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.

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.

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.

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.

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.

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.

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.

• 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.