The article and protocol are for informational purposes only, and not intended as medical advice. Please read the medical disclaimer below, and consult with your physician before taking supplements or acting upon the information presented in this article and protocol.  

Discussion

Normally, less than 5% of the weight of the liver is fat. When the fat percentage of the liver exceeds 5%, it is called a fatty liver, or “steatosis” in medical terms. As the fat percentage increases, inflammation of the liver also increases. When the liver is inflamed it is termed hepatitis. When a fatty liver is inflamed it is termed steatohepatitis. There are two main types of fatty liver disease, alcoholic and nonalcoholic fatty liver disease. These two diseases have similar pathological spectra, ranging from simple hepatic steatosis to steatohepatitis, liver cirrhosis, and hepatocellular carcinoma, however, the two diseases also differ from each other in clinical features to long-term outcomes. Of significance, both diseases are associated with an increased risk of cardiovascular disease.

Worldwide, both alcoholic liver diseases and nonalcoholic fatty liver disease are problematic. In the United States, nonalcoholic fatty liver disease is the number one cause of elevated liver enzymes seen in blood work. With the rise of obesity in developed countries, metabolic syndrome has become an epidemic. Metabolic syndrome often develops in obese individuals, and fatty liver disease is the liver’s manifestation of metabolic syndrome.

Genetic disorders are a less common cause of fatty liver disease, and is not associated with obesity, insulin resistance, or metabolic syndrome. Although a person with an inheritance-based fatty liver disease can also be obese, have insulin resistance, metabolic syndrome and a more serious case of fatty liver disease.

A broad spectrum of micronutrients, meaning vitamins, minerals, and antioxidants, if properly used, can directly and indirectly help prevent and reverse fatty liver disease, as well as metabolic syndrome, insulin resistance, and cardiovascular disease.

Liver— The Workhorse of the Digestive System

The liver is the workhorse of the digestive system. Everything you consume that is absorbed by the intestines, goes into the blood stream, and is filtered through the liver. The liver performs over 500 different functions, which can be divided into three main categories– detoxification, synthesis, and storage. The liver can be negatively affected by high glucose levels, drugs, alcohol, metals, environmental chemicals, viruses, and some herbs.

Main Functions of the Liver

• Detoxification of Toxic Metabolites from Blood
• Detoxification of Toxic Substances that are Consumed (alcohol, etc.)
• Synthesis of Cholesterol and Transport Proteins
• Synthesis of Triglycerides for Fuel
• Synthesis of Blood Proteins (albumin)
• Synthesis of Blood Clotting Proteins
• Synthesis of Angiotensinogen for Blood Pressure Control
• Synthesis and Metabolism of Hormones
• Synthesis of Proteins to Activate Immune System
• Synthesis of Enzymes
• Production of Bile for Emulsification of Fats
• Storage of Glucose as Glycogen
• Maintenance of Stable Blood Glucose Levels
• Storage of Fat Soluble Vitamins (A, D, E, K), and B12
• Recycling of Iron from Damaged Red Blood Cells

The liver processes toxins from food, drink, medications, drugs, and environmental chemicals, as well as toxins that accumulate in the blood as a result of metabolic processes. Ammonia is a by-product of protein metabolism, and in elevated concentrations in the blood it is quite toxic. Fortunately, the liver detoxifies ammonia, converting it into urea, and secreting it into the blood for excretion in the urine via the kidneys.

The liver breaks down old and damaged red blood cells. Bilirubin is generated from the breakdown of hemoglobin, and the iron is stored in the liver for recycling. The liver produces bile which is stored in the gall bladder, until excreted into the duodenum for emulsification of dietary fats.

With liver damage, the detoxification process becomes inefficient or fails, liver enzymes then elevate, and ammonia and bilirubin build up in the blood. These toxic substances essentially poison the organs and cells of the body. Without liver recovery or a liver transplant, death is inevitable.

The liver synthesizes many different proteins, including albumin, the main protein in blood. Also, proteins are synthesized by the liver which are used as immune factors to reduce infections. In addition, the liver synthesizes proteins that are used as clotting factors to prevent hemorrhage.

The liver synthesizes fats, including triglycerides and cholesterol. The liver synthesizes high-density and low-density proteins for transporting the cholesterol through the blood. Cholesterol is needed for cell membranes, repair processes, and for the creation of hormones.

The liver stores fat-soluble vitamins, vitamins A, D, E, and K. Glucose is stored in the liver as glycogen, which is converted back into glucose when blood sugar drops. In this manner, the liver helps maintain normal blood glucose levels.

