Milk Thistle, Nature's Liver Protector


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Mainstream medicine has little to offer those with diseases of the liver. "Most liver treatment," says herbal medicine authority Varro Tyler, PhD, the Lily distinguished professor of pharmacognosy (natural product medicine) at Purdue University, "is simply supportive." Doctors keep patients comfortable and away from liver-damaging drugs, alcohol, and viruses, until the organ can heal itself (if it can).

However, liver healing could be significantly spurred by a remarkable herb that has been hiding in plain sight for almost 2,000 years. It's milk thistle (Silybum marianum). This common herb's value against liver disease has been demonstrated in more than 100 rigorous scientific experiments. Unfortunately, the vast majority of these studies has been European, mostly German, and few mainstream American physicians read German botanical medicine journals. As a result, they are in the dark about milk thistle's astonishing liver-protective powers.

Mary's Milk

Milk Thistle is native to the Kashmir region of India and Pakistan, but it now flourishes throughout the temperate world. The plant grows from five to ten feet tall, and has large prickly leaves and reddish purple flowers with sharp spines that resemble artichokes. When despined, milk thistle leaves are edible, and some vegetable gardeners cultivate the plant as a substitute for spinach. When broken or crushed, the stems and leaves exude a milky white juice, hence this herb's common name. Milk thistle's specific name, marianum, comes from an ancient legend that its leaf veins turned white after being touched by a drop of the Virgin Mary's breast milk.

Milk thistle has been used in traditional herbal medicine since the first century, when the Roman naturalist, Pliny the Elder (AD 23-79), wrote that the plant's milky juice was good for "carrying off bile." (Today "bile" denotes a product of the gall bladder, part of the liver, which assists in the digestion of fats, but in ancient times, bile was used more generally to describe any internal fluid.) The noted 16th-century British herbalist, John Gerard, was the first to recommend milk thistle for liver problems, though his prescription was oblique. He actually suggested the herb for "expelling elancholy," which physicians at the time considered a liver ailment. Half a century later, Britain's most famous herbalist, Nicholas Culpeper, was the first to recommend milk thistle specifically for liver disorders. By the 19th century, German physicians were using a tincture prepared from milk thistle seeds (actually the plant's seed-like fruits) to treat jaundice and other liver diseases. America's 19th-century eclectic physicians, who specialized in botanical medicines, adopted the herb for liver ailments and for internal cleansing.

With the rise of the modern pharmaceutical industry, research of herbal medicines declined considerably in the United States. Fortunately, this did not happen in Germany, where in 1949, scientists noticed that milk thistle seemed to protect animal livers from poisoning from highly toxic carbon tetrachloride. In 1968, scientists isolated the three specific liver protective molecules in milk thistle -- silibinin, silidianin, and silicristin -- now collectively known as silymarin.

Silymarin is not very soluble in water, which means that very little find its way into a tea made from the milk thistle plant. It is also poorly absorbed from the digestive tract, which severely limits its bioavailability from tinctures because they are not sufficiently concentrated to deliver a therapeutic dose. To rectify this problem, German researchers bred a special variety of milk thistle. When carefully cultivated, this medicinal variety produces a high-potency standardized extract of silymarin, which is processed into tablets or capsules. This standardized milk thistle seed extract is 70-percent silymarin. It is widely prescribed by German physicians, who practice the world's most advanced scientific herbal medicine. German silymarin sales now top $180 million a year. Most silymarin marketed in the US comes from German sources and is also 70-percent silymarin. Standard tablets and capsules contain 200 mg of milk thistle seed extract, which contains 140 mg of silymarin.

Studies Galore

More than 100 studies have confirmed silymarin's liver-protective value. Here's a brief overview of what researchers have discovered:

Alcoholic Cirrhosis. A 1989 report in the Journal of Hepatology (the study of the liver) described a study involving 170 people with advanced alcoholic cirrhosis, an often-fatal condition, and the nation's 11th leading cause of death, claiming 25,000 lives each year. The study participants were divided into two groups. One received 200 mg of milk thistle extract (140 mg of silymarin) three times a day, the other received a medically inactive look-alike placebo. Both groups were followed for four years. During that time, the death rate in the placebo group was about 60 percent, but among those taking silymarin, only 40 percent died, a highly statistically significant difference. Other studies have shown that silymarin provides similar benefits for people suffering cirrhosis.

Death Cap Mushroom Poisoning. The common wild mushroom, Amanita phalloides, is known as the "death cap" for a good reason. It takes only a handful of this widely distributed fungus to kill an adult, even less to kill a child. Standard medical treatment -- activated charcoal -- is not particularly effective. Amanita mushroom ingestion proves fatal in about half of the reported cases. Twenty years ago, pilot studies showed that silymarin treatment substantially reduced amanita-poisoning deaths in animals fed the mushroom. Subsequently, several human studies were launched. In one German hospital test, 60 consecutive people with amanita poisoning were given intravenous silymarin. None died. Other studies have produced results that are similar, though not as spectacular. (However, the success of silymarin in treating mushroom poisoning should not encourage anyone to go mushroom hunting without training in amanita avoidance. Unless you're an experienced mycophile, the only place to pick mushrooms is at a produce market.)

