Milk Thistle: Can It Help Fatty Liver?

Early American colonists valued milk thistle (Silybum marianum) so much they brought the plants with them from Europe. Milk thistle’s been used for more than 2,000 years to increase production of breast milk in women and to ease liver problems. Today, herbal supplements are made from milk thistle seeds and their active ingredient. While it's commonly taken as a capsule or tablet, you can also find milk thistle as a tea or extract. Always talk to your doctor before starting any supplement.

The active ingredients in milk thistle, silymarin and silybin, may help your liver in three ways. The first is by reducing inflammation. A review of 41 studies shows silymarin decreased liver enzymes. The second is by acting as an antioxidant, which protects liver cells from damage. The third is preventing fibrosis, decreasing the risk of cirrhosis. These actions could help fatty liver caused by obesity, diabetes, or high cholesterol, like metabolic dysfunction-associated steatotic liver disease (MASLD). 

Silymarin from milk thistle may help conditions that contribute to fatty liver, such as obesity, diabetes, and high cholesterol. A small study of people using silymarin for at least four months showed decreased blood sugar and hemoglobin A1c levels. The people in that study also had lower total cholesterol, LDL cholesterol, and triglycerides. Another study of a compound containing silymarin showed improvements in obesity: reduced waist size, lower cortisol level, and decreased liver enzymes.

Combining lifestyle changes with milk thistle may reverse fatty liver. If you’re overweight, losing weight greatly helps fatty liver disease. Even losing 5%-10% of your body weight can significantly reduce liver fat. Getting regular exercise and eating foods low in sugar, refined carbs, and saturated fats may help you lose some weight. Those changes also help improve liver enzymes, cholesterol, and diabetes. Fatty liver and diabetes often go hand-in-hand. Managing diabetes helps your liver. Improving your liver helps control diabetes. 

If you decide to try milk thistle after talking with your doctor, a typical daily dose is 420 milligrams of silymarin, divided into two or three doses. Look for extracts that contain 70%-80% silymarin. Milk thistle supplements may cause GI issues like nausea, vomiting, or constipation. It may help to take it with food. Taking it with food may also improve absorption. Be patient — herbal remedies often need several months to show effects.

Milk thistle is generally considered safe for most people when taken by mouth in appropriate doses. Common side effects may include stomach upset, diarrhea, nausea, or allergic reactions, especially if you're allergic to plants in the same family (like ragweed or daisies). Start with lower doses and increase gradually to reduce side effects. 

Be cautious with milk thistle if you're pregnant, breastfeeding, or have hormone-sensitive conditions (like breast cancer). It may interact with certain drugs including some antibiotics, anxiety medications, and blood thinners. If you’re taking medications that affect your liver enzymes, talk to your doctor before taking milk thistle. Always tell your doctor about all supplements you're taking.

Milk thistle supplements can be found at national drugstores and grocery chains. They can also be purchased online. The cost varies depending on the number of doses in the bottle, but it ranges from $20 to $50. Remember that the FDA doesn’t approve supplements. Your best bet is to choose supplements that have been tested by a third party, like USP or NSF.

Milk thistle may offer some benefits for fatty liver disease, but it's not a miracle cure. Consider it a potential complementary approach alongside treatments your doctor recommends. Focus on proven strategies like weight management, healthy eating, and exercise. Always talk to your doctor before starting a supplement.