Cases in CAM: Milk Thistle for the Liver -- Any Evidence?

Désirée Lie, MD, MSEd

Disclosures

March 02, 2010

Case Response

Although Mr. Y showed no physical signs or biochemical evidence of alcoholic liver damage at the time of initial presentation, he is at risk for chronic liver disease if his drinking pattern persists or escalates. Because he is motivated to change his approach to drinking, this is an ideal opportunity to move him from 'contemplation' to 'action' on the Prochaska cycle of motivation.[27] His girlfriend could be involved in his future care, and the partnership will help provide the incentives to move him along in small steps to achieve his goal. Since adverse effects of milk thistle are minimal, he may choose it as a supplement to prevent acute alcoholic liver damage during follow-up. When advising Mr. Y, however, the clinician should stress that the evidence for milk thistle's benefits derive from studies on acute viral hepatitis and chronic cirrhosis, and not acute alcohol-induced hepatitis.

There is currently no evidence for a preventive role against liver damage for milk thistle, and using milk thistle is not a substitute for medical care. Follow-up of Mr. Y is essential to ensure progression to abstinence or control of alcohol intake.

The potential for protection against photoaging may be mentioned as a possible benefit of topical milk thistle, although the evidence is preliminary and based mainly on animal studies. Providing the source of evidence for a dermatologic role for milk thistle would be prudent.[17]

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