Top 9 Best Milk Thistle (Silymarin) Supplements (2026)
01 · Best Overall✓ Label verified · Supplement Facts read Sep 7, 2026Best Overall: Thorne Milk Thistle Phytosome (Formerly Siliphos), 90 Capsules
The bioavailability play done by the brand clinicians trust most — silybin bound to a sunflower phospholipid so more of the active actually gets absorbed, with third-party-certified QC and zero soy, dairy, or gluten.
~$29~$0.32/cap (~$0.64–0.97/day at 2–3 caps)
Why it wins: all five scores, pros & cons, full label
- Phytosome delivery targets milk thistle's biggest weakness — poor plain-extract absorption
- Elite third-party QC reputation among clinicians
- Sunflower-sourced phospholipid, so it stays soy-free (rare for a phytosome)
- Clean allergen profile: gluten-, dairy- and soy-free
- The 180 mg is the complex weight, not 180 mg of free silybin
- Label wants 2–3 caps/day, so true cost-per-day is higher than the sticker
- Premium priced per milligram of silybin
- Silybin load
- 180 mg silybin-phytosome complex per capsule
- Supply
- 90 capsules (label: 1 cap 2–3× daily)
- Testing
- Third-party certified; cGMP facility
- Form
- Silybin phytosome (silybin + sunflower phospholipid complex)
- Allergens
- Gluten-, dairy- & soy-free
Our take — If you want the form the bioavailability science actually points to, from the brand with the strongest quality reputation in this list, this is it. You are paying a premium and the per-capsule silybin is modest — plan on 2–3 capsules a day to reach a meaningful dose. But for a supplement whose entire problem is absorption, paying for a real phytosome from Thorne is the most defensible splurge on this page.
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09Who Wins Which Aspect
Sorted by overall SAC Product Score™ — the official ranking.
| # | Pick | Score | Form & Bioavailability30% | Silymarin/Silybin Dose vs Clinical Range25% | Third-Party Testing & Quality Assurance20% | Value per Effective Serving15% | Formulation Suitability & Tolerability10% | Cost Per Dose | Buy |
|---|---|---|---|---|---|---|---|---|---|
| 01 | | 8.6 | 9.51 | 7.8 | 9.51 | 6.8 | 9.02 | ~$0.32/cap | Check price |
| Phytosome delivery targets milk thistle's biggest weakness — poor plain-extract absorptionThe 180 mg is the complex weight, not 180 mg of free silybin | |||||||||
| 02 | | 8.4 | 9.02 | 9.51 | 8.82 | 6.5 | 6.0 | ~$0.53/serving | Check price |
| Highest disclosed silymarin load in the set — right in the clinical range per servingContains soy (softgel/phospholipid) — off-limits for soy-avoiders | |||||||||
| 03 | | 7.8 | 7.03 | 8.33 | 8.53 | 6.5 | 9.51 | ~$0.35/cap | Check price |
| ~200 mg silymarin/cap and a flexible 1–4 cap/day range make clinical doses easy to reachPlain (non-phytosome) extract, so the standard absorption ceiling applies | |||||||||
| 04 | | 7.5 | 6.5 | 8.0 | 6.5 | 9.51 | 8.53 | ~$0.13/cap | Check price |
| Real 80% standardization at a budget price (240 mg silymarin/cap)Third-party testing is brand-stated, not an independent NSF/USP seal | |||||||||
| 05 | | 7.3 | 6.5 | 8.0 | 7.0 | 8.52 | 7.0 | ~$0.11/cap | Check price |
| 240 mg silymarin/cap from a double-strength 2:1 concentrateIt's a blend, so you can't cleanly attribute effects to milk thistle alone | |||||||||
| 06 | | 7.2 | 6.5 | 8.0 | 6.5 | 7.53 | 8.53 | ~$0.30/serving | Check price |
| Highest single-capsule silymarin of the plain extracts — 280 mg guaranteed in the extract line, one a dayPlain extract — no absorption enhancement | |||||||||
| 07 | | 7.1 | 9.02 | 6.8 | 5.0 | 7.53 | 6.0 | ~$0.27/cap | Check price |
| Budget entry into phytosome (Siliphos) bioavailability — milk thistle's key absorption leverThe only pick with no third-party testing claim — in-house GMP only | |||||||||
| 08 | | 7.0 | 6.0 | 8.42 | 7.5 | 5.0 | 8.53 | ~$0.75/serving | Check price |
| Whole-fruit, full-spectrum organic extract (Silactive) rather than an isolateNot a phytosome — the bioavailability edge of the top two picks | |||||||||
| 09 | | 6.4 | 6.5 | 5.5 | 6.5 | 6.0 | 9.02 | ~$0.15/cap | Check price |
| 30:1 concentrated extract standardized to 80% total flavonoidsOnly 120 mg total flavonoids per cap, with silymarin not declared — the lowest per-capsule dose here | |||||||||
The Other 8, Ranked
- 02
Highest Dose + Absorption: Life Extension Advanced Milk Thistle, 120 Softgels
8.4SAC Score™The most loaded formula here — roughly 480 mg of standardized silymarin per serving stacked with a Siliphos phytosome fraction, so you get a clinical-range dose and an absorption boost in the same two softgels.