Hepatitis. The word means liver inflammation, and the condition is not one disease, but several, most of which are caused by different viruses that attack liver cells. The three most common forms are hepatitis A, B, and C. Hepatitis A is food-borne. Hepatitis B and C are blood-borne and can be sexually transmitted. Mainstream medicine treats all forms of hepatitis with rest and the avoidance of alcohol and other drugs and toxins that tax the liver.

However, silymarin is a more effective approach. In one study, 77 people with hepatitis were divided into two groups, one treated with silymarin, the other with a placebo. Average recovery time for the placebo-takers was 43 days, but those who took silymarin recovered in an average of just 29 days.

Gallstones. Up to ten percent of Americans are estimated to have gallstones, little pebbles that develop in the gallbladder. Some cause no symptoms, but many cause abdominal pain, sometimes severe enough to require surgical removal of the gallbladder. Most gallstones are formed from cholesterol, which saturates the bile produced by the gallbladder, and then precipitates out as stones. A low-fat, low-cholesterol diet helps prevent gallstones. So does silymarin. In one study, people with gallstones were given 420 mg of silymarin a day. Without diet changes, after several weeks, they showed significant reductions in the cholesterol concentration of their bile, which minimized risk of stone formation.

Liver Function Tests. The liver metabolizes all drugs, and powerful medications often stress the liver, producing abnormal liver function tests that sometimes require physicians to stop the drug treatment that people need. Silymarin helps normalize liver function, allowing those who must take liver-harming medications to do so with less risk of liver damage. In one study, 66 women taking anti-convulsant or psychiatric medications showed abnormal liver-function tests. They began taking silymarin in addition to their medication, and 52 percent of them showed significant improvement in liver function.

Occupational Toxic Chemical Exposure. Like drugs, toxic chemicals also stress the liver, causing liver-function tests to register abnormal results. European studies show that silymarin renormalizes liver-function tests in workers who produce pesticides, and in those exposed to toxic heavy metals, for example, lead and cadmium.

Psoriasis. A few European studies suggest that silymarin may even help treat the scaly skin patches of psoriasis.

How Silymarin Works

Silymarin works in three ways. It strengthens the outer membranes of liver cells, preventing penetration by liver-damaging substances. This accounts for its effectiveness against amanita mushroom poisoning. Both silymarin and the mushroom toxins bind to the same sites on liver cell membranes. As silymarin blood levels increase, the milk thistle extract occupies the cell-membrane receptor cites, displacing the amanita toxins.

Silymarin also protects liver cells because of its powerful antioxidant action. Antioxidants neutralize cell damage caused by chemically unstable oxygen molecules caused by a high-fat diet, smoking, and other toxic substances. The best known antioxidants are vitamin A (beta-carotene), vitamin C, vitamin E, and the mineral selenium. However, in the liver, silymarin is more than ten times as potent an antioxidant as vitamin E.

Finally, silymarin inhibits the action of the enzyme largely responsible for inflammation in hepatitis.

As far as scientists know, silymarin does not interfere with the liver's metabolism of drugs, so it does not interfere with the action of medications.

Safe, But...

According to Dr Tyler's excellent new clinical guide to herbal medicines, "Herbs Of Choice", silymarin is safe and non-toxic in doses of 200 to 400 mg up to three times per day. However, minor side effects are possible -- primarily headache, irritability, and minor intestinal upset. To minimize the possibility of side effects, Paul Bergner, editor of the newsletter "Medical Herbalism", recommend starting with a low dose and working up slowly. It typically takes about one month of daily silymarin use to see improvements in hepatitis and other liver conditions. Clinicians who prescribe silymarin usually keep people on it for one to three months.

Preventive Medicine?

You don't have to munch amanita mushrooms to stress your liver. Every day we're exposed to pollutants, pesticides, food additives, and other substances that the liver must detoxify. In addition, anyone who drinks alcohol or takes any medication -- either prescription or over the counter drugs -- boosts the liver's workload, and damages some liver cells in the process. Fortunately for all of us, the liver is quite large. It's the second largest organ, after the skin, so you can lose millions of liver cells and still function normally. But why lose even a single liver cell if you don't have to?

Recently, Scandinavian researchers tested silymarin's effect on livers that were stressed but not seriously diseased. They selected 106 consecutive patients who had abnormal liver function tests from alcohol, but who did not have cirrhosis. Half took silymarin; the other half received a placebo. After four weeks, the placebo group showed no change in liver function, but the silymarin group showed highly significant improvement, in some cases, complete normalization of liver function, despite their alcohol consumption.

Perhaps we all should take some silymarin. Robert McCaleb, president of the Herb Research Foundation, in Longmont, Colorado,, does: "If I worked in an occupation [that stressed the liver], I would take milk thistle regularly, one tablet each workday morning. [But I don't, so] I take two tablets before working with paints or solvents, and I never take aspirin or acetaminophen (Tylenol) without also taking a milk thistle tablet. Finally, I always take milk thistle along when traveling because almost invariably I find myself at a cocktail party." Sage counsel. Silymarin is available at herb shops and natural food stores.

"Milk Thistle, Nature's Liver Protector" by Michael Castleman; The Herb Quarterly, Summer 1995

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