Milk THISTLE #1

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Milk Thistle & Liver Function

by Burch, ND

Q.Is milk thistle really helpful in helping the liver function better? As a

ex-drinker, would it be to my advantage to use milk thistle?

A. The seed of the milk thistle plant contains high levels of silymarin, a

flavonoid complex with very potent liver protective action. Silymarin can

prevent liver damage from a variety of toxins. It works by inhibiting

factors that cause liver damage and stimulates the growth of new liver

cells. Silymarin is a potent antioxidant, protecting the liver from damage

by free radical molecules. It also increases glutathione levels in the

liver -- glutathione acts to detoxify hormones, drugs and chemicals. And

silymarin inhibits the formation of liver-damaging leukotrienes, preventing

inflammation and damage of the liver cells. Most remarkable is silymarin's

ability to stimulate the production of new liver cells to replace damaged

ones. In experimental studies, silymarin has been shown to protect the liver

from damage by such toxic chemicals as carbon tetrachloride, alcohol and the

Amanita mushroom toxin.

Clinical studies with silymarin have shown it is effective in treating a

number of liver conditions, including cirrhosis, chronic hepatitis and fatty

liver from alcohol intake. Even severely damaged livers were restored to

normal cell structure with long-term use of silymarin.

Milk thistle is a very good supplement for an ex-drinker to help restore the

normal structure and function of the liver. The dose of milk thistle is

based on silymarin content; 70-210mg of silymarin should be taken three

times a day. Look for a product that has a standardized amount of silymarin

per capsule.

Studies have shown that milk thistle extracts are essentially non-toxic.

Because silymarin causes an increase in bile secretion, large doses may

cause loose stools. This can be prevented by the use of fiber, such as

psyllium or pectin.

Created on February 01, 1999

Last Reviewed on February 01, 1999

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MILK THISTLE

Silybum num or milk thistle is a medicinal plant known since

ancient times, and widely used in traditional European medicine.

Since 1975, silymarin and its main constituent silybin in particular,

have been the subject of numerous experimental, pharmacological and

clinical studies, which have provided support for its current

clinical use in Europe in the treatment of liver disease.

Silybum marianum is a member of the aster family, to which the

artichoke plant also belongs (see below). The plant is native to the

Mediterranean area, where it has been in common use for more than

2000 years. Currently it is grown commercially throughout the Unites

States as well as in Africa and South America. The name " milk

thistle " is surrounded with several myths, but could simply be due to

its characteristic spiked leaves with white veins. The active extract

of milk thistle is silymarin, a mixture of flavolignans, including

silydianin, silychristine, and silybin, with the latter being the

most biologically active. Silymarin has proven to be one of the most

potent liver-protecting substances known, although the mechanisms are

not yet fully understood. Its main routes of protection appear to be

prevention of free radical damage, stabilization of plasma membranes

and stimulation of new liver cell production.

Silymarin acts as an antioxidant and free radical scavenger, many

times more potent than vitamin E. (Hikino H et al. 1984). It has been

shown to inhibit lipid peroxidation and to prevent glutathione

depletion induced by alcohol and other liver toxins and even increase

the total glutathione level in the liver by 35% over controls

(Valenzuela et al. 1989). Silymarin has also been shown to inhibit

the formation of liver-damaging leukotrienes by being a potent

inhibitor of the enzyme lipoxygenase. This enzyme is a needed

catalyst for the transfer of oxygen to polyunsaturated fatty acids

(Fiebrich F et al 1979, Dehmlow C, 1996). Silymarin has furthermore

been reported to decrease the activity of tumor promotors (Agrawal R

et al.1994, Zi X et al 1997) and protect against radiation-induced

suppression of hepatic and splenic DNA and RNA synthesis (Hakova H et

al. 1993). Perhaps the most interesting effect of silymarin on the

liver is its ability to stimulate protein synthesis (Sonnenbichler J

et al., 1986), which results in production of new liver cells to

replace damaged old ones. Interestingly, silybin does not have a

stimulatory effect on malignant hepatic tissue.

