TOC | Herbal Medicine

Herbal Medicine
REF: http://www.intelihealth.com/IH/ihtIH/WSIHW000/8513/31402.html

Milk Thistle (Silybum marianum)

Be aware that the U. S. Food and Drug Administration does not strictly regulate herbs and dietary supplements. There is no guarantee of strength, purity or safety of products containing or claiming to contain valerian. Decisions to use herbs or supplements should be carefully considered. Individuals using prescription drugs should discuss taking herbs or supplements with their pharmacists or health care providers before starting.

Evidence
Unproven Uses
Potential Dangers
Interactions
Dosing
Summary
Resources

Cirrhosis (liver disease)

Multiple studies from Europe suggest that milk thistle may improve cirrhosis and lengthen the lives of cirrhosis patients. However, most of these studies are poorly designed. Better-quality research is needed before a strong recommendation can be made.

Hepatitis (liver inflammation)

Multiple studies of milk thistle for chronic hepatitis caused by viruses or alcohol report improvements in liver tests. However, most of these studies are small and poorly designed. Better research is needed before a strong recommendation can be made.

Studies of milk thistle for acute viral hepatitis do not provide clear results. Therefore, milk thistle cannot be recommended for this potentially life-threatening condition.

Liver damage caused by toxins

There are studies of milk thistle to treat or prevent liver damage caused by drugs or toxic chemicals. Results of this research are unclear. Therefore, there is not enough scientific evidence to recommend milk thistle for this use.

High cholesterol

Laboratory and animal studies show that milk thistle may lower cholesterol. However, there are only a few studies in humans in this area, with unclear results. Therefore, there is not enough scientific evidence to recommend milk thistle for this use.

Type 2 diabetes (adult-onset diabetes)

Studies in humans of milk thistle for diabetes are low quality. Therefore, it cannot be recommended at this time.

Amanita phalloides mushroom poisoning

Several natural medicine textbooks support the use of milk thistle for Amanita phalloides mushroom poisoning, based on tradition and expert opinion. Over the past 30 years, animal research and poor-quality studies in humans have reported benefits. However, without better-quality scientific evidence, it is unclear if milk thistle is useful for mushroom poisoning.

Cancer prevention

There is ongoing laboratory research of the anticancer effects of milk thistle for breast, cervical and prostate cancer. At this time, there are not enough studies in humans to recommend milk thistle for these diseases.

Milk thistle has been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially very serious and even life-threatening. You should consult a health care provider before using milk thistle for any unproven use.

Acute liver injury
Alcoholic cirrhosis
Amiodarone toxicity reactions
Antibacterial
Anti-inflammatory
Antisclerotic
Asthma
Bladder cancer
Bleeding
Breast cancer
Breast milk stimulation
Bronchitis
Bubonic plague
Cancer
Chronic liver injury
Cough
Depression
Diabetic nerve pain
Dyspepsia
Edema (swelling)
Fatty liver
Gallstones
Gynecological cancers
Hemorrhage
Hemorrhoids
Hepatitis C virus
Immunomodulator
Immunostimulant
Ischemic injury
Jaundice

Kidney damage
Kidney stones
Liver cancer
Liver "cleansing"
Liver dysfunction
Liver regeneration
Lung cancer
Malaria
Menstrual problems
Neuroprotection
Peritonitis
Pleurisy
Plague
Primary biliary cirrhosis
Prostate cancer
Psoriasis
Radiation sickness
Radiation toxicity
Skin cancer
Snakebites
Solar ultraviolet protection
Splenic disorders
Spleen diseases
Sunscreen
Surgery
Ulcers
Uterine complaints
Varicose veins
Work capacity

Studies report that milk thistle is well tolerated in recommended doses. Some people experience stomach upset. There are rare reports of rashes, headaches, heartburn, joint pain and impotence with milk thistle use. One person experienced sweating, nausea, stomach pain, diarrhea, vomiting, weakness and collapse after taking milk thistle. She improved after 24 hours. High liver enzyme levels in one person taking milk thistle returned to normal after the person stopped taking the herb.

Milk thistle is sometimes recommended by herbalists to improve the flow of breast milk in nursing mothers. Two very short studies of milk thistle use by pregnant women report no side effects. However, there is not enough scientific evidence at this time to support the use of milk thistle during pregnancy or breast-feeding.

Interactions with drugs, supplements and other herbs have not been thoroughly studied. The interactions listed below have been reported in scientific publications. If you are taking prescription drugs, speak with your health care provider or pharmacist before using herbs or dietary supplements.

