肝脏补充剂很受欢迎，但它们有效吗？他们安全吗？
Liver supplements are popular, but do they work? And are they safe?
顾名思义，肝脏对维持生命很重要。作为最大的内脏之一，它通过产生胆汁来帮助消化，胆汁有助于将食物分解成细胞所需的重要营养素。
As the name implies, the liver is important to maintaining life. One of the largest internal organs, it's integral to digestion by producing bile, which helps break food down into the vital nutrients needed by cells.
肝脏在通过清除废物来保持身体健康方面也起着至关重要的作用。具体来说，肝脏在分解废物氨时会产生尿素。然后尿素通过肾脏从血液中滤出并随尿液排出体外。肝脏还会排泄胆红素，这是一种由血红蛋白（红细胞中的一种蛋白质）分解产生的废物。
The liver also plays a critical role in keeping the body healthy by removing waste products. Specifically, the liver generates urea when breaking down the waste product ammonia. The urea is then filtered out of the blood by the kidneys and excreted in urine. The liver also excretes bilirubin, a waste product that results from the breakdown of hemoglobin, a protein in red blood cells.
肝脏是一个不可思议的器官——它实际上可以在受伤后再生。但它也容易受到各种感染和疾病的影响，例如甲型、乙型和丙型肝炎等病毒感染，可能导致长期肝损伤。
The liver is an incredible organ – it can actually regenerate after an injury. But it's also vulnerable to various infections and diseases, such as viral infections, such as hepatitis A, B and C, that can lead to long term liver damage.
疾病控制和预防中心报告说，450 万美国成年人（占总人口的近 2%）被诊断出患有慢性肝病或肝硬化。当肝脏堆积过多的疤痕组织时，就会发生肝硬化。它可能由感染、受伤或长期酗酒引起。
The Centers for Disease Control and Prevention reports that 4.5 million American adults, nearly 2% of the population, have been diagnosed with chronic liver disease or cirrhosis. Cirrhosis occurs when the liver builds up excess scar tissue. It can result from an infection, injury or chronic abuse of alcohol.
你应该服用肝脏补充剂吗？
Should You Take a Liver Supplement?
如果您担心肝脏的健康，您可能想知道服用肝脏补充剂是否是个好主意。位于哥伦布市的俄亥俄州立大学韦克斯纳医学中心的营养师艾米丽赖斯说，这些产品可能含有广泛的草药成分，这些成分被宣传为支持肝脏健康，但目前尚不清楚它们是否有效。
If you're concerned about the health of your liver, you may be wondering whether taking a liver supplement is a good idea. Emily Rice, staff dietitian with the Ohio State University Wexner Medical Center in Columbus, says these products can contain a wide range of herbal ingredients that are marketed as being supportive of liver health, but it's not clear whether they work.
“据推测，肝脏补充剂可以通过排毒、消除对细胞的损伤和改善流向肝脏的血流量来支持肝脏，”赖斯解释说。 “然而，肝脏是我们体内最重要的器官之一，因为它可以代谢糖、脂肪、酒精和药物。它通过尿液和粪便将食物副产品过滤出体外，从而自然地自我解毒。健康人不需要补充剂来帮助这个过程。”
“Liver supplements are supposedly supporting the liver by detoxing it, undoing damage to cells and improving blood flow to the liver,” Rice explains. “However, the liver is one of the most important organs in our body as it metabolizes sugar, fat, alcohol and medications. It naturally detoxifies itself by filtering food byproducts out of the body through urine and stool. No supplements are needed to aid this process in a healthy individual.”
什么是肝脏补充剂？
What's in Liver Supplements?
Benjamin Hyatt 博士是马萨诸塞州阿克顿米德尔塞克斯消化健康与内窥镜中心的胃肠病学家，他说肝脏补充剂中常见的几种成分包括：
Dr. Benjamin Hyatt, a gastroenterologist with the Middlesex Digestive Health & Endoscopy Center in Acton, Massachusetts, says several ingredients commonly found in liver supplements include:
奶蓟。
朝鲜蓟叶。
蒲公英。
锌。
姜黄或姜黄素。
Milk thistle.
Artichoke leaf.
Dandelion.
Zinc.
Turmeric or curcumin.
奶蓟
Milk Thistle
奶蓟或水飞蓟是一种带刺的开花草本植物，有时用于草药治疗。 Hyatt 解释说，它是“肝脏补充剂中最常见的成分”，因为它具有“抗氧化和抗炎特性”。“作为一种抗氧化剂，水飞蓟被认为可以保护肝细胞免受自由基的侵害——自由基是一种反应性分子，可以损伤组织——这是毒素在肝脏代谢时产生的。”
Milk thistle, or Silybum marianum, is a prickly, flowering herb that's sometimes used in herbal remedies. It's "the most common ingredient in liver supplements,” because of its “antioxidant as well as anti-inflammatory properties,” Hyatt explains. “Functioning as an antioxidant, milk thistle is thought to protect liver cells from free radicals – reactive molecules that can damage tissues – which are produced when toxins are metabolized in the liver.”
