What are the best over-the-counter magnesium supplements available. How do different types of magnesium supplements compare. What are the health benefits and potential side effects of magnesium supplementation. How to choose the right magnesium supplement for your needs.

Understanding Magnesium and Its Importance in the Body

Magnesium is an essential mineral that plays a crucial role in numerous bodily functions. It’s involved in over 300 enzymatic reactions, including energy production, protein synthesis, and muscle and nerve function. Despite its importance, many people don’t get enough magnesium from their diet alone, leading to an increased interest in magnesium supplements.

Why is magnesium so important for our health? Here are some key reasons:

• Supports bone health and helps prevent osteoporosis
• Regulates muscle and nerve function
• Helps maintain a healthy heart rhythm
• Supports the immune system
• Aids in energy production
• May help reduce inflammation
• Can improve sleep quality

Given its wide-ranging benefits, it’s no wonder that magnesium supplements have become increasingly popular in recent years. But with so many options available, it can be challenging to know which one to choose.

Types of Magnesium Supplements: Which One Is Right for You?

Not all magnesium supplements are created equal. Different forms of magnesium have varying levels of bioavailability and specific benefits. Here’s a breakdown of some common types:

Magnesium Oxide

This is one of the most common and affordable forms of magnesium supplement. It has a high concentration of elemental magnesium but lower bioavailability compared to other forms. Magnesium oxide is often used to relieve constipation and indigestion.

Magnesium Citrate

Magnesium citrate is highly bioavailable and easily absorbed by the body. It’s often used to improve digestion and prevent kidney stones. This form is also relatively affordable and widely available.

Magnesium Glycinate

This form of magnesium is bound to the amino acid glycine. It’s known for its high absorption rate and is less likely to cause digestive side effects. Magnesium glycinate is often recommended for those looking to address magnesium deficiency or improve sleep quality.

Magnesium L-Threonate

This newer form of magnesium has gained attention for its potential cognitive benefits. Some studies suggest it may be particularly effective at crossing the blood-brain barrier, potentially supporting brain health and cognitive function.

When choosing a magnesium supplement, consider your specific health goals and any potential side effects. It’s always best to consult with a healthcare professional before starting any new supplement regimen.

The Benefits of Magnesium Supplementation: What Does the Research Say?

Numerous studies have explored the potential benefits of magnesium supplementation. While more research is needed in some areas, here are some of the most promising findings:

Improved Heart Health

Research suggests that magnesium supplementation may help lower blood pressure and reduce the risk of cardiovascular disease. A meta-analysis published in the American Journal of Clinical Nutrition found that magnesium supplementation significantly reduced both systolic and diastolic blood pressure.

Better Sleep Quality

Magnesium plays a role in regulating the nervous system and may help improve sleep quality. A study in the Journal of Research in Medical Sciences found that magnesium supplementation improved subjective measures of insomnia, including sleep efficiency and sleep time.

Reduced Risk of Type 2 Diabetes

Some research suggests that magnesium supplementation may help improve insulin sensitivity and reduce the risk of type 2 diabetes. A meta-analysis in the journal Diabetes Care found that higher magnesium intake was associated with a lower risk of type 2 diabetes.

Alleviation of Migraine Symptoms

Magnesium deficiency has been linked to migraine headaches. Some studies have found that magnesium supplementation may help reduce the frequency and intensity of migraines in some individuals.

While these findings are promising, it’s important to note that magnesium supplementation is not a cure-all. It should be used as part of a balanced diet and healthy lifestyle, and under the guidance of a healthcare professional.

Potential Side Effects and Precautions of Magnesium Supplements

While magnesium supplements are generally considered safe for most people, they can cause side effects in some cases. Common side effects may include:

• Diarrhea
• Nausea
• Abdominal cramping
• Vomiting

These side effects are more likely to occur with higher doses or with certain forms of magnesium, such as magnesium oxide. Starting with a lower dose and gradually increasing it can help minimize these effects.

