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Mth6.5
Milk Thistle Research
Probably helps
86 peer-reviewed studies
What the evidence says
Likely helps
Milk Thistle appears to help in 5 of 7 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 1,088 participants.
Based on 86 studies · 29 meta-analyses · 33 RCTs · 35,753 total participants
Confidence
High confidence
What the studies found
5helped2unclear· 79 more without graded effect data
InflammationA meta-analysis of 15 RCTs found modest reductions in CRP and IL-6 with silymarin · 4-8 weeks
Too few graded studies3 studies
Women's health
Too few graded studies2 studies
Men's vitality
Too few graded studies2 studies
Heart & blood pressure
Too few graded studies1 study
Cognitive function
Too few graded studies1 study
By the numbers
Pulled from 34 studies with measurable effects
Likely real effects
50%
across studies
People studied
36k
typical study: 1088 people
Strongest designs
62
29 pooled, 33 randomised
Showed benefit
71%
5/7 studies
How long studies ran
1–4 weeks
1
1–3 months
1
3+ months
2
Populations Studied
Adults4
Patients with non-alcoholic fatty liver disease3
Patients with cirrhosis2
Cancer patients1
Active research area
48 studies in the last 5 years · Latest meta-analysis: 2026
200120132026
1Hand-foot syndrome preventionMeta-Analysis2026
In plain English: 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.
In plain English: The benefits and harms of silymarin in adults with MASLD are unclear.
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 4×n=1,337 · large study2025
In plain English: 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 →
Likely real
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 8×n=2,509 · very large study2024
In plain English: 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.
5ALT levels reductionMeta-AnalysisCited 35×n=2,375 · very large study2024
In plain English: 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]).
7Liver enzyme levelsMeta-AnalysisCited 73×n=587 · large study2017
In plain English: 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 →
Likely real
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.
8Serum transaminases (ALT and AST)Meta-AnalysisCited 51×2021
In plain English: Silymarin seems to be effective in reducing transaminase levels in individuals with NAFLD.
Kalopitas G et al. · Nutrition (Burbank, Los Angeles County, Calif.) (2021)
Eight randomized clinical trials comparing silymarin with placebo in people with NAFLD were included.
Silymarin treatment led to a statistically significant greater reduction in the levels of transaminases compared to placebo, irrespective of weight loss.
Despite the statistical benefits, the authors call attention to potential flaws related to the quality of the included studies.
1050% decrease or normalisation of liver enzymesMeta-AnalysisCited 43×n=3,268 · very large study2021
In plain English: Based on the scarce number of trials available, tested agents showed limited efficacy in DILI prevention and management and a favourable safety profile.
Niu H et al. · Pharmacological research (2021)
Overall, 22 RCTs were included: 12 on prevention (n = 2,471 patients) and 10 in management (n = 797) of drug-induced liver injury. Silymarin was tested in eight of them.
Based on the scarce number of trials available, tested agents showed limited efficacy in DILI prevention and management and a favourable safety profile.
In conclusion, heterogeneity among studies in DILI case qualification and methodologic quality was evident, and the RCTs performed demonstrated limited efficacy of specific interventions.
11Liver enzymes reductionMeta-AnalysisCited 72×n=2,173 · very large study2022
In plain English: 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.
Silymarin was effective in improving ALT and AST and reducing hepatic fat accumulation and liver stiffness in NAFLD patients.
For resveratrol, naringenin, anthocyanin, hesperidin, and catechin, more RCTs are needed to further evaluate their efficacy and safety.
12Lipid and glucose profileMeta-AnalysisCited 50×n=497 · medium study2019
In plain English: 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)
Five eligible RCTs with 497 subjects tested berberine and silymarin in combination, so the effects cannot be attributed to silymarin alone.
The combination lowered total cholesterol (MD -25.3 mg/dl, 95% CI -39.2 to -11.4), triglycerides (MD -28 mg/dl), LDL-C (MD -29.1 mg/dl) and fasting plasma glucose (MD -7.5 mg/dl, 95% CI -13 to -1.9), and raised HDL-C (MD 6 mg/dl).
13ALT levelsMeta-AnalysisCited 5×n=549 · large study2022
In plain English: 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 effectCombination product. Contains: berberis aristate, Silybum marianum
← 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 34×n=1,198 · large study2019
In plain English: 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].
19Inflammation and oxidative stress markersMeta-AnalysisCited 11×2024
In plain English: Silymarin can help reduce inflammation in patients with diabetes and thalassemia by reducing MDA as an oxidative stress marker and CRP and IL-6 as inflammatory markers.
Bahari H et al. · Inflammopharmacology (2024)
Fifteen RCTs were included in this meta-analysis.
Silymarin consumption significantly decreased CRP (WMD -0.50 mg/L; 95% CI -0.95 to -0.04), MDA (WMD -1.19 nmol/mL; 95% CI -1.99 to -0.38) and IL-6 (WMD -0.44 pg/ml; 95% CI -0.75 to -0.12).
Silymarin consumption had no significant effects on IL-10, TAC, and GSH.
20Glycemic controlMeta-AnalysisCited 66×n=270 · medium study2016
In plain English: However, being aware of the low quality of the available evidence and elevated heterogeneity of these studies, no recommendation can be made and further studies are needed.
Voroneanu L et al. · Journal of diabetes research (2016)
In five randomized controlled trials with 270 patients, silymarin significantly reduced fasting blood glucose (-26.86 mg/dL; 95% CI -35.42 to -18.30) and HbA1c (-1.07; 95% CI -1.73 to -0.40) and had no effect on the lipid profile.
Benefits for silymarin on proteinuria and CKD progressions are reported in only one small study and are uncertain.
However, being aware of the low quality of the available evidence and elevated heterogeneity of these studies, no recommendation can be made and further studies are needed.