Learn more about the research that shows a promising outcome that vitamins B12 and B9 can bring to individuals diagnosed with NASH.
Past research has suggested that non-alcoholic steatohepatitis (NASH) is linked with high homocysteine levels (also called hyperhomocysteinemia), a type of amino acid that your body uses to make protein. Vitamin B plays a role in breaking down homocysteine. Therefore, when you’re getting enough vitamin B, very little amounts of homocysteine should be left in the bloodstream.
What Research Says
Madhulika Tripathi, PhD, of Duke-Nus Medical School along with colleagues tested humans, mice, and primates on the role hyperhomocysteinemia had in regard to the development of NASH. (2)
Human patients from Singapore General Hospital were researched in the first part of the study. All patients recruited had NAFLD (non-alcoholic fatty liver disease), NASH, liver steatosis, and obesity. Results found that individuals with NASH had high levels of homocysteine along with low levels of genes that are utilized to break down homocysteine in the liver.
For the next leg of the study, primates were used to verify the association they saw in humans. In order to onset NASH in the primates, they were fed a high-fat diet for 2 years. When diagnosed with NASH, it was concluded that homocysteine levels were elevated, and this was also linked with liver inflammation and damage.
When it came to testing mice, the researchers did 3 different tests:
- The first involved feeding them a diet that was rich in methionine, a type of amino acid that is the precursor to homocysteine. After 8 weeks of that diet, homocysteine levels increased, and the mice were diagnosed with both hyperhomocysteinemia and NASH.
- The next group of mice had a gene deleted for cystathionine beta-synthase, which is an enzyme that is part of the breakdown process of homocysteine. The mice were then incapable of breaking down homocysteine, which resulted in hyperhomocysteinemia and severe NASH.
- To end their research, the team wanted to confirm whether NASH was causing hyperhomocysteinemia. Mice were fed a western diet that would in turn result in fatty liver disease.
These mice eventually had:
- Glucose intolerance
- Insulin resistance
- High homocysteine levels
- Increased inflammatory cytokines and collagen in liver (fibrosis)
From there, mice that were receiving the NASH-inducing western diet were also supplemented with vitamins B12 and B9. When getting those vitamins, homocysteine levels dropped, glucose tolerance improved, and liver inflammation was less severe. This was compared to mice who were also being fed a western diet, but without the added vitamins.
In their conclusion, the researchers wrote, “vitamins B12 and folate (B9) treatment prevents and decreases the severity of NASH, and thus may represent a novel and inexpensive first-line therapy to prevent and treat NASH.” (1)
The “NASH-inducing” Diet
Diet can play an important role in the onset or the prevention of NASH. In the study, researchers fed mice a “NASH-inducing” diet which was a western diet and 15% liquid fructose. More research (3) has also concluded that a western diet rich in fat, fructose, and cholesterol can induce NASH in mice.
Also referred to as the standard American diet, the western diet symbolizes the over availability of food.
This diet includes high intakes of (4):
- Red meat
- Refined grains
- High-fat dairy products
- High-sugar desserts and drinks
- High-fat foods (specifically saturated and trans fats)
On the other hand, the diet is low in:
- Monounsaturated and polyunsaturated fatty acids
- Plant-derived proteins
Beyond its ability to onset NASH, research has found that the western diet has been linked with other diseases such as:
- Type 2 diabetes
- Cardiovascular disease
- Chronic kidney disease (CKD)
How to Get Vitamin B in Your Diet
Since the study results indicated vitamin B12 (cobalamin) and B9 (folate) may reduce NASH severity, it’s no surprise to want to ensure you’re including enough in your diet.
Foods rich in vitamin B12 include: (5)
- Dairy products
Most individuals can easily get vitamin B12 in their diet, but vegan or vegetarian diets can potentially result in deficiency since plant-based foods do not contain B12. Older individuals and people who have conditions that affect their digestive tract may also have trouble absorbing enough vitamin B12.
Vitamin B9 can easily be included in all diets, where it’s mainly found in foods such as: (6)
- Dark green leafy vegetables
Again, absorption issues in the small intestine such as Celiac Disease can create a deficiency in folate.
If you feel your vitamin B levels aren’t quite being met with your diet, a supplement may be the way to go. According to Mayo Clinic, both vitamin B12 (5) and B9 (6) supplements are generally a safe supplement to take but ensure that you have a conversation with your doctor before adding it to your daily regimen. Since vitamin B is a water-soluble vitamin, your body will only absorb and keep what it needs and pass the remaining through your urine.
It’s important to note that high intakes of folate have the ability to mask vitamin B12 deficiencies. Therefore, it’s recommended to take a supplement that contains 100% of the daily value of both folic acid and B12. Natural Wellness offers a one-a-day Clinical Multi-Vitamin that contains over 100% of both B vitamins along with other important micronutrients.
Although more research needs to be done, especially on human participants, research shows a promising outcome that vitamins B12 and B9 can bring to individuals diagnosed with NASH. Always have a discussion with your doctor before adding a supplement to your day to avoid interactions with medicines or over consuming the vitamin.
- Tripathi, M., Singh, B., Zhou, J., Tikno, K., Widjaja, A., Sandireddy, R., . . . Yen, P. (2020, November 15). HYPERHOMOCYSTEINEMIA is a marker and mediator Of NASH: Discovery of a Novel Vitamin THERAPY (B12 And FOLATE) For nash. Retrieved February 01, 2021, from https://aasld.confex.com/aasld/2020/meetingapp.cgi/Paper/21865
- Could vitamin b help treat fatty liver disease? (2021, January 04). Retrieved February 01, 2021, from https://www.hepmag.com/article/high-levels-homocysteine-associated-nash?utm_source=Hep%2BNewsletter&utm_campaign=30367272cf-01-05-2021_Hep_Email_Update_MC&utm_medium=email&utm_term=0_ca194d7407-30367272cf-76491137#lid=ca194d7407.fbe35be847
- Savari, F., Hard, S. A., Badavi, M., Rezaie, A., & Gharib-Naseri, M. K. (2019). A new method to induce nonalcoholic steatohepatitis (NASH) in mice.BMC Gastroenterology, 19(125). doi:https://doi.org/10.1186/s12876-019-1041-x
- Odermatt, A. (2011). The Western-style diet: A major risk factor for impaired kidney function and chronic kidney disease.American Journal of Physiology, 301(5), F919-F931. doi:https://doi.org/10.1152/ajprenal.00068.2011
- Vitamin b-12. (2017, October 17). Retrieved February 01, 2021, from https://www.mayoclinic.org/drugs-supplements-vitamin-b12/art-20363663
- Folate (folic acid). (2020, November 14). Retrieved February 01, 2021, from https://www.mayoclinic.org/drugs-supplements-folate/art-20364625