Managing MASH With Supplements: What’s Safe and What’s Risky

Note: The U.S. Food and Drug Administration (FDA) doesn’t approve supplements for safety or effectiveness. Always talk with your healthcare professional about whether a supplement fits your health needs, and about possible drug interactions or safety concerns. You’ll want to be careful with vitamins, minerals, and other dietary supplements if you have metabolic dysfunction–associated steatohepatitis (MASH) . While some nutritional supplements can help address deficiencies that are common among people with MASH, others do more harm than good, says Margaret O’Brien, RD , of Banner Health in Phoenix, Arizona. Your lifestyle can strongly affect your liver health, and your MASH treatment plan likely prioritizes weight loss, physical activity, and nutrition. “A potential add-on to these recommendations is the use of nutrition supplements that are plant derived or nature inspired,” says O’Brien. But current clinical evidence of the benefits and risks of such supplements is limited. If you’re considering adding supplements to your MASH treatment plan, it’s essential that you discuss each one with your healthcare provider first.
Consider: Omega-3 Fatty Acids Omega-3s Omega-3-fatty acids are heart-healthy fats found in oily fish and fish oil supplements. “People with MASH tend to consume fewer omega-3 fatty acids and have a greater omega-6 to omega-3 ratio, which leads to greater inflammation in the liver and in the body,” says Katherine Patton, RD, of Cleveland Clinic. Supplementing with omega-3 fatty acids can help you meet your daily recommended intake of these anti-inflammatory fats, as well improve your omega-6 to omega-3 ratio, she says. In addition to potentially helping lower triglycerides, omega-3 fatty acids may help reduce inflammation and fat accumulation in people with fatty liver disease, especially when paired with diet and exercise.e60dc2a1-f33c-4a05-9b50-8e3e8e59762958db73e2-2d81-48c0-92bb-54a43497112ae60dc2a1-f33c-4a05-9b50-8e3e8e597629c19c2802-291e-4bbe-84b4-1dec511659cd Talk with your healthcare provider about supplementing with omega-3 fatty acids, including a recommended dosage, product quality, and potential drug interactions, particularly if you use blood thinners.
Avoid: Curcumin Curcumin Curcumin, the main active compound in the spice turmeric, is known for its antioxidant and anti-inflammatory properties.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fad509b3-5c74-456d-9451-e0e9d44bc62d However, curcumin-containing products, especially concentrated, highly bioavailable formulas, are linked to cases of drug-induced liver injury.e60dc2a1-f33c-4a05-9b50-8e3e8e597629f0dd06c7-40f7-4220-bf80-120fcd54578a Given this risk of harm, turmeric supplements aren’t recommended for people with MASH.
Consider: Vitamin E Vitamin E Studied as a possible treatment for MASH due to its antioxidant effects, vitamin E may help reduce liver enzymes, fat accumulation in the liver, inflammation, and the enlargement and rounding of liver cells, says Patton. A daily dose of 300 milligrams of vitamin E appears to be effective as a MASH treatment.e60dc2a1-f33c-4a05-9b50-8e3e8e597629d75ca312-e118-4026-974e-71d9350d8629 However, vitamin E supplementation is not risk-free. “Vitamin E is associated with an increase in all-cause mortality and a minor risk for prostate cancer and hemorrhagic stroke,” says Patton. For these reasons, physicians typically recommend vitamin E only for certain patients with biopsy-confirmed MASH, and they try to monitor them closely for negative side effects.e60dc2a1-f33c-4a05-9b50-8e3e8e5976291277a366-df99-4b2f-b13b-280b3adcfd5b If you’re interested in trying it, talk with your healthcare provider to weigh the potential benefits against the risks.
Avoid: Green Tea Extract Green Tea Extract While there’s some evidence that taking green tea extract may offer protective benefits for health conditions, including obesity and type 2 diabetes, it may also cause liver damage in some people. The supplement can cause people with certain gene variations to experience elevated liver enzymes, which could be especially risky for people who already have liver disease.e60dc2a1-f33c-4a05-9b50-8e3e8e597629083343b4-f95c-498c-b6c6-df69b7e58f7a Because green tea has been implicated in cases of acute liver injury, people with MASH should avoid the supplement.
Consider: Milk Thistle Milk Thistle Milk thistle is an herbal supplement often marketed for liver health due to the antioxidant and anti-inflammatory properties of its active compound, silymarin. The science is unclear. While some studies show that silymarin supplementation can reduce liver damage and lower liver enzymes, larger clinical trials in people with biopsy-confirmed MASH haven’t shown consistent benefits, says Patton.e60dc2a1-f33c-4a05-9b50-8e3e8e597629eb283ff0-2341-4d02-9b47-c9d0fe8fa8ee Some people may experience mild improvements in liver health with silymarin, but there needs to be more conclusive large studies to make a general recommendation about taking milk thistle for MASH, says Patton.