Can magnesium supplements interact with medications? Yes, magnesium can interact with certain medications, including:

• Antibiotics
• Bisphosphonates (used to treat osteoporosis)
• Diuretics
• Proton pump inhibitors

If you’re taking any medications, it’s crucial to consult with your healthcare provider before starting magnesium supplementation. They can advise on potential interactions and help determine the appropriate dosage for your needs.

How to Choose the Right Magnesium Supplement: A Buyer’s Guide

With so many magnesium supplements on the market, choosing the right one can feel overwhelming. Here are some factors to consider when making your selection:

Form of Magnesium

As discussed earlier, different forms of magnesium have varying levels of bioavailability and specific benefits. Consider your health goals when choosing a form. For example, if you’re primarily concerned with improving sleep, magnesium glycinate might be a good choice.

Dosage

The recommended dietary allowance (RDA) for magnesium varies by age and gender. For adult men, it’s 400-420 mg per day, while for adult women, it’s 310-320 mg per day. However, your individual needs may vary based on factors like diet, health conditions, and medications.

Quality and Purity

Look for supplements that have been third-party tested for purity and potency. Certifications from organizations like USP (United States Pharmacopeia) or NSF International can provide assurance of quality.

Additional Ingredients

Some magnesium supplements contain additional ingredients like vitamin D or calcium. While these combinations can be beneficial, make sure you’re not inadvertently doubling up on nutrients you’re already getting from other supplements.

Brand Reputation

Choose supplements from reputable brands with a history of producing high-quality products. Reading customer reviews and seeking recommendations from healthcare professionals can help guide your decision.

Remember, the “best” magnesium supplement will vary depending on your individual needs and health goals. It’s always a good idea to consult with a healthcare professional before starting any new supplement regimen.

Magnesium-Rich Foods: Complementing Your Supplement Routine

While supplements can be beneficial, it’s always best to obtain nutrients from food sources when possible. Incorporating magnesium-rich foods into your diet can help ensure you’re meeting your daily needs and may reduce your reliance on supplements.

What foods are high in magnesium? Here are some excellent sources:

• Dark leafy greens (spinach, Swiss chard, kale)
• Nuts and seeds (almonds, pumpkin seeds, sunflower seeds)
• Legumes (black beans, chickpeas, lentils)
• Whole grains (quinoa, brown rice, oatmeal)
• Fish (mackerel, tuna, halibut)
• Dark chocolate (70% cocoa or higher)
• Avocados
• Bananas

Incorporating these foods into your diet can help boost your magnesium intake naturally. However, if you have a diagnosed magnesium deficiency or are at risk for one, your healthcare provider may still recommend supplementation in addition to dietary changes.

Magnesium and Other Nutrients: Understanding Interactions and Synergies

Magnesium doesn’t work in isolation in the body. Its absorption and effectiveness can be influenced by other nutrients, and it can also affect how other nutrients are used. Understanding these interactions can help you optimize your supplement routine.

Magnesium and Calcium

Magnesium and calcium work closely together in the body, particularly in bone health. While both are important, they can compete for absorption when taken in large amounts. Some experts recommend taking magnesium and calcium supplements at different times of the day to maximize absorption.

Magnesium and Vitamin D

Vitamin D plays a crucial role in magnesium absorption. At the same time, magnesium is necessary for the activation of vitamin D in the body. This interdependence means that a deficiency in one can affect levels of the other.

Magnesium and B Vitamins

B vitamins, particularly vitamin B6, can enhance magnesium absorption in the body. Some magnesium supplements are formulated with B vitamins for this reason.

Magnesium and Zinc

While both magnesium and zinc are important minerals, high doses of zinc can interfere with magnesium absorption. If you’re taking both supplements, it’s best to space them out by at least two hours.

Understanding these interactions can help you make more informed decisions about your supplement routine. However, the complexity of nutrient interactions underscores the importance of a balanced diet and personalized approach to supplementation under the guidance of a healthcare professional.

The Future of Magnesium Supplementation: Emerging Research and Trends

As our understanding of magnesium’s role in health continues to evolve, new areas of research are emerging. Here are some exciting developments in the field of magnesium supplementation:

Magnesium and Mental Health

Researchers are increasingly interested in the potential role of magnesium in mental health. Some studies suggest that magnesium supplementation may help alleviate symptoms of depression and anxiety, though more research is needed to confirm these effects.

