Milk thistle

Names: Silybum marianum, milk thistle, silymarin, Carduus marianus, Carthamus maculatus, Cirsium maculatum, Mariana mariana, Silybum maculatum.

Originally native to the Mediterranean region, the biennial thistle was mainly known as a vegetable in ancient times and played only a minor role as a medicinal plant. Hildegard von Bingen mentioned the plant as a remedy for side stitches according to the doctrine of signatures, whereby a specific effect is assumed from external plant characteristics (stinging plant helps against stinging pain). It was not until the middle of the 19th century that the effect on the liver was recognized, which was confirmed by scientific studies in the 20th century. The origin of Silybum marianum is Argentina, China, Romania and Hungary.

Description of the parent plant

Annual or biennial, 60 to 150 cm tall plant with an upright, branched, richly leafy stem. Unstalked, glossy green, lobed leaves with milky veins and thorny margins. Flower heads solitary, 4 to 5 cm long, with purple tubular flowers and long, stiffly erect or recurved bracts with spiny tips. Fruits up to 7 mm long, brownish-yellow marbled to black, crowned by a white pappus.

Where does the name come from?

The plant was originally called Carduus marianus (derived from the Latin word "carduus" = thistle) by Linné and was only later transferred to its own genus, Silybum. Silybum is derived from the Greek "silybon" = tassel. Milk thistle was known by this name in ancient times and was also referred to as such by Dioscorides. The German name Mariendistel refers to a legend. The Virgin Mary is said to have poured a few drops of milk over the leaves while breastfeeding, giving them their white marbling.

Ingredients

At least 1.5 %, on average 1.5 to 3 % of the flavolignans known as silymarin, which are a mixture of the three main components silibinin (mixture of the diastereomers silybin A and silybin B), isosilibinin (mixture of the diastereomers isosilybin A and isosilybin B), silychristin and silydianin as well as a large number of secondary components. Other components include numerous flavonoids, 20 to 30 % fatty oil, 25 to 30 % protein and some mucilage.

Silymarin and its mode of action

The liver - the catalyst

The largest gland in the human body works hard every day, on the one hand to process countless substances so that they are suitable for the body's needs and on the other to rid the organism of harmful substances. In contrast to many other organs, which announce an overload with all kinds of warning signals, it is a silent organ in the truest sense of the word, which practically never makes itself known through immediately noticeable signs. As the body's metabolic and detoxification center, it regulates not only the protein, fat and sugar metabolism, but also the mineral, vitamin and hormone balance, while at the same time disposing of foreign substances that are harmful to the organism. With its 24-hour workload, the liver has to cope with a lot and our modern lifestyle full of hectic and stress, with irregular, sumptuous and often too fatty meals, frequently one glass of alcohol too many and often combined with the intake of chemical drugs, forces the organ to perform at its best practically all the time.

Service for the high-performance engine

In order to maintain our vital energy undiminished, the liver as our "engine" must run smoothly. A healthy liver is able to cope with a certain amount of stress without any problems.

However, if the liver is burdened by too many foreign substances (pollutants from food and the environment, alcohol, chemical substances, e.g. in medicines) beyond the natural level, highly reactive, aggressive substances, so-called "free radicals", are increasingly produced during the breakdown of foreign substances, which attack the cell membranes and can impair our metabolic functions in the long term. Even if this detoxification organ itself does not hurt, we soon feel the effects...

Symptoms of an overloaded liver

• Tiredness
• Reduced performance and even persistent tiredness
• concentration problems
• feeling of fullness
• loss of appetite
• nausea and
• indigestion

Where can milk thistle help?

Dry extracts obtained from the fruit using lipophilic extracting agents contain the active ingredient complex silymarin. They are used for the supportive treatment of chronic inflammatory liver diseases, liver cirrhosis or diseases caused by liver toxins such as alcohol. The effectiveness of the silymarin contained in the fruit has been proven in various clinical studies. The effect is based on a protection of the liver cells on the one hand, and on the other hand the regenerative capacity of the liver cells is increased and the liver tissue can heal. Tea preparations, on the other hand, contain hardly any silymarin and are used in folk medicine for digestive complaints.

