Milk Thistle for Fatty Liver and Elevated Liver Enzymes: Useful or Cosmetic Fix?
A lower ALT feels like a success. Whether your liver is carrying less fat is a different question. Why milk thistle can be a passenger, but is not the one behind the wheel.
A fatty liver is rarely a liver problem that happens to show up in your metabolism. It is usually a metabolic problem that shows up in the liver. If you only treat the liver value, you turn down the smoke alarm. The fire is burning somewhere else.
You are sitting at your GP's office, and two lines on the printout are in bold. ALT elevated. GGT elevated. On the ultrasound: "Fatty liver, grade one to two." Then comes the sentence that sounds so harmless: "Try to watch your diet a little."
On the way home you stop at the pharmacy. And there it is, milk thistle. Purple flower, "for the liver," plant-based, well tolerated. Finally something you can do. I understand that reach very well. It comes from a real need: you want to act, not just wait.
And maybe your ALT is even lower at the next check. That would be nice. But then a question arises that hardly anyone asks: Is your liver healthier now, or has only the number become smaller?
That is exactly what this article is about. Not about talking milk thistle down. But about giving it the right place. If you are looking for the general part on detox promises and the death cap mushroom story, you will find it in the article Milk thistle and the liver: detox myth or real protection?. Here we look specifically at fatty liver and liver enzymes.
Why is fatty liver suddenly called MASLD?
May I ask you a question? If a disease was called "non-alcoholic" for decades, what does that actually say about it? Only what it is not. The name reveals nothing about the cause.
That is exactly what changed in 2023. And this change of name is more than cosmetics. It shifts the focus from the liver to the metabolism as a whole.
Rinella and a large international panel surveyed 236 experts and patient representatives from 56 countries over several rounds. The goal was a new, less stigmatizing name for fatty liver disease.
The result: NAFLD became MASLD, metabolic dysfunction-associated steatotic liver disease. The diagnosis requires fat in the liver plus at least one of five cardiometabolic risk factors.
What this means for you: fatty liver is now officially defined through metabolism. Blood sugar, waist circumference, blood pressure and blood lipids are part of the diagnosis.
Rinella ME, Lazarus JV, Ratziu V et al. J Hepatol. 2023;79(6):1542-1556. DOI: 10.1016/j.jhep.2023.06.003Imagine the liver as the storeroom of a restaurant. If more goods are delivered every day than the kitchen can process, at some point everything piles up in storage. The storeroom is not broken. The supply chain is off.
The new nomenclature also adds a second category: MetALD. It describes people in whom metabolic factors and elevated alcohol intake come together. That is honest, too. Because in everyday life the boundaries are rarely as clean as the old terms suggested.
Maybe you thought: I have a sick liver, so I need something for the liver.
A second perspective: your liver is showing you that your metabolism has been receiving more energy for a while than it can cleanly process. The liver is the messenger. The message concerns your whole body.
And now you know why fatty liver is so often about blood sugar and insulin, even though your report only mentions the liver.
How insulin resistance pushes fat into the liver
Do you know the feeling of crashing after lunch? Or that your belly is growing even though the scale barely moves? These are not character flaws. They can be early signs of a metabolism that is under pressure.
Insulin is like a doorman who lets sugar into your cells. With insulin resistance, the cells listen to it less. So the pancreas sends out more and more doormen. The insulin level rises, often for years, long before blood sugar looks abnormal.
Too much energy, too little use
Sugar, liquid fructose, large portions, little movement. The stores in muscle and liver fill up quickly.
Insulin stays high
The cells respond more weakly. The pancreas compensates with more insulin. A high level may drive new fat production in the liver.
Belly fat adds to the load
Enlarged visceral fat may release more free fatty acids, which flow through the portal vein directly to the liver.
Fat in the liver cell
The liver stores what it cannot burn or export. In some people this can lead to inflammation and later scarring.
Look at this chain through the four lenses of clinical psychoneuroimmunology. Then it becomes clear why a single liver herb can only reach a small part of it.