Liver Toxicity, Damage, and Dysfunction

There are numerous causes of liver damage and inflammation. Most of them are due to consequences of lifestyle habits. They also include infections and medications. In this article, we are focusing on fatty liver disease, and how to prevent and reverse it.

Risk Factors of Fatty Liver Disease

• Excessive Alcohol Use
• Overuse of Acetaminophen (Tylenol)
• Obesity
• Diabetes
• Metabolic Syndrome
• Insulin Resistance
• High Glycemic Diet
• High Cholesterol
• High Triglycerides
• Sedentary Lifestyle
• Rapid Weight Loss
• Malnutrition (Lack of Micronutrients)
• Pregnancy
• Genetic Inheritance
• Side Effect of the Medications – methotrexate, tamoxifen, amiodorone, and valproic acid

Alcoholic Fatty Liver Disease

Heavy use of alcohol damages the liver, and impedes its ability for the liver to metabolize fats. Heavy alcohol intake is defined as >30 g/day in men and >20 g/day in women. One standard alcohol drink contains roughly 14 grams of pure alcohol, which is found in: 12 ounces of regular (5% alcohol) beer, 5 ounces of (12% alcohol) wine, and 1.5 ounces of distilled spirits (40% alcohol), such as vodka, tequila, and whiskey. Therefore, more than 2 drinks per day for men, and 1 ½ drinks per day for women is considered heavy, since it greatly increases the negative health consequences.

A fatty liver is the first stage of several liver diseases caused by alcohol. It can occur with less than heavy drinking. However, with continued heavy drinking, inflammation of the liver is likely, which is hepatitis, and since fat is accumulated in the liver, it is alcoholic steatohepatitis. As the disease progresses, inflammation causes scarring, or fibrosis. As fibrosis progresses, liver cirrhosis will develop. Liver cirrhosis (significant scarring) replaces normal liver cells, and eventually the liver fails. In addition, inflammatory changes and oxidative stress can lead to liver cancer.

Fortunately, the liver is very resilient, and can fully recover from fatty changes within 8 weeks after not drinking. However, scarring does not reverse, and the more fibrosis and/or cirrhosis the less likely the liver will recover. With advanced cirrhosis, the liver will be unable to recover and function normally (liver failure), and without a liver transplant, death will follow.

Prior to liver failure, and with cessation of alcohol use, micronutrients, such as milk thistle extract, N-Acetyl-L-cysteine, alpha lipoic acid, broccoli extract, green tea extract, olive extract, turmeric extract, artichoke extract, co-enzyme Q10, and grape seed extract, can all be employed to help the liver recover from fatty and inflammatory changes, and be used to support normal liver functions.

Nonalcoholic Fatty Liver Disease

Non-alcoholic fatty liver disease is defined as steatosis not caused by heavy alcohol intake, hepatitis B or C, autoimmune hepatitis, iron overload, drugs or toxins. Most cases of NAFLD are associated with metabolic dysfunction, such as insulin resistance, type 2 diabetes, obesity, or metabolic syndrome. Genetic causes also exist, which are unrelated to insulin resistance or obesity.

Non-alcoholic fatty liver disease (NAFLD) ranges from simple steatosis (fatty changes), to non-alcoholic steatohepatitis (inflammatory fatty changes) and fibrosis, or scarring. As with alcoholic liver disease, with continued inflammation, fibrosis, or scarring, replaces normal liver cells (hepatocytes). With less hepatocytes and more scarring, fatty changes, and inflammation, there is a decreased ability of the liver to detoxify normal toxic metabolites, let alone perform the other 500 liver functions. Most cases of nonalcoholic liver disease do not progress to more serious liver consequences, and can easily be reversed with lifestyle changes.

Metabolic syndrome is a cluster of conditions occurring together [1]—

• Insulin Resistance (fasting glucose > 100 mg/dl)
• Low HDL Cholesterol (< 40 mg/dl in men, and < 50 mg/dl in women)
• High Triglycerides (> 150 mg/dl)
• Increased Blood Pressure (> 130/85)
• Increased Waist Circumference (> 40 inches for men, > 35 inches for women)

Metabolic syndrome increases the risk of heart disease, stroke, type 2 diabetes, and nonalcoholic fatty liver disease.

Symptoms of Liver Inflammation and Liver Disease

• appetite loss
• nausea and vomiting
• abdominal pain
• jaundice

Elevated Liver Enzymes and C Reactive Protein

Nonalcoholic fatty liver disease (NAFLD) is the most common cause of elevated liver enzymes in the United States. However, the finding of elevated liver enzymes on a blood panel test does not confirm a diagnosis of fatty liver disease, but it does indicate there is inflammation. Other common causes of elevated liver enzymes are viral hepatitis, alcohol toxicity, and medications. Anything that damages liver cells (hepatocytes) will cause elevation of liver enzymes. However, liver enzymes are not always elevated in the presence of NAFLD.