Magnesium and Exercise Performance

There’s growing interest in the potential of magnesium to enhance athletic performance. Some studies have found that magnesium supplementation may improve exercise performance, particularly in those who are deficient in the mineral.

Novel Delivery Methods

While most magnesium supplements come in pill form, researchers are exploring new delivery methods. Transdermal magnesium (applied to the skin) and liposomal magnesium are two areas of interest, though more research is needed to determine their effectiveness compared to traditional oral supplements.

Personalized Supplementation

As we learn more about how individual factors like genetics and gut health affect nutrient needs and absorption, there’s growing interest in personalized approaches to supplementation. In the future, we may see more tailored recommendations for magnesium supplementation based on individual health profiles.

While these areas of research are promising, it’s important to approach new claims with a critical eye and wait for robust scientific evidence before making significant changes to your supplement routine.

In conclusion, magnesium supplementation can be a valuable tool for supporting overall health and addressing specific health concerns. However, it’s not a one-size-fits-all solution. By understanding the different types of magnesium supplements, their potential benefits and side effects, and how they interact with other nutrients, you can make more informed decisions about your health. As always, it’s best to work with a healthcare professional to determine the most appropriate supplement regimen for your individual needs.

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Magnesium supplements

Magnesium supplements are used to treat deficiencies of this vital nutrient as well as to boost the functioning of nerves, muscles, and bones. This nutrient can also be part of dietary supplements designed to improve bone strength or immunity.

Choosing vitamin supplements

Many people who use magnesium supplements also use other vitamins supplements as well. The specific nutrients you choose depends on your specific health condition and general state of health. Common supplements that are used in conjunction with magnesium include calcium supplements, omega-3 fatty acids, and zinc supplements. In some cases, magnesium is combined with other nutrients in a single supplement. Calcium-magnesium supplements are a common combination because both of these nutrients work together to build strong bones. In some cases, vitamin D is also included in the same supplement. Other dietary supplements contain magnesium in combination with chelating agents that help improve absorption.

Using magnesium supplements

Magnesium supplements are available in tablet, capsule, and softgel form. These are typically taken up to three times a day during meals to help make it easier to digest the supplement. People with gastrointestinal disorders may need to take a specific dose of magnesium every day. Magnesium also boosts the uptake of potassium and calcium supplements, so people taking these may also need magnesium supplements. This nutrient may also help lower blood pressure, so magnesium supplements may be used for this purpose as well. Your doctor can help you decide whether and when to take magnesium supplements.

8 Best Magnesium Supplements Of 2023 – Forbes Health

Magnesium has been shown to have a multitude of benefits, including heart, nerve, bone and muscle health. Diets high in magnesium are even thought to help lower rates of disease, though this could be due to the other nutrients involved in a magnesium-rich diet, and additional research is needed.

The following are areas in which magnesium is thought to benefit most:

Bone Health. It’s estimated that 60% of the body’s magnesium is stored in bones, making it a massive contributor to bone health ^{tippy-popover-container-bg-white’ }”>[1]}Magnesium. Harvard T.H. Chan School of Public Health. Accessed 5/13/2022. . The mineral also takes part in bone-building cell activity and calcium regulation through the parathyroid hormone, and is known to impact the concentration of vitamin D in the body, which also contributes to maintaining bone health. In some cases, a magnesium deficiency is thought to lead to an increased risk of osteoporosis.

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Type 2 Diabetes. Due to its role in blood sugar regulation, adequate magnesium intake may help decrease the risk of type 2 diabetes.

The link between magnesium intake and diabetes risk may be connected to hypomagnesemia, a condition that signifies low levels of magnesium in the body, according to the National Institutes of Health (NIH). More research on magnesium deficiency and the development of type 2 diabetes is needed, though, and the American Diabetes Association notes there’s not enough evidence to say magnesium supplements can improve blood sugar regulation in people with diabetes.

