Liver Health – Milk Thistle

By Decker Weiss: ND

• What does the liver actually do?
• What exactly does Milk Thistle do for the liver?
• It sounds as if Milk Thistle is only for people with liver disease. If my liver is healthy, why would I need to take it?
• Is Milk Thistle safe?
• How much Milk Thistle should I take?
• Milk Thisle References

While other herbs such as St. John’s wort and echinacea may appear in the news more often, Milk Thistle is actually the most researched and best understood of all the medicinal herbs. In fact, study after study has confirmed the most significant property of Milk Thistle: namely, the ability to protect and actually rejuvenate the liver.1-3

And, while we know for certain Milk Thistle has been used medicinally to heal the liver since the middle of the first century, it wasn’t until the late 20th century that scientists understood how the key compounds in milk thistle behave in the body. These discoveries have allowed scientists to go the next step and combine milk thistle and its key compounds with other synergistic components for even greater and more potent health effects. When Milk Thistle is taken with other herbs such as dandelion, artichoke, and licorice, liver protection and bile excretion (important for lowering cholesterol levels) are enhanced. And when combined with the natural compound phosphatidylcholine (fos-fa-tid-al-ko-leen), in a patented process, Milk Thistle is better absorbed and remains active in the bloodstream for greater lengths of time.4-6

In this article, we will talk about Milk Thistle, especially when combined with effectiveness-enhancing herbs and/or phosphatidylcholine, and its effect on the liver, a remarkable organ vital to our overall health.

What does the liver actually do?

A. The liver is about the size of a football and weighs on average 3 and a half pounds, making it our largest internal organ. Our entire blood supply passes through the liver many, many times a day. The liver is incredibly complex and has a huge daily "to-do" list, including:
• Filter the blood for bacteria that enter our bodies every day
• Convert carbohydrates and proteins into fat, and store it for later use
• Store vitamins A, D, and B12 and the minerals copper and iron until they are needed
• Convert sugar into glycogen and store it until the muscles need energy
• Synthesize triglycerides and cholesterol
• Make and secrete the bile needed in the digestion of fats
• Make urea from carbon dioxide and ammonia
• Produce hundreds of enzymes needed for digestion and other bodily functions
• Break down medications so we can use them effectively
• Metabolize alcohol and other harmful toxins
• Activate and metabolize hormones
• Produce clotting factors to help blood clot when we get a cut or scrape
• Make heparin to help keep blood from clotting while it circulates7

What exactly does Milk Thistle do for the liver?

The medicinal parts of the Milk Thistle plant are the seeds or fruits. Each Milk Thistle fruit is attached to a single strand of the pink tuft (similar to way dandelion seeds are found floating in the air).

When they ripen, the fruits contain three powerful plant compounds collectively called silymarin (sil-luhmah- rin).1-3 One of the compounds in silymarin is called silibin. Milk Thistle works to help the liver in three ways.

First, Milk Thistle is a powerful antioxidant.1-3,8 Antioxidants protect us from chemicals in our bodies called free radicals. Exposure to second-hand cigarette smoke, exhaust fumes from cars, sitting in the sun, taking certain drugs, or being under stress can all increase free radicals in the body. Free radicals can do lots of damage to our cells (called oxidation) which can eventually lead to cancer, heart disease, and arthritis.9 Milk Thistle protects the liver (and possibly other organs) against harmful oxidation.

Secondly, the silymarin in Milk Thistle protects the liver from harmful toxins and helps treat liver diseases. The silymarin in Milk Thistle helps people with Hepatitis B and Hepatitis C (serious liver diseases) get better.10-12 While silymarin cannot cure cirrhosis (a very destructive and often fatal liver disease), it can improve liver function in people with this serious disease.13-15 In fatty liver disease (often caused by excessive alcohol drinking and often leading to cirrhosis), silymarin can protect the liver from further damage.16,17

And, while we don’t necessarily think of medications as “toxins,” many over-thecounter drugs and prescription medications can hurt the liver if taken in large enough doses or for long periods of time. Researchers have found that Milk Thistle can actually prevent or reduce medication induced liver damage.18-21

Milk Thistle can even detoxify the deadly poison from the Amanita phalloides or Death Cap mushroom. The Death Cap mushroom (as its name implies) is one of the most poisonous mushrooms in the world, containing toxins that are particularly harmful to the liver. Accidentally eating this mushroom can cause severe liver damage and even death. Silymarin not only binds to the liver cells preventing damage from the mushrooms, it also neutralizes the deadly Death Cap poisons.22-25 While mushroom poisoning should always be treated as a lifethreatening emergency and urgent care sought immediately, it is amazing that an herbal compound can detoxify such a dangerous substance

Finally, the liver has the remarkable capacity to completely regenerate after it has been injured. The liver is the only organ (besides blood and skin) that has this ability. Milk Thistle’s silymarin actually helps the liver regenerate itself by stimulating the growth of liver cells to replace the parts of the liver that are damaged.26,27

It sounds as if Milk Thistle is only for people with liver disease. If my liver is healthy, why would I need to take it?