Mechanism of action

Various mechanisms are presumably responsible for the liver-protective effect. Firstly, membrane effects are mentioned, i.e. a change in the outer structure of the hepatocytes occurs with the result that the liver toxins cannot penetrate into the interior of the cells. On the other hand, silymarin stimulates the biosynthesis of nucleic acids and proteins in the hepatocytes, which is due to an increase in the activity of polymerase I (rRNA polymerase). In addition to these effects, a number of other effects are probably responsible for the effect, among which the antiperoxidative effects appear to be the most significant. For the treatment of brain-organ related performance disorders in dementia syndromes with dizziness, ringing in the ears, headaches, memory impairment, concentration disorders, mood instability with anxiety as the most important symptoms. Before starting treatment, it must be clarified whether the symptoms mentioned are not due to an underlying disease that requires specific treatment. Also for peripheral arterial circulatory disorders and tinnitus (ringing in the ears).

Energy cure for a vital liver

Silymarin not only prevents and protects the liver cells through its membrane-stabilizing effect, but is also able to intercept the highly reactive, aggressive "free radicals" that are increasingly produced during the increased breakdown of foreign substances. This can prevent the destruction of cell membranes.

Less itching, better liver values

Over a treatment period of three months, the patients took one to three capsules of 140 mg silymarin daily. The treatment not only improved the clinical symptoms (nausea, bloating, itching, fatigue and upper abdominal pressure), but also the liver function.

This was indicated by an improvement or even normalization of GOT, GPT, AP and bilirubin. And in almost all patients who had elevated PIIIP values at the start of the study, there was a reduction in this parameter, in some cases marked, which can be seen as an expression of reduced fibrogenesis. Milk thistle extract is an effective, easy-to-use and - what is particularly important in the case of a previously damaged liver - well-tolerated treatment option for chronic liver disease. According to Prof. Schuppan, silymarin can be administered, for example, in cases of not yet very advanced alcoholic liver damage - whereby abstinence from alcohol is of course the top priority. On the other hand, treated patients with advanced liver disease (hepatitis, alcoholic cirrhosis) also benefit.

Other health benefits of milk thistle

Milk thistle could help prevent age-related decline in brain function

Milk thistle has been used for over 2000 years as a traditional remedy to treat neurological disorders such as Alzheimer's and Parkinson's disease. The anti-inflammatory and antioxidant properties of this plant mean that it may have neuroprotective properties and could help prevent the decline in brain function that occurs with age (2, 3).

Studies conducted on animals and in test tubes have shown that milk thistle can prevent oxidative damage to brain cells, which could prevent a decline in mental function (4, 5). In these studies, it was also observed that milk thistle may be able to reduce the amount of amyloid plaques in the brains of animals with Alzheimer's disease (6, 7). Amyloid plaques are sticky clusters of amyloid proteins that can form between nerve cells during aging. They are observed in very large quantities in the brains of people with Alzheimer's, which means that milk thistle could potentially be used to treat Alzheimer's (8). However, there are currently no human studies that have investigated these effects of milk thistle in people with Alzheimer's or other neurological diseases such as dementia. In addition, it is still unclear whether milk thistle is absorbed well enough in humans to allow adequate amounts of the active ingredients it contains to cross the blood-brain barrier. It is also unknown what dosage would be required to produce a desirable effect (9).

Milk thistle could protect the bones

Osteoporosis is a disease caused by progressive bone loss. It usually develops slowly over several years and leads to weak and brittle bones that break easily even with minor falls. Experimental in vitro and animal studies have shown that milk thistle stimulates bone mineralization and may protect against bone loss (10, 11). As a result, scientists suggest that milk thistle may be a useful therapy for preventing or delaying bone loss in postmenopausal women (12, 13). However, there are currently no human studies that have investigated the effects of milk thistle on bone density.