Migraines. Both the American Academy of Neurology and the American Headache Society note that magnesium may be an an effective therapy for migraines, due to magnesium’s role in neurotransmitter release and vasoconstriction (the constriction of blood vessels), which play primary roles in the development of migraines.

However, the use of magnesium to help prevent headaches is still being researched, and it should not be used to treat migraines without the supervision of a health care professional, as the effective dosage exceeds the RDA.

Heart health. High rates of magnesium may help reduce blood pressure, though more evidence is needed. While the U.S. Food and Drug Administration (FDA) previously noted diets rich in magnesium may help reduce the risk of hypertension (high blood pressure), they have since found the claim to be inconclusive based on a lack of data. However, magnesium is also believed to potentially decrease risk of stroke, according to NIH.

Mental health. When certain neurological pathways are not functioning correctly, conditions like depression and anxiety may develop. Research from ADD suggests a connection between magnesium and these neurological pathways, therefore magnesium supplementation may help treat these conditions. However, longer, larger clinical trials are needed to determine if this claim holds weight.

Can Magnesium Help with Sleep?

Magnesium may improve sleep due to the mineral’s ability to calm the nervous system and reduce stress. In fact, a small study evaluating 46 older adults who received 500 milligrams of magnesium for eight weeks found that magnesium supplementation improved sleep quality, the time of sleep onset and how long individuals stayed asleep ^{tippy-popover-container-bg-white’ }”>[2]}Abbasi B, Kimiagar M, Sadeghniiat K, Shirazi MM, Hedayati M, Rashidkhani B. The effect of magnesium supplementation on primary insomnia in elderly: A double-blind placebo-controlled clinical trial. J Res Med Sci. 2012;17(12):1161-1169. . Magnesium glycinate, a compound formed by combining magnesium and the amino acid glycine, may promote sleep quality and reduce daytime sleepiness.

Does it help with depression and anxiety, effectiveness, is it worth taking

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07.06.23

Svetlana Belitskaya

biochemist

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Magnesium supplements are popular over-the-counter drugs that try to relieve stress and treat anxiety.

At the same time, the effectiveness of supplements with this trace element as sedative drugs has not been proven.

Even before 2020, anxiety disorders were common health problems. COVID-19 pandemicand the events of the past month have worsened the situation.

Go see a doctor

Our articles are written with love for evidence-based medicine. We refer to authoritative sources and go to doctors with a good reputation for comments. But remember: the responsibility for your health lies with you and your doctor. We don’t write prescriptions, we give recommendations. Relying on our point of view or not is up to you.

Since millions of people on Earth need sedatives every day, scientists are trying to create new effective anti-anxiety drugs that would not cause side effects and would be shown to children, pregnant women, and the elderly. They consider magnesium supplements as one of such means.

According to the State Register of Medicines, several dozens of magnesium preparations, both domestic and foreign, are registered in Russia. Several dietary supplements with magnesium are also registered in the Rospotrebnadzor database.

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In many preparations and supplements, magnesium is combined with other bioactive components: minerals, vitamins, brewer’s yeast. A combination of magnesium and vitamin B6 is usually tried as a sedative.

Russian magnesium preparation from Pharmstandard-UfaVITA. Source: “Eapteka” German preparation of magnesium. Source: Eapteka

How magnesium and anxiety are related

Mg²+ is important for the human body. The trace element is involved in the synthesis of nucleic acids, energy metabolism, insulin release, muscle contractions.

In the 1980s, scientists discovered that Mg²+ affects the functioning of the central nervous system.

There are two main neurotransmitters in the human brain – excitatory glutamate and inhibitory CNS activity gamma-aminobutyric acid, GABA.

Theoretical studies have shown that when the neurons involved in glutamate are too active, a person becomes anxious. Magnesium weakens the action of glutamate. And at the same time, it enhances the effect of GABA on nerve cells, which is important for combating stress, because when GABA is not enough, a person is anxious.

Studies have also shown that stress depletes magnesium, and low levels of the trace element lead to stress. When a person is under stress, he produces special hormones that help him survive in a difficult situation. They activate the cardiovascular and respiratory systems, increase brain activity.

