Why Athletes Take Essential Phospholipids for the Liver
In gym changing rooms across Europe, "essential phospholipids" are often mentioned in the same breath as liver protection. The idea is attractive: a natural compound that repairs cell membranes and shields the liver from the stresses of intense training, supplements and medicines. Our editorial team looks at the origin of these products, the quality of the evidence and the limits of what they can do.
What essential phospholipids are
Phospholipids are the building blocks of every cell membrane. The term "essential phospholipids" (EPL) refers to a highly purified extract from soybeans, rich in polyenylphosphatidylcholine, in which the phosphatidylcholine molecules carry polyunsaturated fatty acids, mainly linoleic acid.
The concept is that these molecules can be incorporated into damaged liver cell membranes, restoring their fluidity and function. Laboratory and animal studies have described antioxidant, anti-inflammatory and anti-fibrotic effects, which are summarised in the review by Gundermann and colleagues.
In several countries of central and eastern Europe, EPL preparations are licensed medicines for liver conditions. In the UK they are not prescribed by the NHS; phosphatidylcholine and lecithin products are instead sold as food supplements, often at lower purity and dose than the pharmaceutical versions used in trials.
This distinction matters when reading marketing claims. Studies on a standardised medicinal product do not automatically apply to a generic lecithin capsule.
Why athletes are interested
Intense training itself can alter liver blood tests. Pettersson and colleagues showed that heavy weight training in healthy men raised ALT and AST, enzymes often interpreted as liver markers, to levels that could look alarming. In reality, much of this rise comes from muscle rather than liver.
Other reasons athletes focus on the liver include:
- high-protein diets and multiple supplements, which some fear burden the liver;
- alcohol use, especially in team sports cultures;
- fatty liver associated with high body weight in strength and power sports;
- use of oral anabolic steroids, particularly 17α-alkylated compounds, which are known to be hepatotoxic.
Oral 17α-alkylated steroids are linked with cholestasis, peliosis hepatis and liver tumours. This is a serious, documented risk, and it is the context in which many people reach for "liver support" products.
The danger is that a supplement creates a false sense of security. No phospholipid preparation has been shown to prevent the liver damage caused by these drugs.
What the clinical evidence shows
The best-designed large trial of polyenylphosphatidylcholine was a US Veterans Affairs study by Lieber and colleagues in heavy drinkers with alcoholic liver disease. Over two years, it did not prevent the progression of fibrosis compared with placebo, although some secondary measures moved in a favourable direction.
In non-alcoholic fatty liver disease, now often called metabolic dysfunction-associated steatotic liver disease, studies such as that by Dajani and colleagues reported improvements in liver enzymes and ultrasound findings with EPL as an adjunct. However, many of these studies were open-label, short and industry-supported.
| Condition | Quality of evidence | Main finding |
|---|---|---|
| Alcoholic liver disease | Large RCT | No effect on fibrosis progression |
| Fatty liver (NAFLD/MASLD) | Mostly small, open-label | Improved enzymes and imaging in some studies |
| Drug-induced liver injury | Very limited | No reliable evidence of protection |
| Exercise-related enzyme rises | No trials | Rises usually reflect muscle, not liver |
The UK NICE guideline on non-alcoholic fatty liver disease focuses on weight loss, physical activity and management of cardiovascular risk. It does not recommend phospholipid supplements.
Safety and practical considerations
EPL and lecithin supplements are generally well tolerated. The most common side effects are mild stomach discomfort, loose stools and a feeling of fullness. People with soya allergy should avoid soy-derived products.
Some researchers, including Tang and colleagues, have shown that gut bacteria convert dietary phosphatidylcholine into TMAO, a compound associated with cardiovascular risk. Whether supplemental phospholipids meaningfully raise cardiovascular risk is not established, but it is a reason not to take high doses indefinitely without a clear purpose.
If your liver tests are abnormal, the priority is to find the cause. A GP can repeat tests after a break from heavy training, check for viral hepatitis, alcohol-related damage, fatty liver and drug effects, and arrange an ultrasound or referral if needed.
When you have blood tests, tell the clinician about recent hard training sessions, supplements and any performance drugs. This honest history prevents both missed diagnoses and unnecessary alarm.
Conclusions of the editorial team
Essential phospholipids have a coherent biological rationale and some supportive data in fatty liver disease, but strong evidence of benefit is lacking and the large alcohol trial was negative.
For athletes, they are not a shield against hepatotoxic substances. The only reliable way to protect the liver from oral anabolic steroids is not to use them; supplements cannot neutralise that risk.
Lifestyle measures — maintaining a healthy weight, limiting alcohol and exercising regularly — have far stronger evidence for liver health than any capsule.
You may also want to read our articles on interpreting ALT and AST after training, milk thistle and the liver, and the hepatic risks of oral steroids.
References
- Gundermann KJ, Kuenker A, Kuntz E, Droździk M. Activity of essential phospholipids (EPL) from soybean in liver diseases. Pharmacol Rep. 2011;63(3):643–659.
- Lieber CS, Weiss DG, Groszmann R, Paronetto F, Schenker S. II. Veterans Affairs Cooperative Study of polyenylphosphatidylcholine in alcoholic liver disease. Alcohol Clin Exp Res. 2003;27(11):1765–1772.
- Dajani AI, Abu Hammour AM, Zakaria MA, et al. Essential phospholipids as a supportive adjunct in the management of patients with NAFLD. Arab J Gastroenterol. 2015;16(3–4):99–104.
- Pettersson J, Hindorf U, Persson P, et al. Muscular exercise can cause highly pathological liver function tests in healthy men. Br J Clin Pharmacol. 2008;65(2):253–259.
- Tang WH, Wang Z, Levison BS, et al. Intestinal microbial metabolism of phosphatidylcholine and cardiovascular risk. N Engl J Med. 2013;368(17):1575–1584.
- National Institute for Health and Care Excellence. Non-alcoholic fatty liver disease (NAFLD): assessment and management. NICE guideline NG49. London: NICE; 2016.
