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regulates · 1
In cell and animal studies, silybin partly restores depleted glutathione; but after it is swallowed, very little reaches the blood, and most of what does is in conjugated form, so whether this step can happen in a person is an open question.
contrast · 8
Milk thistle is the most common ingredient in liver-support pills, but the liver's two-step process for clearing foreign substances (phase I and phase II metabolism) runs all the time anyway; pooled randomized trials found no effect of milk thistle on death or complications in people with liver disease.
No herb has been shown to clear the hepatitis B virus; pooling randomized trials in alcoholic liver disease and in hepatitis B and C liver disease, milk thistle had no significant effect on death or complications.
In a trial of 99 people with steatohepatitis (fatty liver with inflammation) that judged its results by liver biopsy, silymarin at 700 mg three times a day for 48 weeks missed its primary endpoint; the improvement in fibrosis score was only a secondary finding.
Milk thistle is often treated as permission to keep drinking, yet in alcoholic liver disease it had no significant effect on death or complications; what changes the outcome is drinking less or not at all, which lightens the liver's load of breaking down alcohol.
Both are sold as liver supplements, yet the clinical uses that actually hold up for both are intravenous and in the emergency department: intravenous silibinin for death cap mushroom poisoning (supported by observational case series) and intravenous N-acetylcysteine for acetaminophen overdose, not the oral doses on the shelf.
The two face the same problem: both act in a dish, but after being swallowed they are poorly absorbed and quickly conjugated by phase II metabolism, so the active form left in the blood is far below the concentrations used in experiments.
Two examples of one pattern: early small trials looked positive, and the effect disappeared once larger, stricter randomized trials were done. For saw palmetto that means the STEP and CAMUS trials plus an updated Cochrane review; for milk thistle, a Cochrane review that found no effect on death or complications.
The two ends of herbal safety: in LiverTox, the US database on drug-induced liver injury, milk thistle's likelihood of causing liver injury is rated E (unlikely), while Polygonum multiflorum (he shou wu) is rated A (a well-established cause), with about one in ten clinically apparent cases fatal or needing an urgent liver transplant. Being natural makes something neither safe nor dangerous by itself.