Additive anticancer effects may occur with milk thistle and chemotherapy drugs such as doxorubicin, cisplatin and carboplatin. Check with your oncologist and pharmacist before taking milk thistle. Animal studies suggest that milk thistle may interfere with the way the liver processes certain drugs. As a result, milk thistle may cause the levels of drugs in the body to be too high, leading to serious side effects. Some studies suggest that indinavir levels may be altered, but other study results disagree. Milk thistle may lower blood sugar levels, and patients taking oral drugs for diabetes or using insulin should be monitored closely by their health care provider while using milk thistle. Dosing adjustments may be necessary. A possible interaction with phenytoin (Dilantin) has been reported with milk thistle. However, the facts are unclear. Milk thistle ingredients have been shown to prevent amiodarone toxicity in studies done in animals, but before this herb is used for this indication, further studies in humans must be done.

Milk thistle may lower blood sugar levels. People using other herbs or supplements that may affect blood sugar levels, such as bitter melon (Momordica charantia), should be monitored closely by their health care provider while using milk thistle. Dosing adjustments may be necessary
Silymarin and vitamin E have been shown to prevent amiodarone toxicity in studies done in animals, but before this herb is used for this indication, further studies in humans must be done. Milk thistle may bind with iron and slow calcium metabolism.

The doses listed below are based on scientific research, publications or traditional use. Because most herbs and supplements have not been thoroughly studied or monitored, safety and effectiveness may not be proven. Brands may be made differently, with variable ingredients even within the same brand. Combination products often contain small amounts of each ingredient and may not be effective. Appropriate dosing should be discussed with your health care provider before starting therapy; always read the recommendations on a product's label. The dosing for unproven uses should be approached cautiously, because scientific information is limited in these areas.

Note: One study analyzing the stability of milk thistle tincture showed a shelf life of only about three months.

The safety and effectiveness of doses for other conditions are not clear. Milk thistle has also been used intravenously, but this method of administration has not been proven safe. Milk thistle does not dissolve easily in water, therefore milk thistle tea is not recommended.

Children (Younger Than 18): There is not enough scientific evidence to recommend using milk thistle for children.

Although milk thistle has been suggested for many conditions, the most promising uses supported by science are the treatment of cirrhosis and hepatitis. Evidence does not support the use of milk thistle for other health problems. Check with your health care provider or pharmacist before taking milk thistle if you are taking other drugs, herbs or supplements, because there may be dangerous interactions. Diabetic patients should monitor their blood sugar levels closely. Consult your health care provider immediately if you experience side effects.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

Agoston M, Orsi F, Feher E, et al. Silymarin and vitamin E reduce amiodarone-induced lysosomal phospholipidosis in rats. Toxicology 2003;Aug 28, 190(3):231-241.
Bass NM. Is there any use for nontraditional or alternative therapies in patients with chronic liver disease? Curr Gastroenterol Rep 1999;Feb-Mar, 1(1):50-56.
Bean P. The use of alternative medicine in the treatment of hepatitis C. Am Clin Lab 2002;May, 21(4):19-21.
DiCenzo R, Shelton M, Jordan K, et al. Coadministration of milk thistle and indinavir in healthy subjects. Pharmacotherapy 2003;Jul, 23(7):866-870.
Ferenci P, Dragosics B, Dittrich H, et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989;Jul, 9(1):105-113.
Flora K, Hahn M, Rosen H, et al. Milk thistle (Silybum marianum) for the therapy of liver disease. Am J Gastroenterol 1998;93(2):139-143.
Jacobs BP, Dennehy C, Ramirez G, et al. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med 2002;Oct 15, 113(6):506-515.
Marcelli R, Bizzoni P, Conte D, et al. Randomized controlled study of the efficacy and tolerability of a short course of IdB 1016 in the treatment of chronic persistent hepatitis. Eur Bull Drug Res 1992;1(3):131-135.
Mulrow C, Lawrence V, Jacobs B, et al. Milk thistle: effects on liver disease and cirrhosis and clinical adverse effects. Evid Rep Technol Assess (Summ) 2000;(21):1-3.
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(4):615-621.
Singh RP, Agarwal R. Prostate cancer prevention by silibinin. Curr Cancer Drug Targets 2004 Feb;4(1):1-11.
Velussi M, Cernigoi AM, De Monte A, et al. Long-term (12 months) treatment with an anti-oxidant drug (silymarin) is effective on hyperinsulinemia, exogenous insulin need and malondialdehyde levels in cirrhotic diabetic patients. J Hepatol 1997;26(4):871-879.
Zuber R, Modriansky M, Dvorak Z, et al. Effect of silybin and its congeners on human liver microsomal cytochrome P450 activities. Phytother Res 2002;Nov, 16(7):632-638.