The energy balance
When mitochondria in muscle and liver cannot keep up, surplus energy gets parked as fat. Movement can make your muscles better consumers of sugar again.
Insulin and cortisol
Persistently high insulin may promote new fat production. Chronically elevated cortisol can raise blood sugar further and favor belly fat.
Silent inflammation
Overloaded liver cells and the liver's immune cells may release inflammatory messengers. This may favor the transition from simple fat accumulation to inflammation.
Sleep and stress
Short sleep and constant tension can shift hunger and satiety signals. When you are exhausted, you are more likely to reach for quick energy. That is biology, not a failure of willpower.
In 2024 the European societies for the liver, diabetes and obesity jointly published a guideline on MASLD. It summarizes definition, diagnostics and treatment.
At its center are lifestyle change with weight loss, nutrition, exercise and less alcohol, as well as good management of accompanying conditions. For type 2 diabetes or obesity it names incretin-based therapies where indicated. No medicinal plant appears as a treatment in the guideline's summary.
What this means for you: the guideline treats fatty liver as a metabolic disease. Starting there means working at the root.
EASL, EASD, EASO. J Hepatol. 2024;81(3):492-542. DOI: 10.1016/j.jhep.2024.04.031A fatty liver is not a verdict on your discipline. It is a measure of how long your metabolism has had to carry more than it can comfortably carry.
And that is good news. Because metabolism can be moved. The liver is one of the organs most likely to recover when conditions change.
And now you know why the most important question with fatty liver is not "What do I take for my liver?" but "What takes the load off my metabolism?"
What milk thistle shows for fatty liver in studies
Now it gets interesting. Because milk thistle is not a fantasy. Its standardized extract, silymarin, is one of the most frequently studied herbal remedies for liver disease. The only question is: what exactly improves?
For the Cochrane Collaboration, Wang and colleagues analyzed 17 randomized trials with 2,069 adults with MASLD. Treatment duration ranged from four to 48 weeks.
Silymarin alone might lower ALT by about 7.2 U/L compared with placebo, based on six trials with 409 people. The authors rated the certainty of this evidence as very low. No trial examined mortality or quality of life.
What this means for you: a small effect on a lab value is possible. Whether you feel better or stay healthy longer as a result simply was not measured.
Wang C, Shang Y, Kanaan G et al. Cochrane Database Syst Rev. 2025;6(6):CD015524. DOI: 10.1002/14651858.CD015524.pub2Kalopitas and a team from Thessaloniki pooled eight placebo-controlled trials on silymarin in fatty liver disease.
Transaminases fell more with silymarin than with placebo, independently of weight loss. At the same time, the authors pointed out clear quality shortcomings in the included trials.
What this means for you: the effect on liver enzymes appears to be real. Whether it also means an improvement in liver tissue remains open, according to the researchers.
Kalopitas G, Antza C, Doundoulakis I et al. Nutrition. 2021;83:111092. DOI: 10.1016/j.nut.2020.111092So much for the good news. Now come the studies that looked more closely, namely into the liver itself, by biopsy.
In Kuala Lumpur, Wah Kheong and colleagues treated 99 people with biopsy-confirmed fatty liver inflammation with silymarin or placebo for 48 weeks and then performed a second biopsy.
The primary endpoint, a clear reduction in the activity score, was reached by 32.7 percent with silymarin and 26.0 percent with placebo. The difference was not significant. Fibrosis, on the other hand, improved more often, 22.4 versus 6.0 percent.
What this means for you: a signal for scarring is interesting, but the researchers themselves called for a larger confirmatory trial. Inflammation as a whole did not improve measurably more than with placebo.
Wah Kheong C, Nik Mustapha NR, Mahadeva S. Clin Gastroenterol Hepatol. 2017;15(12):1940-1949. DOI: 10.1016/j.cgh.2017.04.016Navarro and a team at five US centers gave 78 people with fatty liver inflammation without cirrhosis two different, higher than usual amounts of silymarin or placebo for 48 weeks.
