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Milk thistle (Silybum marianum)

Synonyms/Common Names/Related Substances:

  • Asteraceae, BIO-C®, bull thistle, cardo blanco, Cardui mariae fructus, Cardui mariae herba, Cardum marianum L., Carduus marianus L., Carsil®, Chardon-Marie, dehydrosilybin, desoxy-silydianin, emetic root, flavonolignans, Frauendistel (German), fructus Silybi mariae, fruit de chardon Marie (French), heal thistle, holy thistle, IdB1016®, isosilibinin, isosilybin, isosilybin A, isosilybin B, Kanger, Kocakavkas, kuub, lady's thistle, Legalon®, Legalon® 140, Legalon® Forte, Legalon® SIL, Leviaderm®, Livergol®, Marian thistle, mariana mariana, Mariendistel (German), Marienkrörner (German), Mary thistle, mild thistle, milk ipecac, natursil, natursilum, pig leaves, PiùLatte®, royal thistle, S. marianum, St. Mary's thistle, shui fei ji (Chinese), silibinin, silidianin, Silybi mariae fructus, silybin, silybin A, silybin B, Silybin Meglumine, silybinin, silybinomer, silybin-phytosome, Silybum marianum, Silybum marianum Gaertn., Silybum marianum (L.) Gaertn., silychristin, silydianin, silymarin, snake milk, sow thistle, taxifolin, Thisylin®, variegated thistle, Vegicaps®, Venus thistle, wild artichoke.
  • Select combination products: Iberogast (STW-5; composed of milk thistle, bitter candy tuft, chamomile flower, peppermint leaves, caraway fruit, licorice root, lemon balm leaves, angelica root, celandine herbs), Phyto-Female Complex (SupHerb, Netanya, Israel; ingredients: standardized extracts of black cohosh, dong quai, milk thistle, red clover, American ginseng, chaste tree berry), Realsil (composed of silybin, phosphatidylcholine, vitamin E).

Clinical Bottom Line/Effectiveness

Brief Background:

  • Milk thistle (Silybum marianum) has been used medicinally for more than 2,000 years, principally for the treatment of hepatic and biliary disorders. A flavonoid complex called silymarin can be extracted from the seeds of milk thistle and is believed to be the biologically active component. The terms "milk thistle" and "silymarin" are often used interchangeably.
  • Milk thistle products are popular in Europe and the United States for the management of various types of liver disease. Although numerous clinical trials have been conducted, most studies have suffered from methodological weaknesses, including heterogeneous patient populations, inadequate blinding and randomization, small sample sizes, large dropout rates, and concomitant alcohol use. Nonetheless, there is preliminary evidence that silymarin may reduce serum transaminase levels, improve liver histology, and improve survival in patients with cirrhosis or chronic hepatitis. There is insufficient evidence regarding the efficacy of milk thistle in the management of Amanita phalloides mushroom toxicity or drug- or toxin-induced liver damage.
  • An exploratory meta-analysis was conducted on 16 placebo controlled trials identified in a high-quality systematic review prepared for the Agency for Healthcare Research and Quality (AHRQ) (1;2). The analysis focused on serologic outcomes (transaminases, bilirubin, albumin, prothrombin time) and Child's classification of cirrhosis. Although most results favored the use of milk thistle, the majority of effect sizes were small or lacked statistical significance. Notably, this report concluded that the clinical efficacy of milk thistle for liver disease has not been clearly established.
  • Silibinin, the flavonoid found in the milk thistle, has been shown to suppress cell growth and exhibit anticancer effects.
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Dosing/Toxicology

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Precautions/Contraindications

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Interactions

Most herbs and supplements have not been thoroughly tested for interactions with other herbs, supplements, drugs, or foods. The interactions listed below are based on reports in scientific publications, laboratory experiments, or traditional use. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare provider before starting a new therapy.

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Mechanism of Action

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History

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Evidence Table

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Evidence Discussion

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Products Studied

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Author Information

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References

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

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The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.