Rescuing the liver

The study, published in the New England Journal of Medicine, included 247 people with nonalcoholic steatohepatitis. They were randomly assigned to receive 800 IU of vitamin E per day, 30 mg of a medication used to increase insulin sensitivity (pioglitazone) per day, or placebo for 96 weeks. They underwent liver biopsies at the beginning and end of the trial and were monitored for 24 weeks after the end of treatment. The findings were as follows:

• Steatohepatitis improved in both the vitamin E and medication groups compared with placebo, but the difference between medication and placebo was not statistically significant.
• Medication and supplement reduced fatty deposits and inflammation in both treatment groups compared with placebo.
• Liver function tests improved in both treatment groups.
• Insulin resistance improved only in the medication group, but this group also experienced an average weight gain of 4.7 kg (10.3 pounds) that was not lost after stopping the medication.

Repairing the liver with vitamin E

Although the exact cause of nonalcoholic steatohepatitis is not fully understood, insulin resistance and obesity clearly play a role. The primary finding of this study—“vitamin E was superior to placebo for the treatment of nonalcoholic steatohepatitis in adults without diabetes” —suggests that oxidative damage might also contribute to liver cell injury in people with this condition.

Taking steps to improve metabolism and to reduce cell damage caused by unstable compounds in the environment may be the best way to reverse nonalcoholic steatohepatitis:

• Stick to a low-glycaemic-load diet. This type of diet has the best effect on blood sugar control, insulin sensitivity, and weight loss. Researchers have found that people with steatohepatitis can reduce liver injury through diet and weight loss.
• Exercise regularly. Physical activity improves insulin sensitivity and carbohydrate metabolism, and facilitates weight loss.
• Aim for gradual weight loss (about 1 to 2 pounds per week). There is some evidence that rapid weight loss may actually worsen fatty liver disease.
• Eat foods high in vitamin E, especially nuts and seeds. Not only are these the richest sources of vitamin E, they also have low glycaemic loads and protect against cardiovascular disease.
• Consider adding a vitamin E supplement. Add 800 IU of vitamin E per day to help protect your liver.

(NEJM 2010;18:1675–85)