The primary endpoint was reached by 15 and 19 percent in the silymarin groups and 12 percent with placebo. Statistically, that was no difference. Tolerability was good.
What this means for you: even a higher dose brought no clear benefit in the tissue. The trial did have methodological problems, however, so the question is not considered conclusively answered.
Navarro VJ, Belle SH, D'Amato M et al. PLoS One. 2019;14(9):e0221683. DOI: 10.1371/journal.pone.0221683A liver value is a smoke alarm. If you turn it down, the fire is not automatically smaller. Sometimes it is. Sometimes not. That is why it pays to look beyond the number.
Cosmetic fix is a harsh phrase. I do not mean it disparagingly. A falling ALT can be a genuine sign of relief.
It only becomes cosmetic when the nicer number leads you to postpone the work on your metabolism. Then the plant soothes your conscience while the cause keeps running.
And now you know why, with milk thistle, I distinguish between "lab value improved" and "liver healthier." Those are two different promises.
Why milk thistle seems to achieve less with severe overweight
Here is a finding that made me thoughtful while researching. It fits the core idea of this article very closely.
Shahsavari and a team from Tehran and Mashhad analyzed 55 randomized trials with 3,545 people with liver injury of various causes.
Overall, AST and ALT fell with silymarin. In the subgroup with a BMI of 30 or above, however, there was no significant effect on these values. For alcohol-related and drug-induced liver injury, no significant effect was found either.
What this means for you: precisely where the metabolic load is greatest, the plant seems to move the least. That argues for reducing the load first.
Shahsavari K, Ardekani SS, Ardekani MRS et al. BMC Complement Med Ther. 2025;25(1):134. DOI: 10.1186/s12906-025-04886-yA subgroup analysis is not proof. It is a hint. But this hint is biologically plausible. Imagine trying to bail water out of a basement with a bucket while the pipe is still open. The bigger the leak, the less your bucket matters.
Another meta-analysis fits this picture. Zhang and colleagues compared 25 studies with 2,283 patients. ALT fell most clearly where silymarin was combined with lifestyle change. At the same time, mild side effects occurred more often with silymarin, mainly gastrointestinal complaints.
Zhang, Li and Sun analyzed silymarin alone and in combination with a Mediterranean diet, lifestyle change or medication in fatty liver disease.
The combination of silymarin and lifestyle change lowered ALT considerably, with a standardized mean difference of minus 0.88. The risk of side effects was roughly doubled with silymarin, relative risk 1.98.
What this means for you: the plant seems most useful as a companion to lifestyle change, not as a substitute for it.
Zhang Z, Li S, Sun J. Asia Pac J Clin Nutr. 2025;34(4):516-530. DOI: 10.6133/apjcn.202508_34(4).0003Milk thistle is a passenger. A good passenger can read the map, keep you awake and hand you water. Someone else still has to drive.
Behind the wheel with fatty liver are nutrition, movement, sleep, weight and, where necessary, medical treatment of diabetes or obesity.
And now you know why I think the question "Milk thistle, yes or no?" is too small. The better question is: "Milk thistle in addition to what?"
What can take the most load off the liver in fatty liver disease
Maybe you are feeling a little resistance right now. "Lose weight, move more, I know all that." Yes. And that is exactly why it is worth seeing how big this lever really is in numbers.
Vilar-Gomez and a team in Havana followed 293 people with biopsy-confirmed fatty liver inflammation for 52 weeks during a lifestyle change. At the end, a second biopsy was performed.
In 58 percent of those who lost at least 5 percent of their body weight, the inflammation regressed. With weight loss of 10 percent or more, this was the case in 90 percent, and in 45 percent even the fibrosis regressed.
What this means for you: no supplement has reached such numbers in liver tissue in the studies so far. Weight loss is the strongest known lever here.
Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L et al. Gastroenterology. 2015;149(2):367-378. DOI: 10.1053/j.gastro.2015.04.005Promrat and a team at Brown University randomly assigned 31 people with fatty liver inflammation to an intensive lifestyle group or a group receiving general education.