Milk thistle could support cancer treatment

It is thought that the antioxidant effects of silymarin may have anti-cancer effects, which could be useful for people undergoing cancer treatment (14). Some animal studies have shown that milk thistle may help reduce the side effects of cancer treatment (15, 16). Milk thistle may also make chemotherapy more effective against certain types of cancer and in some cases even destroy cancer cells (17, 18, 19). However, there are few human studies to date and milk thistle has yet to be shown to have clinical effects in humans. One obstacle could be that not enough of the active ingredients can be absorbed to achieve a medicinal effect. Further studies are therefore needed before it can be said with certainty that milk thistle can be used as an adjuvant treatment for cancer.

Milk thistle can increase milk production

One effect of milk thistle is that it can increase milk production in breastfeeding women. This is believed to be due to an increase in the levels of the milk-producing hormone prolactin. The scientific data on this is limited, but a randomized controlled trial found that mothers taking 420 mg of silymarin per day for 63 days produced 64% more milk than women who received only a placebo (20). However, this is the only clinical study on the subject. Further research is therefore needed to determine these results and the safety of milk thistle for breastfeeding women.

Milk thistle could help in the treatment of acne

Acne is a chronic inflammatory disease. Although it is not dangerous, it can cause scarring. Some people also find acne painful and feel embarrassed by its effects on their appearance. It is thought that oxidative stress in the body may play a role in the development of acne. Due to its antioxidant and anti-inflammatory effects, milk thistle could be a useful supplement for people with acne. Interestingly, a study of subjects suffering from acne found that those who took 210mg of silymarin daily for 8 weeks experienced a 53% reduction in their acne lesions (21). However, this is only one study and further research is needed.

Milk thistle may lower blood sugar levels in diabetics

Milk thistle may be a useful adjunctive treatment for type 2 diabetes. It has been discovered that a compound found in milk thistle may act similarly to some diabetes medications by increasing insulin sensitivity and lowering blood sugar levels (23). In fact, a recent study review concluded that people who regularly took silymarin experienced a significant reduction in their fasting blood glucose levels and HbA1c - a marker of blood sugar control (24). In addition to this, the antioxidant and anti-inflammatory properties of milk thistle may also be useful in reducing the risk of diabetic complications such as kidney disease (23). However, the review mentioned above noted that the quality of the studies was not very high, so more studies are needed before it is possible to make meaningful recommendations (24).

Need in sport

Athletes and bodybuilders can benefit from the use of milk thistle. They usually consume many supplements at once to improve their performance. The use of several supplements at once can produce synergism, which causes enormous pressure on the liver. After a course of various substances such as steroids, pro-hormones or thermogenics, athletes can regenerate their liver with the use of Milk Thistle to promote liver health and performance.

Is Milk Thistle safe and harmless?

Milk thistle is generally considered safe and harmless when taken orally (24, 25). Even in studies where very high doses were taken over a long period of time, only about 1% of subjects experienced any side effects. When side effects were reported, they were generally related to the digestive tract, such as diarrhea, nausea or bloating.

Some people should be cautious when using milk thistle. These include

• Pregnant women: There is no data regarding the safety of milk thistle in pregnant women, so they are usually advised to avoid this supplement.
• People who are allergic to milk thistle: Milk thistle may cause reactions in people who are allergic to the Asteraceae/Compositae family of plants.
• Diabetics: The blood sugar-lowering effects of milk thistle may increase the risk of low blood sugar levels in people taking diabetes medication.
• People suffering from certain diseases: Milk thistle may have estrogen-like effects, which could exacerbate hormone-sensitive conditions including some types of breast cancer.

Conclusion

Milk thistle is a safe supplement that has potential as an adjunctive therapy for a variety of conditions including liver disease, cancer and diabetes.

