Liver milk thistle

Milk thistle Ambiguous and uncertain evidence for protection against liver disorders... 

Milk thistle has shown promise in improving liver function parameters in various hepatotoxic situations, such as alcoholic cirrhosis and mushroom poisoning. It is still unclear whether it will offer protection against viral hepatitis and various nephrotoxic agents. 

T raditionally, milk thistle fruits have been used for disorders of the liver, spleen, and gall bladder, such as jaundice and gall bladder colic. Milk thistle has also been used for nursing mothers for stimulating milk production, as a bitter tonic, for hemorrhoids, for dyspeptic complaints, and as a demulcent in catarrh and pleurisy. It is stated to possess hepatoprotective, antioxidant, and choleretic properties (128). Current interest is focused on the hepatoprotective activity of milk thistle and its use for the treatment of liver, spleen, and gall bladder disorders (129). Recently it has been shown that silibinin reduced prostate-specific antigen levels in prostate carcinoma cells lines, indicating a possible role of silibinin in human prostate cancer (130,131). 

Although milk thistle has not been confirmed as an antidote following acute exposure to liver toxins in humans, parenteral silybin is nevertheless marketed and used in Europe as an antidote in Amanita phalloides mushroom poisoning. This use is based on favorable outcomes reported in case-control studies. 

Rambaldi A et al Milk thistle for alcoholic and/or hepatitis or C virus liver diseases. Cochrane Database Syst Rev 2007 (4) CD003620. 

It has been suggested that milk thistle may be beneficial in the management of hypercholesterolemia and gallstones. A small trial in humans showed a reduction in bile saturation index and biliary cholesterol concentration. The latter may reflect a reduction in liver cholesterol synthesis. To date, however, there is insufficient evidence to warrant the use of milk thistle for either of these disorders. 

Milk thistle has been used to treat acute and chronic viral hepatitis, alcoholic liver disease, and toxin-induced liver injury in human patients. Milk thistle has most often been studied in the treatment of alcoholic hepatitis and cirrhosis. In both of these disorders, outcomes have been mixed and reports include significant reductions in markers of liver dysfunction and in mortality, as well as no effect. In acute viral hepatitis, studies have generally involved small sample sizes and have shown mixed outcomes of improved liver function (eg, aminotransferase values, bilirubin, prothrombin time) or no effect. Studies in chronic viral hepatitis and toxin-induced injury have also been of small size but have reported mostly favorable results. Parenteral silybin is marketed and used in Europe as an antidote in Amanitaphalloides mushroom poisoning, based on favorable outcomes reported in case-control studies. 

Overall, milk thistle may be effective in improving survival and liver function in a variety of conditions, but additional well-designed clinical trials are needed to confirm these findings. 

Herbal medicines are becoming more and more popular, and indeed some herbal products may be considered to benefit people with liver disease, e.g. Silybum marianum (milk thistle), Picrorhiza kurroa, Phyllanthus, etc. Herbal hepatotoxicity is increasingly being recognised, for example, with kava kava, black cohosh, and many traditional Chinese remedies. The range of liver injury includes minor transaminase elevations, acute and chronic hepatitis, steatosis, cholestasis, zonal or diffuse hepatic necrosis, veno-occlusive disease and acute liver failure. In addition to the potential for hepatotoxicity, herb-drug interactions may affect the safety and efficacy of concurrent medical therapy [15]. 

Flavonolignans are the most extensively studied group of non-conventional lignans, particularly because of their diverse pharmacological activities. Milk thistle (Silybum marianum), an ancient therapy for acute and chronic liver diseases, is the first known source of this group of compounds (15). Havonolignans, isolated... 

Hoofhagle JH (2005) Milk Thistle and Chronic Liver Disease. Hepatology 42 4... 

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

Quercetin and other flavonoids are effective inhibitors of 02 -production by cells. Quercetin is a potent inhibitor of human neutrophil degranulation and 02 -production, and also inhibits the phosphorylation of neutrophil proteins accompanying neutrophil activation by phorbol myristate acetate. Quercetin can also suppress lipid peroxidation in several biological systems, such as mitochondria, microsomes, chloro-plasts, and erythrocytes. Silymarin, a 3-OH flavone present in Silybum marianum (the European milk thistle), protects rat liver mitochondria and microsomes from lipid peroxide formation induced by Fe " "-ascorbate and NADPH-Fe -ADP systems. Soybean isoflavonoids have shown antioxidative potency... 

