29 Milk Thistle & Silymarin

Benefits + Dosage, Side Effects

AFFILIATE DISCLOSE
Written by: Ana Aleksic, MSc (Pharmacy)

Milk thistle is a powerful and safe herb for liver support. Its extract (silymarin) boosts detox, lowers
inflammation, and increases antioxidant defense, which is beneficial for liver and gallbladder issues,
diabetes, and autoimmune diseases. Read on to learn more, along with dosage information and smart ways
to improve the poor bioavailability of its active compound silybin.
CONTENTS [HIDE]
 Milk Thistle Snapshot
 What is Milk Thistle (Silymarin)?
 The Health Benefits of Milk Thistle
 Milk Thistle Synergies
 Milk Thistle Dosage & Forms of Supplementation
 Milk Thistle Safety and Side Effects
 Buy Milk Thistle
 Caveats and Limitations

Milk Thistle Snapshot

Pros

 Great for improving liver function and detoxification

 Has gentle action and a diverse array of beneficial effects

 Good antioxidant and anti-inflammatory
 Improves metabolism and lowers lipids
 May fight cancer and reduce radiation side effects
 Low risk for side effects

Cons

 There are stronger anti-inflammatories and antioxidants out there

 Regular extracts and supplements have poor bioavailability
 Milk thistle tinctures taste slightly bitter

What is Milk Thistle (Silymarin)?

Milk thistle (Silybum marianum) is a medicinal plant that belongs to a large family of flowering plants
(Asteraceae). It has been used traditionally for thousands of years as a “liver elixir” for a variety of
diseases to do with liver dysfunction or gallbladder problems. It was also used to protect the liver
against snake poison, insect stings, mushroom poisoning, and alcohol abuse [R, R, R].
Milk thistle is a relative of dandelion and regular artichoke. Sometimes it’s called “wild artichoke”. It’s
native to Southern Europe, Russia, Asia, and Africa and is now also cultivated throughout the world. The
seed-like fruits of the plant are used medicinally. Traditionally, though, the leaves were used in salads
and the fruit of the flower roasted as a coffee substitute [R, R, R].
Silymarin is a mix of active components that are highly concentrated in a standardized extract of
milk thistle seeds [R].
In the US, milk thistle is among the most popular herbal supplements. It’s also commonly used in other
parts of the world, especially in Germany — the largest producer of milk thistle (Madaus). The German
Scientific Board recommends its use for indigestion, toxin-induced liver damage, cirrhosis, and liver
inflammation [R, R, R].
Although more studies are needed, milk thistle is a great example of traditional plant knowledge being
successfully put to scientific scrutiny. Since the 1970s, milk thistle extracts and its main active component
(silybin) have been regarded as an official medicine for liver diseases [R].
Numerous high-quality clinical trials have investigated the health benefits of milk thistle in the 21st
century; over 70 human studies in total have been published so far. This article will take you through all
the latest scientific findings and their health implications.

Bioactive Components (Silybin)

The seed-like milk thistle fruit (achenes) contains the active ingredient silymarin along with other
compounds such as:

 Other flavonoids (taxifolin, quercetin, kaempferol, apigenin, naringin),

 Oils (linoleic, oleic acid, and palmitic acid)

 Vitamin E (Tocopherol)
 Plant sterols (campesterol, stigmasterol, and sitosterol)
 Some sugars and proteins

Silymarin makes up to 3% of the dry fruit, while fruit extracts can have up to 80% [R].
 Silymarin is a complex mixture of flavonoid complexes that includes [R]:

 The flavonoid Silybin (a flavonolignan), the most active ingredient

 Other Silybin-like flavonoid complexes (Silybins and isosilybins A and B)

Since silybin is the main active compound of this mixture, most milk thistle supplements are
measured by how much of it they contain [R, R].
Silybin concentrations in various extracts can vary:

 The highest concentration of silybin in extracts is 50–70%

 Silybin concentrations in common supplements are 20–40%

Tip: Don’t get confused when you look at the supplement label. Remember: Milk thistle extracts should be
high in silymarin (60-80%) and a large part of this silymarin complex should be silybin (at least 20% but
aim for those with 50-70%)!

Mechanism of Action & Metabolism

Silymarin acts on many important pathways in the body to [R]:

 Increase liver regeneration by enhancing the production of DNA and RNA

 Prevent poisoning from drugs and toxic substances by making the membrane of liver cells less penetrable
to them
 Stop liver viruses such as Hepatitis C from multiplying
 Neutralize free radicals and increase levels of the master antioxidant glutathione
 Reduce inflammatory cytokines (TNF-a, INF-b) while increasing anti-inflammatory defense (IL-10)
 Stop tumor growth and kill cancer cells by triggering their death pathways (p53) and turning on cancer-
fighting genes

However, silymarin has poor bioavailability (check the dosage section for ways to overcome this) . Plus,
absorbed silymarin is broken down and transformed into inactive metabolites in the liver. Most of it is
eliminated through bile, together with bile acids [R].

