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Section Contents:<a name="top"></a> - Exploratory meta-analyses generally showed positive but small and nonsignificant effect sizes and a sprinkling of significant positive effects.<a href="#hdng0">(More...)</a>
- Sixteen prospective trials were identified.<a href="#hdng1">(More...)</a>
<a name="hdng0"></a> Exploratory meta-analyses generally showed positive but small and nonsignificant effect sizes and a sprinkling of significant positive effects. No studies were identified regarding milk thistle and cholestatic liver disease or primary hepatic malignancy. Available evidence does not establish whether effectiveness of milk thistle varies across preparations. One Phase II trial suggested that effectiveness may vary with dose of milk thistle. <a href=" http://www.ahrq.gov/clinic/epcsums/milktsum.htm" TARGET="_blank" [1]</a> Reduce mortality or morbidity, or improve the quality of life in adults with alcohol-related, toxin-induced, or drug-induced liver disease, viral hepatitis, cholestasis, or primary hepatic malignancy. One question addresses the constituents of commonly available milk thistle preparations, and three questions address the common and uncommon symptomatic adverse effects of milk thistle.<a href=" http://www.ahrq.gov/clinic/epcsums/milktsum.htm" TARGET="_blank" [1]</a> Evidence exists that milk thistle may be hepatoprotective through a number of mechanisms: antioxidant activity, toxin blockade at the membrane level, enhanced protein synthesis, antifibriotic activity, and possible anti-inflammatory or immunomodulating effects. The largest producer of milk thistle is Madaus (Germany), which makes an extract of concentrated silymarin.<a href=" http://www.ahrq.gov/clinic/epcsums/milktsum.htm" TARGET="_blank" [1]</a> Attention to specific study populations (e.g., patients with hepatitis B virus, or hepatitis C virus, or mixed infection or coinfection with human immunodeficiency virus ), comorbidities, alcohol consumption, and potential confounders. There also should be detailed attention to preparation, standardization, and bioavailability of different formulations of milk thistle (e.g., standardized silymarin extract and silybin-phosphatidylcholine complex).<a href=" http://www.ahrq.gov/clinic/epcsums/milktsum.htm" TARGET="_blank" [1]</a> Agency for Healthcare Research and Quality. Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects <a href=" http://www.ahrq.gov/clinic/epcsums/milktsum.htm"> Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects</a>.<a href="http://nccam.nih.gov/health/milkthistle/" TARGET="_blank" [2]</a> Milk thistle is believed to have protective effects on the liver and improve its function. It is typically used to treat liver cirrhosis, chronic hepatitis (liver inflammation), and gallbladder disorders.<a href="http://nccam.nih.gov/health/milkthistle/" TARGET="_blank" [2]</a> Silymarin, which can be extracted from the seeds (fruit) of the milk thistle plant, is believed to be the biologically active part of the herb.<a href="http://nccam.nih.gov/health/milkthistle/" TARGET="_blank" [2]</a>
Occasionally, people report a laxative effect, upset stomach, diarrhea, and bloating. Milk thistle can produce allergic reactions, which tend to be more common among people who are allergic to plants in the same family (for example, ragweed, chrysanthemum, marigold, and daisy).<a href="http://nccam.nih.gov/health/milkthistle/" TARGET="_blank" [2]</a> Accessed on July 3, 2007. Milk thistle ( Silybum marianum ), silymarin.<a href="http://nccam.nih.gov/health/milkthistle/" TARGET="_blank" [2]</a> Rockville, MD: Agency for Healthcare Research and Quality; 2000. 01-E024. Milk thistle ( Silybum marianum ).<a href="http://nccam.nih.gov/health/milkthistle/" TARGET="_blank" [2]</a> A plant that has been used in some cultures to treat certain medical problems, including stomach, liver, and gallbladder disorders. The active extract of milk thistle seeds is called silymarin. It is being studied in the prevention of liver damage caused by some cancer treatments.<a href="http://www.cancer.gov/templates/db_alpha.aspx?CdrID=305993" TARGET="_blank" [3]</a> Pastures are invaded from roadside populations, ditches, and disturbed areas. Geographic Distribution : Milk thistle is native to the Mediterranean region of Europe. History : Milk thistle was listed on the first South Australia noxious weed list of 1851.<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> The seeds do have a tuft of minutely barbed bristles, which is deciduous, and falls off in a ring when the seeds mature. Economic Importance : Detrimental : Considered toxic to livestock, the bigger concern of milk thistle is the establishment in rangeland or pastures with dense stands displacing native or beneficial forage species. Dense, established milk thistle stands in California produce 1.4 million viable seeds per acre and four tons of vegetation per acre (Roche' 1991).<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Practices include establishment of perennial pasture species, slashing/mowing, goats as initial grazers, herbicides when necessary, and grazing management. Thistles are the most susceptible to control during the seedling stage, or as they grow from the seedling stage to the rosette state. Goats will graze milk thistle. Less than one percent of seeds passed through their digestive tract, and none of those germinated (as cited in Sindel 1991).<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Heavy infestations limit the movement of livestock and prevents access to water. Low weed densities are able to displace a high number of pasture plants, as the rosette of a milk thistle plant can reach three feet in diameter (Sindel 1991). Milk thistle is an established weed in Canada, southwestern Oregon, California, Texas, and Nebraska. Milk thistle has escaped cultivation in central Texas to infest over 200,000 acres in three counties.<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> The main stem is stout, ridged, and branching, and the overall plant size can range from two to six feet tall. A distinguishing characteristic of milk thistle is the white patches, or marbling found along the veins of the dark green leaves.<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Young, J.A, Evans, R.A. and Hawkes, R.B. 1978. Milk thistle ( Silybum marianum ) seed germination.<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Coombs, E., C. Turner, and N. Rees. 1995. Milk thistle Silybum marianum.<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Description and Variation : Milk thistle is described as an annual, winter annual, and biennial herb. It is an annual in its native range.