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Mth6.5
Milk Thistle Research
Likely helps
84 peer-reviewed studies
What the evidence says
Likely helps
Milk Thistle appears to help in 11 of 15 studies with measurable effects — the evidence leans clearly favourable.
Most evidence is from high-quality meta-analyses and randomised trials published 2001–2026 with a typical study size of 915 participants.
Based on 84 studies · 34 meta-analyses · 30 RCTs · 44,487 total participants
Confidence
High confidence
What the studies found
11helped3unclear1didn't help· 69 more without graded effect data
43 studies in the last 5 years · Latest meta-analysis: 2026
200120132026
1Hand-foot syndrome preventionMeta-Analysisn=2,192 · very large study2026
In this systematic review and network meta-analysis, diclofenac and silymarin were the most effective preventive strategies for HFS, with silymarin requiring confirmation in a larger randomized trial.
Registration Protocol available via doi.org/10.1002/14651858.CD015524.
Wang C, Shang Y, Kanaan G, Chai L, Li H, Qi X. · The Cochrane database of systematic reviews (2025)
Rationale Metabolic dysfunction-associated steatotic liver disease (MASLD) is a major public health challenge, with approximately 32.4% of adults globally diagnosed with the condition and a steadily increasing prevalence.
We calculated risk ratio (RR) for dichotomous data and mean difference (MD) for continuous data, both with 95% confidence intervals (CI).
For rare events, we used the Peto odds ratio (OR) and 95% CI.
3HbA1c reductionMeta-AnalysisCited 3×n=1,337 · large study2025
However, further validation of these findings is necessary through extensive clinical studies with larger sample sizes.
Miao R et al. · Phytotherapy research : PTR (2025)
Noticeable benefit
← WorseNo effectBetter →
Borderline
For HbA1c, silymarin was more effective than resveratrol (MD -2.08, 95%Cl -3.50 to -0.72) (P < 0.05).
For body mass index (BMI), curcumin was more effective than resveratrol (MD -1.27, 95%Cl -2.43 to -0.03) (P < 0.05).
Curcumin, resveratrol, silymarin, and berberine can effectively improve cardio-metabolic risk factors in T2DM, and different herbal phytochemicals have different clinical advantages.
4AST levels reductionMeta-AnalysisCited 3×n=3,545 · very large study2025
This meta-analysis examined the effects of Milk Thistle.
Shahsavari K et al. · BMC complementary medicine and therapies (2025)
Large benefit
← WorseNo effectBetter →
Likely real
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.
While it had no statistically significant effect on ALP level (SMD [95% CI]: - 0.236 [- 1.929, 1.458], p-value = 0.159).
The subgroup analysis was also showed significant decrease in AST and ALT levels for patients with BMI less than 30, while silymarin treatment had no significant effects on AST and ALT levels in patients with BMI ≥ 30.
5AST levels reductionMeta-AnalysisCited 7×n=2,509 · very large study2024
This study may help guide clinicians and lead to further detailed studies.
Liu H et al. · Phytotherapy research : PTR (2024)
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%).
Naringenin conferred an advantage in reducing triglyceride (TG) levels (SUCRA: 97.3%), total cholesterol (TC) levels (SUCRA: 73.9%), and improving high-density lipoprotein cholesterol (HDL-C) levels (SUCRA: 74.9%).
High-density catechins significantly reduced body mass index (BMI) levels (SUCRA: 98.5%) compared with the placebo.
6ALT levels reductionMeta-AnalysisCited 32×n=2,375 · very large study2024
Silymarin can regulate energy metabolism, attenuate liver damage, and improve liver histology in NAFLD patients.
Li S et al. · Annals of hepatology (2024)
Huge benefit
← WorseNo effectBetter →
In addition, silymarin attenuated liver injury as indicated by the decreased levels of ALT (SMD[95%CI]=-12.39[-19.69, -5.08]) and AST (SMD[95% CI]=-10.97[-15.51, -6.43]).
The levels of fatty liver index (SMD[95%CI]=-6.64[-10.59, -2.69]) and fatty liver score (SMD[95%CI]=-0.51[-0.69, -0.33]) were also decreased.
Liver histology of the intervention group revealed significantly improved hepatic steatosis (OR[95%CI]=3.25[1.80, 5.87]).
8Non-alcoholic fatty liver disease parametersMeta-AnalysisCited 64×n=2,173 · very large study2022
Based on current evidence, curcumin can reduce BMI, TG, TC, liver enzymes, and insulin resistance; catechin can reduce BMI, insulin resistance, and TG effectively; silymarin can reduce liver enzymes.