The legend about the “blessed virgin thistle”

The fruits of milk thistle, not to be confused with blessed thistle (Cnicus benedictus), have long been used
by mothers for stimulating milk production. Its use was associated with a legend according to which the
white veins of the plant’s leaves were a drop of the milk of the mother of Jesus who found shelter in a
bower of the plants. Thanks to this legend, the plant is sometimes called Mary thistle, holy thistle, blessed
virgin thistle or Christ’s crown [R].
The Health Benefits of Milk Thistle

1) Milk Thistle Protects Liver

Out of all the health benefits listed here, milk thistle has been most researched for its powerful liver-
protective action. A large recent analysis of 17 clinical trials concluded that silymarin can reduce liver
enzymes ALT and AST, common markers of liver damage [R].
Milk thistle can boost levels of the crucial antioxidant enzyme glutathione, reduce inflammation and liver
scarring, detox drugs and toxins, and help the liver tissue regenerate [R, R]:

Fatty Liver Disease

A combination of Milk thistle’s active compound, Silybin, phosphatidylcholine, and vitamin E over 1
year improved non-alcoholic fatty liver disease (NAFLD) in a clinical trial of 179 people. It reduced
liver enzymes, insulin resistance, and liver scarring with no serious side effects. Some of the included
Hepatitis C+ participants included in the trial experienced the same benefits [R, R].
However, the active ingredients can reach higher blood levels in people just with fatty liver disease than in
those with Hepatitis C. After being absorbed, silybin is secreted into the gut with bile. People with
Hepatitis C can’t absorb silybin again and “recycle” it, which lowers its blood concentration [R].
Overall, silybin from milk thistle improves fatty liver disease, even in people who also have Hepatitis C.
But those with Hepatitis C may need higher doses (2.1g/day of silybin) to compensate for the liver damage
that affects bioavailability [R].

Hepatitis C and B

An analysis of over 1k people concluded that people with hepatitis B or C who took milk thistle are less
likely to die of liver-related issues [R].
In an observational study of over 1000 people with hepatitis C, those with the more severe forms of the
disease who used silymarin were less likely to experience worsening and further liver damage (cirrhosis)
[R].
In one clinical trial of 36 people with hepatitis C who didn’t respond just to drugs (Peg interferon +
ribavirin), IV silybin alone or as an add-on to the anti-Hep C drugs greatly reduced viral activity and
load. In 7 people, the virus became completely undetectable after 6 weeks (15-20 mg/kg) [R].
However, in another trial of 154 people with Hepatitis C who previously didn’t respond to standard therapy
(interferons), oral silymarin (2.1g/day) did not lower liver enzymes or virus activity much after 6 months.
But the researchers didn’t measure the silybin content in the extract, blood levels of its active components,
nor focus on the virus load [R, R].
According to an analysis of almost 400 people, oral silymarin has modest effects on reducing the activity of
the Hepatitis C virus, not much different from the placebo. Silybin, the active ingredient, may work better
if given through a high-dose IV in people with Hepatitis C, but further studies are needed [R].
People with liver disease often have very high ferritin levels due to liver inflammation and injury. In a
trial of 37 people with Hepatitis C, silybin combined with phosphatidylcholine reduced ferritin levels in
~80% of the cases over 12 weeks [R, R]
People with any Hepatitis virus can experience a sudden, acute worsening and liver inflammation. In a
clinical trial of 105 people such cases, silymarin (420 mg/day) reduced symptoms, improved jaundice and
bile flow over 4 weeks [R].

Hepatitis and HIV (cellular studies)

Milk thistle was active against Hepatitis C in many cellular studies. Silymarin blocks the Hepatitis C
virus from entering cells, infecting them, and dividing. But in this cellular study, it wasn’t active against
all strains of the virus, so some people may not respond to it [R, R].
In one cellular study, silybin protected from the HIV virus, reduced its activity and division. It also
reduced immune activation and inflammation that contributes to the spreading of HIV [R].

Alcoholic Liver Disease

In an observational study of over 600 people, a water-soluble Silymarin extract (420 mg/day) over 11
months safely lowered high liver enzymes and bilirubinin those with alcoholic liver disease [R].
Silymarin (450 mg/day) increased the master antioxidant glutathione and reduced oxidative stress in red
blood cells in a clinical trial of 60 people with alcoholic liver disease after 6 months. It didn’t affect liver
function or enzymes in this study, though [R].