虽然奶蓟可能是一种流行的补充剂，但尚不清楚它是否真的有效。 Hyatt 指出，“一些研究表明，奶蓟草可以降低肝酶，但 2017 年的一项更大规模的系统审查表明，这些改善没有临床意义。”
While milk thistle might be a popular supplement, it's not clear that it actually works. Hyatt notes that “a few studies have demonstrated that milk thistle can reduce liver enzymes, but a larger systematic review in 2017 showed that these improvements were not clinically significant.”
同样，2007 年一篇关于“研究奶蓟在病毒性肝炎或酒精引起的肝病中使用的文献，由于缺乏高质量证据而质疑其有益作用，”Hyatt 说。
Similarly, a 2007 review of “literature studying milk thistle use in liver disease due to viral hepatitis or alcohol questioned the beneficial effects due to lack of high-quality evidence,” Hyatt says.
奶蓟通常被认为是安全的，但“它很少会引起过敏反应、腹泻、恶心、呕吐、皮疹或头痛，”Hyatt 说。它还可以与某些药物相互作用，“因此，与您的医生讨论这种药物的使用非常重要。”
Milk thistle is generally considered safe when taken in usual doses, but “it can rarely cause allergic reaction, diarrhea, nausea, vomiting, rash or headaches,” Hyatt says. It can also interact with some medications “so, it's important to discuss the use of this medication with your physician.”
朝鲜蓟叶
Artichoke Leaf
当用作食品时，朝鲜蓟富含纤维、维生素 C 和其他抗氧化剂。虽然它们通常像蔬菜一样准备，但朝鲜蓟实际上是一种蓟。 Hyatt 指出，这种植物的提取物有时用于补充剂，这些补充剂“已被证明具有抗氧化作用，可用于支持肝脏健康”。
When used as a food item, artichokes are high in fiber, vitamin C and other antioxidants. While they're typically prepared like a vegetable, artichokes are actually a type of thistle. An extract from the plant is sometimes used in supplements, which have been “shown to have antioxidant effects and is used to support liver health,” Hyatt notes.
一些研究表明，朝鲜蓟叶提取物有助于维持健康的血压和降低低密度脂蛋白或“坏”胆固醇的水平。
Some studies have suggested that artichoke leaf extract could help support healthy blood pressure and lower levels of LDL or the “bad” type of cholesterol.
同样，Hyatt 说，“2016 年发表的一项随机双盲研究表明，在患有一种非酒精性脂肪肝的患者中，肝酶有所改善”。非酒精性脂肪肝，有时也称为与脂肪肝相关的代谢功能障碍，当过多的脂肪积聚在肝脏并阻碍最佳功能时会发生。肥胖和 2 型糖尿病是 NAFLD 的危险因素。
Similarly, “a randomized double-blind study published in 2016 showed improvement in liver enzymes,” in patients who had one type of non-alcoholic fatty liver disease, Hyatt says. Non-alcoholic fatty liver disease, also sometimes called metabolic dysfunction associated fatty liver disease, can develop when too much fat accumulates in the liver and hinders optimal function. Obesity and Type 2 diabetes are risk factors for NAFLD.
但赖斯说，这个证据是微不足道的。 “目前的文献表明，奶蓟草和朝鲜蓟叶对肝脏的益处很小甚至没有。”
But this evidence is slim, Rice says. “Current literature states that there is minimal to no benefit of milk thistle and artichoke leaf on the liver.”
蒲公英
Dandelion
蒲公英以其开朗的黄色花朵和可识别的锯齿叶而闻名，它不仅仅是一种花园杂草。长期用作食物来源和顺势疗法，这种常见植物似乎可以帮助支持健康。
Known for its cheerful yellow flowers and recognizable sawtooth leaves, dandelions are more than just a garden variety weed. Long used as a food source and in homeopathic remedies, it seems there could be something about this common plant that can help support health.
整个蒲公英植物都是可食用的，当用作食物时，它可以提供大量的维生素，包括 A、C 和 K。蒲公英也是 β-胡萝卜素的丰富来源，这种抗氧化剂使胡萝卜呈现橙色并可被肝脏转化为维生素A。
The entirety of the dandelion plant is edible, and when used as a food, it can provide lots of vitamins, including A, C and K. Dandelions also are a rich source of beta-carotene, the same antioxidant that gives carrots their orange color and can be converted by the liver into vitamin A.
