Shilajit, a traditional Ayurvedic supplement derived from mountain plant decomposition, is increasingly marketed for various health concerns, including fatty liver disease. Fatty liver disease affects approximately one in three UK adults and is closely linked to obesity, type 2 diabetes, and metabolic syndrome. Whilst shilajit proponents claim antioxidant and anti-inflammatory properties, it is crucial to understand that shilajit is not a licensed medicine in the UK and lacks robust clinical evidence for treating liver conditions. This article examines the available evidence, safety considerations, and evidence-based treatments for fatty liver disease to help you make informed decisions about your liver health.

What Is Shilajit and How Is It Used?

Shilajit is a sticky, tar-like substance that forms over centuries from the decomposition of plant material in mountainous regions, particularly the Himalayas, Altai, and Caucasus mountains. It has been used for centuries in traditional Ayurvedic medicine and is marketed as a natural supplement purported to support energy, vitality, and various health conditions.

The composition of shilajit is complex and variable, containing fulvic acid (considered its primary active component), humic acid, trace minerals, and various organic compounds. Commercial preparations are typically available as resin, powder, or capsules. There is no established, evidence-based dose for shilajit, and product strength and purity vary considerably between manufacturers. If you are considering shilajit, do not exceed the manufacturer's label instructions and seek advice from your GP or pharmacist before use.

In traditional medicine systems, shilajit has been used for numerous purposes including enhancing physical performance, supporting cognitive function, and addressing metabolic concerns. Proponents claim it possesses antioxidant and anti-inflammatory properties, though the quality and purity of commercially available products can vary considerably.

Shilajit products sold in the UK are food supplements, not licensed medicines. They are regulated under food law by the Food Standards Agency (FSA) and must not make medicinal claims. The Medicines and Healthcare products Regulatory Agency (MHRA) regulates medicines and assesses borderline products. Because shilajit is not a licensed medicine, claims about its therapeutic benefits have not been formally evaluated for safety and efficacy by the MHRA.

Consumers should be aware that supplement quality, authenticity, and safety can vary significantly between manufacturers. Contamination with heavy metals (including lead, mercury, and arsenic) has been documented in some Ayurvedic and herbal products, including shilajit. To reduce risk, purchase only from reputable UK suppliers, request a recent certificate of analysis showing testing for contaminants, and avoid unlabelled or raw resins of uncertain origin.

Understanding Fatty Liver Disease: Causes and Symptoms

Fatty liver disease, medically termed hepatic steatosis, occurs when excess fat accumulates in liver cells. There are two main types: alcohol-related fatty liver disease (ARLD) and non-alcoholic fatty liver disease (NAFLD). NAFLD is increasingly common in the UK, affecting approximately one in three adults, and is closely associated with obesity, type 2 diabetes, and metabolic syndrome. (International terminology is evolving, with some guidelines now using 'metabolic dysfunction-associated steatotic liver disease' or MASLD, though NAFLD remains the term in current UK guidance.)

The condition develops when the liver's ability to process and export fat is overwhelmed, leading to triglyceride accumulation within hepatocytes. Key risk factors include:

• Obesity, particularly central adiposity

• Type 2 diabetes and insulin resistance

• Dyslipidaemia (abnormal cholesterol levels)

• Metabolic syndrome

• Certain medications and rapid weight loss

In its early stages, fatty liver disease is often asymptomatic, discovered incidentally through blood tests showing elevated liver enzymes (ALT, AST) or imaging studies. When symptoms do occur, they may include persistent fatigue, discomfort in the upper right abdomen, and general malaise. However, these symptoms are non-specific and can be attributed to numerous conditions.

The natural history of NAFLD varies considerably. Whilst many individuals maintain simple steatosis without progression, a proportion develop non-alcoholic steatohepatitis (NASH), characterised by inflammation and liver cell damage. NASH can progress to fibrosis, cirrhosis, and hepatocellular carcinoma over time. Before diagnosing NAFLD, other causes of liver disease must be excluded, including excessive alcohol intake, viral hepatitis (hepatitis B and C), autoimmune liver disease, and drug-induced liver injury.

Diagnosis and risk stratification typically involve:

• Blood tests (liver function tests, metabolic markers, viral hepatitis serology)

• Ultrasound or other imaging (CT, MRI)

• Risk stratification using the FIB-4 score (calculated from age, ALT, AST, and platelet count) with age-adjusted cut-offs

• Enhanced Liver Fibrosis (ELF) blood test for those with intermediate or high FIB-4 scores; an ELF score ≥10.51 suggests advanced fibrosis and warrants specialist referral

• Transient elastography (e.g., FibroScan) to assess liver stiffness

• Liver biopsy in selected cases

NICE guidance (NG49) emphasises the importance of identifying and managing underlying metabolic risk factors as the cornerstone of fatty liver disease management, alongside systematic risk stratification to identify those at higher risk of progressive disease.

Safety Considerations and Potential Risks of Shilajit

Whilst shilajit is marketed as a natural supplement, 'natural' does not automatically mean safe, and several important safety considerations warrant attention, particularly for individuals with liver conditions.