Because our livers are so vital to our health, many of us could benefit by taking Milk Thistle even in the absence of liver disease. However, Milk Thistle is especially helpful if you:

• Eat fatty foods
• Smoke or live or work with a smoker
• Drink alcohol
• Are overweight
• Are dieting
• Live in a large or polluted city
• Drive a car a lot
• Have your clothes dry cleaned
• Live or work in a building that has been freshly painted
• Use pesticides in your home or garden
• Take an over the counter medication, such as acetaminophen (Tylenol®), ibuprofen, or aspirin
• Take a prescription medication for anxiety, gout, pain, inflammation, cancer, HIV, TB, high cholesterol, depression, seizures, psychosis, infections, or to prevent pregnancy
• Have problems with digestion
• Have high cholesterol or triglyceride levels1-3,17-21,26-33

Is Milk Thistle safe?

Milk Thistle is very safe to take. Studies have not shown any negative effects even when high doses were administered over a long period of time. However, a few people may notice some loose stools when they first start taking Milk Thistle. Cutting back on the dose generally stops this problem.34

How much Milk Thistle should I take?

It depends on your own individual health. Doses of Milk Thistle generally range from 140mg to 300mg taken 2 to 3 times a day. However, you need to pay attention to silymarin content, too. The best Milk Thistle comes standardized to contain a high percentage of silymarin.

If you take Milk Thistle combined with patented phosphatidylcholine complex, you can take less because more is absorbed. Doses of this combination are generally between 100mg and 120mg taken once or twice a day. And, if you take a product that also contains artichoke, dandelion, licorice, turmeric, and/or boldo, the Milk Thistle doses often range between 100mg to 140 mg taken 2 or 3 times a day.

Conclusion Diseases of the liver are most often quite serious. If you think you might have a problem with your liver, you need to see a qualified health care practitioner. If you have a diagnosis of liver disease, you need to work closely with your health care practitioner. Diseases of the liver can be prevented. In general:

• Don’t drink more than two alcoholic drinks a day
• Be careful about drinking alcohol while taking over the counter or prescription medicines
• Avoid taking medications unnecessarily
• Avoid exposure to industrial chemicals whenever possible
• Get vaccinated against hepatitis B
• Do not share needles with anyone
• Practicing safer sex will minimize the risk of transmission of hepatitis B
• Don’t share toothbrushes or razors35

And, most importantly, take Milk Thistle every day to keep your liver as healthy as possible!

References

1. Steven Foster Group. The Milk Thistle Silybum marianum. Accessed January 2, 2002. Available at: http://www.stevenfoster.com/education/monograph/ milkthistle.html

2. Blumenthal M, Goldberg A, Brinckmann J., ed. Milk thistle fruit. In: Herbal Medicine. Expanded Commission E Monographs. Austin, Tex: American Botanical Council; Integrative Medicine Communications; 2000: 257-263.

3. Robbers JE, Tyler VE. In: Tyler’s Herbs of Choice. Binghamton, NY: The Haworth Herbal Press: 1999: 76-79.

4. Savio D, Harrasser PC, Basso G. Softgel capsule technology as an enhancer device for the absorption of natural principles in humans. A bioavailability crossover randomised study on silybin. Arzneimittelforschung. 1998;48:1104-1106.

5. Skottova N, SVagera Z, Vecera R, Urbanek K, Jegorov A, Simanek V. Pharmacokinetic study of iodine-labeled silibinins in rat. Pharmacol Res. 2001;44:247-253.

6. Buzzelli G, Moscarella S, Giusti A, et al. A pilot study on the liver protective effect of silybinphosphatidylcholine complex (IdB 1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol. 1993;31:456-460.

7. Porth CM. The liver and hepatobiliary system. In: Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998:745-753.

8. Wellington K, Jarvis B. Silymarin: a review of its clinical properties in the management of hepatic disorders. BioDrugs. 2001;15:465-489.

9. Porth CM. Mechanisms of cell injury. In: Pathophysiology: Concepts of Altered Health States. 5th ed. Philadelphia, Pa: Lippincott; 1998:39-40.

10. Liu JP, Manheimer E, Tsutani K, Gluud C. Medicinal herbs for hepatitis C virus infection (Cochrane Review). Cochrane Database Syst Rev. 2001;4:CD003183.

11. Patrick L. Hepatitis C: epidemiology and review of complementary/alternative medicine treatments. Altern Med Rev. 1999;4:220-238.

12. Buzzelli G, Moscarella S, Giusti A, Duchini A, Marena C, Lampertico M. A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol. 1993;31:456-460.

13. Lieber CS. Alcoholic liver disease: new insights in pathogenesis lead to new treatments. J Hepatol. 2000;32:113-128.

14. Pares A, Planas R, Torres M, et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol. 1998;28:615-621.

15. Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol. 1989;9:105-113.

16. Par A. Treatment of alcoholic liver diseases. Abstinence, nutritional support, drug therapy, liver transplantation. Orv Hetil. 2000;141:827-833.

