The Liver Life-Saver
Your Doctor Has Never Heard Of
Two years ago, a friend of mine, Lisa, died of cirrhosis at
age 35. I know what you’re thinking: She must have been a
hopeless alcoholic to succumb to liver disease so young.
But Lisa was not an alcoholic. She may have suffered some
liver damage from mind-bending drugs in her youth (who
didn’t?), but her cirrhosis was caused by hepatitis C.
Chances are you’ve heard of hepatitis A and B, but not C.
That’s because this viral liver infection was identified
only recently. The virus was first isolated in 1989. The
test to detect it is only five years old.
Scientists still are not sure how hepatitis C spreads, but
it seems clear that, unlike hepatitis A, it is not
food-borne. It appears to be passed more like hepatitis
B--sexually, by blood-to-blood contact among needle-sharing
IV drug users, and through blood transfusions (until the
test largely eliminated contaminated blood). Last spring,
for the first time, the National Institutes of Health
sounded an alarm about hepatitis C. An estimated 4 million
Americans now have it. About 30,000 new cases are diagnosed
each year. And some 8,000 Americans die annually from
cirrhosis caused by it. To make matters worse, like AIDS,
hepatitis C may not cause symptoms for many years after
infection. Today, an estimated 1 million Americans are
asymptomatic carriers who can spread the infection. A
recent report in the Journal of the American Medical
Association used the phrase “time bomb.”
Hepatitis C is just one of several serious diseases that
target the liver, the body’s largest organ. Some 300,000
cases of hepatitis B are diagnosed each year, and 1.25
million Americans are chronic carriers. Some 20 percent of
them die prematurely from either cirrhosis or liver cancer.
Then, of course, there’s alcoholic cirrhosis. You don’t
have to pass out in gutters to develop it. As little as
three drinks a day for several years can damage the liver.
Finally, the liver can be damaged by prescription drugs and
by occupational exposure to toxic chemicals.
Unfortunately, mainstream medicine doesn’t have much to
offer people with liver disease. For cirrhosis, all doctors
can do is treat the complications. Cirrhosis now kills more
than 25,000 Americans a year, about as many as die from
homicide. Until recently, rest was the only treatment for
hepatitis. Now there’s interferon, but it costs up to
$10,000 a year and causes many unpleasant side effects,
among them: flu-like symptoms, rashes, depression, and
thyroid disorders.
Lisa was vivacious, but her cirrhosis diagnosis embarrassed
her into silence. She swore her husband to secrecy, and
none of her friends learned what killed her until after her
death. Her decision not only denied her the support of
those who loved her, it also kept me from telling her about
a remarkable medicinal herb, milk thistle, that just might
have saved her life. I don’t know what’s more
astonishing—milk thistle’s extraordinary ability to treat
liver disease, or the fact that mainstream American
medicine has virtually ignored it.
Milk thistle grows throughout the temperate world.
Traditional herbalists used it to treat liver problems with
anecdotal success, which led pharmacologists to investigate
it as a possible liver medicine. In 1968, German
researchers isolated three liver-protective compounds from
milk thistle seeds—silibinin, silidianin, and
silicristin—collectively known as “silymarin.” Unlike many
medicinal herbs, tea made from milk thistle seeds doesn’t
contain enough silymarin to do much good. So German plant
scientists bred a high-silymarin variety, that produces a
standardized extract. A 200 mg dose of this extract
contains 140 mg of silymarin. This dose, taken three or
four times a day, has become the standard used in many
studies showing that milk thistle is Nature’s gift to the
liver:
• General liver protection. Scandinavian researchers
recruited 97 heavy drinkers with liver damage, but not
cirrhosis, and gave 47 of them silymarin for four weeks.
Compared with controls who took a placebo, the silymarin
group showed significant decreases in abnormally high
levels of several liver enzymes, and a greater likelihood
of returning to normal liver function.
• Hepatitis. Several European studies show that compared
with hepatitis sufferers who did not receive silymarin,
those who did recovered more quickly.
• Cirrhosis. In one study, 170 people (91 with alcoholic
cirrhosis) were divided into two groups. One received 200
mg of milk thistle extract three times a day. The other
received a placebo. Four years later, 31 people in the
placebo group had died of liver disease, but among those
who took silymarin, there were only 18 deaths, 42 percent
fewer. Several other studies show that milk thistle can
normalize liver function in people with cirrhosis.