However, many of the studies conducted with milk thistle had small numbers of subjects and methodological flaws, making it difficult to provide precise guidelines on the use of this supplement or to confirm its effects (26).

All in all, more high-quality research is needed to determine dosages and clinical effects of this fascinating medicinal plant.

References

1. https://www.ncbi.nlm.nih.gov/pubmed/28025940
2. https://www.ncbi.nlm.nih.gov/pubmed/23492971
3. https://www.ncbi.nlm.nih.gov/pubmed/24118806
4. https://www.ncbi.nlm.nih.gov/pubmed/19647779/
5. https://www.ncbi.nlm.nih.gov/pubmed/24866499
6. https://www.ncbi.nlm.nih.gov/pubmed/26881043
7. https://www.ncbi.nlm.nih.gov/pubmed/21071836
8. https://www.ncbi.nlm.nih.gov/pubmed/21185897
9. https://www.ncbi.nlm.nih.gov/pubmed/26881043
10. https://www.ncbi.nlm.nih.gov/pubmed/23781510
11. https://www.ncbi.nlm.nih.gov/pubmed/19577454
12. https://www.ncbi.nlm.nih.gov/pubmed/24093748
13. https://www.ncbi.nlm.nih.gov/pubmed/24354586
14. https://www.ncbi.nlm.nih.gov/pubmed/27517806
15. https://www.ncbi.nlm.nih.gov/pubmed/26858957
16. https://www.ncbi.nlm.nih.gov/pubmed/26510913
17. https://www.ncbi.nlm.nih.gov/pubmed/27517806
18. https://www.ncbi.nlm.nih.gov/pubmed/27557939
19. https://www.ncbi.nlm.nih.gov/pubmed/29190895
20. https://www.ncbi.nlm.nih.gov/pubmed/19260380
21. https://www.omicsonline.org/effects-of-oral-antioxidants-on-lesion-counts-associated-with-oxidative-stress-and-inflammation-in-patients-with-papulopustular-acne-2155-9554.1000163.php?aid=10078
22. https://www.ncbi.nlm.nih.gov/pubmed/25396404
23. https://www.ncbi.nlm.nih.gov/pubmed/27340676
24. https://www.ncbi.nlm.nih.gov/pubmed/20564545
25. https://www.ncbi.nlm.nih.gov/pubmed/21685957
26. https://www.ncbi.nlm.nih.gov/pubmed/24134155

The following side effects can occur with overdoses

Nausea, stomach pain, vomiting and headaches. To avoid these complications, it is recommended to follow the instructions of the respective product.

