Got Milk Thistle?

Milk thistle flower (Photo by Fir0002/Wikimedia Commons/CC BY-SA 3.0)

Milk thistle. It seems like everyone with liver issues is taking milk thistle. People have heard through the grapevine that this herb is the cure-all for all liver diseases, especially hepatitis C. If you search the Internet, you will find innumerable posts touting the benefits of milk thistle, in many different combinations. I find this phenomenon fascinating. So, what is the real scoop on this over-the-counter herbal product? Well, in reality, despite all these claims, there are no scientific studies to support its use in any liver diseases except perhaps in alcoholic liver disease, where it may make people feel better but does nothing to the liver. Those that feel better have also stopped drinking, so no one can be sure if it is the milk thistle or the alcohol cessation causing the overall symptomatic improvement. Interestingly, how can hundreds of thousands of people be wrong or be misled? Maybe it is great marketing.

In the United States, more than one billion dollars is spent annually on herbal remedies. The actual amount spent on milk thistle in the United States is unknown, but Germans spend more than $180 million dollars a year on silymarin and its derivatives.

Early European settlers to the Americas first introduced silymarin to the United States. It has been in use in Europe for more than 2,000 years, since the ancient Greeks noted its effectiveness in curing snakebites. It was not until the 16th century that milk thistle was widely touted as a cure for jaundice and other liver disorders. It has been used sporadically ever since.

Silymarin acts as an anti-oxidant that stabilizes plasma membranes, as does vitamin E and a whole host of other anti-oxidants. In the United States, silymarin is classified as food supplement, not a drug, so its use and testing does not fall under the strict jurisdiction of the Food and Drug Administration. Therefore, all milk thistle preparations are not created equal as the actual silymarin content of any particular preparation may vary and there may be different types of silymarin in various products.

There have been many studies using silymarin to treat liver disease. Most of these studies, however, are flawed due to multiple uncontrolled variables such as the varied content of silymarin used in the studies, small study sample sizes, varied severity of liver disease included in the trials and inadequately defined endpoints, to name a few. These small studies, however, have led to the following unsubstantiated and unproven conclusions. Silymarin appears to hasten recovery from acute hepatitis. It shows no benefit when used to treat drug-induced liver disease. Its benefits are questionable in alcohol-induced liver disease although some studies report improvement in liver enzymes with its use. There are no large published studies evaluating its effect on eradicating the hepatitis C virus.

So where do we stand on silymarin? Although we cannot state whether there is any clear benefit from its use in liver disease, there is one thing that we know about milk thistle. We can unequivocally state that silymarin, when not combined with other products, is generally safe. Many people who take it appear to derive symptomatic relief and this is a good effect, even if it is a placebo effect. Does it really matter if someone feels better? Regardless, many people will argue that milk thistle is natural so it must be good for us. That is a tough sell as, please remember, poisons such as arsenic, curare and belladonna are also natural as they are derived from plants. Whether you choose to take milk thistle or not, it is important to have realistic expectations of what it can and cannot do. The choice is yours.

David Bernstein
David Bernstein, MD, is a columnist for Long Island Weekly and chief of gastroenterology, hepatology and nutrition at North Shore University Hospital and Long Island Jewish Medical Center.

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