9138. doi:10.3390/nu7115454
  19. 19.
    Temple J, Cordero P, Li J, Nguyen V, Oben J. A Guide to Non-Alcoholic Fatty Liver Disease in Childhood and Adolescence. Int J Mol Sci. 2016;17(6). doi:10.3390/ijms17060947
  20. 20.
    Della P, Vetrani C, Lombardi G, Bozzetto L, Annuzzi G, Rivellese A. Isocaloric Dietary Changes and Non-Alcoholic Fatty Liver Disease in High Cardiometabolic Risk Individuals. Nutrients. 2017;9(10). doi:10.3390/nu9101065

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