How does Milk Thistle work?

Milk Thistle liver protection

What is Milk Thistle?

Milk thistle (Silymarin marianum) is a plant that originates from the Mediterranean and North African coasts [1]. It has been used as a remedy for multiple ailments for thousands of years for its protective qualities for the liver and gallbladder with milk thistle today being primarily used to treat high cholesterol levels and  cirrhosis of the liver [1].

In the liver, milk thistle exerts an anti-fibrotic effect. Liver fibrosis is caused by a build of proteins outside the cell, including collagen. As part of this, normal liver cells are converted to myofibroblasts, which are cells that are similar to skin cells.  However, milk thistle extract has been shown to stop this process and in doing so protecting the liver [2].  Furthermore, a systematic review of 13 randomised control trials published in 2005 by Rambaldi et al. concluded that silymarin may increase the life expectancy of patients with liver disease [5]

Milk thistle is also thought to protect the brain due to the role it plays in protecting cells from oxidative stress. Oxidative stress is caused by by-products of reactions involving oxygen within the cell metabolism [3] such as the breakdown of Alcohol to prevent it's inflammatory effects on the brain.

Table 1: Summary of studies of how milk thistle extracts can improve the outcome of liver disease

Dosage (mg/day)
Treatment Duration (days)
Ferenci [4] Chronic alcohol and other forms of liver disease



58% of patients increased life expectancy

Salmi [6] Chronic alcohol liver disease



73% of patients improved

Palasciano [7] Chronic drug-induced liver disease



Reduction in liver cell damage
Buzelli [8] Chronic hepatitis



Reduction in liver cell damage
  1. Zhu, H.-J., et al., An Assessment of Pharmacokinetics and Antioxidant Activity of Free Silymarin Flavonolignans in Healthy Volunteers: A Dose Escalation Study. Drug Metabolism and Disposition, 2013. 41(9): p. 1679-1685.
  2. Yadav, S. and S.K. Prajapati, Silymarin: A Review of the Pharmacology and Bioavailabity Enhancement Whacks. Pharmatutor, 1982.
  3. Coyle, J.T. and P. Puttfarcken, Oxidative stress, glutamate, and neurodegenerative disorders. Science, 1993. 262(5134): p. 689-695.
  4. Ferenci, P., et al., Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. Journal of Hepatology, 1989. 9(1): p. 105-113.
  5. Rambaldi, A., B.P. Jacobs, and C. Gluud, Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev, 2007(4): p. Cd003620.
  6. Salmi, H.A. and S. Sarna, Effect of Silymarin on Chemical, Functional, and Morphological Alterations of the Liver. Scandinavian Journal of Gastroenterology, 1982. 17(4): p. 517-521.
  7. Palasciano, G., et al., The effect of silymarin on plasma levels of malon-dialdehyde in patients receiving long-term treatment with psychotropic drugs. Current Therapeutic Research, 1994. 55(5): p. 537-545.
  8. Buzzelli, G., et al., A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol, 1993. 31(9): p.

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