Milk Thistle (Silymarin) and liver
What 6 graded rows on milk thistle (silymarin) agree on for liver, and where they differ. Counted side by side, never averaged.
Consensus finder Rows from the Milk Thistle (Silymarin) page, reviewed Oct 21, 2026 How it decides
What the rows agree on
Each block and row is one graded row from the Milk Thistle (Silymarin) page, with its PubMed record.
Your question
Milk Thistle (Silymarin) and liver
6 rows · 2,415 peopleSplit. 2 rows found an improvement, 3 found no difference and 1 had mixed results.
- CGrade C× 5
- ∅No effect× 1
- Rows
- 6
- Trials
- 35
- People
- 2,415
- Pooled reviews may count some twice
Where they differ
From the rowsThe best-graded row, grade C, is a systematic review of 1,088 people (2007) and found no difference. 1 row is graded No effect, our grade for adequately powered trials that found no effect.
The 2 rows that found an improvement were larger: a median of 498 people, against a median of 154 people for the 3 rows that found no difference.
1 row with mixed results is left out of this comparison.
The rows
2 improved · 3 no difference · 1 mixed- CGrade CMortality and complications in alcohol-related or hepatitis B/C liver disease · No difference
Systematic review, 18 studies · n 1,088 · 2007 · People with alcoholic and/or viral liver disease
Varied across trials · Varied across trials
No significant effect on all-cause mortality (RR 0.78), complications or histology; liver-related mortality was lower across all trials but not in the high-quality trials.
Row on the Milk Thistle (Silymarin) page · PubMed 17943794 (opens PubMed)
- CGrade CLiver histology in NASH without cirrhosis · No difference
RCT · n 78 · 2019 · Adults with NASH (US, 5 centres)
420 or 700 mg three times a day · 48 weeks
Histological improvement in 15% (700 mg), 19% (420 mg) and 12% (placebo); no significant difference. Well tolerated.
Row on the Milk Thistle (Silymarin) page · PubMed 31536511 (opens PubMed)
- ∅No effectALT in chronic hepatitis C after failed interferon · No difference
RCT · n 154 · 2012 · Adults with chronic hepatitis C and raised ALT
420 or 700 mg three times a day · 24 weeks
Only 2 people per group met the ALT goal; no difference in ALT, viral load or quality of life. Side effects matched placebo.
Row on the Milk Thistle (Silymarin) page · PubMed 22797645 (opens PubMed)
- CGrade CLiver enzymes (ALT, AST) in fatty liver disease · Improved
Meta-analysis, 8 studies · n 587 · 2017 · Adults with nonalcoholic fatty liver disease
Varied across trials · Varied across trials
AST −6.57 U/L and ALT −9.16 U/L versus control.
Row on the Milk Thistle (Silymarin) page · PubMed 29245314 (opens PubMed)
- CGrade CLiver enzymes and safety in fatty liver disease (MASLD) · Improved
Meta-analysis, 6 studies · n 409 · 2025 · Adults with metabolic dysfunction-associated steatotic liver disease (17 RCTs, 2,069 people in total; 12 in Asia)
Varied across trials · 4 to 48 weeks
Silymarin alone versus placebo or no treatment: ALT −7.21 U/L (6 trials, 409 people). Silymarin complexes: no clear ALT change (4 trials, 309 people). Serious adverse events did not clearly differ.
Row on the Milk Thistle (Silymarin) page · PubMed 40552569 (opens PubMed)
- CGrade CLiver histology in NASH (biopsy-proven) · Mixed
RCT · n 99 · 2017 · Adults with NASH and NAFLD activity score 4 or more (Malaysia)
700 mg three times a day (2,100 mg/day) · 48 weeks
Main outcome (30% drop in activity score) did not differ (32.7% vs 26.0%); fibrosis improved in 22.4% vs 6.0%.
Row on the Milk Thistle (Silymarin) page · PubMed 28419855 (opens PubMed)