Contamination concerns represent a significant risk. Studies and safety alerts have identified heavy metals including lead, mercury, and arsenic in some commercially available Ayurvedic and herbal products, including shilajit. These contaminants can accumulate in the body and potentially cause additional liver damage, which is particularly concerning for individuals already experiencing hepatic dysfunction. The lack of standardised manufacturing processes and quality control in the supplement industry means product purity cannot be guaranteed.

Drug interactions are poorly understood. There is insufficient evidence to confirm specific interactions, but theoretical concerns exist regarding medications commonly prescribed for conditions associated with fatty liver disease, including antihypertensives, diabetes medications, and anticoagulants. If you take any prescribed medicines—especially anticoagulants or drugs with a narrow therapeutic index—consult your GP or pharmacist before using shilajit to review potential interactions.

Potential adverse effects reported with shilajit use include:

• Gastrointestinal disturbances (nausea, diarrhoea)

• Allergic reactions

• Dizziness and headache

• Potential effects on blood pressure and blood glucose

Stop taking shilajit immediately and seek urgent medical attention if you develop signs of liver injury, including jaundice (yellowing of the skin or eyes), dark urine, severe itching, persistent nausea or vomiting, or pain in the upper right abdomen.

Individuals should seek medical advice before using shilajit if they:

• Have active liver disease or elevated liver enzymes

• Are pregnant or breastfeeding (insufficient safety data)

• Have any chronic medical condition or take regular prescribed medication

There is no established clinical evidence from rigorous trials that shilajit supplementation improves fatty liver disease. Anyone considering shilajit, particularly those with existing liver conditions, should consult their GP or hepatologist before use. It is essential to inform healthcare providers about all supplements being taken, as this information is crucial for safe medical management.

If you experience any suspected side effects from shilajit or any other supplement, report them via the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app. This helps improve the safety monitoring of all health products.

Evidence-Based Treatments for Fatty Liver Disease

Lifestyle modification remains the cornerstone of evidence-based management for fatty liver disease, supported by NICE guidance (NG49) and UK hepatology societies. No pharmacological treatment is currently licensed specifically for NAFLD in the UK, making non-pharmacological interventions the primary therapeutic approach.

Weight loss is the most effective intervention for NAFLD. Studies demonstrate that losing 7–10% of body weight can significantly reduce liver fat, inflammation, and fibrosis. Even modest weight reduction of 3–5% can improve hepatic steatosis. Weight loss should be gradual (0.5–1 kg per week), as rapid weight loss can paradoxically worsen liver inflammation. Dietary approaches should focus on:

• Reducing overall calorie intake

• Limiting refined carbohydrates and added sugars

• Reducing saturated fat consumption

• Increasing fibre intake through vegetables, fruits, and whole grains

• Following a Mediterranean-style diet pattern, which has shown particular benefit

Physical activity provides benefits independent of weight loss. The UK Chief Medical Officers recommend at least 150 minutes of moderate-intensity aerobic activity weekly, combined with muscle-strengthening activities on two or more days per week. Exercise improves insulin sensitivity, reduces liver fat, and addresses metabolic dysfunction even without significant weight reduction.

Alcohol reduction or abstinence is important. Even modest alcohol intake may worsen liver disease in individuals with NAFLD. Discuss safe alcohol limits with your GP.

Management of associated conditions is essential:

• Diabetes control: Optimising glycaemic control, typically with metformin as first-line therapy (metformin treats diabetes but is not a treatment for NAFLD itself)

• Dyslipidaemia management: Statins are safe in NAFLD and reduce cardiovascular risk

• Hypertension treatment: Using appropriate antihypertensive medications

Pharmacological options are limited. Pioglitazone and vitamin E may be considered in selected patients with biopsy-proven NASH, but both carry risks and are not routinely recommended. GLP-1 receptor agonists show promise in clinical trials but are not currently licensed for NAFLD treatment.

For eligible individuals with severe obesity and NAFLD, referral for assessment for bariatric or metabolic surgery may be appropriate, in line with NICE obesity guidance.

Risk stratification and monitoring are important. NICE NG49 recommends using the FIB-4 score (with age-adjusted cut-offs) to assess fibrosis risk, followed by the Enhanced Liver Fibrosis (ELF) blood test for those at intermediate or high risk. An ELF score ≥10.51 indicates likely advanced fibrosis and is a trigger for specialist hepatology referral. Regular monitoring through blood tests and imaging helps assess disease progression and treatment response.

Seek urgent medical attention (call 999 or go to A&E) if you experience:

• Vomiting blood or passing black, tarry stools

• Jaundice with fever or feeling systemically unwell

• Acute confusion or altered mental state

• Rapidly worsening abdominal swelling or shortness of breath

Contact your GP promptly if you experience:

• Persistent or worsening abdominal pain or swelling

• Unexplained weight loss

• New or worsening jaundice

The focus remains on addressing underlying metabolic dysfunction through sustainable lifestyle changes, managing cardiovascular and metabolic risk factors, and identifying those who require specialist hepatology input, rather than seeking unproven supplements.

Frequently Asked Questions