Protecting the Liver from Drugs and Toxins

Milk thistle may protect the liver from drugs and toxins [R].
In animals, silymarin and silybin protected the liver against damage from alcohol, toxins (carbon
tetrachloride and thallium), chemotherapy drugs (cisplatin), Tylenol (acetaminophen),
radiation, iron overload, and the poisonous mushroom death cap (Amanita phalloides) [R+, R].
In a clinical trial of 50 children with leukemia, milk thistle protected the liver and reduced damage from
chemotherapy drugs after 1 month [R].
In a woman with leukemia, silymarin (800 mg/day) reduced the side effects of chemotherapy drugs and
protected the liver over 4 months [R].
Milk thistle doesn’t protect the liver from all drugs. For example, it didn’t protect the liver from anti-
tuberculosis drugs in a study of 380 people. On the contrary, it even slightly increased the risk of liver
damage [R]
Most mushroom poisonings worldwide are from a mushroom called “death cap”. Milk thistle is the number
1 antidote for death cap poisoning, given as IV silybin (oral silybin doesn’t work). It saved lives in over
90% of 1500 cases in the US, which is better than any other antidote. It should be given within 48h to
prevented severe liver damage and increase survival [R, R, R].

Quality of Life
 In a survey of 32 people who received liver transplants, those who used milk thistle and other herbal
products had better problem-solving skills, considered the supplement investment worthwhile, and reported
better overall health [R].
This does not speak to the benefits of milk thistle, but shows that people who tend to take their health into
their own hands actively seek natural alternatives.

2) Milk Thistle Liver Detox from Chemicals

and Toxins
The liver breaks down and helps eliminate all harmful substances, both from waste products produced in
the body and those that enter via food and environment. Since milk thistle protects the liver, many people
use it to facilitate detox and reduce disease risk.
Milk thistle reduces oxidative damage and inflammation and helps regenerate liver cells. It boosts
glutathione, the liver’s key antioxidant, as well as the protective enzyme SOD. It may help detox the
liver from pollutants, environmental toxins, and drugs in healthy people based on the mentioned clinical
studies [R, R, R].
Milk thistle may also protect the heart from heavy metals such as arsenic, environmental pollutants,
fluoride, and oxidative stress, based on many animal and cellular studies [R, R].
Silybin protected against an algae liver toxin (microcystin) in mice and against a fungal toxin (aflatoxin) in
chickens [R, R].
The exact effects of milk thistle on healthy people who want to detox hasn’t been confirmed. But short
occasional detoxes may be helpful even in people not exposed to any specific toxins. In one study of 25
healthy people, a 7-day detox improved wellbeing and liver health. Milk thistle is a safe supplement and
could be used in short detox protocols, alone in combination products [R, R].

3) Milk Thistle is an Antioxidant

In a clinical trial of 40 people with type 2 diabetes, Silymarin (420 mg/day) over 45 days enhanced
antioxidant defense, boosting total antioxidant capacity and key enzymes such as glutathione
and SOD. It also reduced the inflammatory marker CRP [R].
According to cellular studies, milk thistle acts as an antioxidant by:

 Activating the body’s detox hub, Nrf2 [R].

 Blocking the master inflammation pathway called NF-kB [R].
 Increasing mitochondrial health and activating Heat Shock Proteins, which protect cells and tissues under
stress [R, R].
 Increasing sirtuins, which help conserve energy, reduce aging and inflammation [R].
 Neutralizing free radicals, chelating free iron and copper [R].
 Blocking harmful enzymes that increase oxidative stress [R].

4) Milk Thistle Reduces Inflammation

Tightly tied to its antioxidant activity, milk thistle is a strong anti-inflammatory. It blocks most
pathways that trigger or worsen inflammation in the body.
In pregnant mice with infections, its active compound silybin reducedinflammation in the brain and preterm
births. It lowered inflammatory substances (IL-6, IL-8, PGE2) and enzymes (COX-2) and gene expression
(MMP9) [R].
In white blood cells from healthy people, silybin reduced inflammation by blocking the release of harmful
products (such as hydrogen peroxide and TNF-alpha) [R].

