Supplements are typically unregulated and have little scientific evidence supporting their claims to improve health. That being said, it is important to recognize when supplements may actually provide benefit to patients. Vitamin E has long been a compound of interest for the NAFLD/NASH community, and ongoing studies and updated guidelines are reflecting its increasingly recognized benefit for patients.
What is Vitamin E?
Vitamin E is the major lipid-soluble chain-breaking antioxidant with additional anti-inflammatory and anti-fatty plaque accumulating in the arteries properties found in the human body. Today the term “vitamin E” encompasses a group of eight fat soluble molecules that are synthesized by plants, with the molecule α-Tocopherol considered the most abundant form in nature and the predominant compound in synthetic forms of vitamin E. Vitamin E is commonly found in green leafy vegetables, whole grains, fortified cereals, and vegetable oils. This background information was synthesized from this study, which can be referred to for more in depth discussion of vitamin E and NAFLD.
How does Vitamin E impact my liver health?
Though we still don’t fully understand the progression of NAFLD and NASH, it is thought that oxidative stress contributes significantly to the injury to liver cells associated with the disease. Vitamin E is a powerful antioxidant, which means it can help reduce the level of oxidative stress in the body. Vitamin E is also anti-inflammatory, which can help slow down fibrosis in NAFLD/NASH patients by reducing inflammation. Lastly, vitamin E helps prevent liver cell injury and death which contribute to cirrhosis. This information comes from this study on the role of vitamin E in the treatment of NAFLD.
Recent studies have confirmed that vitamin E improves the biochemical and histological outcomes in both adult and pediatric NAFLD/NASH populations. In this meta-analysis, vitamin E was superior at improving alanine aminotransferase (ALT), aspartate aminotransferase (AST), NAFLD activity score (NAS). The effect of vitamin E on ALT and AST was found to be dose dependent; a higher dose of vitamin E led to greater improvements. Though the dose of vitamin E appropriate for NAFLD/NASH patients has been debated, the most favorable improvements were found between 400 and 800 IU vitamin E. This dose is consistent with the recommendation of FLF’s Liver Friendly Diet.
Even the American Association of Liver Diseases (AASLD) has recommended vitamin E supplementation as a treatment of biopsy-proven NASH in non-diabetic patients in their NAFLD Practice Guidelines document. It is important to note that AASLD has recommended the use of vitamin E to this small subset of the population until further data supporting its effectiveness become available, not recommending it for treatment of NASH in diabetic patients, NAFLD without liver biopsy, NASH cirrhosis, or cryptogenic cirrhosis. This doesn’t mean vitamin E won’t help these patients, it just means that the AASLD is taking a conservative stance in its recommendation.
Eating with Your Liver in Mind
Click here to view a summary guide of Fatty Liver Foundation's Liver Friendly Diet. It is a useful tool to help guide your eating practices. It is printer-friendly and can be posted in your kitchen as a daily reminder to eat with your liver's health in mind.