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Milk Thistle; Silybum marianum

Proposed Uses: Alcoholic Hepatitis; Viral Hepatitis; Liver Cirrhosis; Mushroom Poisoning (Special Intravenous Form Only); Protection from Liver-toxic Medications

Milk thistle is currently used to treat alcoholic hepatitis, liver cirrhosis, liver poisoning, and viral hepatitis, as well as to protect the liver from the effects of liver-toxic medications. However, despite this wide usage, there is no definitive evidence that it is effective.

The active ingredients in milk thistle are assumed to be four substances known collectively as silymarin, of which apparently the most potent is named silibinin. When injected intravenously, silibinin is thought to act as an antidote to poisoning by the deathcap mushroom, Amanita phalloides.

Animal studies suggest that milk thistle extracts can also protect against many other poisonous substances, from toluene to the drug acetaminophen. One animal study suggests that milk thistle can also protect against fetal damage caused by alcohol.

Silymarin is hypothesized to function by displacing toxins trying to bind to the liver as well as by causing the liver to regenerate more quickly. It may also act as an antioxidant and also stabilize liver cell membranes.

In Europe, milk thistle is often added as extra protection when patients are given medications known to cause liver problems. However, milk thistle failed to prove effective for preventing liver inflammation caused by the Alzheimer's drug Cognex (tacrine).

Dosage
The standard dosage of milk thistle is 200 mg 2 to 3 times a day of an extract standardized to contain 70% silymarin.

There is some evidence that silymarin bound to phosphatidylcholine may be better absorbed. This form should be taken at a dosage of 100 to 200 mg twice a day.

Warning: Considering the severe nature of liver disease, a doctor's supervision is essential. Also, do not inject milk thistle preparations that are designed for oral use!

Safety Issues
Milk thistle is believed to possess very little toxicity. Animal studies have not shown any negative effects even when high doses were administered over a long period of time.

A study of 2,637 participants reported in 1992 showed a low incidence of side effects, limited mainly to mild gastrointestinal disturbance. However, on rare occasions severe abdominal discomfort may occur.


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