The History of Essential Phospholipids

Few liver products have such a divided reputation as essential phospholipids: a standard prescription in parts of Eastern Europe, a little-known supplement in Britain. Our editorial team traces their history from egg yolk chemistry to modern trials.

From egg yolk to the pharmacy shelf

The story of essential phospholipids begins with lecithin. In the nineteenth century the French chemist Théodore Gobley isolated a fatty substance from egg yolk and named it after the Greek word for yolk, lekithos. Lecithin was later shown to consist largely of phosphatidylcholine, a building block of every cell membrane in the body.

Through the first half of the twentieth century, biochemists worked out the structure of phospholipids and their role in membranes, bile and lipid transport. Soybeans emerged as a convenient, inexpensive industrial source of lecithin, a by-product of soy oil refining.

The idea that underpinned "essential" phospholipids was straightforward: if liver cell membranes are damaged by alcohol, toxins or fat accumulation, supplying highly purified phosphatidylcholine might help repair them.

The word "essential" was a marketing and conceptual label rather than a nutritional one. Unlike essential fatty acids, phospholipids can be made by the body; the term referred to the high content of polyunsaturated fatty acids, especially linoleic acid, in the purified fraction.

The birth of a branded medicine

In post-war West Germany, pharmaceutical manufacturers developed a concentrated soybean fraction rich in polyenylphosphatidylcholine (PPC). The best-known product, Essentiale, was introduced by a German company and later passed into the portfolio of larger groups that eventually became part of Sanofi.

The product was positioned as a "hepatoprotector", a drug class that remains popular in Central and Eastern Europe, the former Soviet Union and parts of Asia. Capsules and an intravenous solution became staples of hospital and outpatient practice in these regions.

In the UK, by contrast, essential phospholipids never became a licensed medicine. Phosphatidylcholine and lecithin are available here as food supplements, while hepatology practice follows NICE and European guidelines that do not include them as standard treatment.

This geographical split remains one of the most striking features of the product's history: a household name in Kyiv or Warsaw, largely unknown to a GP in Watford.

The science: promising animals, mixed humans

Much of the scientific credibility of essential phospholipids rests on work by Charles Lieber, an American researcher who studied alcoholic liver disease in baboons. His group reported that polyenylphosphatidylcholine protected against fibrosis and cirrhosis in animals fed alcohol.

These results prompted a large Veterans Affairs cooperative study in people with alcoholic liver disease. Published in 2003, it found no significant effect of PPC on the progression of fibrosis, although many participants reduced their drinking, which complicated interpretation.

Reviews by Gundermann and colleagues summarised numerous smaller clinical studies suggesting improvements in liver enzymes, ultrasound findings and symptoms, particularly in fatty liver. Many of these studies were open-label, short or industry-supported, so their conclusions carry limited weight.

Why the product became popular among athletes

In bodybuilding culture across Eastern Europe, essential phospholipids became a common "liver support" alongside courses of oral anabolic steroids. The belief was that they would counteract the liver strain caused by 17-alpha-alkylated compounds.

There is no good evidence that phospholipids prevent steroid-induced liver injury. Oral anabolic steroids can cause cholestasis, peliosis hepatis and liver tumours, and no supplement removes that risk. Relying on a "hepatoprotector" may create a false sense of safety.

Several factors explain the product's lasting appeal:

• long familiarity from medical practice in the region;
• a plausible biological mechanism that is easy to explain;
• good tolerability, so users notice few downsides;
• improvements in liver enzymes that may simply reflect stopping alcohol or drugs at the same time.

Where things stand today

Today, phosphatidylcholine remains of research interest in metabolic dysfunction-associated steatotic liver disease, where membrane composition and lipid metabolism are central. Some trials continue, but the evidence base is still weaker than for weight loss and exercise.

Essential phospholipids are generally well tolerated. The most frequently reported side effects are mild digestive complaints such as loose stools or stomach discomfort. People with soy allergy should avoid them.

For UK readers, phosphatidylcholine products are food supplements, so their quality and dose vary. They should not be used in place of medical assessment of abnormal liver tests.

The history of essential phospholipids is a useful case study in how a plausible mechanism, strong regional tradition and modest evidence can keep a product on shelves for decades.

Editorial conclusions

Essential phospholipids grew from basic membrane biochemistry into a widely used hepatoprotector in some parts of Europe and Asia, while remaining outside mainstream practice in the UK and USA. Animal data were encouraging, but the largest human trial did not confirm a benefit on fibrosis.

For athletes, the key lesson is that no "liver support" product makes hepatotoxic substances safe.

Abnormal liver tests deserve a proper diagnosis rather than self-treatment.

Related reading: fatty liver disease and when to see a doctor, how oral anabolic steroids affect the liver, and what liver blood tests can and cannot tell you.

References

1. Lieber CS, Robins SJ, Li J, et al. Phosphatidylcholine protects against fibrosis and cirrhosis in the baboon. Gastroenterology. 1994;106(1):152–159.
2. 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.
3. 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.
4. Gundermann KJ, Gundermann S, Drozdzik M, Mohan Prasad VG. Essential phospholipids in fatty liver: a scientific update. Clin Exp Gastroenterol. 2016;9:105–117.
5. European Association for the Study of the Liver (EASL), EASD, EASO. EASL-EASD-EASO Clinical Practice Guidelines for the management of non-alcoholic fatty liver disease. J Hepatol. 2016;64(6):1388–1402.