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Mth9.0
Milk Thistle Research
Probably helpsHigh safety
36 peer-reviewed studies
What the evidence says
Probably helps
Milk Thistle helped in about half (9/13) of the studies that measured an effect — promising, but not unanimous.
Most evidence is from high-quality meta-analyses and randomised trials published 2001–2026 with a typical study size of 915 participants.
Based on 36 studies · 24 meta-analyses · 3 RCTs · 39,244 total participants
Confidence
High
What the studies found
9helped3unclear1didn't help· 23 more without graded effect data
23 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.
2HbA1c 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.
3AST 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.
4AST 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.
5ALT 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]).
7Non-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.
8Child-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.
950% 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.
11Liver enzyme levelsMeta-AnalysisCited 4×n=1,031 · large study2021
Silymarin significantly improved liver enzyme levels and hepatic steatosis in NAFLD patients.
Zhong S et al. · Clinical Nutrition ESPEN (2021)
Noticeable benefit
← WorseNo effectBetter →
Silymarin reduced ALT by a weighted mean difference of -10.55 IU/L vs placebo
Significant improvements in hepatic steatosis on imaging
No significant differences in adverse events between silymarin and placebo groups
12ALT 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.
13Anti-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].
14Lipid 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.
Still, the inconsistent results across the included RCTs require further clinical research to establish optimal dosage and duration.
Ranneh Y et al. · Nutrients (2024)
Most studies on silymarin showed a reduction in liver enzymes and lipid profile; however, no changes were observed in inflammatory cytokine levels.
The dietary supplementation of hesperidin and naringenin or green tea extract caused improvements in liver enzyme, lipid profile, and inflammatory cytokine, while genistein supplementation did not modulate blood lipid profile.
In conclusion, dietary supplementation of polyphenols could potentially prevent and ameliorate NAFLD.
16Liver function markersMeta-AnalysisCited 18×2024
Additional high-quality RCTs with longer durations are required to determine the clinical efficacy of SIL supplementation on renal and oxidative stress markers.
Mohammadi S et al. · Phytotherapy research : PTR (2024)
In addition, there was a nonsignificant decrease in serum levels of gamma-glutamyl transferase, malondialdehyde (MDA), total bilirubin, albumin (Alb), total antioxidant capacity, and blood urea nitrogen.
Sub-group analyses revealed a considerable decline in MDA and Alb serum values among SIL-treated participants with liver disease in trials with a longer duration (≥12 weeks).
These findings suggest that SIL may ameliorate certain liver markers with potential hepatoprotective effects, specifically with long-term and high-dose supplementation.
17All-cause mortalityMeta-AnalysisCited 67×n=915 · large study2005
Based on high-quality trials, MT does not seem to significantly influence the course of patients with alcoholic and/or hepatitis B or C liver diseases.
Rambaldi A et al. · The American journal of gastroenterology (2005)
No clear effect
← WorseNo effectBetter →
The methodological quality was low: only 23% of the trials reported adequate allocation concealment and only 46% were considered double blind.
MT versus placebo or no intervention for a median duration of 6 months had no significant effects on all-cause mortality (relative risk (RR) 0.78, 95% confidence interval (CI) 0.53-1.15), complications of liver disease, or liver histology.
Liver-related mortality was significantly reduced by MT in all trials (RR 0.50, 95% CI 0.29-0.88), but not in high-quality trials (RR 0.57, 95% CI 0.28-1.19).
The results of the comprehensive analysis suggested hypoglycemic drug therapy as an effective intervention for NAFLD, with or without diabetes mellitus.
Wang Y et al. · Drugs (2024)
Huge harm
← WorseNo effectBetter →
Improvement of liver fibrosis stage (≥ 1) was observed with obeticholic acid 25 mg/day (OR 2.01, 95% CI 1.35-2.98), lanifibranor 1200 mg/day (OR 2.39, 95% CI 1.19-4.82) and silymarin (OR 4.54, 95% CI 1.18-17.43) in traditional meta-analysis.
The results of the comprehensive analysis suggested hypoglycemic drug therapy as an effective intervention for NAFLD, with or without diabetes mellitus.
A prioritized selection of TZDs, vitamin E plus pioglitazone, GLP-1 receptor agonists and FGF-21 analogue may be considered for NASH resolution.
19Inflammation and oxidative stress markersMeta-AnalysisCited 8×2024
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)
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.
20Glycemic controlMeta-AnalysisCited 65×n=270 · medium study2016
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)
Silymarin, an herbal drug with antioxidant and anti-inflammatory properties, may improve glycemic control and prevent the progression of the complications.
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.