5) Milk Thistle May Reduce Autoimmunity

Milk thistle may improve autoimmune conditions by reducing the Th17response.
Once of the reasons why women are more susceptible to Th17-dominant autoimmune diseases is
because estrogen is involved in maintaining a healthy immune response. In order to reduce the Th17
inflammatory response, estrogen receptors need to be activated. Estrogen normally does this, but its levels
drastically fall in women after menopause [R].
Milk thistle can activate estrogen receptors and reduce autoimmunity. In a study of healthy people and
those with rheumatoid arthritis, silybin had a beneficial epigenetic effect (increasing ER-beta and miR-
155). It binds to estrogen receptors in white blood cells, reduces the autoimmune response and
inflammatory cytokines (IL-17 and TNF-a) [R].

6) Milk Thistle for Infections

Milk thistle’s active component Silybin blocked the most dangerous flu-causing virus, Influenza A, and
reduced its spreading in mice [R].
It was also active against hard-to-treat bacteria, the so-called Methicillin-Resistant Staphylococcus Aureus,
in cells [R].
It killed bacteria and stopped them from multiplying, including the ulcer-causing E.coli, in cells. It could
also reduce and disrupt biofilms [R, R, R].
Milk thistle may also help fight parasites. Silymarin reduced a parasitic infection from blood-flukes
(Schistosomiasis) in the liver and killed the parasite eggs in mice [R].

7) Milk Thistle Protects the Brain

Silybin reduced brain injuries and brain inflammation in mice with infections [R].
It prevented memory loss and improved learning in rats by reducing oxidative stress in the brain.
This active compound from milk thistle reduced damage in the brain’s memory hub, the hippocampus. The
hippocampus is part of the limbic system, which controls emotions and the stress response. This region is
often inflamed in people with brain fog [R].
It also had a beneficial epigenetic effect in mouse brains. Silybin increased the expression of BDNF, which
helps make new brain cells, and of tyrosinereceptor kinase B (TrkB), which helps make and strengthen
new connectionsin the brain in response to BDNF [R].
Silymarin reduced symptoms of Parkinson’s disease and damage from stroke in mice. It neutralizes free
radicals in the brain, blocks the master inflammation pathway NF-kB, and reduces damage to brain cells. It
lowers the activation of the brain’s immune cells (microglia), which may help prevent many
neurodegenerative diseases [R, R].
Silymarin may also be anti-aging. It extended the lifespan of worms by 10-20%, improved tolerance
to stress, and reduced the toxicity of proteins that trigger Alzheimer’s Disease in the brain [R].
In worms, Silymarin activates hormesis pathways, increasing stress resilience and defense mechanisms
similar to adaptogens. This explains its longevity and brain-protective benefits.
8) Milk Thistle May Improve OCD
As milk thistle protects the brain, it may also help with mental health disorders. In one clinical trial of 35
people with OCD, milk thistle extract (600 mg/day) worked as well as the standard SSRI drug
(fluoxetine) to reduce OCD symptoms over 8 weeks [R]

9) Milk Thistle May Help with Diabetes

Silymarin (420 mg/day) improved symptoms in 2 studies of 80 people with type 2 diabetes. It
reduced fasting blood sugar, insulin, and insulin resistance over 45 days [R, R]
In another trial of 51 people with type 2 diabetes, 4 months of silymarin (600 mg/day) added to standard
therapy reduced both short- and long-term (fasting blood glucose and HbA1C) [R]
Milk thistle can be combined with berberine for blood sugar control. In one study of 85 people with type 1
diabetes, this combination reduced the insulin doses needed to keep blood sugars in check and also lowered
blood fats [R]
In a trial of 60 people with diabetes and alcoholic liver damage, Silymarin (600 mg/day)
improved insulin resistance and oxidative stress while reducing the need for insulin injections over 1 year
[R].

10) Milk Thistle Improves Metabolic

Syndrome
Milk thistle is a promising natural alternative for people with metabolic syndrome [R].
In 136 obese people with type 2 diabetes, a combination of berberine and silymarin improved all
harmful disease markers after 6 months. It reduced fasting blood glucose and insulin, improved insulin
resistance, raised HDL, reduced total, LDL cholesterol, and triglycerides. It also reduced the BMI, waist
circumference, and belly fat [R]
In 51 people with type 2 diabetes, silymarin (600 mg/day) didn’t only reduce blood sugars but also lowered
total cholesterol, LDL, triglycerides, and liver enzymes (AST and ALT) [R].
In another study of 40 people with type 2 diabetes, Silymarin (420 mg/day) improved insulin resistance,
blood triglycerides, and increased the beneficial HDL cholesterol over 45 days. Plus, it reduced the
inflammatory marker CRP and increased antioxidants [R, R]
In 137 people who didn’t tolerate high doses of lipid-lowering statin drugs, silymarin with berberine
(~200/1200 mg/day silymarin/berberine) improved blood sugar, insulin, and didn’t worsen blood fats when
the drugs were stopped [R]
In cells, milk thistle can block Pancreatic Lipase, an enzyme that breaks down fats in the gut and helps
absorb them. By blocking this enzyme, milk thistle may reduce the amount of fat absorbed from the diet
[R].

