DEAR DR. ROACH: I was diagnosed with nonalcoholic steatohepatitis and had very high AST and ALT numbers. I lost about 25 pounds, and the numbers were normal. As a result of other health issues, the weight came back and the numbers went up. My liver specialist suggested we try 800 IU of vitamin E daily. Without losing weight the reports are now in the normal range. Although it will not clear the existing damage, this will prevent further damage. Its worth suggesting that people try this. If it works, great. If it doesnt, no harm has been done. J.T.
ANSWER: Weight loss and abstinence from alcohol are the interventions with the best evidence to prevent progression from nonalcoholic steatohepatitis (commonly called fatty liver) to fibrosis and cirrhosis of the liver. However, there is evidence, beyond anecdotal, to support the use of vitamin E in some situations.
The largest trial done for this was in 2010 and showed that people who took 800 IU of vitamin E were more likely to have improvement in their liver disease, as proven by biopsy. Many experts will use this dose of vitamin E in some people with NASH. However, it is not proven for people with diabetes or with advanced fibrosis. Vitamin E also has been linked in one study to increased risk of prostate cancer, so men with a history of or at high risk for prostate cancer usually should not take supplemental vitamin E.
Weight loss remains the best proven therapy to treat fatty liver disease.