Further studies

1. J Chromatogr B Analyt Technol Biomed Life Sci. 2003 Sep 5;794(2):303-10. Application of liquid chromatography-electrospray ionization-ion trap mass spectrometry to investigate the metabolism of silibinin in human liver microsomes. Gunaratna C, Zhang T.
2. Phytother Res. 2004 Feb;18(2):107-10. Chemoprotective effect of plant phenolics against anthracycline-induced toxicity on rat cardiomyocytes. Part I. Silymarin and its flavonolignans. Chlopcikova S, Psotova J, Miketova P, Simanek V.
3. J Steroid Biochem Mol Biol. 2003 Aug;86(2):179-88. silymarin is a selective estrogen receptor beta (ERbeta) agonist and has estrogenic effects in the metaphysis of the femur but no or antiestrogenic effects in the uterus of ovariectomized (ovx) rats. Seidlova-Wuttke D, Becker T, Christoffel V, Jarry H, Wuttke W.
4. J Appl Toxicol. 2004 Jan-Feb;24(1):21-6. Protective effect of alpha-lipoic acid against chloroquine-induced hepatotoxicity in rats. Pari L, Murugavel P.
5. Toxicol Lett. 2003 Feb 3;137(3):201-12. Primary cultures of human hepatocytes as a tool in cytotoxicity studies: cell protection against model toxins by flavonolignans obtained from Silybum marianum. Dvorak Z, Kosina P, Walterova D, Simanek V, Bachleda P, Ulrichova J.
6. J Hepatol. 2003 Sep;39(3):333-40. silibinin protects mice from T cell-dependent liver injury. Schumann J, Prockl J, Kiemer AK, Vollmar AM, Bang R, Tiegs G.
7. Planta Med. 2003 Jan;69(1):44-9. Physiological responses of a natural antioxidant flavonoid mixture, silymarin, in BALB/c mice: III. Silymarin inhibits T-lymphocyte function at low doses but stimulates inflammatory processes at high doses. Johnson VJ, He Q, Osuchowski MF, Sharma RP.
8. Am J Med. 2002 Oct 15;113(6):506-15. Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Jacobs BP, Dennehy C, Ramirez G, Sapp J, Lawrence VA.
9. Toxicology. 2003 Sep 30;191(2-3):179-87. antioxidants protect primary rat hepatocyte cultures against acetaminophen-induced DNA strand breaks but not against acetaminophen-induced cytotoxicity. Lewerenz V, Hanelt S, Nastevska C, El-Bahay C, Rohrdanz E, Kahl R.
10. J Pharm Belg. 2003;58(1):28-31. [St. Mary's Thistle: an overview] [Article in French] Laekeman G, De Coster S, De Meyer K.
11. J Med Food. 2002 Winter;5(4):197-204. Influence of Piper betle on hepatic marker enzymes and tissue antioxidant status in ethanol-treated Wistar rats. Saravanan R, Prakasam A, Ramesh B, Pugalendi KV.
12. Methods Find Exp Clin Pharmacol. 2002 Oct;24(8):497-500. pyrogallol-induced hepatotoxicity in rats: a model to evaluate antioxidant hepatoprotective agents. Gupta YK, Sharma M, Chaudhary G.
13. Hepatol Res. 2003 Jul;26(3):217-224. Protection against post-ischemic mitochondrial injury in rat liver by silymarin or TUDC. Rolo AP, Oliveira PJ, Moreno AJ, Palmeira CM.
14. J Clin Gastroenterol. 2003 Oct;37(4):336-9. silymarin retards the progression of alcohol-induced hepatic fibrosis in baboons. Lieber CS, Leo MA, Cao Q, Ren C, DeCarli LM.
15. Dtsch Med Wochenschr. 2004 Jan 23;129(4):137-40. [The development of a toxic megacolon due to Amanita phalloides poisoning. A rare complication] [Article in German] Eyer F, Felgenhauer N, Zilker T.
16. Mol Cancer Ther. 2002 May;1(7):525-32. Inhibition of retinoblastoma protein (Rb) phosphorylation at serine sites and an increase in Rb-E2F complex formation by silibinin in androgen-dependent human prostate carcinoma LNCaP cells: role in prostate cancer prevention. Tyagi A, Agarwal C, Agarwal R.
17. Drugs. 2001;61(14):2035-63. The use of silymarin in the treatment of liver diseases. Saller R, Meier R, Brignoli R.
18. BioDrugs. 2001;15(7):465-89. silymarin: a review of its clinical properties in the management of hepatic disorders. Wellington K, Jarvis B.