11) Milk Thistle Protects the Heart

One way that milk thistle can protect the heart is indirectly, by lowering blood fats that contribute to
hardening of the arteries and heart disease. Milk thistle reduced triglycerides, total and LDL cholesterol and
increased HDL cholesterol in several clinical trials [R, R, R]
But it may also lower blood pressure by reducing inflammation. In one study, silymarin was applied to the
immune cells of pregnant women with high blood pressure. It blocked all the major inflammatory pathways
(TNF-a, IL-1b, NF-κB) [R]
 Milk thistle prevented heart injury and disease in rats. It also protected muscle cells from injury by
restoring healthy activity in the mitochondria. Plus, milk thistle can turn on genes that reduce inflammation
and protect the cells from damage (Bcl-2) [R, R].

12) Milk Thistle May Fight Cancer

In one clinical trial, 60 people with benign polyps in the colon (which often develop into colon cancer) took
a herbal blend with milk thistle, a flaxseed antioxidant, and oat fiber for 2 months before colonoscopy. The
combination increased estrogen receptors in the colon, which helps kill these “pre-cancerous” cells and
prevent colon cancer [R]
A combination of Milk thistle (Silymarin) and selenium reduced markers of prostate cancer
worsening (LDL and total cholesterol) in 19 men who previously had their prostate removed [R].
Milk thistle has low bioavailability, but standardized extracts can still reach the blood and cancer tissues. In
12 women with breast cancer, a combination of silybin and phosphatidylcholine (2.8 g/day) for 4 weeks
before surgery was safe and built up in the breast cancer tissue more than in healthy tissue [R]
In one study, even high doses (up to 13 g/day) of a special milk thistle formulation (Silybin-phytosome)
over 4 weeks was safe in 13 people with prostate cancer [R]
Milk thistle could also be added to sunscreen to naturally protect against skin cancer, as it prevented skin
damage in animal studies [R].
Silybin blocked prostate tumor growth, progression, invasion, and spreading in mice with prostate cancer
[R, R].
It also delayed the development of breast tumors in mice genetically prone to breast cancer [R, R].
In cells, silymarin act to fight cancer by [R, R].

 Increasing cancer cell suicide (apoptosis)

 Preventing cancer cells from spreading and invading other tissues
 Stopping cancers from making blood vessels that help them survive
 Blocking the abnormal division of prostate, ovarian, breast, lung, skin, bone, and bladder cancer cells
 Reducing the expression of inflammatory genes

13) Milk Thistle May Reduce Chemo and

Radiotherapy Side Effects
Silymarin from milk thistle formulated into a cream (Leviaderm) prevented skin damage from radiotherapy
in over 100 breast cancer patients [R].
Silymarin gel 1% applied on the palms and soles of hands and feet protected from skin damage typically
caused by a chemotherapy drug (capecitabine) in 40 people with stomach cancer [R]
In people with brain metastases undergoing radiotherapy, a combination of omega-3 fatty acids and milk
thistle increased survival and decreased tissue damage from the radiation [R].
In 77 people with cancer undergoing radiotherapy of the head and neck, silybin (420 mg/day) reduced
painful mouth inflammation over 6 weeks [R].
However, milk thistle didn’t reduce kidney damage from the chemotherapy drug Cisplatin in one small
clinical trial [R].
In mice with lung cancer, milk thistle reduced lung damage from radiation and improved survival [R].

14) Milk Thistle Improves Bone Health

Milk thistle (silymarin) improved bone healing and increased bone mineral density in mice with bone
fractures [R].
Milk thistle may compensate for low estrogen levels after menopause, as the drop in estrogens increases the
risk of osteoporosis. It prevented bone loss and increased the activity of cells that help mineralize and
rebuild bones in postmenopausal mice [R].
In bone cells, milk thistle boosted the activity bone-forming cells and blocked bone-degrading cells [R].

15) Milk Thistle Estrogen Effects

Milk thistle has estrogenic effects, which can be a double-edged sword.
By mimicking the effects of the main female sex hormone, it could increase parathyroid hormones in mice,
which helps retain calcium and build bones [R].
But it can thicken the uterus lining and increase its weight. This can be harmful as it increases the risk of
uterine cancer [R].
Milk thistle doesn’t affect the brain the same way that estrogen does and has to effects on hormones of
the hypothalamus or pituitary (LH and FSH) [R].
Milk thistle alone doesn’t affect menopausal symptoms. But it may work it combination with other
supplements, mentioned in the synergies section.