Common Causes of Elevated Liver Enzymes

• Alcohol
• Acetaminophen (Tylenol)
• Medications (statin drugs, fluoxetine, aka, Prozac)
• Toxic hepatitis (from chemicals or drugs)
• Obesity
• Insulin resistance
• Hepatitis A, B, or C
• Heart failure
• Autoimmune hepatitis
• Celiac disease
• CMV or mononucleosis infections
• Hemochromatosis (iron overload)
• Wilson’s disease (copper metabolism disorder)
• Excessive Exercise on Day of Blood Work
• Some herbs (greater celandine, chaparral, pennyroyal, kava kava, wall germander, mistletoe, Atractylis gummifera, possibly green tea extract at very high doses)

No matter the cause, damaged hepatocytes and inflammation lead to elevation of some or all liver enzymes, notably aspartate aminotransferase (AST), alanine aminotransferase (ALT), Gamma-glutamyl-transpeptidase (GGTP), as well as C Reactive Protein (CRP) and coagulation factors. An elevation of CRP and coagulation factors from the liver are also used as indicators of cardiovascular disease and thrombotic vascular disease.

The liver enzymes are not always specific to the liver. For example, AST (also known as SGOT) is found in the liver, pancreas, cardiac muscle, skeletal muscle, brain, kidneys, lungs, leukocytes (white blood cells) and erythrocytes (red blood cells). And the enzyme, ALT is found in liver, skeletal muscles, cardiac muscles, and kidneys. Both enzymes are normally present at low levels in the blood, and with liver injury they are leaked into the blood. ALT has been the standard marker of liver injury when elevated. Only the liver enzyme gamma-glutamyl-transpeptidase (GGTP) in unique to the liver.

The Most Common Liver Tests Include—

• Bilirubin
• Aspartate transaminase (AST, formerly referred to as serum glutamic-oxaloacetic transaminase, SGOT)
• Alanine transaminase (ALT, formerly called serum glutamic-pyruvic transaminase, SGPT)
• Gamma-glutamyl-transpeptidase (GGTP)
• Alkaline phosphatase
• Lactate dehydrogenase (LDH)

As mentioned, only GGTP is unique to the liver, so when it is elevated, and/or several of the other tests are simultaneously elevated, then the liver can be assumed to be damaged or inflamed. Elevation of only one of the other tests (other than GGTP) may indicate a dysfunction or inflammation of an organ or tissue other than the liver.

Sources of liver function values—

• Bilirubin:  Liver, Red blood cells (e.g., hemolysis, intra-abdominal bleed, hematoma)
• AST:  Liver, Skeletal muscle, cardiac muscle, red blood cells
• ALT:   Liver, Skeletal muscle, cardiac muscle, kidneys
• LDH:  Liver, Heart, red blood cells (e.g., hemolysis)
• Alkaline Phosphatase (ALP):   Liver, Bone, first trimester placenta, kidneys, intestines

ALT values do not always correlate with the severity of liver disease, particularly with chronic liver disease due to fibrosis (scarring) of the liver. With increased fibrosis, there are fewer hepatocytes to produce liver enzymes. Therefore, liver disease can be advanced, but the liver enzymes may only be modestly elevated.

The normal range of AST is between 10 to 40 units per liter and ALT between 7 to 56 units per liter. Mild elevations of 2 – 3 times higher than the normal upper range should not cause alarm, but used as an early warning sign to make needed lifestyle or medication changes. The blood work can be repeated in 8 – 12 weeks to assess whether the lifestyle changes reversed the course. If not, further diagnostic tests are often done. Liver enzyme numbers that reach into the 1000s are investigated from the outset, rather than followed expectantly.

When elevated liver enzymes are found on blood panels, physicians usually recommend patients stop all vitamin and herbal supplements. However, this is not always the best course of action, and scientifically does not make sense. Many vitamins, minerals, antioxidants, and some herbal supplements protect the liver, and help reduce elevated liver enzymes.

High quality vitamins, minerals, and antioxidants, including a high quality liver support supplement, certainly do not cause the elevation of liver enzymes, especially not at the suggested doses found on the bottle, nor even at ten times the dose stated on the bottle. Therefore, high quality supplements, including a liver support supplement, should be continued, even in the presence of elevated liver enzymes. They are the very things needed to protect hepatocytes from inflammation and oxidative stress, and support normal liver functions.