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But stress hormones work in such a way that they reduce the concentration of magnesium in the blood serum and lead to its loss in the urine. The endocrine glands that produce stress hormones are sensitive to magnesium deficiency: when the level of the microelement decreases, they work more actively. And gradually, there are more and more stress hormones, and the body continues to lose magnesium and become “nervous”. A vicious circle closes: stress – loss of magnesium – increased stress – additional losses of the microelement.

In other words, magnesium regulates the functioning of the nervous system in such a way that it prevents the negative effects of stress and the development of anxiety. Therefore, scientists have suggested that micronutrient supplementation may be useful for treating anxiety.

Is Magnesium Effective in Combating Anxiety

In 2017, Nutrients magazine published a review article that analyzed the scientific literature available at the time on the effects of magnesium supplementation in treating anxiety. In total, the authors of the review found 6573 publications on this topic. But the review included only double-blind randomized clinical trials, RCTs, in which people with mild anxiety participated without serious physical illnesses and identified depletion of magnesium reserves in the body.

According to the rules of the RCT, one group of volunteers takes the study drug, the second – a placebo or a drug with proven efficacy. Who got a placebo or a drug with recognized efficacy, and who got the study drug, neither the volunteers nor the doctors know.

Eight were selected from 6573 studies according to RCT criteria. But they also turned out to be unreliable: they all had at least one of the three shortcomings.

Problems with statistical processing of results. Six out of eight studies assessed the effectiveness of treatment using the Hamilton Anxiety Scale – HAM-A. The authors of the review indicate that the use of this scale is associated with errors in data processing.

No placebo control. Three studies compared magnesium supplements to other drugs rather than placebo. The lack of “dummy” control reduces the reliability of studies, since the assessment of the placebo effect is important in the development of treatments for psychiatric conditions – anxiety, depression, addictions. At the same time, all studies with a placebo group analyzed by the authors of the review showed that the effectiveness of the “dummy” is comparable to the effectiveness of magnesium preparations.

They say the placebo effect doesn’t work for everyone, right?

The use of magnesium in combination with other bioactive compounds. Only one study out of eight used magnesium by itself. In all the rest, the trace element was supplemented with vitamin B6 or medicinal plants. Vitamin B6 can alter the functioning of neurotransmitters involved in the development of anxiety.

Instructions for Medical Use “Magne B6″PDF, 40.7 KB

As a result, the authors of the review concluded that the effectiveness of magnesium for the treatment of even mild anxiety has not been proven. Those clinical studies that seem to meet modern quality standards, upon careful examination, turn out to be not completely reliable.

Since the review was published, the situation with studies of the relationship between magnesium and anxiety has not changed.

Examine.com, an independent database of dietary supplements, lists only one study in March 2022 on the effects of magnesium on anxiety. But it is dedicated to the treatment of premenstrual syndrome, not stress and background anxiety.

A paper published in PLoS One in 2018 claims to be a randomized and blinded trial and proves the effectiveness of magnesium supplements for treating anxiety. But in fact, in the experiment, magnesium and magnesium + vitamin B6 were compared in a blind, randomized method.

Stress suppression efficacy of magnesium and magnesium in combination with vitamin B6 was approximately the same. But the study did not evaluate either placebo or other anti-anxiety agents. Therefore, it cannot be argued that the stress in the volunteers in the experiment decreased due to the intake of magnesium. Perhaps their condition has improved over time or for some other reason.

A 2021 study demonstrated the effectiveness of magnesium against social stress induced by the Trier Social Stress Test – TSST. Volunteers gave a speech introducing themselves as candidates for employment, and then performed mathematical operations. They did it in front of a jury, which was a major stressor.

The study was randomized: volunteers were assigned to groups at random. A placebo control was used: 25 out of 100 people received a dummy tablet instead of a magnesium preparation.

The experimental group of 75 people was divided into three subgroups. All subgroups received magnesium, vitamins B6, B9 and B12. The difference between the subgroups was in the supplementation of green tea and rhodiola extracts.

