Wednesday, October 29, 2014

Wisdom Wednesday: Milk Thistle

Milk Thistle or silymarin is considered to be both hepatoprotective and hepatic trophorestorative. That is it protects and restores liver cells. I have used it for many years to treat various forms of hepatitis.

Hepatitis C often goes undiagnosed until someone has their liver enzymes checked for a routine physical or insurance quote and they come back slightly elevated. The SGPT and SGOT are liver enzymes that are released in the blood stream as liver cells die. When liver cell death is accelerated, the enzymes rise in the blood stream.

In active hepatitis, the enzymes can elevate ten to fifty times the medical norms. However, after the acute infection passes, the enzymes tend to stay just a few points above medical norms. This chronic, accelerated liver cell death can go on for 20 years or more. Then, without warning, the liver will fail. These patients require a liver transport or face certain death.

Milk thistle is extremely effective in bringing the liver enzymes back within medical norms. I have several patients with a history of hepatitis. We monitor their liver enzymes periodically. Every couple of years, the enzymes will start to creep back up again. A three month course of silymarin generally brings the enzymes back within the normal range.

Lecithin or phosphatidylcholine is also effective at lowering liver enzymes. However, research has shown that combining lecithin with silymarin is more effective than using the products individually. In addition to helping the liver heal, lecithin binds to silymarin holding it in the liver for a longer period of time thus amplifying the benefit. Lecithin is also very effective at raising the HDL cholesterol, improving the HDL/total cholesterol ratio.

There are some drug interaction issues with silymarin. It enhances the cytochrome P-450 pathways of phase one liver detoxification. Several common prescription drugs are eliminated through this pathway. Coumadin (Warfarin) and the proteases used to treat HIV/Aids are among the drugs in that list. The use of silymarin is contraindicated in these cases as it will eliminate the drug completely from the body before it has time to alter body chemistry.

Good quality extracts of milk thistle contain up to 80% flavanolignans, such as silybin, silychristin, and silydianin (collectively described at silymarin). Standardized or quantified extracts of milk thistle are often express the level of flavanolignans as “calculated as silybin.” I use a 1:1 extract that provides 125mg of flavanolignans from 5g of herb in 5ml of liquid. This can also be dried and compressed into tablet form for ease of ingestion without any loss of potency.

Milk thistle is safe for use in both pregnancy and lactation. In less than 1% of patients, some mild gastrointestinal complaints have been noted, most commonly a mild laxative effect. Silymarin is often combined with coleus forte for use as a laxative.

Alcohol abuse is another common cause of liver damage. Alcohol has to be processed through both phase 1 and phase 2 liver detoxification. Excess intake increases liver cell death and results in fatty infiltration into the liver. Milk thistle can reverse this fatty infiltration. However, once the liver becomes scarred (cirrhosis), the changes are permanent.

NASH (non-alcoholic steratohepatitis) is fast becoming a common disease in the US. Fat infiltrates the liver as liver cells die, just as it does in alcoholics. However, in NASH there is no history of alcohol abuse. It is believed this condition is the result of environmental pollution. I suspect the vast number of artificial chemicals that must pass through both phases of liver detoxification are to blame. This includes most prescription drugs. The average American takes four prescription drugs daily in addition to several OTC (over-the-counter) drugs. Although NASH also responds favorably to milk thistle and lecithin, you must stop the ongoing contamination of the body for any lasting results, just like an alcoholic.

Milk thistle and lecithin are very effective tools for healing the liver. However, you must use a good quality botanical and eliminate the source of liver damage.

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