Yang K et al. · Frontiers in immunology (2022)
Based on current evidence, curcumin can reduce BMI, TG, TC, liver enzymes, and insulin resistance; catechin can reduce BMI, insulin resistance, and TG effectively; silymarin can reduce liver enzymes.
For resveratrol, naringenin, anthocyanin, hesperidin, and catechin, more RCTs are needed to further evaluate their efficacy and safety.
9Child-Pugh score improvementSystematic ReviewCited 2×n=613 · large study2023
However, due to the limited number of studies, further high-quality studies are warranted.
Amini S et al. · Phytotherapy research : PTR (2023)
An article including four patients investigated the effect of ginseng on cirrhosis; two patients reported improvement in the Child-Pugh score, and ascites decreased in two.
All studies included here reported no or negligible side effects.
Results showed that medicinal plants including silymarin, curcumin, and ginseng have beneficial effects on cirrhosis.
1050% decrease or normalisation of liver enzymesMeta-AnalysisCited 37×n=2,471 · very large study2021
In management RCTs, the efficacy parameter was usually 50 % decrease or normalisation of liver enzymes, or survival rate in DILI-related ALF patients.
Niu H et al. · Pharmacological research (2021)
In management RCTs, the efficacy parameter was usually 50 % decrease or normalisation of liver enzymes, or survival rate in DILI-related ALF patients.
In conclusion, heterogeneity among studies in DILI case qualification and methodologic quality was evident, and the RCTs performed demonstrated limited efficacy of specific interventions.
International research networks are needed to establish a framework on RCTs design and therapeutic endpoints.
12Liver enzyme levelsMeta-Analysisn=587 · large study2017
The results showed that SIL reduced the AST and ALT levels more significantly than the control group (AST UI/L: MD = -6.57; 95% CI, -10.03 to -3.12; P = .0002; ALT UI/L: MD = -9.16; 95% CI, -16.24 to -2.08; P = .01).
Zhong S et al. · Medicine (Baltimore) (2017)
Noticeable benefit
← WorseNo effectBetter →
The results showed that SIL reduced the AST and ALT levels more significantly than the control group (AST UI/L: MD = -6.57; 95% CI, -10.03 to -3.12; P = .0002; ALT UI/L: MD = -9.16; 95% CI, -16.24 to -2.08; P = .01).
Compared with other interventions, there were significant differences decreasing AST and ALT levels when SIL was used alone.
SIL has positive efficacy to reduce transaminases levels in NAFLD patients.
13ALT levelsMeta-AnalysisCited 5×n=549 · large study2022
We did not find any significant reduction in liver enzymes following BBR-silymarin consumption in adults.
Mohtashaminia F et al. · Clinical nutrition ESPEN (2022)
No clear effect
← WorseNo effectBetter →
Could be chance
Berberis aristate and Silybum marianum resulted in no statistically significant change in ALT (weighted mean differences (WMD): -0.39 mg/dl; 95% CI: -1.67 to 0.89, P = 0.55), and AST (WMD: -0.44 mg/dl; 95% CI: -2.02 to 1.14, P = 0.58).
We did not find any significant reduction in liver enzymes following BBR-silymarin consumption in adults.
Further clinical trials with high quality according to the challenges mentioned seem to be helpful to use BBR-silymarin as a supplement for improving liver function.
14Anti-tuberculosis drug-induced liver injuryMeta-AnalysisCited 31×n=1,198 · large study2019
Prophylactic therapy of silymarin is contributed to a noticeably reduced risk of development of anti-TB DILI four weeks after the initiation.
Tao L et al. · Canadian journal of gastroenterology & hepatology (2019)
Huge benefit
← WorseNo effectBetter →
Overall, silymarin significantly reduced the occurrence of anti-TB DILI at week 4 [RR: 0.33, 95% CI (0.15, 0.75)].
In addition, silymarin exerted protective effect on liver function in patients undergoing anti-TB drugs [SMD = - 0.15, 95% CI (-0.24, -0.07), P < 0.001 (ALT); SMD =-0.14, 95% CI (-0.23, -0.06), P = 0.001(AST); SMD =-0.12, 95% CI (-0.20, -0.03), P = 0.008 (ALP)].
Silymarin led to similar AEs in placebo groups [OR: 1.09, 95% CI (0.86, 1.39), P = 0.47].
15Lipid and glucose profileMeta-AnalysisCited 47×n=497 · medium study2019
The present findings suggest that the coadministration of berberine and silymarin is associated with an advantageous improvement in lipid and glucose profile, suggesting the possible use of this nutraceutical combination in order to promote the cardiometabolic health.
Fogacci F et al. · Phytotherapy research : PTR (2019)
Quantitative data synthesis was performed using a random-effects model.
We identified five eligible RCTs, with 497 subjects overall included.