The results of the experiment showed that the combination of magnesium, vitamins B6, B9 has the highest effectiveness against stress, B12, green tea and Rhodiola extracts. That is, the study does not prove the effectiveness of magnesium: it is possible that stress in participants decreased due to the action of vitamins or herbal extracts.

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Do I need to take magnesium to calm down

Magnesium preparations registered in Russia do not belong to the group of sedatives. Even those manufacturers who advertise their drugs as a means of combating anxiety honestly indicate that the medicine helps with anxiety only if it arose against the background of a trace element deficiency.

The official website of Magne B6 indicates that it is effective for magnesium deficiency

If we open the instructions posted on this site, we will see that the indication for the use of the drug is an established magnesium deficiency, which may be accompanied by irritability and insomnia.

Established magnesium deficiency, or hypomagnesemia, may be asymptomatic. But it usually manifests itself with trembling, convulsions, and heart rhythm disturbances. Hypomagnesemia develops against the background of hunger, taking certain medications and serious illnesses – for example, Crohn’s disease, acute pancreatitis, alcoholism.

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You can’t self-diagnose magnesium deficiency. Such a diagnosis can only be made by a doctor based on tests. True, the manufacturers of Magne B6 posted a special questionnaire on their website, with the help of which one can suspect a lack of a microelement. However, as if by chance, they warn that the test results are not a diagnosis, and for a reliable detection of trace element deficiency, you should consult a doctor.

Magnesium Deficiency QuestionnairePDF, 40.7 KB

The effect of magnesium on anxiety has only been shown in basic research. There is no reliable clinical evidence of the effectiveness of micronutrient therapy for anxiety disorders.

Clinical Guidelines for the Diagnosis and Treatment of Panic Disorder and Generalized Anxiety Disorder – Russian Society of Psychiatrists

Guidelines for the Treatment of Generalized Disorder – American Anxiety and Depression Association

None of the domestic or foreign clinical guidelines for the treatment of anxiety contain supplements with magnesium and magnesium in combination with vitamin B6. Therefore, it is unreasonable to try to treat anxiety with a trace element without consulting a doctor.

There are five ways you can use to reduce anxiety to stay calm during difficult times. If you can’t calm down, you need to contact a psychotherapist.

Essential skills in times of stress – WHO pictorial guide

Dietary supplements and liver. Healthy and Harmful Food Supplements for the Liver

Food and herbal supplements are becoming more and more popular. According to studies, they are taken by approximately 50% of the adult population of developed countries. Most nutritional supplements are in the form of vitamins and minerals, as well as muscle building and weight loss supplements, but herbal supplements are also very popular. However, many people are not well aware of the active ingredients of dietary supplements, side effects and drug interactions. In our article, we collected data on healthy and harmful dietary supplements based on scientific research.

Why are dietary supplements so popular?

In medical practice, one often comes across diagnoses that do not require treatment, and it is only necessary to monitor its course in dynamics. In such cases, representatives of alternative medicine can easily convince a person to “do not hesitate” and drink drugs that will help cure the disease and prevent its progression. However, it is extremely rare that they inform the patient about the harm and side effects of the recommended dietary supplement / nutritional supplement.

Often people prescribe these remedies to themselves after reading forums, Instagram blogs and watching some Youtube channels. Recently, the idea that taking a dietary supplement can replace the positive health effects of proper diet and physical activity has become extremely attractive.

In addition, drugs with proven efficacy have a long list of possible side effects from taking them, and little is known about the side effects of dietary supplements. Therefore, patients can make a seemingly obvious, but in fact the wrong choice in favor of unreasonable intake of dietary supplements instead of the drug prescribed by the doctor.

Health risks associated with taking dietary supplements

Contamination with heavy metals, bacteria and fungal infections

nutritional supplements, because their pills contained large amounts of lead. Bacterial and fungal (potentially dangerous mold fungi) contamination (contamination) is also not uncommon. In a 2009 study138 out of 138 formulations studied, bacterial contamination of food additives was found.