Course of Fatty Liver Disease

In most cases, NAFLD does not end in liver cirrhosis or failure. For alcoholic liver disease, cirrhosis and failure depends upon when alcohol is stopped. With either form of fatty liver disease, the diagnosis of steatohepatitis increases the likelihood of fibrosis and liver cirrhosis due to inflammation. Twenty percent of people with steatohepatitis will go on to develop fibrosis, and early form of cirrhosis.

If the amount of liver fibrosis progresses to cirrhosis, the risk of liver failure and death rises significantly. There is also a higher risk for liver cancer, as well as death from heart disease.

Management and Treatment of Fatty Liver Disease

Most cases of fatty liver disease do not progress. The liver can repair itself, so if you take the necessary steps, as outlined below, including the daily use of high quality micronutrient supplements, you can reverse fatty liver disease.

First line therapy for prevention and treatment of fatty liver disease is making lifestyle changes.

• Limiting or Avoiding Alcohol
• Lose and/or Maintain a Healthy Weight
• Follow a Low-Gylcemic Diet (Reduce Sugar & Simple Carbohydrates)
• Control Blood Sugar
• Avoid Trans-Fats, and Eat Healthy Fats
• Avoid Tylenol
• Avoid Medications Known to Negatively Affect the Liver (discuss changes with your doctor first)
• Use High Quality, Broad Spectrum Nutritional Supplements (see below)

Nutritional Supplementation for Preventing or Reversing Fatty Liver Disease

High quality vitamins, minerals, antioxidants, including co-enzyme Q10, grape seed extract, and a high-quality liver support supplement, work synergistically to protect liver cells and maintain normal liver function better than any drug or known therapy. Medical studies have shown that high quality, that is, potent, pure, and bio-available micronutrients, are both safe and effective. Several micronutrients also support phase 2 liver detoxification, which is the elimination of the most toxic metabolites produced by phase 1 liver detoxification. Hepatocyte protection and support is reflected in the normalization of liver enzymes levels.

Daily use of a liver support supplement that provides several different antioxidants, will reduce inflammation of the liver and support normal liver functioning. The various micronutrients protect the liver from oxidative stress and inflammation, which are increased in those with fatty liver disease and hepatitis. The high quality nutritional supplements also benefit every other tissue and cell of the body, as the micronutrients in a liver support supplement are not restricted to the liver.

Micronutrients included in a quality liver support supplement—

• N-Acetyl-L-Cysteine (NAC)
• Alpha Lipoic Acid (ACA)
• Broccoli Extract
• Green Tea Extract (EGCG)
• Olive Extract
• Milk Thistle Extract (silymarin)
• Turmeric Extract (curcumin)

Below is a cursory overview of the benefits and safety of numerous micronutrients provided in a high-quality liver support supplement. The cited references to this article are not meant to be comprehensive for all studies on the subject, nor do they reflect every benefit provided by each individual micronutrient. This means that there are many studies and many benefits of the various antioxidants which are beyond the scope of this article.

N-Acetyl-L-Cysteine (NAC)

N-Acetyl-L-Cysteine (NAC) is given intravenously to patients who present to the emergency room with a Tylenol overdose. NAC counteracts the toxic effect of acetaminophen, as well as other drugs and environmental toxins. NAC directly provides antioxidant protection. It also is converted in the body to glutathione, one of the most powerful antioxidants known. Increasing glutathione within the liver is very effective in providing protection from oxidative stress and inflammation. NAC also protects the kidneys, brain, lungs, intestines, prostate, breasts, and every other tissue and cell in the body.

NAC regulates the important brain neurotransmitter, glutamate. Glutamate is involved in cognition, learning, memory, and behavior. In Alzheimer’s disease and Parkinson’s disease patients, supplementation with generous doses of NAC improves both dopamine function and disease symptoms. [2, 3]

N-Acetyl-L-Cysteine also supports the immune system, possibly reducing the risk of cancer. Studies have shown the ability of NAC to induce apoptosis, or cancer cell death. [4, 5] It also blocks cancer cell duplication and proliferation.

NAC does not elevate liver enzymes; quite the opposite. It protects the liver, and together with the other micronutrients, will bring about the normalization of liver enzymes as the dysfunction of the fatty liver improves.

Alpha Lipoic Acid

Alpha lipoic acid is well known for its therapeutic role in the treatment of insulin resistance and diabetic polyneuropathy. It is used to treat alcohol-induced liver and nerve damage, mushroom poisoning, metal toxicity, carbon tetrachloride poisoning, and insulin resistance.

