Healthy Liver Metabolism

Written by Dr. Ryan Kneessi, ND

The mechanisms this protocol supports

The liver stores and releases energy, makes and packages fats, and responds to insulin. When insulin signaling becomes less efficient, fat can build up inside liver cells, which places extra demand on their mitochondria.

Liver cells rely on glutathione as their main antioxidant to manage oxidative stress, and they need phosphatidylcholine to package fat and send it out into the bloodstream. Research has linked low choline intake with fat buildup in the liver.

In the PIVENS trial, natural vitamin E was linked with better liver fat and inflammation scores in adults with nonalcoholic steatohepatitis (NASH) who did not have diabetes, and research has linked omega-3 fats with lower liver fat and triglycerides. This protocol supports those mechanisms alongside nutrition, movement and limiting alcohol.

What is in the protocol

The exact products and directions are listed in the Fullscript plan, and here is what each one is commonly used to support.

• Milk Thistle Phytosome from Thorne, formerly called Siliphos, provides silybin from milk thistle bound to phosphatidylcholine for better absorption, and it supports the liver’s antioxidant defenses.
• NAC from Thorne provides N-acetylcysteine, which supplies cysteine for making glutathione.
• Vitamin E from Pure Encapsulations provides a fat-soluble antioxidant that helps protect cell membranes from oxidative stress.
• ProOmega from Nordic Naturals provides the omega-3 fats EPA and DHA, which have been linked with lower liver fat and triglycerides.
• Phosphatidyl Choline from Thorne provides choline in the form the liver uses to package and export fat.

Related protocols you may find helpful include Daily Defense & Clearance and Metabolic Flexibility.

How to use it thoughtfully

Please talk with your provider before starting, especially if you take medications, are pregnant or nursing, or have a health condition. This page does not list amounts, so follow the label or the specific guidance your provider gives you. When you can, add one product at a time so it is easier to notice how you feel. Sleep, nourishing food, daily movement and stress care are the foundation, and supplements are meant to build on them.

Vitamin E is not right for everyone and may raise bleeding risk, so please check with your provider if you take a blood thinner or have a history of prostate concerns. Fish oil may also affect bleeding, so tell your provider if you have surgery planned. Milk thistle may interact with some medications that are cleared by the liver, and it is best avoided if you are allergic to ragweed-family plants. Abnormal liver labs, yellowing of the skin or eyes, or pain under the right ribs need a medical evaluation.

What the research shows

This protocol has not been tested as a whole in a clinical trial, so the studies below cover its main ingredients.

Vitamin E has one of the best-known liver trials. In the PIVENS trial, 247 adults with fatty liver inflammation (NASH) and without diabetes took 800 IU of vitamin E, the drug pioglitazone, or a placebo for 96 weeks. Liver biopsies improved in 43% of the vitamin E group compared with 19% on placebo, and liver enzymes fell, but scarring did not improve significantly. High-dose vitamin E has potential risks, so this is a decision for your clinician, not a general recommendation.

Milk thistle was tested in a 2017 trial by Wah Kheong and colleagues of 99 adults with biopsy-confirmed NASH who took 700 mg of silymarin or placebo three times daily for 48 weeks. The main goal, a 30% drop in disease activity, was not significantly different (32.7% versus 26.0%), though fewer people on silymarin had worsening scarring. The results are encouraging but not conclusive.

Frequently asked questions

Sources

• Corbin KD, Zeisel SH. Choline metabolism provides novel insights into nonalcoholic fatty liver disease and its progression. Curr Opin Gastroenterol 2012. PMID: 22134222. https://pmc.ncbi.nlm.nih.gov/articles/PMC3601486/
• Fischer LM, et al. Sex and menopausal status influence human dietary requirements for the nutrient choline. Am J Clin Nutr 2007. PMID: 17490963. https://pmc.ncbi.nlm.nih.gov/articles/PMC2435503/
• Sanyal AJ, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010. PMID: 20427778. https://pmc.ncbi.nlm.nih.gov/articles/PMC2928471/
• Parker HM, et al. Omega-3 supplementation and non-alcoholic fatty liver disease: a systematic review and meta-analysis. J Hepatol 2012. PMID: 22023985. https://pubmed.ncbi.nlm.nih.gov/22023985/
• Skulas-Ray AC, et al. Omega-3 Fatty Acids for the Management of Hypertriglyceridemia: A Science Advisory From the American Heart Association. Circulation 2019. PMID: 31422671. https://pubmed.ncbi.nlm.nih.gov/31422671/

Browse all A-Z protocols