Essential Phospholipids: Side Effects and Contraindications
Essential phospholipids, best known under the brand Essentiale in Central and Eastern Europe, are often presented as a harmless liver shield. In the gym world they are sometimes taken during periods of heavy training or drug use in the belief that they protect the liver. Our editors review what these products are, the side effects reported, who should avoid them and why they are no guarantee of safety.
What essential phospholipids are
Essential phospholipids (EPL) are a highly purified extract of soya bean lecithin, rich in polyenylphosphatidylcholine (PPC). The dominant molecule, dilinoleoylphosphatidylcholine, carries two linoleic acid chains and is a natural component of cell membranes, including those of liver cells.
The idea behind EPL is that damaged hepatocyte membranes can incorporate these phospholipids, restoring membrane fluidity and the function of membrane-bound enzymes. Laboratory and animal studies support some of these effects, and reviews by Gundermann and colleagues summarise decades of research, much of it from countries where the products are licensed medicines.
In the United Kingdom, EPL are not licensed medicines and are not included in NICE guidance on fatty liver disease. Phosphatidylcholine and lecithin are, however, sold as food supplements, which means they are regulated as foods and cannot carry medical claims.
The quality of clinical evidence is mixed. A large US Veterans Affairs study of PPC in alcoholic liver disease did not show that it prevented progression of fibrosis, while smaller trials in non-alcoholic fatty liver disease report improvements in liver enzymes and ultrasound findings but often lack robust blinding.
Reported side effects
At standard oral doses used in studies and on product labels — typically around 1.8 g of phospholipids per day in divided doses — essential phospholipids are generally well tolerated. Most reported problems involve the digestive tract.
- Gastrointestinal symptoms: stomach discomfort, a feeling of fullness, soft stools or diarrhoea, especially when capsules are taken without food.
- Nausea: occasionally reported, usually mild and dose-related.
- Allergic reactions: skin rash, itching or urticaria; rarely more serious reactions in people sensitised to soya.
- Injection-related effects: intravenous formulations, used in some countries, can cause local irritation and contain excipients such as benzyl alcohol.
Because EPL are largely composed of phosphatidylcholine, a theoretical concern has been raised about trimethylamine N-oxide (TMAO), a metabolite produced when gut bacteria break down choline-containing compounds. Research by Wang and colleagues linked higher TMAO levels to cardiovascular risk. Whether supplemental phospholipids meaningfully raise TMAO or cardiovascular risk in humans remains unclear.
Contraindications and cautions
Product information for licensed EPL preparations in Europe lists a small number of situations in which they should not be used or should be used with care. Food supplement versions in the UK usually carry fewer warnings, but the same biological considerations apply.
| Situation | Reason for caution |
|---|---|
| Allergy to soya or peanuts | EPL are soya-derived; cross-reactivity with peanut is possible |
| Children under 12 | Insufficient safety data for oral capsules |
| Pregnancy and breastfeeding | Lack of controlled studies; avoid unless advised by a doctor |
| Anticoagulant therapy | Some leaflets state an interaction cannot be excluded |
| Diagnosed liver disease | Should not replace medical assessment or treatment |
Some capsule formulations contain soya oil, ethanol or other excipients. People who must avoid alcohol entirely, or who have specific intolerances, should read the full list of ingredients.
For anyone taking warfarin or other anticoagulants, any new supplement should be discussed with the anticoagulation clinic, as small changes in diet or supplements can shift clotting test results.
The 'liver protection' myth in strength sport
Among bodybuilders and strength athletes, essential phospholipids are often bought as a safeguard against liver strain from oral anabolic steroids, high-dose paracetamol or alcohol. This is where the greatest misunderstanding lies.
Oral 17-alpha-alkylated steroids can cause cholestasis, peliosis hepatis and liver tumours. There is no clinical evidence that EPL prevent these injuries, and taking a supplement may create a false sense of security that delays medical attention.
Drug-induced liver injury often produces non-specific symptoms — fatigue, itching, dark urine, pale stools or yellowing of the eyes. These signs need urgent assessment by a doctor, not a higher supplement dose.
Normal liver blood tests after a period of supplement use do not prove that the supplement worked. Liver enzymes can be normal even when significant damage is developing, and they can also rise from hard training alone, particularly ALT and AST after heavy resistance exercise.
Using essential phospholipids sensibly
If a doctor recommends phosphatidylcholine as part of managing fatty liver disease, it should sit alongside the interventions with the strongest evidence: weight loss where appropriate, regular physical activity, reduced alcohol intake and control of blood sugar and lipids, as set out in NICE guidance.
Take capsules with meals and swallow them whole to reduce stomach upset. Do not exceed the amount stated on the label, and stop if you develop a rash, swelling or breathing difficulty.
Keep a list of all supplements you take and share it with your GP or pharmacist, especially before surgery or when starting new medicines.
Finally, remember that the label of a food supplement is not checked by a medicines regulator. Choosing products from established manufacturers with independent quality testing reduces, but does not eliminate, the risk of contamination or inaccurate dosing.
Editorial conclusions
Essential phospholipids are soya-derived phosphatidylcholine preparations with a reasonable safety profile; side effects are mostly mild digestive complaints and occasional allergic reactions.
The main contraindications are soya or peanut allergy, young age, pregnancy without medical advice and caution with anticoagulants. In the UK they are food supplements, not licensed liver medicines.
Crucially, they are not proven to protect the liver from steroids, alcohol or other drugs. Symptoms of liver injury need medical assessment, not more supplements.
You may also wish to read our editorial guides on interpreting liver function tests, on drug-induced liver injury and on milk thistle (silymarin) and the evidence behind it.
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.
- Gundermann KJ, Gundermann S, Drozdzik M, Mohan Prasad VG. Essential phospholipids in fatty liver: a scientific update. Clin Exp Gastroenterol. 2016;9:105–117.
- Lieber CS, Weiss DG, Groszmann R, et al. 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.
- Wang Z, Klipfell E, Bennett BJ, et al. Gut flora metabolism of phosphatidylcholine promotes cardiovascular disease. Nature. 2011;472(7341):57–63.
- National Institute for Health and Care Excellence. Non-alcoholic fatty liver disease (NAFLD): assessment and management. NICE guideline NG49. London: NICE; 2016.
