Evidence Level
Alpha lipoic acid's hepatoprotective properties stem from its unique position as a universal antioxidant that operates in both aqueous and lipid environments. Packer et al. (1995) published the foundational review establishing ALA's role in regenerating glutathione and other antioxidants. For NAFLD specifically, Koh et al. (2011) showed 1200mg/day ALA reduced body weight and liver enzymes in obese patients, while multiple studies have confirmed ALA's insulin-sensitizing effects are relevant to fatty liver pathogenesis. Jacob et al. (1999) demonstrated significant improvements in insulin sensitivity with 600mg/day in type 2 diabetics. In Europe, ALA has pharmaceutical status for diabetic neuropathy (Thioctacid), and its liver-protective applications are increasingly recognized. The R-enantiomer is the biologically active form and is roughly twice as potent as the racemic mixture commonly sold.