16) Milk Thistle May Increase Milk

Production
Milk thistle has been used traditionally by pregnant women to increase milk production. Clinical trials are
lacking to support this, although milk thistle is probably not dangerous if used by pregnant women [R, R].
In only one low-quality study of 50 breastfeeding women with low milk production, milk thistle slightly
increased milk production after a month of daily use ( 420 mg/day) [R, R].
In pregnant or breastfeeding pigs, silymarin increased prolactin levels. Since prolactin boosts milk
production, there may be some rationale to the purported claims [R].

17) Milk Thistle Reduces Iron Overload

The active compounds in milk thistle act as iron chelators, which can be useful for binding excessive iron
in genetic disorders of iron buildup.
Silybin reduced iron absorption in 10 people with a genetic disorder that causes iron buildup and overload
(Hemochromatosis) [R].
Silymarin reduced iron overload (in combination with desferrioxamine) in 49 people with β-thalassemia,
one of the most common genetic disorders(R).
According to a large review 74 studies, silybin from milk thistle reduces high iron and organ damage in
people with thalassemia when used as an add-on [R].
18) Milk Thistle May Protect Red Blood Cells
Free radicals can damage red blood cells, especially in people with genetic disorders that affect them (such
as sickle cell anemia and β-thalassemia). Silymarin neutralized free radicals in red blood cells, increased
their glutathione levels, and reduced their breakdown [R].

19) Milk Thistle May Help with Weight Loss

Milk thistle prevented mice fed a high-fat diet from developing metabolic disorder [R].
Silybin blocked fat cells from developing and dividing in test tubes [R].
In human fat tissue, it reduced fat storage and the size of fat cells. It could also turn on fat-burning genes,
such as SIRT1, PPAR alpha, and Pgc-1alpha, which could potentially help with weight loss [R].
It’s uncertain if milk thistle can aid in weight loss in humans, though.

20) Milk Thistle Improves Acne

In a trial of 14 people, a combination of silymarin (210 mg/day), N-acetylcysteine, and Selenium reduced
acne after 8 weeks by 53% [R].
Some studies in cancer patients showed that creams or gels with milk thistle protect the skin, reduce
inflammation, and prevent damage. Skin products with milk thistle may help with acne and skin irritation
too but haven’t been tested yet.

21) Milk Thistle May Improve Bile Flow

Based on animal and cellular studies, milk thistle may improve bile flow and help with diseases in which
the flow is blocked. Often, liver disease is the cause, but it can also be due to a bile disorder. Milk thistle
increases the production of bile salts and their secretion into the gut [R, R].

22) Milk Thistle for Heartburn

The European monograph mentions heartburn and indigestion as one of the uses of milk thistle.
The popular heartburn product Iberogast contains milk thistle along with 8 other herbs. Iberogast improved
indigestion, stomach pain, and heartburn in 3 studies. It has been around for 40 years and has a good safety
profile [R, R].
Milk thistle is a mild bitter. Bitter herbs reduce indigestion by increasing the secretion of stomach acids and
digestive enzymes, as well as by activating the vagus nerve. As a mild bitter, milk thistle may reduce
heartburn on its own, but studies are lacking to support it [R].

23) Milk Thistle for Hangovers

Due to its liver-protective effects, some people use milk thistle to reduce hangovers. Clinical studies have
not investigated this (and expectedly so), but some animal studies may actually back it up.
In mice given a lot of alcohol over a short period of time, milk thistle protected the liver from injury. It also
reduced inflammation and boosted antioxidants [R].

24) Milk Thistle and Anti-Seizure Drugs

SIlymarin reduced liver injury from anti-seizure drugs in 55 children with epilepsy [R].
It also increased the effects of anti-seizure drugs in rats. Milk thistle blocks Pgp, a protein that stops drugs
from being absorbed in the gut or from passing to the brain. This way, it increases the amount of anti-
seizure drugs that can reach the brain [R, R].

25) Milk Thistle May Protect the Kidneys

In one clinical trial, silymarin (210 mg/day) for 8 weeks in people on dialysis reduced inflammatory
cytokines, especially TNF-alpha [R].
It also protected the kidneys in animal studies and boosted antioxidants in kidney cell studies [R].
In dogs, it reduced kidney damage from an antibiotic (gentamicin) when combined with vitamin E [R]

26) Milk Thistle May Help Heal Wounds

Silymarin increases skin regeneration and decreases inflammation in rats with wounds. Silybin sped up
wound healing in rats by turning on genes that help the skin rejuvenate. In cellular studies, milk thistle gel
increased collagen and the activity of collagen-producing cells (fibroblasts) [R].

