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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