After 48 weeks, the lifestyle group had lost an average of 9.3 percent of body weight, the control group 0.2 percent. A clear improvement in tissue was reached by 72 versus 30 percent.
What this means for you: even single-digit percentage weight loss can measurably take load off the liver. It does not take a radical transformation.
Promrat K, Kleiner DE, Niemeier HM et al. Hepatology. 2010;51(1):121-129. DOI: 10.1002/hep.23276Working on the cause
- Weight loss, even 5 to 10 percent counts
- Less sugar and above all less liquid fructose
- Movement that turns muscles into sugar consumers
- Little to no alcohol
- Medical treatment of diabetes and obesity where necessary
Milk thistle
- May moderately lower ALT and AST
- Evidence very uncertain according to Cochrane
- No documented effect on inflammation in tissue
- Barely measurable effect at a BMI of 30 or above
- Well tolerated, but no substitute for working on the cause
You can find more on these levers in the articles on insulin resistance and weight loss, on sugar, fructose and liver metabolism and on fasting and blood sugar.
This is about more than a lab value. A metabolism that becomes flexible again can show up as more energy in the afternoon, calmer hunger and a body that feels like yours again.
Energy is not a luxury. Energy is freedom. The liver is often one of the first organs to follow along.
And now you know why, with fatty liver, I talk about your plate, movement and sleep first, and only then about a plant.
When milk thistle can make sense as a passenger
Does that mean milk thistle is pointless? No. It means it has a place that is smaller than its reputation and larger than zero.
A pattern I often see
I know this pattern very well: someone comes in with elevated liver enzymes and a pack of milk thistle in their bag. The liver values have dropped a little. No one has looked at waist circumference, fasting insulin or HbA1c yet.
In moments like these I try to honor both. The wish to do something. And the question of whether the direction is right. Often only a look at the metabolic values gives a complete picture. This is an observation from my work, not a study.
Mechanistically, silymarin is genuinely interesting. In cell and animal models it shows antioxidant and anti-inflammatory properties. In humans, however, this is not proven with regard to hard endpoints. What is documented so far is mainly a possible effect on liver enzymes.
Loguercio and an Italian team treated 179 people with fatty liver for twelve months with a complex of silybin, phosphatidylcholine and vitamin E or with placebo.
In the active group, liver enzymes, the insulin resistance index HOMA and histology improved. However, 41 participants dropped out early, and the analysis was per protocol only.
What this means for you: combination products might have an effect on metabolism. The Cochrane review, however, found no clear advantage for such complexes over placebo in liver enzymes.
Loguercio C, Andreone P, Brisc C et al. Free Radic Biol Med. 2012;52(9):1658-1665. DOI: 10.1016/j.freeradbiomed.2012.02.008Voroneanu and a team from Iasi pooled five randomized trials with 270 people with type 2 diabetes.
With silymarin, fasting blood sugar was on average 26.86 mg/dl lower and HbA1c 1.07 points lower. Because of low study quality and large differences between the trials, however, the authors explicitly made no recommendation.
What this means for you: an effect on blood sugar is conceivable, but not yet reliably established. It does not replace diabetes treatment.
Voroneanu L, Nistor I, Dumea R et al. J Diabetes Res. 2016;2016:5147468. DOI: 10.1155/2016/5147468| Situation | My assessment |
|---|---|
| You are actively working on nutrition, movement and weight | Milk thistle can make sense as a companion. The combination data point most in this direction. |
| You take milk thistle instead of changing your lifestyle | This is where a cosmetic fix looms. The lab value may fall, the cause remains. |
| You have type 2 diabetes or take blood sugar lowering medication | Only after discussing it with your doctor. A possible effect on blood sugar should be taken into account medically. |
| Pregnancy, breastfeeding, allergy to the daisy family | Caution. Reliable data are lacking, allergies are possible. |
| Significant fibrosis or cirrhosis | Belongs in hepatology care. A plant is not a treatment plan here. |
Preparation and bioavailability
A word on form. Milk thistle tea contains only a little silymarin, because the flavonolignans dissolve poorly in water. The studies used standardized extracts. A pharmacokinetic study by Schrieber and colleagues is interesting here: in people with fatty liver, blood levels of certain silymarin components were higher than in people with hepatitis C, and there were signs of a circulation between gut and liver.