27) Milk Thistle May Increase Fertility

Milk thistle with rosemary increased semen quality, boosted antioxidant status, fertility, and sexual
performance in rabbits [R].
Since milk thistle also has estrogen-like effects, its benefits for increasing fertility in men would need to be
studied well in humans. Although men need healthy levels of estrogen to maintain fertility and sexual
health, phytoestrogens that overactivate estrogen receptors usually reduce libido in men and increase the
risk of erectile dysfunction [R].
Milk thistle could potentially be used to increase the chances of successful In vitro fertilization, but more
studies are needed [R]

28) Milk Thistle and Prostate Health

A mix of silymarin and selenium reduced prostate symptoms in a clinical trial of 55 men. It improved urine
flow and reduced bladder fullness [R]
The same combination reduced blood fats that are linked to prostate cancer worsening in men who
previously underwent prostate-removal surgery [R]

29) Milk Thistle for Premenstrual Syndrome

(PMS)
Women who experience mood changes, bloating, cramps, and breast tenderness in the premenstrual phase
are more likely to have high CRP, a marker of inflammation. No studies have examined the effects of milk
thistle on premenstrual syndrome. But since it did reduce CRP in some studies and is a safe supplement,
it’s possible that it could help with PMS [R, R].
 Milk Thistle Synergies

 The combination with berberine improves metabolic syndrome and type 1 diabetes [R, R]
 Berberine and Milk thistle added on to statins improved blood lipid levels [R].
 Silybin with Vitamin E and Phospholipids work together to reduce chronic liver damage [R].
 Milk thistle increases antioxidant defense in combination with Bacopamonnieri, Ashwagandha, N-
acetyl cysteine, Curcumin (turmeric extract), green tea extract, gotu-kola powder, Ginkgo biloba leaf
extract, Aloe verapowder [R].
 A combination with garlic, Aloe vera, black cumin, Plantago psyllium, and fenugreek was used for
advanced type 2 diabetes [R]
 Milk thistle with red yeast rice extract and octacosanol improved blood fats and inflammation [R]
 Milk thistle was combined with selenium to improve prostate health [R, R]
 To reduce menopausal symptoms, milk thistle was combined with black cohosh, dong quai, red
clover, American ginseng, and chaste-tree berry [R]
 In Iberogast for indigestion, milk thistle is combined with bitter candytuft, chamomile flower, peppermint
leaves, caraway fruit, licorice root, lemon balm leaves, angelica root, and celandine herbs [R]

Milk Thistle Dosage & Forms of

Supplementation

Milk thistle is considered a very safe herbal supplement. Standardized milk thistle extracts should contain
70-80 % Silymarin. Ideally, the the silybin content should also be mentioned and account for ~40% (the
higher the better).

 The typical silymarin dosage used in most studies was ~420 mg/day divided into 2 or 3 doses.
 In people with liver disease, the typical dosage is higher, around 1.3 g/day of the standardized for 6-8
weeks (divided into 3 doses during the day). For maintenance, the dose can be reduced to 280 mg/day [R].
 Silymarin doses up to 2.1 g per day may need to be used in people with viral hepatitis, especially in those
with a chronic hepatitis C infection. Even so, IV silybin may work better than oral extracts in people with
serious liver damage [R].
 Very high doses of the silybin IV solution are used for mushroom poisoning

Milk thistle appears to be safe even if used daily for over 3 years. In cancer patients, the highest safe dose
was about 13 g/day. [R].
Milk thistle is available in many forms as a supplement. Milk thistle supplements, including silymarin
extracts, include all the following:

 Capsules
 Tablets
 Tinctures
 Intravenous solutions.

Milk thistle has a bitter taste, which you will notice if you take it as a tincture. This helps if you’re taking it
for indigestion but can be unpleasant otherwise.
Some people consider that taking organic milk thistle has additional benefits. Organically-grown plants
sometimes have higher concentrations of bioactive compounds, but this has not been confirmed for milk
thistle. It’s more important to make sure the supplement you decide to buy is standardized to the active
ingredients.

What’s the best time to take milk thistle?

Daily milk thistle doses are usually divided into 3, which can be spread out evenly during the day. Milk
thistle has poor bioavailability, though (more about this below), but taking it with some oils or fats is one
way to increase its absorption.