<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Strong vegetative growth and allelopathy during germination could account for the dense, monospecific stands (as cited in Gabay et al. 1994). Reproduction : Milk thistle reproduces by seed.<a href="http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Two trials included patients with alcoholic or nonalcoholic cirrhosis. The milk thistle arms showed a trend toward improved survival in one trial and significantly improved survival for subgroups with alcoholic cirrhosis or Child's Group A severity. The second study reported no significant improvement in laboratory measures and survival for other clinical subgroups, but no data were given.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a> The two studies of chronic viral hepatitis differed markedly in duration of therapy (7 days and 1 year). The shorter study showed improvement in aminotransferases for milk thistle compared with placebo but not other laboratory measures. In the longer study, milk thistle was associated with a nonsignificant trend toward histologic improvement, the only outcome measure reported.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a>
In one additional placebo-controlled trial, blinding or randomization was not clear, and one placebo-controlled study was a cohort study with a placebo comparison group. Seventeen additional trials used nonplacebo controls; two other trials studied milk thistle as prophylaxis in patients with no known liver disease who were starting potentially hepatotoxic drugs.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a> Interpretation of the evidence is hampered by poor study methods and/or poor quality of reporting in publications. Problems in study design include heterogeneity in etiology and extent of liver disease, small sample sizes, and variation in formulation, dosing, and duration of milk thistle therapy.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a> The identified studies addressed alcohol-related liver disease, toxin-induced liver disease, and viral liver disease. No studies were found that evaluated milk thistle for cholestatic liver disease or primary hepatic malignancy (hepatocellular carcinoma, cholangiocarcinoma).<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a> Further mechanistic investigations are needed and should be considered before, or in concert with, studies of clinical effectiveness. More information is needed about effectiveness of milk thistle for severe acute ingestion of hepatotoxins, such as occupational exposures, acetaminophen overdose, and amanita poisoning.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a> Causality is rarely addressed in available reports. For randomized trials reporting adverse effects, incidence was approximately equal in milk thistle and control groups. Clinical efficacy of milk thistle is not clearly established.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a> Two studies indicated a possible survival benefit. Three placebo-controlled studies evaluated milk thistle for viral hepatitis.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a> Selection Criteria. Selection criteria regarding efficacy were placebo-controlled trials of milk thistle.<a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a>
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<a name="hdng1"></a>Sixteen prospective trials were identified. Fourteen were randomized, blinded, placebo-controlled studies of milk thistle's effectiveness in a variety of liver diseases. <a href="http://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1.chapter.29128" TARGET="_blank" [5]</a>
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Section Contents:<a name="top"></a> - Unopened, fully formed flower buds will produce seeds if left attached to the plant (Sindel 1991).<a href="#hdng2">(More...)</a>
<a name="hdng2"></a> Unopened, fully formed flower buds will produce seeds if left attached to the plant (Sindel 1991). Response to Herbicide : Annual thistles are most susceptible to chemical control in the fall. Biennial thistles are most susceptible to control in the early spring, in the rosette stage, although the rosettes may cover some seedlings (Hodge 1970 and cited in Sindel 1991). <a href=" http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> For specific chemical control recommendations, refer to the Pacific Northwest Weed Control Handbook, updated annually (William et al. 1998). Response to Cultural Methods : An integrated pasture management approach is effective in thistle control.<a href=" http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Sindel, B.M. 1991. A review of the ecology and control of thistles in Australia.<a href=" http://www.nwcb.wa.gov/weed_info/Silybum_marianum.html" TARGET="_blank" [4]</a> Mowing should also be timed to occur just prior to flowering. These biological control agents aid in reducing populations of the thistle. In areas of Missouri where the weevils have been present for the longest period of time (1976-1992), an 80-90% reduction in thistle population has occurred. These weevils are increasing and dispersing naturally. They have also been collected for recolonization throughout the state.<a href=" http://mdc.mo.gov/nathis/exotic/vegman/eighteen.htm" TARGET="_blank" [6]</a> Recent recolonizations of the rosette weevil (1990-1992) have been made in 13 additional counties. An integrated pest management system has been developed utilizing knowledge of thistle and weevil life cycles. This program encourages survival of the weevils through a harmonious use of herbicides and mechanical control methods.<a href=" http://mdc.mo.gov/nathis/exotic/vegman/eighteen.htm" TARGET="_blank" [6]</a> Damage to cool-season grasses was reported in a study using higher concentrations of picloram (1 lb per acre). Mowing, brushhogging, and spraying when thistles are in full bloom is ineffective. Cutting the stems does not kill the plant at this stage.<a href=" http://mdc.mo.gov/nathis/exotic/vegman/eighteen.htm" TARGET="_blank" [6]</a> Rotationally grazed or deferred pasture is less susceptible to infestation than heavily grazed pastures. Although some investigators report thistle populations declined rapidly as natural succession proceeded, others report populations that persisted for twelve years in an unmanaged area.<a href=" http://mdc.mo.gov/nathis/exotic/vegman/eighteen.htm" TARGET="_blank" [6]</a> A Virginia study found that treatment with 2,4-D did not adversely affect either Rhinocyllus conicus or Trichosirocalus horridu s. Chemical control of all types is most effective in the rosette stage and least effective when musk thistle is in flower.<a href=" http://mdc.mo.gov/nathis/exotic/vegman/eighteen.htm" TARGET="_blank" [6]</a> <a href="#top"><img alt="Back to Top" title="Back to Top" src=" " style="border: 0px solid ; width: 72px; height: 14px;"></a>
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