Schrieber and a team from North Carolina compared how silymarin is distributed and broken down in the body in people with fatty liver and with chronic hepatitis C.
In fatty liver, plasma levels of silybin A and B tended to be higher, and those of the metabolized forms lower. An enterohepatic circulation appeared only in fatty liver.
What this means for you: how much active substance arrives also depends on the condition of the liver. That might explain why study results differ so much between diseases.
Schrieber SJ, Hawke RL, Wen Z et al. Drug Metab Dispos. 2011;39(12):2182-2190. DOI: 10.1124/dmd.111.040212The question is not whether milk thistle is good or bad. The question is what job you give it.
As a beacon of hope that takes the work off your hands, it will probably disappoint you. As a small companion on a path you are walking anyway, it can have its place.
And now you know why I neither demonize nor glorify milk thistle. It is a tool with a limited reach.
How you can tell whether your fatty liver is improving
If ALT is not the best compass, what is? A fair question. The European guideline recommends a stepwise approach.
Liver enzymes can also be within the normal range in fatty liver disease. So a normal ALT does not reliably rule out a fatty liver, and a lower ALT does not prove that there is less fat in the liver.
That is why the guideline first uses a blood-based score such as FIB-4 and then, if needed, a measurement of liver stiffness, for example by transient elastography. This makes it possible to estimate whether relevant scarring is already present.
Three levers you can work on this week
- Have your metabolism measured too. At your next blood test, ask for fasting blood sugar, HbA1c and blood lipids as well. Ask whether a FIB-4 score can be calculated. Measure your waist circumference yourself.
- Cut out liquid fructose. Soft drinks, juices and sweetened beverages are particularly taxing for the liver. Water, unsweetened tea and coffee without sugar are an easy first step.
- Move after meals. A walk of ten to fifteen minutes after your main meals can flatten the rise in blood sugar and put your muscles to work as sugar consumers.
If you are already taking milk thistle, you do not have to stop. Just see it for what it is according to current knowledge: a possible companion, not a substitute for the three levers above.
And now you know why the way out of fatty liver usually leads through metabolism, and why the liver often gratefully follows along.
Frequently asked questions about milk thistle for fatty liver
Can milk thistle reverse a fatty liver?
So far there is no solid evidence for that.
A 2025 Cochrane review of 17 randomized trials with 2,069 participants found that silymarin alone might lower ALT by about 7 U/L compared with placebo, but rated the certainty of this finding as very low. In two placebo-controlled trials with liver biopsy, silymarin missed its primary endpoint.
A fatty liver is a metabolic condition. So far, weight loss through lifestyle change has the largest documented effect on liver fat.
Can milk thistle lower elevated liver enzymes?
Yes, that is possible, but the effect is moderate and uncertain.
Several meta-analyses found lower ALT and AST values with silymarin, for example Kalopitas and colleagues with eight randomized trials. The 2025 Cochrane review estimated the difference in ALT at around 7 U/L, with very low certainty.
The context matters: a lower lab value does not automatically show that there is less fat in the liver or that inflammation in the tissue is decreasing.
What is MASLD and why does fatty liver have a new name?
MASLD stands for metabolic dysfunction-associated steatotic liver disease, meaning a fatty liver linked to metabolic disturbances.
In 2023 an international Delphi process with 236 experts from 56 countries replaced the old term NAFLD. The diagnosis requires fat in the liver plus at least one of five cardiometabolic risk factors, such as elevated blood sugar, excess abdominal weight, elevated blood pressure or unfavorable blood lipids.
The new name makes the core issue visible: metabolism, not just the liver.