Alpha lipoic acid helps reduce cardiovascular disease, by protecting arterial endothelial cells, as well as by lowering blood pressure in those with hypertension. [6, 7] ALA reduces the risk for cardiovascular disease among diabetics. [8]

In a study among pregnant women with gestational diabetes, 100 mg/day of alpha lipoic acid was shown to reduce glucose levels and improve liver function, as shown by improved liver enzymes. [9] Animal studies have shown that alpha lipoic acid prevents fatty liver disease. [10]

Due to ALA’s effectiveness in reducing insulin resistance, and protection of fatty liver disease, it is an important micronutrient as part of a liver support supplement.

Curcumin (Turmeric Extract)

The benefits of curcumin seem unlimited, as an increasing number of studies are published revealing its benefits in the prevention and possible treatment of cancer, as wells as liver disease, heart disease, diabetes, neurological diseases, and pulmonary diseases. [11]

The number of studies showing the health benefits of curcumin is so voluminous that it is unreasonable for me to reference them all. A simple PubMed search of curcumin will quickly remove any doubt even from the most skeptical physician.

Curcumin enhances phase 2 detoxification, and in animal studies, has been shown to attenuate hepatic pathological damage, and decrease serum ALT and AST levels. [12] In a short-term randomized controlled study of curcumin administered to patients with nonalcoholic fatty liver disease, 1000 mg/day of curcumin was found to be safe and well tolerated. Curcumin was shown to improve liver fat percentage in fatty liver disease, and reduce liver enzyme levels. [13]

Broccoli Extract

Broccoli extract (containing at least sulforaphane and glucoraphanin), is a powerful antioxidant, that appears to reduce the risk of several types of cancers, as well as inhibit ulcer-causing Helicobacter pylori bacteria, and lower LDL cholesterol. It also protects against liver damage and dysfunction.

Studies have shown benefits of glucoraphanin from broccoli extract for reducing obesity-induced inflammation and insulin resistance. Broccoli extract also helps reduce fatty liver disease. [14] Broccoli extract also helps improve glucose control in type 2 diabetics. [15]

Broccoli extract protects against liver damage, and helps improve liver function, as seen with improved liver enzyme levels. [16]

Olive Extract

Olive extract (containing polyphenolic antioxidants, such as oleuropein, oleanolic acid, and maslinic acid), has shown to provide numerous health benefits, including reducing the risk of cardiovascular disease, cancers, neurological diseases, liver disease, and skin disorders. The micronutrients found in olive extract improve arterial elasticity, and reduce triglyceride levels and oxidized LDL cholesterol. (16) Olive extract reduces the neurological changes seen within neurons that are associated with Parkinson’s disease. [18]

Olive extract is beneficial for protecting against cancers. It has been shown to inhibit cancer cell proliferation, and induce apoptosis in colon cancer cells. [19, 20] In the animal model, olive extract has been shown to inhibit the development of liver cancer. [21]

Olive extract helps protect the liver, and improve liver enzyme levels. In animal studies with known hepato-toxic medications or chemicals (fluoxetine, doxorubicin, carbon tetrachloride), olive extracts were shown to protect against liver damage, and normalize liver enzyme levels. [22 – 24] Olive extract has been shown to specifically help prevent and improve fatty liver disease. [25, 26]

Milk Thistle Extract

Many doctors treating a patient with elevated liver enzymes, might evaluate a liver support supplement, and upon seeing the herb, milk thistle extract (silymarin) on the ingredient list, have a negative knee-jerk reaction, and recommend discontinuance of the supplement. Unfortunately, this is counter to the scientific research, which shows that milk thistle extract supports liver function, protects against liver damage, and improves liver enzyme levels. [27]

Milk thistle extract (containing silymarin and silibinin) is an antioxidant that improves liver function, including supporting detoxification functions. In a meta-analysis of studies involving over 10,000 patients with liver disease, administration of milk thistle extract (silymarin) was shown to reduce serum levels of the liver enzymes alanine aminotransferase (ALT), aspartate aminotransferase (AST) and gamma glutamyl transpeptidase (GGT), albeit, minimally. [28] Despite the minimal decrease in enzymes, milk thistle extract was shown not to cause an elevation of liver enzymes, and therefore, a milk thistle extract supplement would not need to be stopped in the presence of liver disease.

The bio-availability of commercially available milk thistle extract varies considerably. The potency and purity vary as well. These factors greatly affect the effectiveness of milk thistle extract in protecting and supporting the liver. These are a few possible reasons for discrepancies in the various studies. This is why I only advise the use of a high-quality liver support supplement.

