Our proprietary “Star-Rating” system was developed to help you easily understand the amount of scientific support behind each supplement in relation to a specific health condition. While there is no way to predict whether a vitamin, mineral, or herb will successfully treat or prevent associated health conditions, our unique ratings tell you how well these supplements are understood by the medical community, and whether studies have found them to be effective for other people.
For over a decade, our team has combed through thousands of research articles published in reputable journals. To help you make educated decisions, and to better understand controversial or confusing supplements, our medical experts have digested the science into these three easy-to-follow ratings. We hope this provides you with a helpful resource to make informed decisions towards your health and well-being.
3 Stars Reliable and relatively consistent scientific data showing a substantial health benefit.
2 Stars Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
1 Star For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.
Hepatitis and Nonalcoholic Steatohepatitis
20 grams daily
Supplementing with zinc (in the form of a zinc complex of L-carnosine) enhanced the response to interferon therapy in patients with chronic hepatitis C in a preliminary trial.
In a preliminary trial, supplementation with betaine (20 grams per day) for 12 months improved signs of liver inflammation in seven patients with nonalcoholic steatohepatitis, a type of liver inflammation. No significant side effects were seen.4
1.5 to 6 grams daily
Betaine (trimethylglycine) has been shown to lower homocysteine levels.
Betaine (trimethylglycine) (6 grams per day) and choline (2 grams per day) have each been shown to lower homocysteine levels.5 , 6 Choline in the amount of 2.6 grams per day (provided as 34 grams per day of soy lecithin) has also been shown to lower homocysteine levels in a double-blind trial.7 More recently, 1.5 grams of betaine per day, an amount similar to that in a typical diet, also has been found to lower homocysteine levels.8 Doctors usually consider supplementation with these nutrients only when supplementation with folic acid, vitamin B6, and vitamin B12 do not reduce homocysteine levels sufficiently. The results of this study, however, point to the potential benefit of increasing one’s intake of foods rich in betaine (such as whole wheat, spinach, beets, and other plant foods).
Refer to label instructions
For the few cases in which vitamin B6, vitamin B12, and folic acid fail to normalize homocysteine, adding betaine (trimethylglycine) may be effective.
Blood levels of an amino acid called homocysteine have been linked to atherosclerosis and heart disease in most research,9 , 10 though uncertainty remains about whether elevated homocysteine actually causes heart disease.11 , 12 Although some reports have found associations between homocysteine levels and dietary factors, such as coffee and protein intakes,13 evidence linking specific foods to homocysteine remains preliminary. Higher blood levels of vitamin B6, vitamin B12, and folic acid are associated with low levels of homocysteine14 and supplementing with these vitamins lowers homocysteine levels.15 , 16
For the few cases in which vitamin B6, vitamin B12, and folic acid fail to normalize homocysteine, adding 6 grams per day of betaine (trimethylglycine) may be effective.17 Of these four supplements, folic acid appears to be the most important.18 Attempts to lower homocysteine by simply changing the diet rather than by using vitamin supplements have not been successful.19
For people with alcohol-induced fatty liver, the recommended amount for betaine citrate or betaine aspartate supplementation is 1,000 to 2,000 mg three times daily. Lower amounts are often used as nutritional support for general liver health, although use of betaine in this manner has not undergone clinical research.
Dietary sources of betaine include fish, beets, and legumes. Betaine is most widely available as betaine hydrochloride (betaine-HCl), but that form is used primarily as a source of hydrochloric acid for people with hypochlorhydria (low stomach acid). The forms used specifically to provide betaine are betaine citrate and betaine aspartate. These forms have also been used to improve liver function.
Betaine is not an essential nutrient, and thus no deficiency state exists.
1. Selhub J. Homocysteine metabolism. Annu Rev Nutr 1999;19:217-46 [review].
2. Barak AJ, Tuma DJ. Betaine, metabolic by-product or vital methylating agent? Life Sci 1983;32:771-4 [review].
3. Chambers ST. Betaines: their significance for bacteria and the renal tract. Clin Sci 1995;88:25-7 [review].
4. Abdelmalek MF, Angulo P, Jorgensen RA, et al. Betaine, a promising new agent for patients with nonalcoholic steatohepatitis: results of a pilot study. Am J Gastroenterol 2001;96:2711–17.
5. Wilcken DEL, Wilcken B, Dudman NP, Tyrrell PA. Homocystinuria—the effects of betaine in the treatment of patients not responsive to pyridoxine. N Engl J Med 1983;309:448–53.
6. Jancin B. Amino acid defect causes 20% of atherosclerosis in CHD. Fam Pract News 1994(Oct 15):7.
7. Olthof MR, Brink EJ, Katan MB, Verhoef P. Choline supplemented as phosphatidylcholine decreases fasting and postmethionine-loading plasma homocysteine concentrations in healthy men. Am J Clin Nutr 2005;82:111–7.
8. Olthof MR, van Vliet T, Boelsma E, Verhoef P. Low dose betaine supplementation leads to immediate and long term lowering of plasma homocysteine in healthy men and women. J Nutr 2003;133:4135–8.
9. Stampfer MJ, Malinow R, Willett WC, et al. A prospective study of plasma homocyst(e)ine and risk of myocardial infarction in US physicians. JAMA 1992;268:877–81.
10. Bostom AG, Silbershatz H, Rosenberg IH, et al. Nonfasting plasma total homocysteine levels and all-cause and cardiobascular disease mortality in elderly Framingham men and women. Arch Intern Med 1999;159:1077–80.
11. Folsom AR, Nieto FJ, McGovern PG, et al. Prospective study of coronary heart disease incidence in relation to fasting total homocysteine, related genetic polymorphisms, and B vitamins. Circulation 1998;98:204–10.
12. Kuller LH, Evans RW. Homocysteine, vitamins, and cardiovascular disease. Circulation 1998;98:196–9 [editorial/review].
13. Stolzen berg-Solomon RZ, Miller ER III, Maguire MG, et al. Association of dietary protein intake and coffee consumption with serum homocysteine concentrations in an older population. Am J Clin Nutr 1999;69:467–75.
14. Selhub J, Jacques PF, Wilson PW, et al. Vitamin status and intake as primary determinants of homocysteinemia in an elderly population. JAMA 1993;270:2693–8.
15. Ubbink JB, Hayward WJ, van der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927–33.
16. Manson JB, Miller JW. The effects of vitamin B12, B6, and folate on blood homocysteine levels. Ann NY Acad Sci 1992;669:197–204 [review].
17. Franken DG, Boers GHJ, Blom HJ, et al. Treatment of mild hyperhomocysteinemia in vascular disease patients. Arterioscler Thromb 1994;14:465–70.
18. Ubbink JB, Vermaak WJH, van der Merwe A, et al. Vitamin requirements for the treatment of hyperhomocysteinemia in humans. J Nutr 1994;124:1927–33.
19. Ubbink JB, van der Merwe A, Vermaak WJH, Delport R. Hyperhomocysteinemia and the response to vitamin supplementation. Clin Investig 1993;71:993–8.
Last Review: 05-01-2013
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The information presented in Aisle7 is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires June 2014.
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