Q. Are vitamin A and D supplements safe to take with fatty liver?

Answered by
Dr. Sagar Ramesh Makode
and medically reviewed by Dr. Hemalatha
This is a premium question & answer published on May 03, 2020

Hi doctor,

I have low vitamin A and D levels. Are vitamin A and D supplements safe to take with liver disease? What are the highest doses that are safe to take? I have fatty liver but I do not know if it is a simple fatty liver or has progressed to NASH and fibrosis. I am a 33-year-old female. I smoke and have a history of acid reflux, low heart rates, fat indigestion, and fatty liver. Lab tests showed vitamin A 0.9 umol/L and vitamin D 37 nmol/L.

Previously, I had an abdominal ultrasound and it showed liver 14.6 cm in length which gives rise to a moderately coarse dense echo pattern consistent with fatty infiltration. ALT level was 58 U/L. I am currently on N-acetyl cysteine (NAC). Thank you.

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine


Welcome to icliniq.com.

Your vitamin A level is marginal rather than low. Less than 0.7 or 0.5 is considered low and up to 1.05 is considered marginal. So, you will probably need supplements at a very low dose. Total intake of up to 10,000 units daily is unlikely to cause any harmful effects. So, supplements of 7500 units or even 10,000 units per day for a month or two would be enough for you.

I guess you do not have any symptoms of vitamin D deficiency like xerophthalmia or visual difficulties where one would need higher doses. Also, for vitamin D, supplements like Calcirol sachet are recommended in dosing of 60,000 units once a week for eight weeks with milk, and following which you may have it once a month for the next six months.

Both these are unlikely to interfere with liver issues considering fatty liver and high ALT level. You are unlikely to have progressed to the severe liver disease within such a short period and without symptoms.

Hope this helps you and get back if you have any doubts.

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If I take a supplement and my level gets back to normal and I stop the supplement then how long until my level goes low again? I don't know if that will happen but because I don't digest fat well and I have fatty liver I know these conditions can cause low levels of fat soluble vitamins. I know the liver stores these vitamins so how long can it take to deplete them? Would fat digestive enzymes help fat absorption or are they bad for the liver?

Dr. Sagar Ramesh Makode

Cardiology General Medicine Internal Medicine
# Hello,
This time period is variable depending upon the quantity of vitamins stored in the liver and body requirement. However usually it takes 6 to 12 months after supplements are stopped. As your Vit A is marginally low, increasing intake of Vit A rich food would be enough to make this, and deficiency should be recur with increased intake. Regarding vit D, dietary intake is not the primary source for Vit D, but its synthesis within the skin on sunlight exposure. So you should increase sunlight exposure especially in the morning. Otherwise you may need intermittent Vit D supplements.
Digestive enzymes may slightly increase the absorption but not necessary and fatty liver doesn't imply that you have digestive disturbances. Fatty liver is usually due to excessive calorie intake or impaired internal fat handling by liver rather than in gut digestion. So, increasing intake is better option compared to other.

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