蒲公英植物具有抗炎和抗氧化作用，被认为可以保护肝脏。然而，赖斯指出，“没有足够的研究来说明蒲公英根对肝脏是否安全和/或有效。”
The dandelion plant has anti-inflammatory and antioxidant effects that are thought to protect the liver. However, Rice notes that “there isn't enough research to state whether dandelion root is safe and/or effective for the liver.”
锌
Zinc
“锌是一种微量矿物质，对细胞生长至关重要，”Hyatt 解释说。但是这种必需矿物质的水平“在肝病患者中通常很低”。因此，锌补充剂被认为对维持肝功能有保护作用。
“Zinc is a trace mineral that is essential for cell growth,” Hyatt explains. But levels of this essential mineral are “often low in patients with liver disease.” Therefore, zinc supplementation is thought to be protective in maintaining liver function.
补锌有时被用作酒精相关肝硬化患者治疗方案的一部分，2018 年的一项研究回顾指出，在 3 到 6 个月内接受锌补充剂和药物联合治疗的患者比接受治疗的患者有更好的结果。单独用药。
Zinc supplementation is sometimes used as part of the treatment protocol for patients with alcohol-related cirrhosis, and a 2018 review of studies noted that patients who received a combination of zinc supplementation with medication over three to six months had better outcomes than those treated with the medication alone.
姜黄或姜黄素
Turmeric or Curcumin
复合姜黄素是姜黄的活性成分，姜黄是一种在印度和南亚美食中广泛使用的亮橙色香料。与蒲公英一样，姜黄还具有抗氧化和抗炎特性，据信可以保护肝脏。
The compound curcumin is the active component of turmeric, a bright orange spice that's used widely in Indian and South Asian cuisine. Like dandelion, turmeric also has antioxidant and anti-inflammatory properties that are believed to be protective for the liver.
“2016 年和 2017 年的两项随机安慰剂对照试验研究了姜黄（姜黄素）在非酒精性脂肪性肝病中的使用，结果表明，在减少肝脏脂肪和改善肝脏检查方面有一些益处，”Hyatt 说。
“Two randomized placebo controlled trials from 2016 and 2017 studying the use of turmeric (curcumin) in non-alcoholic fatty liver disease showed some benefit with reduction in liver fat and improvement in liver tests,” Hyatt says.
姜黄素补充剂通常还含有另一种称为胡椒碱的化合物，它是一种黑胡椒提取物，可显着提高姜黄素的吸收。
Curcumin supplements often also contain another compound called piperine, which is an extract of black pepper that significantly improves curcumin absorption.
在补充之前与您的医生交谈
Talk to Your Doctor Before Supplementing
Hyatt 警告说，虽然一些研究表明某些补充剂可能提供肝脏保护，但“缺乏高质量的有力证据，需要更多的研究。”
Hyatt cautions that while some studies have suggested that certain supplements might offer liver protection, “high-quality robust evidence is lacking and more studies are needed.”
赖斯同意。 “大多数关于肝脏补充剂的研究在动物研究中比人体研究更明显，所以我们还没有发现它们的显着益处，如果有的话。”
Rice agrees. “Most research on liver supplements is more evident in animal studies than human studies, so we have yet to find a significant benefit, if any, from them.”
尽管上面列出的许多补充剂已使用多年，并且“通常被认为在推荐数量下是安全的，但由于缺乏 FDA（食品和药物管理局）的重大监督，任何草药补充剂的安全性都无法保证，”Hyatt 补充道。 “此外，联邦法律不要求膳食补充剂在上市前被证明是安全的。”
Although many of the supplements listed above have been used for years and “are generally considered safe in recommended quantities, the safety of any herbal supplement cannot be guaranteed given lack of significant oversight by the FDA (Food and Drug Administration),” Hyatt adds. “Furthermore, federal law does not require dietary supplements to be proven safe prior to marketing.”
此外，由于 FDA 不像管理药物那样对补充剂进行监管，“补充剂被视为食物，如果没有第三方测试，很难确切知道补充剂中的成分和含量，”赖斯说。
Plus, because the FDA doesn't regulate supplements like it does medications, “supplements are considered food and it's hard to know exactly what's in the supplement and at what quantities without third-party testing,” Rice says.
更糟糕的是，您为支持肝脏健康而服用的补充剂实际上可能会产生相反的效果。 “草药补充剂可能对肝脏有害，由于补充剂导致严重肝损伤的病例正在增加，”Hyatt 说。
What's worse, the supplement you're taking to support liver health could actually have the opposite effect. “Herbal supplements can be harmful to the liver, and cases of severe liver injury due to supplements are increasing,” Hyatt says.