Experimental liver damage in animals can be produced by numerous

toxic chemicals, such as carbon tetrachloride and ethanol. Silymarin

has been shown to be very effective in protecting the liver from

these toxins. Most interesting is its effect against the poisoning of

Amanita phalloides (the toadstool mushroom). The toxins in this

mushroom are the most powerful liver-damaging substances known, and

ingestion causes severe poisoning and leads to death in approximately

30% of the cases. In experimental models silymarin was 100% effective

in preventing toxicity, when it was administered before amanita

poisoning, Even if given 10 minutes after the amanita toxin, it

completely counteracted the toxic effects. If given within 24 hours,

silymarin would still prevent death and greatly reduce the amount of

liver damage. (Vogel G et al., 1984; Desplaces A et al., 1975).

Observation of human cases with Amanita poisoning has demonstrated

similar results. In 60 patients who were treated with silybin 20

mg/kg/day starting 24-36 hours after ingestion of the mushroom, the

survival rate was 100% (Vogel G 1977). Another European trial

involving 220 patients resulted in a mortality rate of 12.8%, versus

a 22.4% in patients who had not received silymarin therapy.

The effectiveness of silymarin to protect the liver against chemical-

induced damage is true also for alcohol. In a double blind trial of

patients who chronically abused alcohol and had histologic

documentation of chronic alcoholic hepatitis, the patients were given

silymarin 140 mg twice a day for 6 months. Several liver function

tests normalized and others decreased significantly, as compared to

the levels in the control group (Feher J, 1989). Positive effects on

histology, lymphocyte proliferation and lipid peroxidation were also

described.

Another study involving ninety-seven patients with persistent liver

function test abnormalities after one month of alcohol abstinence,

showed impressive results. The patients were given either silymarin

or placebo for a period of 4 months. At the end of therapy mean serum

levels of AST and ALT had fallen by 30% and 41% respectively in the

silymarin group, compared to an increase of 5 % and 3% respectively

in the placebo group. Significantly more patients returned to a

normal bromsulphalein retention with treatment, and there was

significantly more reversal of tissue damage (histological injury)

(Salmi HA, 1982).

Ferenci P et al. (1989) asked 170 patients (92 alcoholic and 78 non-

alcoholic) with biopsy-confirmed cirrhosis (the most severe form of

liver scarring) to abstain from alcohol. He then treated 87 with

silymarin 140 mg three times a day and 83 with placebo for a period

of 2-6 years. The study showed a reduction of mortality in the

treated group, particularly in the patients with cirrhosis of

alcoholic origin. Silymarin has also been shown to improve immune

function in patients with cirrhosis, the mechanism of which has yet

to be determined (Deak G, 1990).

Silymarin is also reported to be effective in both acute and chronic

viral hepatitis. A study of 29 patients with acute viral hepatitis

(Magliulo E et al., 1978) showed a significantly higher rate of

normalized laboratory parameters in the silymarin group after 3 weeks

of treatment compared to the placebo group. In a study on chronic

viral hepatitis, silymarin treatment resulted in a remarkable

improvement (Berenguer J et al. 1977). Used in a dose of 420 mg/day

for 3-12 months the effects achieved were: reversal of liver cell

damage (as noted by biopsy), increase in plasma protein levels, a

lowering of liver enzymes and improvement of common hepatitis

symptoms.

Interestingly, some studies on phophatidylcholine-bound silymarin

indicate an even greater effectiveness, which most likely is due to

enhanced absorption across the gastrointestinal mucosa (Barzaghi N et

al. 1990). In a small short-term study of 20 patients with chronic

hepatitis due to either virus or alcohol, phosphatidyl-bound

silymarin was given for two weeks with significant decrease in

bilirubin and liver enzyme levels. (Vailati A et al. 1993)

In animal studies it has recently been demonstrated that silymarin

from milk thistle can inhibit the development of diet-induced

hypercholesterolemia (Krecman V et al. 1997) as well as inhibit

cholesterol biosynthesis (Skottowa et al 1998.). This potential

characteristic is not surprising, as the same is known to be true for

artichoke, which is a close relative to the milk thistle.