Open Source Apothecary At Home / The herbs

Milk thistle

The liver herb that does not work — and a genuinely interesting plant to grow anyway. — Silybum marianum

remedy

Milk thistle (Silybum marianum) is grown for its seed, which contains the silymarin complex — the most-used herbal liver treatment in the world, and the one whose clinical record is most disappointing.

The honest summary: trials in chronic liver disease have not shown a clear clinical benefit. Milk thistle is safe and well tolerated, and it is taken by a great many people; the outcome evidence does not support it as a treatment for alcoholic hepatitis or cirrhosis.

The intervention that does change the trajectory is stopping alcohol. Fatty liver reverses, alcoholic hepatitis improves, and in established cirrhosis abstinence improves survival. That is mechanism rather than moralism.

Where it is genuinely important. N-acetylcysteine is the antidote for acetaminophen (paracetamol) overdose and it is time-critical. There is no home equivalent, and a suspected overdose means an emergency department immediately, even if the person feels completely well, because the early stage is silent and the liver is destroyed over days. No milk thistle product substitutes for this.

As a plant it is striking, spiny, statuesque, and feeds pollinators. It is a biennial and self-seeds. Wear gloves — the leaves are genuinely painful.

What the studies found

Growing it

| | | |---|---| | Life | Biennial; flowers in year two | | Propagation | Direct-sow; it self-seeds readily | | Light | Full sun | | Soil | Any; tolerates poor, dry ground | | Spacing | 60 cm — it is a large plant | | Handling | Gloves. The spines are real. | | Harvest seed | When the flower heads form pappus and dry | | Dry | Seed in a paper bag in a warm dry room |

One or two plants is plenty. Cut the heads into a bag and shake the seed out. Crush the seed before use — whole seed passes through undigested.

Preparation

Seed, crushed — 1-2 teaspoons crushed seed per cup, or ground and added to food. Crushing is essential; whole seed is not absorbed.

Standardised extract — the form used in the clinical trials, stated as silymarin content.

Tea — crushed seed infused; less palatable than the extract.

What not to rely on it for — alcoholic hepatitis, cirrhosis, or any acute liver problem. It is not a treatment, and it is not a substitute for N-acetylcysteine in paracetamol overdose.

Cautions and interactions

• Milk thistle does not treat liver disease. Do not use it instead of medical care for any liver condition.
• Suspected paracetamol/acetaminophen overdose — emergency department immediately. N-acetylcysteine is time-critical and there is no home substitute.
• Avoid in pregnancy and breastfeeding without advice.
• Wear gloves when handling the plant.
• May interact with drugs metabolised by CYP2C9, including some diabetes and anticoagulant medication.

When this is not a self-care problem — get help

• Confusion, vomiting blood or black stool, jaundice, easy bruising, or a swollen abdomen in someone with liver disease — emergency care.
• Any suspected overdose of paracetamol or any medicine — emergency department now, even if the person feels fine.

Known interactions

• May affect CYP2C9-metabolised drugs; possible additive effect with blood-sugar-lowering medication.

Related

• Liver and bile: milk thistle, artichoke, and the limits of liver herbs
• Alcohol and the liver
• Herbal liver injury, and the plant that ends the matter
• Perennial medicinals: echinacea, valerian, milk thistle, St John's wort
• Herb-drug interactions: the ones with numbers behind them

Sources

1. Effects berberine-silymarin on liver enzymes: A systematic review and meta-analysis of randomized controlled trials. Clinical nutrition ESPEN 2022; doi:10.1016/j.clnesp.2022.01.037 PubMed 35623810
2. The therapeutic effect of silymarin in the treatment of nonalcoholic fatty disease: A meta-analysis (PRISMA) of randomized control trials. Medicine 2017; doi:10.1097/MD.0000000000009061 PubMed 29245314
3. Novel nutraceutical supplements with yeast β-glucan, prebiotics, minerals, and Silybum marianum (silymarin) ameliorate obesity-related metabolic and clinical parameters: A double-blind randomized trial. Frontiers in endocrinology 2022; doi:10.7759/cureus.27438 PubMed 36778595
4. A Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis. Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association 2017; doi:10.1016/j.cgh.2017.04.016 PubMed 28419855
5. A randomized double-blind, placebo-controlled study of therapeutic effects of silymarin in β-thalassemia major patients receiving desferrioxamine. European journal of haematology 2013; doi:10.1111/ejh.12061 PubMed 23278124
6. Differences in the disposition of silymarin between patients with nonalcoholic fatty liver disease and chronic hepatitis C. Drug metabolism and disposition: the biological fate of chemicals 2011; doi:10.1124/dmd.111.040212 PubMed 21865319