Milk thistle extract, and the other micronutrients mentioned in this article, are all beneficial to use in the presence of various liver disorders, particularly fatty liver disease, other chronic liver diseases, liver cirrhosis, and hepatocellular carcinoma. All antioxidants protect against oxidative stress and inflammation, and work everywhere in the body. Through modulation of the inflammatory cascade and supporting the immune system, liver damage is minimized from all types of liver disorders– alcoholic or nonalcoholic liver disease, infectious hepatitis, toxic substances, etc.

In regard to alcohol, silymarin is able to increase liver cellular vitality and reduce both lipid peroxidation and cellular necrosis. [29] Importantly, a silymarin/silybin-containing supplement is able to reduce non-alcoholic fatty liver disease. [30]

Green Tea Extract

Doctors are being encouraged to inquire about the use of green tea extract supplements when they find elevated liver enzymes on a patient’s lab report. Unfortunately, other than hearing that supplements containing green tea extract are “toxic” to the liver, most doctors are unaware of the protective benefits of green tea extract to the liver, let alone the numerous other benefits provided by this remarkable micronutrient.

Indeed, there are reports of elevated liver enzymes among people using high-dose green tea extract supplements for weight loss. A review by the US Pharmacopeia found 34 reports on green tea extract and possible liver toxicity. [31] Out of the 34 cases of green tea extract and liver damage, 27 were categorized as “possible causality,” and only 7 cases were deemed “probable causality.” Again, that is 7 cases out of literally thousands of liver toxicity reports. In other words, if high-dose green tea extract is a concern, in most cases it will not cause liver toxicity.

Green tea extract raises metabolism and reduces appetite. For this reason, some people eager to lose weight quickly, tend to over-do it with such weight-loss supplements. Despite this concern, to date, it appears that only 7 people have experienced any significant liver toxicity. And, it is unclear whether green tea extract alone, or in conjunction with other factors, caused liver damage.

We don’t know if the seven people who had liver toxicity were also taking certain medications or drinking alcohol, which are known to elevate liver enzymes. Could the combination of liver-toxic substances and high-dose green tea extract be the problem? Either way, if we go ahead and assume the 7 cases were solely due to high-dose (> 700 mg/day) of green tea extract, the high-quality liver support supplement that I recommend, provides only a dose of 45 mg/day. Therefore, taking even 10 times the dose of a liver support supplement providing 45 mg/day of green tea extract, is well below what is considered safe.

Studies show that green tea extract (EGCG) may help prevent and reverse nonalcoholic fatty liver disease. In one study, patients with nonalcoholic fatty liver disease were given 500 mg/day of concentrated green tea powder extracts. At the end of 90 days, the patients were found to have improved liver function tests. [32] In a second study among patients with nonalcoholic fatty liver disease, 500 mg/day of green tea extract was shown to significantly improve metabolic, chemical, inflammatory, and radiological parameters. [33]

A 2018 published review of adverse events from 159 human intervention studies found that taking a single large dose of green tea extract (EGCG) of 704 mg or more per day, could cause liver toxicity in a dose-dependent manner. [34] It was also concluded that a single dose of 338 mg of green tea extract (EGCG) each day does not cause liver toxicity, and is considered safe. Therefore, it was concluded that the total daily safe dose, or the Observed Safe Level (OSL), of EGCG (green tea extract) is 704 mg per day.

Multiple studies show that green tea extract is both safe and effective. As mentioned, studies show that even doses of green tea extract up to 700 mg per day does not cause an elevation of liver enzymes. [35, 36] Additionally, the European Food Safety Authority (EFSA) concluded that “there was no indication of liver injury for doses below 800 mg/day from green tea supplements.”

Clearly, the liver benefits of green tea extract outweigh any theoretical risks, as long as the daily dose of EGCG remains below 800 mg/day. Therefore, a high-quality liver support supplement that provides only 45 mg in a total daily dose, along with the other micronutrients mentioned in this article, would be both safe and effective, even if the green tea extract containing supplement were taken at ten-times the recommended dose.