What is so disconcerting are the number of problems associated with well-known medicinal herbs such as ginseng, golden seal, ginkgo, milk thistle, cassia, saw-palmetto, valerian, and a variety of stimulants (De Smet, 2004 Elvin-Lewis, 2001 Ernst, 1998 Lewis and Elvin-Lewis, 2003 O Hara et al., 1998). Symptoms of misuse can vary from trivial to extreme and may include life-threatening events affecting the heart, blood pressure, liver, GI tract, as well as nervous and endocrine systems. Dermatological reactions are considered elsewhere in the chapter. 

Silybium marianun (milk thistle) used for repairing liver function including cirrhosis ... 

Milk Thistle Inhibits liver toxification from cl7 Alkylated AAS while aiding in hepatic clearing and cell regeneration. 

Milk thistle T Liver function in viral hepatitis antidote to amanita mushroom poisoning Antioxidant, free radical scavenger, t SOD, 4- LTs Loose stools j. ] 1... 

Milk thistle Improves liver function in viral hepatitis antidote to Amanita mushroom poisoning... 

Pharmacology In vitro studies show that milk thistle reduces lipid peroxidation, scavenges free radicals, enhances superoxide dismutase, inhibits formation of leukotrienes, and increases hepatocyte RNA polymerase activity. In animal models, milk thistle protects against liver injury caused by alcohol, acetaminophen, and amanita mushrooms. The outcomes of clinical trials in patients with liver disease caused by alcohol have been mixed. In viral hepatitis and liver injury caused by amanita mushrooms, results of clinical trials have been mainly favorable. A commercial preparation of silybin (an isomer of silymarin) is available in some countries as an antidote to Amanita phalloides mushroom poisoning. 

Milk thistle contains compounds that may have C3Toprotective actions against liver toxins including those present in amanita mushrooms. The answer is (D). 

Milk thistle Siiybum marianum Toxic hepatitis and other liver diseases Mild Gl distress possible allergic reaction. 

II. Indications. Unproven but possibly effective as adjuvant therapy in cases of acute hepatic injury due to Amanita phaiioides mushroom ingestion, acetaminophen toxicity, and potentially other chemical and drug-induced liver diseases. Silymarin is not available as a pharmaceutical drug in the United States, but milk thistle extracts can be purchased for oral use as dietary supplements. However, these products may not be comparable in quality and consistency to European prescription preparations. 

Sylybum marianum L. Milk thistle Seeds Liver disorders, lactation problems Sylimarins, flavonoids (apigenin, chrysoeriol, quercetin, taxifolin)... 

Hobbs, C., Milk Thistle The Liver Herb, 2nd. ed.. Botanical Press, Capitola, CA, 1992, pp. 1-32. 

One woman experienced repeated attacks of sweating, nausea, colicky abdominal pain, diarrhea, vomiting, weakness, and collapse after taking a milk thistle product (Adverse Drug Reactions Advisory Committee 1999). Other cases of adverse events, reported without details, include a case of abdominal pain, nausea, listlessness, and insomnia and one case of thrombocytopenia (Adverse Drug Reactions Advisory Committee 1999). The symptoms in these reports are similar to those associated with liver disease, for which the patients may have been taking milk thistle. 

Exacerbation of hemochromatosis (an inherited disease in which excessive iron accumulates in the body) was reported in a 68-year-old woman with a history of type 2 diabetes, asthma, hypothyroidism, borderline hypertension, borderline diastolic dysfunction, and a fatty liver. The women had been taking 200 mg of milk thistle daily for over a year, along with two extra-strength acetaminophen pills every 2 to 3 days, and a can of cola (presumably a diet cola) every day (Whittington 2007). A letter regarding this case noted that elevated liver enzymes, reported as a sign of hemochromatosis exacerbation, may occur with regular acetaminophen use (Kidd 2008). 

Jacobs, B.P., C. Dennehy, G. Ramirez, J. Sapp, and V.A. Lawrence. 2002. Milk thistle for the treatment of liver disease A systematic review and meta-analysis. Am.. Med. 113(6) 506-515. 

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