Abstract
Our aim is to review the efficacy of various herbs and supplements as a possible therapeutic option in the treatment and/or prevention of nonalcoholic fatty liver disease (NAFLD). We performed a systematic review of medical literature using the PubMed Database by searching the chemical names of many common herbs and supplements with “AND (NAFLD or NASH)”. Studies and medical literature that discussed the roles and usage of herbs and supplements in NAFLD and nonalcoholic steatohepatitis (NASH) from inception until 20 June 2018 were reviewed. Many studies have claimed that the use of various herbs and supplements may improve disease endpoints and outcomes related to NAFLD and/or NASH. Improvement in liver function tests were noted. Amelioration or reduction of lobular inflammation, hepatic steatosis, and fibrosis were also noted. However, well-designed studies demonstrating improved clinical outcomes are lacking. Furthermore, experts remain concerned about the lack of regulation of herbs/supplements and the need for further research on potential adverse effects and herb–drug interactions. In conclusion, preliminary data on several herbs have demonstrated promising antioxidant, anti-inflammatory, anti-apoptotic, and anti-adipogenic properties that may help curtail the progression of NAFLD/NASH. Clinical trials testing the safety and efficacy must be completed before widespread use can be recommended.
Highlights
Nonalcoholic fatty liver disease (NAFLD) and its progressive subset, nonalcoholic steatohepatitis (NASH), affect a significant proportion of the population, with no approved drug treatment.The current treatment option is lifestyle modification through diet and exercise [1,2,3]
Silymarin is the extract from the milk thistle plant (Silybum marianum); both Silybum and silymarin have been consistently studied with respect to nonalcoholic fatty liver disease (NAFLD) and have been shown to have therapeutic effects [6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24]
In a double-blinded randomized controlled trials (RCTs) by Faghihzadeh et al, 50 NAFLD patients were divided to receive lifestyle modification and placebo or 500 mg of resveratrol for 12 weeks and after the study period the treatment group had improved inflammatory cytokines, ALT, and hepatic steatosis compared to the placebo group [27,29]
Summary
Nonalcoholic fatty liver disease (NAFLD) and its progressive subset, nonalcoholic steatohepatitis (NASH), affect a significant proportion of the population, with no approved drug treatment. The current treatment option is lifestyle modification through diet and exercise [1,2,3]. In this special issue, the discussion on potential drug targets, oral hypoglycemics, lipid-lowering agents, vitamins/minerals, and surgical options will be reviewed in other sections. The focus of this article is to review the role of herbs and supplements in patients with NASH, the less common but aggressive subset of NAFLD. Alternative medicine has recently gained interest as a possible approach to disease therapy [4,5]. Herbs have many great antioxidant, anti-inflammatory, anti-apoptotic, and anti-adipogenic effects (decreased adipose tissue formation and weight loss) that allow them to be possible therapeutic agents in NAFLD treatment [4,5]
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