Avoid: Garcinia Cambogia Garcinia Cambogia Garcinia cambogia is an herbal weight loss product promoted for its hydroxycitric acid content. However, it not only shows little meaningful benefit but has also been repeatedly linked to liver injury that can lead to serious (and sometimes lethal) complications.e60dc2a1-f33c-4a05-9b50-8e3e8e597629101d6e4c-8d37-4192-994d-653cb4b0082c G. cambogia also appears on the list of commonly used botanicals in the United States that can be toxic to the liver.e60dc2a1-f33c-4a05-9b50-8e3e8e597629cd5a7679-fcce-4a8b-9292-64a1892f0bc8
Consider: Vitamin D Vitamin D Vitamin D deficiency is common in people with MASH, and it’s linked to increased liver inflammation and scarring.e60dc2a1-f33c-4a05-9b50-8e3e8e597629fd8b0c5d-9056-44eb-a362-e8e230f457c5 Supplementing with vitamin D may help lower liver enzymes and improve markers of inflammation, particularly in people who start out deficient, although more research is needed. The type of supplement, the dose, and how it’s administered may affect outcomes as well. People with MASH should have their vitamin D levels checked regularly for deficiency and supplement if needed based on the recommendations of their healthcare providers, says Patton. Supplementation is not a proven treatment for MASH, but it could be seen as a potentially supportive one.e60dc2a1-f33c-4a05-9b50-8e3e8e5976292466d1bc-c79a-4be3-91bf-0fcb14b3382f
Avoid: Ashwagandha Ashwagandha Ashwagandha is a popular herbal supplement often marketed as helpful for stress management, sleep quality, and overall energy. However, it’s linked to cases of serious liver injury, including acute hepatitis and liver failure requiring transplantation. There are also reports of otherwise healthy people developing jaundice, fatigue, and elevated liver enzymes after taking ashwagandha, with symptoms improving once the supplement was stopped.e60dc2a1-f33c-4a05-9b50-8e3e8e597629210e8e9c-5bda-4aeb-80a0-13f2abed1b9f Because MASH already involves liver injury, adding a supplement to your treatment plan with known potential to harm the liver isn’t safe. Experts recommend avoiding ashwagandha if you have MASH or any other chronic liver condition.
Avoid: Black Cohosh Black Cohosh Black cohosh is an herbal supplement sometimes taken to ease menopausal symptoms like hot flashes. However, it’s associated with liver toxicity, including cases of hepatitis, liver failure, and transplantation. The U.S. Pharmacopeia has issued warnings about black cohosh in people with liver disorders.e60dc2a1-f33c-4a05-9b50-8e3e8e59762910197035-e572-43b4-bb58-fcf8a92534a5 Given these risks, black cohosh should be avoided by anyone with MASH, as increased liver damage outweighs any potential relief from menopausal symptoms. Safer alternatives should be discussed with your healthcare provider.
A Word of Caution A Word of Caution Taking supplements, especially in high doses, to improve liver health or as a way to detox the liver isn’t necessary or recommended, says O’Brien. “Risks of liver detoxes may include dehydration, electrolyte imbalances, medication interactions, and potential for increased risk of liver problems,” she says. Some products may also be contaminated or lack listed ingredients, and severe liver overload from supplements can accelerate liver damage. Steer clear of concentrated botanicals marketed for detoxification, energy, or rapid weight loss. Just because a supplement is listed as natural doesn’t mean it’s safe, especially if you have MASH. Several botanicals can actually cause liver toxicity, leading to hospitalization and severe complications.e60dc2a1-f33c-4a05-9b50-8e3e8e59762982f03623-90cc-4386-84d7-4cc02385b9fd No supplement is a cure for MASH. Share every supplement and planned dose with your healthcare team before you start taking it, and make sure you understand both the benefits and risks of all the ingredients in any product you’re considering.
The Takeaway While supplements can be a potential add-on for managing MASH, current clinical evidence is limited, and some may cause more harm than good. After consulting with a healthcare professional, supplements that may be worth considering for your MASH treatment plan include omega-3 fatty acids, vitamin E, milk thistle, and vitamin D, as they’ve shown some potential to help with inflammation and fat accumulation in the liver. Supplements that should be avoided due to known risks of liver injury include curcumin, green tea extract, garcinia cambogia, ashwagandha, and black cohosh. It’s essential to discuss all supplements with your healthcare provider before taking them to weigh potential benefits against risks and avoid adverse drug interactions.
Resources We Trust Cleveland Clinic: 8 Lifestyle Changes to Help Manage MASHJohns Hopkins Medicine: Detoxing Your Liver: Fact Versus FictionMayo Clinic: Lifestyle Do’s and Don’ts When Managing MASLD, MASH, and Liver HealthWeill Cornell Medicine: Liver Damage Caused by Supplements Is Becoming More CommonAmerican Liver Foundation: Tips on How to Take Care of Your Liver