A list of green tea extract’s proven benefits–

• Liver support (help with detoxification process, and reduction of fatty liver disease)
• Reduction of blood pressure
• Heart support (reduction of cardiovascular disease and blood pressure)
• Neuroprotection (e.g., Alzheimer’s disease, Parkinson’s disease, Multiple Sclerosis)
• Eye support (particularly glaucoma)
• Bone support
• Fat metabolism
• Immune support (protection against cancers, including liver cancer)
• Chemo-prevention against many cancers, including cancer of the liver
• Anti-HPV (reduction of cervical dysplasia and cervical cancer)

Additional Micronutrients for Liver Protection and Support

Vitamin D is well known for its cardio-protective effects, as well as for bone health, immune support, and more. Clinical studies show that daily vitamin D supplementation improves insulin resistance and related risk factors in patients with NAFLD. [37, 38]

Fish oil provides numerous benefits. A meta-analysis of controlled clinical trials revealed that supplementation with omega-3 fatty acids (DHA and EPA), significantly reduced levels of AST and gamma-glutamyl transferase (GGT) [39] Fish oil provides such omega-3 fatty acids, and they are known to have anti-inflammatory action. These combined effects make fish oil an effective nutraceutical in the management of NAFLD and steatohepatitis. [40] A meta-analysis of 4 randomized clinical trials conducted in 263 children showed that long-term supplementation with EPA and DHA is associated with a 25% reduction of circulating levels of AST and ALT, as well as a 25% reduction of steatosis (fatty liver), with no side effects. [41]

Co-enzyme Q10, or co-Q10, is a powerful antioxidant, with a very high safety profile, without any risk of drug interactions. [42] It is needed within mitochondria for conversion of glucose and oxygen into ATP, the energy molecules of the cells. Second to heart muscle cells, liver cells have the next most abundant mitochondria per cell in the body, as the liver requires an abundant amount of energy to perform its functions. As we age, our co-Q10 levels decline, and as a result, our energy levels decline, as does the efficiency and health of all our organs, from the heart, brain, and liver, to our muscles and skin. Co-Q10 helps support every tissue of the body.

In a double-blind, randomized, placebo clinical study, 100 mg/day of co-enzyme Q10 for 3 weeks resulted in a significant reduction of transaminases, gamma-GT, CRP and the severity of NAFLD. [43] Furthermore, co-enzyme Q10 reduces oxidized LDL cholesterol levels, improves blood pressure, and improves the lipid profile typically associated with NAFLD. [44] The most important thing about taking co-enzyme Q10, is to take at least 200 mg/day, and use a supplement that is pharmaceutical quality; meaning with high potency, purity, and bio-availability, as low-quality co-Q10 is commonly available.

Grape seed extract is a powerful bioflavanoid antioxidant with safe Cox-2 inhibiting action. It is well known for improving lipid profiles, reducing oxidized LDL cholesterol levels, improving blood pressure, and thus supporting cardiovascular health. Because of the numerous benefits of such a supplement, I have long recommended a pharmaceutical quality grape seed extract to my patients with significant results.

In a 3-month controlled trial of patients with NAFLD with elevated liver enzymes, 100 mg of grape seed extract twice daily was shown to reduce liver ALT levels. A decrease in liver fat percentage was also seen. [45]

In a 4-week controlled trial among type 2 diabetics, 600 mg of grape seed extract per day was shown to significantly improve markers of type 2 diabetes and cardiovascular risk, including inflammatory markers (CRP), oxidative stress, insulin resistance, etc. [46] These are the same indicators and risk factors for nonalcoholic fatty liver disease. Therefore, reducing risk factors for cardiovascular disease, insulin resistance, and metabolic syndrome, is equal to reducing the risk for nonalcoholic fatty liver disease.

Beta glucans derived from mushroom and/or baker’s yeast, provide numerous health benefits, including activating immune cells that help prevent infections and cancer, and reducing cardiovascular disease. Animal studies have shown that beta glucans help reverse high-fat induced fatty liver disease, and lower liver enzymes. [47, 48]

Given the numerous benefits of beta glucans, it is prudent to make this micronutrient part of an overall protocol to help prevent and reverse fatty liver disease.

Conclusion

Both alcoholic and nonalcoholic liver diseases can be reversed if the causal factors are addressed. With alcoholic liver disease, the number one factor is to stop drinking. For nonalcoholic liver disease, the number one factor is to reduce insulin resistance through several means. In both cases, fatty liver disease is improved with the use of high-quality nutritional supplements, including a liver support supplement.

Although a high-quality liver support supplement is marketed for the liver, the various micronutrients benefit the body far beyond protecting and supporting the liver. The collective benefits of the micronutrients are so significant, that everyone, not just those with liver disease, should highly consider taking the high-quality liver support supplement daily. Those with any type of liver disease should consider taking the high-quality liver support supplement at double or triple the daily dose.