17. Saller R, Meier R, Brignoli R. The Use of Silymarin in the Treatment of Liver Diseases. Drugs. 2001;61:2035- 2063.

18. Bokemeyer C, Fels LM, Dunn T,et al. Silibinin protects against cisplatin-induced nephrotoxicity without compromising cisplatin or ifosfamide anti-tumour activity. Br J Cancer. 1996;74:2036-2041.

19. Masini A, Ceccarelli D, Giovannini F, Montosi G, Garuti C, Pietrangelo A. Iron-induced oxidant stress leads to irreversible mitochondrial dysfunctions and fibrosis in the liver of chronic iron-dosed gerbils. The effect of silybin. J Bioenerg Biomembr. 2000;32:175-82.

20. Shear NH, Malkiewicz IM, Klein D, Koren G, Randor S, Neuman MG Acetaminophen-induced toxicity to human epidermoid cell line A431 and hepatoblastoma cell line Hep G2, in vitro, is diminished by silymarin. Skin Pharmacol. 1995;8:279-291.

21. Muriel P, Garciapina T, Perez-Alvarez V, et al. Silymarin protects against paracetamol-induced lipid peroxidation and liver damage. J Appl Toxicol. 1992;12:439-442.

22. Vogel G, Tuchweber B, Trost W, Mengs U. Protection by silibinin against Amanita phalloides intoxication in beagles. Toxicol Appl Pharmacol. 1984;73:355-362.

23. Carducci R, Armellino MF, Volpe C, Basile G, Caso N, Apicella A, Basile V. Silibinin and acute poisoning with Amanita phalloides. Minerva Anestesiol. 1996;62:187-193.

24. Sierralta A, Jeria ME, Figueroa G, et al. Mushroom poisoning in the IX region. Role of Amanita gemmata. Rev Med Chil. 1994;122:795-802.

25. Rambousek V, Janda J, Sikut M. Severe Amanita phalloides poisoning in a 7-year-old girl Cesk Pediatr. 1993;48:332-333.

26. Feher J, Lengyel G, Blazovics A. Oxidative stress in the liver and biliary tract diseases. Scand J Gastroenterol Suppl. 1998;228:38-46.

27. Flora K, Hahn M, Rosen H, Benner K. Milk thistle (Silybum marianum) for the therapy of liver disease. Am J Gastroenterol. 1998;93:139-143.

28. Sonnenbichler J, Scalera F, Sonnenbichler I, Weyhenmeyer R. Stimulatory effects of silibinin and silicristin from the milk thistle Silybum marianum on kidney cells. J Pharmacol Exp Ther. 1999;290:1375- 1383.

29. Horvath ME, Gonzalez-Cabello R, Blazovics A, et al. Effect of silibinin and vitamin E on restoration of cellular immune response after partial hepatectomy. J Ethnopharmacol. 2001;77:227-232.

30. Edwards J, Grange LL, Wang M, Reyes E. Fetoprotectivity of the flavanolignan compound siliphos against ethanol-induced toxicity. Phytother Res. 2000;14:517-521.

31. Crocenzi FA, Sanchez Pozzi EJ, Pellegrino JM, et al. Beneficial effects of silymarin on estrogen-induced cholestasis in the rat: a study in vivo and in isolated hepatocyte couplets. Hepatology. 2001;34:329-339.

32. Boari C, Montanari FM, Galletti GP, et al. Toxic occupational liver diseases. Therapeutic effects of silymarin. Minerva Med. 1981;72:2679-2688.

33. Szilard S, Szentogyorgyi D, Demeter I. Protective effect of Legalon in workers exposed to organic solvents. Acta Med Hung. 1988;45:249-256.

34. National Institutes of Health. Agency for Healthcare Research and Quality. Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects. Evidence Report/Technology Assessment: Number 21. Accessed January 7, 2002. Available at: http://www.ahcpr.gov/clinic/milktsum.htm.

35. American Liver Foundation. Prevention of Liver Disease. Accessed January 9, 2002. Available at: http://www.liverfoundation.org/hmtl/liveheal.dir/

HEALTH FACT:

Milk Thistle’s silymarin actually helps the liver regenerate itself by stimulating the growth of liver cells to replace the parts of the liver that are damaged.

Milk thistle (Silybum marianum) is an herbal supplement used to treat liver and biliary disorders. Silymarin, a mixture of flavanoid complexes, is the active component that protects liver and kidney cells from toxic effects of drugs, including chemotherapy. Although milk thistle has not significantly altered the course of chronic liver disease, it has reduced liver enzyme levels and demonstrated anti-inflammatory and T cell-modulating effects. There is strong preclinical evidence for silymarin's hepatoprotective and anticarcinogenic effects, including inhibition of cancer cell growth in human prostate, skin, breast, and cervical cells. Milk thistle is considered safe and well-tolerated, with gastrointestinal upset, a mild laxative effect, and rare allergic reaction being the only adverse events reported when taken within the recommended dose range. More clinical trials of rigorous methodology, using standardized and well-defined products and dosages, are needed to evaluate the potential of silymarin against liver toxicity, chronic liver disease, and human cancers. PMID: 17548789

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