In addition, hundreds of weight loss, sexual dysfunction, and muscle building products contain substandard or harmful substances.

Cancer risks

Taking more than the recommended dosage of the vitamin A precursor beta-carotene, such as in immune system stimulants, has been found to increase the risk of lung cancer and heart disease by 20%. In a study of 35,533 participants, supplementation with vitamin E in the form of tocopherols was shown to significantly increase the risk of developing prostate cancer in healthy men (17% higher in the study group than in the placebo group, while the dosage of vitamin E was 400 IU per day).

Risks of interaction with the main therapy, for example, chronic diseases

Patients of the older age group tend to keep silent about the multivitamin complexes and/or biologically active supplements they take, herbal preparations, as a result of which there is a risk of side effects, aggravation of the clinical picture of the underlying disease .

Incorrect positioning

Supplements are sold to children as sweetened lozenges or candies. This practice is unhealthy and carries an inappropriate educational message in the field of nutrition.

Quality problems

Food supplement quality problems have long been a commonplace in the industry. For example, a study of multivitamin and mineral supplements showed significant differences between the amounts of various ingredients listed on the labels and the amounts contained in the supplements themselves.

Are there any proven liver supplements?

There are a number of herbal medicines and herbal supplements that are being offered as natural treatments for liver disease, but it is worth noting that only a small proportion of these have been included in clinical studies.

The first group includes nutritional supplements based on milk thistle seeds , which contain the flavonoid silymarin in their composition. Taking into account that milk thistle seeds can have different content of silymarin depending on the place of growth, only nutritional supplements standardized by its composition are used in medical practice.

Clinical studies of silymarin preparations were carried out with intravenous administration of its preparations, as well as when taken in tablet form. The use of this drug in chronic hepatitis C has been studied, but after the advent of direct-acting antiviral drugs, silymarin preparations have lost their relevance in this case. In non-alcoholic fatty liver disease (non-alcoholic fatty liver disease), the effectiveness of taking the drug in tablet form was noted only in combination with other hepatoprotectors.

Studies have also been conducted on the use of silymarin preparations for the prevention and treatment of drug-induced hepatitis while taking anti-tuberculosis drugs, which showed its effectiveness as a prophylactic agent.

Based on research data, taking preparations containing milk thistle seed extract for liver diseases can be recommended in some cases only on prescription and in a standardized form.

The second group is represented by preparations containing extracts from the root licorice (glycyrrhizic acid) . The use of preparations containing glycyrrhizic acid has shown its effectiveness in various liver lesions and has been confirmed by a number of clinical studies in the treatment of hepatitis of various origins. Preparations based on glycyrrhizin are not recommended for independent use and are used only as directed by a doctor, as they have a number of contraindications.

The third group is food supplements based on artichoke or other medicinal herbs that have choleretic properties and improve the outflow of bile. The use of these nutritional supplements has not been shown to be effective in liver diseases, they are recommended only for diseases of the biliary system.

Although these are over-the-counter products, artichoke supplements require consultation with a gastroenterologist before use, as certain gastrointestinal conditions, such as gallstones, can aggravate the condition. In addition, the use of some medicinal herbs, which are recommended as cholagogues in various sources, can cause liver damage. Therefore, the intake of choleretic food supplements and medicinal herbs must be agreed with the attending physician.

Herbs and food additives harmful to the liver

Toxic liver damage is a specific type of inflammation and/or changes in the structure of the liver, often leading to liver cell death, caused by drugs, herbs and food additives, which are often recognized late because their negative impact on the liver is considered minimal or absent, and there are no specific blood tests before the stage of exclusion of other causes.

Due to interdrug interactions, including those between dietary supplements, the risk of adverse reactions during treatment increases significantly, and the rate of development of drug-induced hepatitis varies from several days to several months.

The FDA (Food and Drug Administration) estimates that there are about 50,000 adverse events each year that can be associated with the intake of dietary supplements, and these are only cases that were reported, and how many more are unreported adverse events phenomena is a big question. Adverse reactions can vary from a slight increase in biochemical parameters to severe, life-threatening conditions, such as liver failure requiring a liver transplant.