19. Am J Gastroenterol. 2003 Mar;98(3):538-44. Medicinal herbs for hepatitis C virus infection: a Cochrane hepatobiliary systematic review of randomized trials. Liu J, Manheimer E, Tsutani K, Gluud C.
20. Curr Cancer Drug Targets. 2004 Feb;4(1):1-11. prostate cancer prevention by silibinin. Singh RP, Agarwal R.
21. Biochem Biophys Res Commun. 2003 Dec 26;312(4):1178-84. silibinin down-regulates survivin protein and mRNA expression and causes caspases activation and apoptosis in human bladder transitional-cell papilloma RT4 cells. Tyagi AK, Agarwal C, Singh RP, Shroyer KR, Glode LM, Agarwal R.
22. Oncogene. 2003 Nov 13;22(51):8271-82. silibinin upregulates the expression of cyclin-dependent kinase inhibitors and causes cell cycle arrest and apoptosis in human colon carcinoma HT-29 cells. Agarwal C, Singh RP, Dhanalakshmi S, Tyagi AK, Tecklenburg M, Sclafani RA, Agarwal R.
23. Carcinogenesis. 2004 Mar 19 [Epub ahead of print]. Silibinin prevents ultraviolet radiation-caused skin damage in SKH-1 hairless mice via a decrease in thymine dimer positive cells and an up-regulation of p53-p21/Cip1 in epidermis. Dhanalakshmi S, Mallikarjuna GU, Singh RP, Agarwal R.
24. Carcinogenesis. 2002 May;23(5):787-94. dietary silymarin suppresses 4-nitroquinoline 1-oxide-induced tongue carcinogenesis in male F344 rats. Yanaida Y, Kohno H, Yoshida K, Hirose Y, Yamada Y, Mori H, Tanaka T.
25. Oncol Rep. 2004 Feb;11(2):493-9. Synergistic anti-cancer effects of silibinin with conventional cytotoxic agents doxorubicin, cisplatin and carboplatin against human breast carcinoma MCF-7 and MDA-MB468 cells. Tyagi AK, Agarwal C, Chan DC, Agarwal R.
26. Cancer Biol Ther. 2003 Sep-Oct;2(5):526-31. epidermal growth factor receptor mediates silibinin-induced cytotoxicity in a rat glioma cell line. Qi L, Singh RP, Lu Y, Agarwal R, Harrison GS, Franzusoff A, Glode LM.
27. Anticancer Res. 2003 May-Jun;23(3B):2649-55. silibinin induces growth inhibition and apoptotic cell death in human lung carcinoma cells. Sharma G, Singh RP, Chan DC, Agarwal R.
28. Phytother Res. 2003 May;17(5):524-30. plasma lipoproteins in transport of silibinin, an antioxidant flavonolignan from Silybum marianum. Svagera Z, Skottova N, Vana P, Vecera R, Urbanek K, Belejova M, Kosina P, Simanek V.
29. Biochem Pharmacol. 2004 Jan 1;67(1):175-81. protection against lipopolysaccharide-induced sepsis and inhibition of interleukin-1beta and prostaglandin E2 synthesis by silymarin. Kang JS, Jeon YJ, Park SK, Yang KH, Kim HM.
30. Phytother Res. 2002 Mar;16 Suppl 1:S63-7. Influence of silymarin and its flavonolignans on doxorubicin-iron induced lipid peroxidation in rat heart microsomes and mitochondria in comparison with quercetin. Psotova J, Chlopcikova S, Grambal F, Simanek V, Ulrichova J.
31. Toxicol In Vitro. 2003 Aug;17(4):385-95. cytotoxicity of inorganic mercury in murine T and B lymphoma cell lines: involvement of reactive oxygen species, Ca(2+) homeostasis, and cytokine gene expression. Kim SH, Sharma RP.
32. Phytomedicine. 2000 Mar;7(1):21-4. Anti-inflammatory and anti-arthritic activities of silymarin acting through inhibition of 5-lipoxygenase. Gupta OP, Sing S, Bani S, Sharma N, Malhotra S, Gupta BD, Banerjee SK, Handa SS.
33. Phytother Res. 2002 Nov;16(7):632-8. Effect of silybin and its congeners on human liver microsomal cytochrome P450 activities. Zuber R, Modriansky M, Dvorak Z, Rohovsky P, Ulrichova J, Simanek V, Anzenbacher P.
34. FEBS Lett. 2003 Aug 28;550(1-3):89-93. silymarin inhibits TNF-alpha-induced expression of adhesion molecules in human umbilical vein endothelial cells. Kang JS, Park SK, Yang KH, Kim HM