As traditional pharmaceutical approaches struggle to address the complex nature of NAFLD and NASH, patients are increasingly turning to alternative treatments, including supplements, in search of relief and support. In fact, over 100,000 over-the-counter herbal and dietary supplements are available for retail and online purchase in the United States. While some compounds, like Vitamin E, have been tested in clinical trials and other studies which offer credible evidence of potential benefits for the liver, not all have gone through the same level of testing. Because of this, it's essential to approach supplements with caution since their efficacy (effectiveness) and safety may vary widely.

In the United States, the supplement industry is not as strictly regulated as the pharmaceutical industry, leading to concerns about product quality, potential contaminants, and unsubstantiated health claims. A few interesting facts on dietary supplements in the U.S.:

• The FDA does not approve dietary supplements. Unlike pharmaceutical drugs, whose safety and efficacy must be evaluated before approval, dietary supplements are regulated after the supplement has been brought to market. Supplements do not need to be registered with the FDA before their sale. 
• Dietary supplements do not have to be evaluated for efficacy (effectiveness) under U.S. law.
• Dietary supplement manufacturers themselves are responsible for evaluating product safety and labeling (including references to health claims), ensuring it does not violate the law. Periodically, the FDA inspects manufacturing facilities. 

Drug induced liver injuries (DILI) are another potential threat faced by those who choose to incorporate dietary supplements into their treatment plan. DILI is an acute or chronic injury to the liver as a result of taking a natural or manufactured compound. Although herbal and dietary supplements currently are responsible for a small number of total DILI cases in the United States, we are seeing this number increase with time. Patients should always consult with their healthcare providers before incorporating any supplement into their treatment plan to ensure it does not interact with other medications and is safe for their specific medical condition. 

As supplements become more popular, patients and healthcare professionals alike must remain vigilant in their approach, seeking evidence-based information and guidance to ensure the safe and effective integration of supplements into the overall treatment plan. A comprehensive approach including lifestyle changes and medical interventions may hold the key to improving outcomes for the NAFLD/NASH patient population.