Vitamin E has been investigated as a potential adjunctive therapy for certain types of liver disease, particularly nonalcoholic steatohepatitis (NASH), which can progress to cirrhosis. The scientific rationale is largely based on vitamin E’s antioxidant properties, which may help reduce oxidative stress, a key factor in liver cell injury and fibrosis. Several randomized controlled trials, most notably the PIVENS trial (Sanyal et al., NEJM 2010), have shown that high-dose vitamin E supplementation (typically 800 IU/day) can improve liver histology in non-diabetic adults with NASH.

However, when it comes to established cirrhosis—whether from NASH or other causes—the evidence for vitamin E’s efficacy is much weaker. Most studies exclude patients with advanced fibrosis or cirrhosis due to concerns about safety and potential side effects (e.g., increased risk of hemorrhagic stroke or prostate cancer with long-term high-dose use). There is insufficient clinical evidence to support vitamin E as a treatment for cirrhosis itself, and it is not routinely recommended in clinical guidelines for cirrhosis management. Its role is primarily in earlier stages of liver disease, with the goal of slowing progression rather than reversing cirrhosis.

In summary, while vitamin E is scientifically validated for use in NASH (a precursor to cirrhosis), there is limited direct evidence to support its use in established cirrhosis. Its use in this context is experimental and should be considered with caution.