DEAR DR. ROACH: Any thoughts on milk thistle supplements in fatty liver disease that was diagnosed by an ultrasound due to elevated AST and ALT levels? — B.S.

ANSWER: Milk thistle (sylmarin) has had mixed results in clinical trials regarding metabolic-associated steatotic liver disease (MASLD, formerly called fatty liver disease). Although a few individual trials have shown benefit, the major association for liver disease has concluded that sylmarin does not improve the condition as measured by biopsy, and they recommend waiting for larger trials before recommending this treatment.

When the diagnosis of MASLD is suspected due to elevated liver enzymes (ALT and AST are blood tests that look for damage to liver cells called hepatocytes), then a person should be examined for scarring and

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