If you have fatty liver disease, insulin resistance, diabetes (type 1 or type 2), high cholesterol, high triglycerides, hepatitis, exposure to toxic substances (including alcohol), gall bladder disorders, liver cancer, any cancer, high blood pressure, cardiovascular disease, obesity, Alzheimer’s disease, Parkinson’s disease, or are taking a statin drug, using Tylenol, or are concerned about any of these issues, then definitely consider taking this important high-quality liver support supplement daily, at two -to-three times the suggested dose  …for life. (Discuss with your doctor first.)

Supplement Protocols for Fatty Liver Disease

The article and protocol are for informational purposes only, and not intended as medical advice. Please read the medical disclaimer below, and consult with your physician before taking supplements or acting upon the information presented in this article and protocol.  

Minimal Protocol for Fatty Liver Disease

Basic Protocol for Fatty Liver Disease

Average Protocol for Fatty Liver Disease

Advanced Protocol for Fatty Liver Disease

• AM: With, or after breakfast
• Noon: At lunchtime with food, or shortly thereafter
• PM: Late afternoon with food, or at, or after dinner
• Booster Antioxidant Supplement, with each tablet providing 50 mg Pterocarpus marsupium extract (containing pterostilbene), 10 mg Olive Fruit Extract, 75 mg alpha lipoic acid (ALA), and 60 mg Quercetin.
• Liver Support Supplement supports brain function. A good one will provide Milk Thistle Extract, N-Acetyl-L-Cysteine, Alpha-Lipoic Acid, Broccoli Extract, Turmeric Extract (Curcumin), Olive Extract, Green Tea Extract, and Biotin.
• Beta glucan supplement that is derived from the Reishi and Shiitake mushrooms, as well as baker’s yeast extract.
• Probiotics, at least take 12 billion colony-forming bacteria, providing Lactobacillus rhamnosus LGG® and Bifidobacterium BB12®, every other day or daily.

Ingredients that I like to see provided collectively by vitamin-antioxidant & chelated mineral tablets

Vitamin A, mostly as Beta Carotene
Vitamin C
Vitamin D3
Vitamin E
Vitamin K (K1 & K2)
B-Complex Vitamins
Curcumin (turmeric extract)
Quercetin
Green Tea Extract
Olive Extract
Rutin
Resveratrol
Choline
Lutein
Lycopene
N-Acetyl-L-Cysteine (NAC)
Calcium
Magnesium
Iodine (as potassium iodide)
Zinc
Selenium
Copper
Manganese
Chromium
Molybdenum
Including Ultra Trace Minerals

Medical Disclaimer

Information on this website, written, spoken, or in any other communication by Dr. Ladd McNamara or any other information or reference is for informational purposes only. The information provided on this website is a result of years of practice, experience, and study by the author. This information is not intended as a substitute for the advice provided by someone’s personal licensed physician or other healthcare professional, or any information contained on or in any product label or packaging. Do not use the information on this website, or any other form of communication from Dr. Ladd McNamara or the Dr. Ladd VIP Program, for diagnosing or treatment of a health issue or disease, or for the prescribing of medication or the use of supplementation without a discussion with your licensed health professional first.  At best, the information provided on this website is only meant to supplement information provided by your own doctor or health professional, not to replace medical advice.  The information from this website is not meant to cover all possible uses, precautions, interactions or possible adverse effects of nutritional supplements with or without medications, or in conjunction with specific medical conditions. The information from this website may not fit your specific health circumstances.  Never delay seeking medical care or disregard advice from your health care professional because of information you have received directly or indirectly from this website, from the Dr. Ladd VIP Program, or from Dr. Ladd McNamara himself.  Always speak with your physician or other healthcare professional before making any changes to your medication or embarking on a nutritional, herbal or homeopathic supplement program, or before using any treatment for a health concern. If you have, or suspect that you have, a medical problem, contact your health care provider promptly.  Do not disregard professional medical advice or delay in seeking professional advice because of something you have read or heard on this website, or due to any other information from Dr. Ladd McNamara or his representatives. Information provided on this website or the V.I.P. Program, and the use of any products or services mentioned on this website (or as a result of information provided this program, article, or website) by you DOES NOT create a doctor-patient relationship between you and Ladd McNamara, M.D.  Information and statements regarding dietary supplements have not been evaluated by the Food and Drug Administration and are not intended to diagnose, treat, cure, or prevent any disease.

References

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46. Kar P, et al. Effects of grape seed extract in Type 2 diabetic subjects at high cardiovascular risk: a double blind randomized placebo controlled trial examining metabolic markers, vascular tone, inflammation, oxidative stress and insulin sensitivity. Diabet Med. 2009 May;26(5):526-31.
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