Despite the established belief that natural remedies do not harm the liver, dietary supplements and medicinal herbs can be even more dangerous for the liver than chemically synthesized drugs. This is due to the lack of clinical trials of their safety, the unknown composition of the active substances and the presence of hazardous impurities due to insufficient purification. For example, in Asia, especially in China, where herbal treatments are more common, liver damage associated with herbal use predominates over drug-induced liver damage.

Many nutritional supplements are positioned as natural remedies that are safe and cannot harm health, but this is not always true, since among natural remedies there are enough of those that are poisonous, for example, plants – belladonna, celandine and many others or snake venom.

Before appearing in medical practice, drugs go through a long path of clinical trials, during which all the side effects that occur are recorded. On the contrary, nutritional supplements are not a medicine, it is written on their packaging, clinical studies are not conducted for most of them, and one can only guess about the effect of dietary supplements on the body.

More than 100 natural food supplements have been described to date with hepatotoxic effects. The most famous among them are Herbalife, dietary supplements for weight loss and muscle building, supplements containing linoleic acid, aloe vera, green tea, kava kava, noni juice. More than 6,000 types of medicinal plants contain substances that can be harmful to the liver. Hepatotoxic effects have been reported with comfrey, ephedra, senna, dubrovnik, celandine, valerian, turmeric, pennyroyal, kava kava, black cohosh, heliotrope, ragwort, crotalaria, and other medicinal herbs, as well as some traditional Chinese medicine and Ayurveda.

Herbal remedies and dietary supplements can cause a wide range of liver damage from mild asymptomatic elevations in liver enzymes to acute or chronic hepatitis, cirrhosis of the liver, acute or chronic inflammation of the bile ducts (cholangitis), and vascular lesions of the liver. In addition, the use of anabolic steroids in bodybuilding can lead to a wide variety of liver damage, from acute hepatitis to liver tumors, both benign and malignant.

The most harmful food additives for the liver

1. Bodybuilding supplements.
2. Weight loss supplements. For example, aegelin, an alkaloid from the aegle jujube fruit, has been used for many years for gastrointestinal problems and for weight loss. However, studies show that this substance can cause serious liver damage, including the need for an emergency liver transplant.
3. Green tea extracts from Camellia sinensis are often used for weight loss. It has been proven that the substance can cause liver damage due to the production of free radicals. The negative effects of taking usually develop 3 months after the start of use and stop immediately after stopping its use. Approximately 10% of cases of liver damage are fatal. As a result, weight loss products containing green tea extract have been banned in some countries.
4. Energy drinks for frequent or high consumption and herbal complex supplements that increase energy levels.

Even vitamin and dietary supplements can damage the liver. An excess of iron or vitamin A that occurs while taking prophylactic drugs can lead to significant damage to it. Therefore, iron supplements should not be taken unless a deficiency has been diagnosed, and vitamin A should never exceed 5,000 units per day.

When taking dietary supplements and medicinal herbs, we recommend that you follow the same precautions as when taking medication and do not take them without consulting a doctor. During long-term use of drugs or dietary supplements, it is necessary to monitor the biochemical parameters of the liver at least once every three months. When taking dietary supplements and medicinal products at the same time, drug interactions may occur, so inform your doctor about any food supplements and medicinal herbs you are taking.

Doctors “Expert Gastroenterology Center” before prescribing a course of treatment, including drugs with high hepatotoxicity, recommend checking the health of the liver. This is especially true for people who are obese and regularly drink alcohol or patients who are constantly taking medications for a chronic disease. You can check the health of the liver using the comprehensive HepatoCheck-up program, which includes all the necessary examinations and an appointment with a hepatologist.

References

1. Stephanie M Woo, William D Davis, Soorya Aggarwal, Joseph W Clinton, Sara Kiparizoska, and James H Lewis
   Herbal and dietary supplement induced liver injury: Highlights from the recent literature.
   World J Hepatol. 2021 Sep 27; 13(9): 1019–1041. Published online 2021 Sep 27.