Researchers tested whether two natural supplements—silymarin (from milk thistle) and alpha-lipoic acid—could help people with fatty liver disease when combined with a Mediterranean diet. The study found some promising signs that these supplements might improve certain health markers related to metabolism and liver function. However, the research had some important limitations that make it hard to know for sure if the supplements themselves were responsible for the improvements, or if the diet was doing most of the work. Scientists say more rigorous testing is needed before doctors can confidently recommend these supplements for fatty liver disease.

The Quick Take

  • What they studied: Whether a combination of two supplements (silymarin and alpha-lipoic acid) plus a Mediterranean diet could improve fatty liver disease
  • Who participated: People diagnosed with metabolic dysfunction-associated steatotic liver disease (a type of fatty liver disease linked to metabolism problems). The exact number of participants wasn’t clearly specified in the available information.
  • Key finding: The combination showed some improvements in metabolic markers, suggesting the supplements may have helped, but the study design makes it unclear whether the supplements or the diet deserves the credit
  • What it means for you: While these supplements show potential, you shouldn’t start taking them based on this study alone. Talk to your doctor first, especially since we don’t know yet if they actually work better than just eating a healthy Mediterranean diet

The Research Details

Researchers looked at a trial where patients with fatty liver disease received a special supplement combination containing silymarin (an extract from milk thistle plants) and alpha-lipoic acid (a natural compound found in cells) along with instructions to follow a Mediterranean diet. The Mediterranean diet emphasizes olive oil, fish, vegetables, and whole grains. The researchers then reviewed this study and identified several important problems with how it was conducted. They noted that the study didn’t have a comparison group that took only the supplements without the diet, making it impossible to know which treatment actually helped. The study also didn’t include liver biopsies (tissue samples) to directly measure whether the liver actually improved.

This research approach matters because it highlights the difference between a promising preliminary study and a truly reliable one. When you combine multiple treatments (supplements plus diet) without testing each one separately, you can’t figure out what’s actually working. It’s like trying to know if your cake tastes good because of the flour or the sugar when you can’t taste them separately. The researchers are essentially saying: ‘This study suggests something might work, but we need better-designed experiments to be sure.’

This study has moderate reliability concerns. The main issues are: (1) no control group taking only the supplements, (2) no liver tissue analysis to confirm actual improvement, (3) unclear sample size, and (4) the diet component makes it hard to isolate the supplement effects. These limitations mean the findings are interesting but not definitive. Think of it as a yellow light rather than a green light—worth investigating further, but not ready for widespread use.

What the Results Show

The study found that patients who took the supplement combination and followed the Mediterranean diet showed improvements in several metabolic markers—these are blood test measurements that doctors use to assess health. Some of these markers related to liver function and metabolism appeared to improve during the study period. However, because there was no group taking only the supplements (without the diet), researchers couldn’t determine how much improvement came from the supplements versus how much came from the Mediterranean diet itself. The Mediterranean diet alone is already known to be beneficial for liver health, so this is a crucial distinction.

The research didn’t report on other important outcomes like whether the liver actually looked better under a microscope, whether patients felt better, or whether the benefits lasted over time. These details matter because sometimes blood tests improve without actual tissue healing occurring. The study also didn’t track potential side effects or safety concerns with long-term use of these supplements.

Previous research has shown that the Mediterranean diet helps fatty liver disease. Alpha-lipoic acid and silymarin have individually shown some promise in smaller studies, but combining them with diet and testing them together is relatively new. This study adds to the conversation but doesn’t definitively prove these supplements work better than diet alone, which is what previous research already supports.

Several important limitations reduce confidence in these findings: (1) The study lacked a group taking only supplements without diet changes, so we can’t separate the effects; (2) No liver biopsies were performed, meaning doctors couldn’t directly see if liver tissue actually improved; (3) The sample size appears small, making results less reliable; (4) The study design doesn’t meet the rigorous standards typically required for approving new medications; (5) It’s unclear how long benefits lasted after the study ended; (6) The formulation tested was proprietary (owned by a company), which can sometimes bias results.

The Bottom Line

Based on this single study, these supplements cannot be recommended as a proven treatment for fatty liver disease. However, the Mediterranean diet—which was part of this study—is strongly supported by extensive research and should be the first step. If you have fatty liver disease, focus on diet changes first and discuss any supplement use with your doctor. If your doctor agrees supplements might help, they should be used alongside, not instead of, dietary improvements. Confidence level: Low to Moderate for the supplements; High for the Mediterranean diet approach.

People with fatty liver disease or metabolic problems should pay attention to this research. However, you shouldn’t start taking these specific supplements based on this study alone. People with liver disease, those taking medications, and pregnant or nursing women should definitely consult their doctor before trying any new supplements. Healthy people without liver disease don’t need these supplements.

If you were to try the Mediterranean diet (the proven part), you might notice improvements in blood work within 2-3 months and more significant changes within 6 months. For supplements, if they work at all, benefits would likely appear on a similar timeline, but this hasn’t been clearly established in research yet.

Want to Apply This Research?

  • Track Mediterranean diet adherence by logging meals daily and measuring how many days per week you eat fish, use olive oil, and include vegetables. Also track any supplements taken with dates and amounts. If you have access to blood work, log key markers like liver enzymes (ALT, AST) and triglycerides every 3 months.
  • Start by adopting Mediterranean diet habits: replace cooking oils with olive oil, eat fish at least twice weekly, increase vegetable intake to half your plate, and choose whole grains. Only after establishing these habits should you discuss supplements with your doctor. Use the app to set daily reminders for meals and weekly shopping lists focused on Mediterranean foods.
  • Track diet compliance weekly, monitor energy levels and digestion daily, and schedule quarterly blood work to measure liver function markers. Document any side effects or changes in how you feel. Compare your progress month-to-month to see if the Mediterranean diet alone is helping before considering supplements.

This article discusses preliminary research findings and should not be considered medical advice. Fatty liver disease is a serious condition that requires professional medical evaluation and treatment. Do not start, stop, or change any supplements or medications without consulting your healthcare provider first. This research has significant limitations and should not be used as the sole basis for treatment decisions. Always work with your doctor to develop a personalized treatment plan for liver disease. If you have liver disease, metabolic disorders, or take medications, consult your healthcare provider before using any supplements, as they may interact with your medications or condition.