Why does insulin resistance play such a big role in fatty liver?
When cells respond poorly to insulin, the pancreas releases more of it.
A persistently high insulin level may drive new fat production in the liver, and enlarged abdominal fat can also send more free fatty acids to the liver. This is how fat can accumulate in liver cells.
That is why the 2024 European guideline focuses on lifestyle, weight and the treatment of type 2 diabetes and obesity. The liver often signals what is out of balance in the metabolism as a whole.
How much weight do I need to lose for my fatty liver to improve?
Even moderate weight loss appears to make a big difference.
In a prospective study by Vilar-Gomez and colleagues with 293 people with biopsy-confirmed fatty liver inflammation, the inflammation regressed in 58 percent of those who lost at least 5 percent of their body weight. With at least 10 percent weight loss the figure was 90 percent, and in 45 percent even the fibrosis regressed.
These numbers apply to groups and are not a promise for any individual case.
Can milk thistle affect blood sugar?
There are hints, but on a weak basis.
A meta-analysis by Voroneanu and colleagues with five randomized trials and 270 people with type 2 diabetes found lower fasting blood sugar and HbA1c values with silymarin. However, the authors emphasized the low quality and high heterogeneity of the studies and explicitly made no recommendation.
Silymarin does not replace diabetes treatment. If you take blood sugar lowering medication, discuss any supplement with your doctor first.
Does milk thistle help with severe overweight?
This is exactly where the data are sobering.
A meta-analysis by Shahsavari and colleagues with 55 studies and 3,545 participants did find lower AST and ALT values with silymarin overall. In the subgroup with a BMI of 30 or more, however, there was no significant effect on these values.
This fits the core idea of this article: the heavier the metabolic load, the less a plant can achieve on its own.
Does milk thistle have side effects?
Silymarin is generally considered well tolerated.
The 2025 Cochrane review found no clear difference in serious adverse events compared with placebo. A meta-analysis by Zhang and colleagues did, however, find mild side effects more often, mainly gastrointestinal complaints.
If you are allergic to plants of the daisy family (Asteraceae), you should be careful. Reliable data for pregnancy and breastfeeding are lacking.
Are there interactions with medications?
Based on the clinical data so far, they appear to be smaller than often feared.
Kawaguchi-Suzuki and a team gave nine healthy volunteers a standardized milk thistle extract for 14 days. The activity of the enzymes CYP1A2, CYP2C9, CYP2D6 and CYP3A4/5 did not change.
The study was small, however, and conducted in healthy people. If you take medication long term, discuss any supplement with your doctor.
How can I tell whether my fatty liver is actually improving?
Not from ALT alone.
The 2024 European guideline recommends a stepwise approach: first a blood-based score such as FIB-4, then, if needed, a measurement of liver stiffness, for example with transient elastography. Waist circumference, weight, fasting blood sugar, HbA1c and blood lipids complete the picture.
When these metabolic markers improve, that is often more meaningful than a single liver value. Which test is right for you is best clarified with your doctor.
Further reading in the Medicinal Plants Guide
Related articles from this cluster
- Milk thistle and the liver: detox myth or real protection?
