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1115615
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1115615
Tel : 020 8693 8789
helping people suffering from Primary Sclerosing Cholangitis
milk thistle
MANY of us are taking herbal medicines and other supplements in the hope that they may be of benefit. Whenever this subject is brought up at our annual meetings, Dr. Chapman is rather sceptical, expressing the view that there's no harm in taking these things if they are not toxic, but he doubts that they're doing our liver disease much good.
At the 2006 Pittsburgh conference of PSC Partners Seeking A Cure, Dr. Keith Lindor said that there were only two medicines, Urso and possibly Silymarin (Milk Thistle) that are of benefit to PSCers.
We wrote about Milk Thistle many issues ago. In Germany it's been used for years in treating acute poisoning from eating death cup mushrooms, with a 95% success rate. There is no doubt that it has such value and may be protective against toxins to the liver. Whether it's of value in treating PSC is another matter.
Intravenous Milk Thistle extract is not approved by the Food and Drug Administration in the U.S. and therefore is not available for treatment. Consequently there are high mortality rates for mushroom poisoning in the U.S. For a gripping and tragic story (in the best tradition of the Reader's Digest), of a Californian family of six, age range 17 to 83, who all ate poisonous mushrooms with their taco, see Santa Cruz Sentinel.com, July 14, 2007. The grandmother died but all the others were saved in a dramatic bid to get a supply of Silymarin from Germany in time.
At the 2006 Pittsburgh conference of PSC Partners Seeking A Cure, Dr. Keith Lindor said that there were only two medicines, Urso and possibly Silymarin (Milk Thistle) that are of benefit to PSCers.
We wrote about Milk Thistle many issues ago. In Germany it's been used for years in treating acute poisoning from eating death cup mushrooms, with a 95% success rate. There is no doubt that it has such value and may be protective against toxins to the liver. Whether it's of value in treating PSC is another matter.
Intravenous Milk Thistle extract is not approved by the Food and Drug Administration in the U.S. and therefore is not available for treatment. Consequently there are high mortality rates for mushroom poisoning in the U.S. For a gripping and tragic story (in the best tradition of the Reader's Digest), of a Californian family of six, age range 17 to 83, who all ate poisonous mushrooms with their taco, see Santa Cruz Sentinel.com, July 14, 2007. The grandmother died but all the others were saved in a dramatic bid to get a supply of Silymarin from Germany in time.
For a recent statement on Silymarin and treatment for liver disease, see Clinical Gastroenterology and Hepatology 13th January, 2007. (Abstract).
Articles in Press
COMPLEMENTARY AND ALTERNATIVE MEDICINE IN HEPATOLOGY: REVIEW OF THE EVIDENCE OF EFFICACY
Published online 15 January 2007.
There is an increase in the use of complementary and alternative medicine (CAM), especially herbal therapy, among patients with liver disease. The most commonly used herbal agent is Silymarin ~ in animal models, many of the commonly used agents have shown anti-inflammatory and antibiotic effects. Although many human studies have shown improvements in subjective symptoms (well being) and liver biochemistry, there are no convincing data to suggest a definite histologic and/or virologic improvement with most of these agents. Poorly designed studies, heterogeneous patient populations, lack of standardized preparations, and poorly defined objective and points may partly explain the conflicting reports in the literature.
Hepatoloxicity and drug interactions are common with many herbal medications, and therefore physicians need to be cognizant of known or occult use of CAM by their patients. Only well-designed, randomized, controlled trials will be able to ascertain whether CAM has any role in the management of patients with acute or chronic
liver diseases. Until such time, the use of CAM cannot be recommended as a therapy for patients with liver disease.
There was a trial of Silymarin at the Mayo Clinic for PBC patients who were not responding to Urso. It concluded that "although Silymarin was well tolerated, this medicine did not provide benefit to patients with PBC responding sub-optimally to Urso. The results of this pilot study would seem to discourage further controlled trials of Silymarin in patients with PBC". (Angulo ... Lindor, etc. “Silymarin in the treatment of patients with a sub-optimal response to Urso". 30 December 2003. Hepatology Vol. 32 Issue 5 pp 897 - 900).
There was a trial of Silymarin at the Mayo Clinic for PBC patients who were not responding to Urso. It concluded that "although Silymarin was well tolerated, this medicine did not provide benefit to patients with PBC responding sub-
This was disappointing, especially since Silymarin is described as
"... ... a drug with multiple hepatoprotective effects as shown in several experimental and clinical studies. Silymarin is a potent antioxidant that inhabits lipid peroxide formation in liver cells and possesses anti-inflammatory activities, mediated by alteration of hepatic kupffer-cell function (kupffer-cells ~ cells that have become specialised liver-cells). Silymarin has been shown to have immuno-modulatory effects decreasing the number and cytotoxic activity (destructive to cells), of CD9 + lymphocytes ... In addition Silymarin has major anti-fibrotic effects ... ... "
"All these hepatoprotective effects have made Silymarin an attractive drug for evaluation of patients with liver disease of different causes. (It) improved LFTs in patients with alcoholic liver disease and in patients with chronic hepatitis. In a randomized, placebo controlled trial (it) led to a reduction in mortality in patients with alcoholic cirrhosis. However, its potential therapeutic benefit ... ... in patients with chronic cholestatic liver disease such as PBC (and PSC) remains unknown ... ...
"... ... a drug with multiple hepatoprotective effects as shown in several experimental and clinical studies. Silymarin is a potent antioxidant that inhabits lipid peroxide formation in liver cells and possesses anti-
We have no evidence that Silymarin helps us -- but no evidence that it doesn't help PSC patients. So you take your choice. If you have a G.P. who supports the use of some herbal medicines, you might try to get it on prescription.
Some time ago we reviewed an American book Christopher Wanjek -- "Bad Medicine", (John Wiley & Sons Ltd.), 2003, which has some sensible things to say about herbal medicines and it’s worth quoting from him again. If you use Amazon you can get it for less than £3. You should .................