• Mushroom poisoning. Amanita (“death cap”) mushrooms
contain one Nature’s most potent poisons. Silymarin blocks
its entry into liver cells. Several studies have shown what
a life-saver this can be. Without treatment, the death rate
from Amanita poisoning is greater than 50 percent. Standard
medical treatment (activated charcoal) saves many, but not
all lives, which is why reports of Amanita deaths appear
fairly regularly in the press. But in one study of 60
people treated with silymarin for death cap poisoning, none
died. In another involving 205 people, 189 received
standard medical care and 16 received silymarin. In the
standard care group, 46 (24 percent) died. In the silymarin
group, none died.
• Drug Toxicity. Alcohol is not the only drug that damages
the liver. In high enough doses, even such everyday
medications as acetaminophen (Tylenol) do the same. In one
animal study, silymarin prevented liver damage from large
doses of acetaminophen. In other studies, it has protected
the liver from damage caused by antibiotics (tetracylcine,
erythromycin), antidepressants (Elavil, Pamelor), and
antipsychotics (Thorazine, Haldol).
• Occupation Exposures. Longterm exposure to may chemicals
can cause liver damage. In one study of workers with liver
damage from toluene and xylene, 140 mg of silymarin three
times a day for a month significantly reduced their
abnormally high levels of liver enzymes.
Milk thistle helps the liver in three ways: It binds
tightly to the receptors on liver cell membranes that allow
toxins in, thus locking them out. It is also a powerful
antioxidant, which helps protect liver cells form oxidative
damage, the chemical process responsible for a great deal
of harm around the body. And it spurs repair of damaged
liver cells. Not to mention that silymarin is remarkably
safe. The vast majority of users report no side effects. A
few develop mild stomach upsets or allergic reactions.
Lisa’s doctors did not offer her silymarin. Nor is it
prescribed for alcoholism, mushroom poisoning, and exposure
to liver-damaging pharmaceuticals and occupational
chemicals. Why not? The answer lies in the uniquely
dysfunctional culture of the American drug industry and the
Food and Drug Administration. To win FDA approval, agency
regulations require that drugs be proven safe and
effective. That sounds reasonable enough. But proving
safety and efficacy to the FDA’s satisfaction costs
millions of dollars per drug. There’s only one way to
recoup that kind of investment—develop unique molecules
that can be patented, own them exclusively for the patent’s
term, and market them for major bucks (the main reason why
so many drugs are so expensive). Drug companies shy away
from natural products like silymarin because they cannot be
patented. From the drug industry perspective, why spend
millions to win approval for a plant extract you can’t turn
a profit on by monopolizing?
So silymarin falls through the major crack at the strange
junction of capitalism and federal drug regulations. It
remains virtually unknown outside of herbal medicine
circles—often with tragic results. Recently, five people
suffered Amanita mushroom poisoning in Sonoma, California.
Media coverage spurred herbal medicine advocates in the
area to urge treatment with silymarin. But none of the
victims received milk thistle because it’s not an accepted
treatment in the U.S. One of the victims died. Another
would have, but was saved by a liver transplant, a costly
and traumatic procedure.
Would milk thistle have saved my friend, Lisa? It might
have, but now there’s no way to know. However, it’s clear
that the politics of drug approval in this country
discourage use of a safe, clearly valuable, easily
affordable medicine that could help tens of thousands of
people with liver disease. The FDA should do what Germany
has done—create a panel of experts to review the scientific
evidence and recommend approval of useful natural medicines
like silymarin that cannot be patented, and then let drug
companies market them without having to invest millions in
preapproval testing. But I’m not holding my breath.
In the meantime, medical populism is our best bet. About 25
years ago, alternative medicine pionners around the country
began trying meditation, acupuncture, medicinal herbs, and
other unconventional therapies most of their doctors knew
nothing about. They worked, and alternative medicine spread
largely by word of mouth. Today, more than one-third of
Americans use it.
Eventually, the research community caught up with the
public, and hundreds of studies have shown that many
alternative approaches are safe and effective. As a result,
many once-fringe therapies are becoming mainstream, among
them: acupuncture, massage, meditation, and yoga. They are
no longer “alternative,” but rather “complementary.” They
don’t replace mainstream medicine. They complete it.
The same kind of from-the-bottom-up approach can work for
milk thistle. If enough people with liver problems use it,
and enough doctors see them survive cirrhosis or Amanita
poisoning, or recover unusually quickly from hepatitis, or
drug or chemical liver damage, eventually silymarin will
become mainstream. And we don’t have to wait for FDA
approval. Silymarin is sold over the counter at most health
food stores. Look for a standardized extract. The dose is
140 mg. of silymarin three or four times a day.
It’s too late for Lisa. But maybe not for you, or someone
you love.