- Turmeric for inflammation: what curcumin can do and where the hype goes too far
- Curcumin bioavailability: why most turmeric capsules barely work
- Medicinal plants and the gut microbiome
- Bitter compounds: dandelion, artichoke and digestion
- Medicinal plants by infusion: what science shows and what it does not
- Adaptogens explained: what the term means
- All articles in the Medicinal Plants Guide
Related topics
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This articleInsulin resistance
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Liver
Phase I, phase II and what the liver does every day
Sources
- European Association for the Study of the Liver (EASL), European Association for the Study of Diabetes (EASD), European Association for the Study of Obesity (EASO). EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). J Hepatol. 2024;81(3):492-542. DOI: 10.1016/j.jhep.2024.04.031 [Guideline, review]
- Rinella ME, Lazarus JV, Ratziu V et al. A multisociety Delphi consensus statement on new fatty liver disease nomenclature. J Hepatol. 2023;79(6):1542-1556. DOI: 10.1016/j.jhep.2023.06.003 [Review, Delphi consensus, n=236 experts]
- Wang C, Shang Y, Kanaan G et al. Silymarin for adults with metabolic dysfunction-associated steatotic liver disease. Cochrane Database Syst Rev. 2025;6(6):CD015524. DOI: 10.1002/14651858.CD015524.pub2 [Systematic review, Cochrane, k=17 RCTs, n=2,069]
- Kalopitas G, Antza C, Doundoulakis I et al. Impact of Silymarin in individuals with nonalcoholic fatty liver disease: A systematic review and meta-analysis. Nutrition. 2021;83:111092. DOI: 10.1016/j.nut.2020.111092 [Meta-analysis, k=8 RCTs]
- Shahsavari K, Ardekani SS, Ardekani MRS et al. Are alterations needed in Silybum marianum (Silymarin) administration practices? A novel outlook and meta-analysis on randomized trials targeting liver injury. BMC Complement Med Ther. 2025;25(1):134. DOI: 10.1186/s12906-025-04886-y [Meta-analysis, k=55 studies, n=3,545]
- Zhang Z, Li S, Sun J. Efficacy of different interventions for nonalcoholic fatty liver disease: A meta-analysis of lifestyle modifications, silymarin, and medications. Asia Pac J Clin Nutr. 2025;34(4):516-530. DOI: 10.6133/apjcn.202508_34(4).0003 [Meta-analysis, k=25 studies, n=2,283]
- Wah Kheong C, Nik Mustapha NR, Mahadeva S. A Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol. 2017;15(12):1940-1949. DOI: 10.1016/j.cgh.2017.04.016 [RCT, double-blind, n=99, with biopsy]
- Navarro VJ, Belle SH, D'Amato M et al. Silymarin in non-cirrhotics with non-alcoholic steatohepatitis: A randomized, double-blind, placebo controlled trial. PLoS One. 2019;14(9):e0221683. DOI: 10.1371/journal.pone.0221683 [RCT, phase II, double-blind, n=78]
- Loguercio C, Andreone P, Brisc C et al. Silybin combined with phosphatidylcholine and vitamin E in patients with nonalcoholic fatty liver disease: a randomized controlled trial. Free Radic Biol Med. 2012;52(9):1658-1665. DOI: 10.1016/j.freeradbiomed.2012.02.008 [RCT, double-blind, n=179]
- Voroneanu L, Nistor I, Dumea R et al. Silymarin in Type 2 Diabetes Mellitus: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Diabetes Res. 2016;2016:5147468. DOI: 10.1155/2016/5147468 [Meta-analysis, k=5 RCTs, n=270]
- Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L et al. Weight Loss Through Lifestyle Modification Significantly Reduces Features of Nonalcoholic Steatohepatitis. Gastroenterology. 2015;149(2):367-378. DOI: 10.1053/j.gastro.2015.04.005 [Real-world, prospective cohort, n=293, with biopsy]
- Promrat K, Kleiner DE, Niemeier HM et al. Randomized controlled trial testing the effects of weight loss on nonalcoholic steatohepatitis. Hepatology. 2010;51(1):121-129. DOI: 10.1002/hep.23276 [RCT, n=31, with biopsy]
- Schrieber SJ, Hawke RL, Wen Z et al. Differences in the disposition of silymarin between patients with nonalcoholic fatty liver disease and chronic hepatitis C. Drug Metab Dispos. 2011;39(12):2182-2190. DOI: 10.1124/dmd.111.040212 [RCT, pharmacokinetics, phase I]
- Kawaguchi-Suzuki M, Frye RF, Zhu HJ et al. The effects of milk thistle (Silybum marianum) on human cytochrome P450 activity. Drug Metab Dispos. 2014;42(10):1611-1616. DOI: 10.1124/dmd.114.057232 [Real-world, clinical interaction study, n=9]