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Head-to-head evidence comparison — which supplement is right for you?
Milk Thistle wins 1 of 3 categories. Both are solid choices — the best pick depends on your specific goals.
Verdict
Probably helps
9 of 13 studies with measurable effects showed benefit.
Top outcomes
Verdict
Likely helps
11 of 14 studies with measurable effects showed benefit.
Top outcomes
200-400mg silymarin (standardized extract)
With meals, Split into 2-3 doses
Standardized extract (70-80% silymarin)
100-200mg daily
Morning with food, Can be divided into two doses
Pycnogenol (standardized extract)
4-8 weeks
8-12 weeks
4 weeks
4-8 weeks
6-12 weeks
4-8 weeks
Initial use
Clinical Efficacy of Curcumin, Resveratrol, Silymarin, and Berberine on Cardio-Metabolic Risk Factors Among Patients With Type 2 Diabetes Mellitus: A Systemic Review and Bayesian Network Meta-Analysis
Phytotherapy research : PTR (2025) · Meta analysis · n=1337
For HbA1c, silymarin was more effective than resveratrol (MD -2.08, 95%Cl -3.50 to -0.72) (P < 0.05).
Effects of different natural products in patients with non-alcoholic fatty liver disease-A network meta-analysis of randomized controlled trials
Phytotherapy research : PTR (2024) · Meta analysis · n=2509
The results of the network meta-analysis showed that artichoke leaf extract confers a relative advantage in reducing the aspartate aminotransferase (AST) levels (SUCRA: 99.1%), alanine aminotransferase (ALT) levels (SUCRA: 88.2%) and low-density lipoprotein cholesterol (LDL-C) levels (SUCRA: 88.9%).
Are alterations needed in Silybum marianum (Silymarin) administration practices? A novel outlook and meta-analysis on randomized trials targeting liver injury
BMC complementary medicine and therapies (2025) · Meta analysis · n=3545
According to the findings of this meta-analysis silymarin administration showed a significant reduction in AST (SMD [95% CI]: - 0.670 [- 0.931, - 0.408], p-value = 0.000), and ALT (SMD [95% CI]: - 0.912 [- 1.177, - 0.646], p-value = 0.000) levels.
Phlebotonics for venous insufficiency
The Cochrane database of systematic reviews (2020) · Meta analysis · n=7690
Pooled data suggest that phlebotonics probably increase adverse events slightly, compared to placebo (RR 1.14, 95% CI 1.02 to 1.27; 37 studies; 5789 participants; moderate-certainty evidence).
Pine bark (Pinus spp.) extract for treating chronic disorders
The Cochrane database of systematic reviews (2020) · Meta analysis · n=1641
In a mixed group of participants with type 1 and type 2 DM we do not know whether pine bark extract decreases HbA1c (MD -0.20 %, 95% CI -1.83 to 1.43; one study; 67 participants; very low-certainty evidence).
Effect of pycnogenol supplementation on blood pressure: A systematic review and meta-analysis of clinical trials
Phytotherapy research : PTR (2020) · Meta analysis · n=922
Pooled analysis suggested that pycnogenol supplementation can reduced systolic blood pressure (SBP) of (-3.22 mmHg; 95% CI [-5.52, -0.92]) and diastolic blood pressure (DBP; -1.91 mmHg; 95% CI [-3.64, -0.18]).
Based on multiple meta-analyses showing significant ALT/AST reduction. Effect size modest (SMD -0.67 to -0.9). Effectiveness assumes standardized 80% silymarin extract. Lower bioavailability forms may require higher doses.
Based on meta-analyses showing modest reductions in systolic (-3.22 mmHg) and diastolic (-1.91 mmHg) blood pressure. Effects are clinically small and studies show heterogeneity.
AI-estimated from published studies. Interpret as directional guidance.
Milk Thistle has a higher evidence score (9/10 vs 9/10) and wins in 1 of 3 categories.
For reduce inflammation, Milk Thistle has a higher relevance score (95 vs 75).
No known interactions between Milk Thistle and Pine Bark Extract have been documented in our database. However, always consult a healthcare provider before combining supplements.