问题是肝脏是负责从体内清除毒素的器官，根据补充剂的成分，当它被分解时，补充剂在某些情况下实际上会产生肝脏现在必须处理和排泄的有毒代谢物。您的肝脏可能最终不得不更加努力地处理旨在支持其功能的补充剂。因此，在您开始服用任何补充剂之前，“重要的是要检查可能的副作用”，Hyatt 说。
The issue is that the liver is the organ responsible for removing toxins from the body, and depending on the components of the supplement, when it's broken down the supplement can in some cases actually generate toxic metabolites that the liver must now process and excrete. Your liver may end up having to work harder to cope with the supplement that was meant to support its function. Therefore, before you start taking any supplement, “it's important to review possible side effects” Hyatt says.
此外，草药补充剂中的某些成分可能会降低您正在服用的其他药物的效果或增加它们的副作用。在所有情况下，在开始任何补充之前与您的医疗保健提供者交谈非常重要。
In addition, some ingredients in herbal supplements could make other medications you're taking less effective or heighten their side effects. In all cases, it's really important to talk with your health care provider before starting any supplement.
当然，如果您最近被诊断出患有肝病，最好与您的医生讨论您正在服用或考虑服用的所有药物和补充剂，并检查您的饮食和其他可能加剧肝病的生活方式因素。
And naturally, if you've recently been diagnosed with liver disease, it's best to confer with your doctor about all medications and supplements you're taking or considering taking and to review your diet and other lifestyle factors that can exacerbate liver disease.
改善肝脏健康的生活方式
Lifestyle Modifications for Liver Health
虽然服用药丸来支持肝脏健康而不是改变饮食或改变其他生活方式可能更有吸引力，但赖斯指出，通过食物获取所需的营养是最好的。我们吃的许多食物的各种成分之间存在复杂的相互作用，仅仅因为一种特定的化合物已在细胞或动物中显示出可能支持肝脏健康，当该化合物进入人体和所有其他环境时生活方式和饮食因素在起作用，结果可能不一样。
While it may be appealing to reach for a pill to support liver health rather than change your diet or make other lifestyle changes, Rice notes getting the nutrients you need through food is best. There's a complex interplay between the various components of the many foods we eat, and just because a specific compound has been shown in cells or animals to potentially be supportive of liver health, when that compound enters the context of the human body and all the other lifestyle and dietary factors that are in play, the results may not be the same.
赖斯建议不要花钱购买可能无济于事且实际上可能造成伤害的产品，而是建议专注于通过生活方式来支持肝脏健康。这需要：
Instead of spending money on products that may not help and could actually cause harm, Rice recommends focusing on supporting liver health through lifestyle instead. This entails:
吃均衡、健康的饮食：加入更多的水果和蔬菜、全谷物、瘦肉蛋白和低脂乳制品是健康饮食的基础，可以支持肝脏健康。整体健康的饮食提供身体自我修复和保持功能平衡所需的所有维生素和营养。对于肝脏来说，这意味着它的工作得到支持。
Eating a balanced, healthy diet. Incorporating more fruits and vegetables, whole grains, lean protein and low-fat dairy are the basis of a healthy diet, and that can support liver health. An overall healthy diet provides all the vitamins and nutrients the body needs to repair itself and stay in functional balance. For the liver, that means it's supported in doing its work.
定期锻炼： Hyatt 说，身体活动可以“使体重保持在正常范围内，从而降低患脂肪肝的风险”。预防 NAFLD 可降低发生肝脏瘢痕或肝硬化的风险。
Exercising regularly. Being physically active can “keep body weight in a normal range, which reduces the risk of fatty liver,” Hyatt says. Preventing NAFLD reduces your risk of developing scarring of the liver or cirrhosis.
避免大量饮酒：酒精由肝脏代谢，会对这个重要器官造成过度压力。 “目前的指导方针建议女性每天饮酒少于 1 杯，男性每天少于 2 杯，”Hyatt 指出。每多喝一杯都会给肝脏带来更大的压力，并可能导致依赖性，随着时间的推移，这会增加您患酒精相关肝硬化的风险。
Avoiding significant alcohol consumption. Alcohol is metabolized by the liver and can place undue stress on this vital organ. “Current guidelines advise consuming less than one drink per day for women and less than two drinks per day for men,” Hyatt notes. Each additional drink places more strain on the liver and can lead to dependence, which over time can increase your risk of developing alcohol-related cirrhosis.
限制高脂肪和含糖食物：赖斯说限制油炸食品、甜点和快餐也有助于保持良好的肝脏健康。为了分解富含饱和脂肪的食物，肝脏必须比处理健康脂肪和低脂肪食物时更努力地工作。长期食用高脂肪食物也会限制肝脏储存葡萄糖的能力，这可能会增加患 2 型糖尿病的风险。
Limiting higher fat and sugary foods. Rice says limiting fried foods, desserts and fast food can also help support good liver health. To break down foods that are high in saturated fats, the liver must work harder than when it processes healthy fats and lower-fat foods. Chronic consumption of high fat foods can also limit the liver's ability to store glucose, which may elevate risk for Type 2 diabetes.