Bioavailability Issues & Ways to Overcome

Them
Silybin, the main active component in the standardized milk thistle extract Silymarin, has poor
bioavailability. Only around 20–50% of it gets absorbed from the gut. This is because silybin can’t dissolve
in water that makes most of the stomach and gut fluids. What’s even worse is that stomach acid can also
degrade it, so sometimes it won’t even reach the gut.
There are many ways to overcome its bioavailability issues. Some smart approaches have been
researched and several of them can be easily applied while others are commercially available, such as [R]:

 Berberine increases the bioavailability of silybin and the two act together in synergy [R]
 Other flavonoids (such as quercetin) increase its absorption [R]
 Fats, proteins, amino acids, and cholesterol increase its absorption [R]
 Vitamin E helps dissolve silybin and increases bioavailability [R]
 Soluble water extracts
 Silymarin complexes with phospholipids like phosphatidylcholine (SIliphos)
 Liposomal silymarin
 Nano-silymarin or nano-silybin [R]
 Purified extracts from the fruit [R]
 Mixing it into small particles (micelles) with bile salts [R]
 Soft gels [R]
 Advanced formulations (microemulsions or solid dispersion systems)
 Modifying silybin by binding it to sugars to make it water-soluble (still in the research phase) [R+]

Milk Thistle Safety and Side Effects

Milk thistle and its active component silymarin is a safe herbal product as long as the researched doses are
not surpassed.
The main adverse effects reported are [R, R, R].

 Nausea, stomach pain and discomfort (most common)

 Mild diarrhea
 Headaches
 Joint pain
 Skin allergies, itching, and eczema
 Fatigue and insomnia
 Nasal congestion, runny nose, sneezing
 Impotence (rare)
 Anaphylaxis (serious life-threatening allergic reaction) (very rare)

Pregnancy and Children

Although there aren’t enough clinical studies to confirm that milk thistle is completely safe in pregnancy,
the studies so far suggest it’s not harmful. Caution is advised in pregnant and breastfeeding women.
 Milk thistle is probably safe in children, but more studies are needed. Its use in babies and very small
children (<2 years) has not been studied and isn’t recommended [R].

Milk Thistle for Dogs and Cats

Milk thistle is a great antioxidant that can be safely used in cats and dogs. But the bioavailability is also an
issue, as in humans. If you’re looking to use milk thistle for your pets, rather go with a formulation of milk
thistle combined with phosphatidylcholine, which has been researched in dogs [R]
Follow the dosage outlined for humans and adapt it to your cat or dog based on their size/weight.

Drug Interactions
Although milk thistle generally safe, not much is known about its food and drug interactions [R].
Although some cellular studies found that it may affect CYP enzymes in the liver that metabolize
drugs, human studies show it doesn’t have a large enough effect to trigger drug interactions [R]
Milk thistle is probably safe to use in HIV positive people with Hep C alongside other medications (such as
darunavir, ritonavir, and indinavir) [R, R, R].
It doesn’t affect nifedipine, used in people with heart disease, digoxin used for heart failure, or antibiotics
[R, R, R]
Some animal studies suggest it may increase the effects of anti-seizure medications. Exercise caution and
consult your doctor if you are taking anti-seizure drugs or have epilepsy [R, R].

Buy Milk Thistle

 Amazon or iHerb

Caveats and Limitations

Although there is a fair amount of good quality clinical trials, more research is still needed to confirm many
of the listed benefits. Bioavailability was a big issue in some studies, especially in cases of disease when
high levels of the active compounds need to reach the blood. Intravenous silybin was used at times, which
can’t be considered the same as taking the regular oral supplements. Some studies were only done in
animals or in cells.
 FDA Compliance
The information on this website has not been evaluated by the Food & Drug Administration or any other
medical body. We do not aim to diagnose, treat, cure or prevent any illness or disease. Information is
shared for educational purposes only. You must consult your doctor before acting on any content on this
website, especially if you are pregnant, nursing, taking medication, or have a medical condition.
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JOE
COHEN
CEO, SelfHacked

About Joe
Growing up, Joe was plagued with a myriad of health issues such as gut problems,
autoimmune issues, chronic fatigue, brain fog, insomnia, and general inflammation. Both
conventional and alternative doctors weren’t able to help him, so he decided to fix himself.
With lots of health questions and few satisfying answers, Joe decided to read every research
paper he could get his hands on and conduct thousands of experiments on his own body in
order to fix his health issues. Joe started SelfHacked in late 2013 when he successfully fixed
all of his issues, and now it gets millions of readers a month looking to educate themselves
about how they can improve their health. Joe is now a thriving author, speaker, and serial
entrepreneur, founding SelfDecode & LabTestAnalyzer.

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