StrongestSilymarin/Silybin Dose vs Clinical Range9.51WeakestFormulation Suitability & Tolerability6.0- Standardization
- Silibinins + isosilybin A & B
- Silymarin load
- ~480 mg silymarin / ~180 mg silybin per 2-softgel serving
- Phytosome add-on
- 160 mg Siliphos silybin-phytosome
All five scores, pros & cons, full label
What We Like- Highest disclosed silymarin load in the set — right in the clinical range per serving
- Adds a Siliphos phytosome fraction on top of high-dose standardized extract
- Standardized to specific silybin isomers, not just total silymarin
- NSF-registered manufacturing with a Certificate of Analysis
What You Live With- Contains soy (softgel/phospholipid) — off-limits for soy-avoiders
- Two-softgel serving and the priciest-per-serving standardized option
- 'Up to 3× absorption' is a brand claim, not an independent head-to-head
- Form
- Standardized extract + Siliphos silybin-phospholipid (softgel)
- Supply
- 120 softgels = 60 servings
- Testing
- NSF-registered GMP facility; CoA available
Our take — This is the pick if your goal is to hit a trial-level silymarin dose without counting out four capsules — one serving does it, and the Siliphos fraction hedges the absorption problem. The catches are real: it contains soy, it costs the most per serving of the standardized options, and the absorption multiplier is the brand's own number. For a soy-tolerant buyer who wants dose and bioavailability in one bottle, it's the strongest formulation on the page — it loses the top spot only on soy and price.
- 03
Cleanest Formula: Pure Encapsulations Silymarin (Milk Thistle) 250 mg, 120 Capsules
7.8SAC Score™The hypoallergenic clinic staple — 250 mg of 80%-standardized extract (~200 mg silymarin) in a capsule whose only other ingredient is cellulose, backed by one of the strongest raw-material testing programs in the industry.
StrongestFormulation Suitability & Tolerability9.51WeakestValue per Effective Serving6.5- Silymarin load
- ~200 mg silymarin per capsule
- Supply
- 120 capsules (label: 1 cap 1–4× daily)
- Excipients
- Cellulose capsule only — hypoallergenic
All five scores, pros & cons, full label
What We Like- ~200 mg silymarin/cap and a flexible 1–4 cap/day range make clinical doses easy to reach
- Minimal-excipient, hypoallergenic formula — a physician favorite
- Strong brand QC and raw-material testing reputation
- Vegan and gluten-free
What You Live With- Plain (non-phytosome) extract, so the standard absorption ceiling applies
- Premium price buys purity and QC, not enhanced bioavailability
- No independent NSF/USP seal despite the price
- Form
- Milk thistle extract, 80% silymarin (veg capsule)
- Testing
- Brand third-party raw-material testing program
- Suitability
- Non-GMO, gluten-free, vegan
Our take — If you react to fillers or just want the cleanest possible silymarin, this is the one — a bare-bones, hypoallergenic capsule from a brand clinicians reach for by reflex. Just know what you're paying for: purity and testing, not absorption. It's plain extract, so take it with food and don't expect the phytosome edge that #1 and #2 deliver.
- 04
Best Value: Nutricost Milk Thistle 300 mg (80% Silymarin), 120 Capsules
7.5SAC Score™A genuine 80%-standardized extract — ~240 mg silymarin per capsule — for around $16 a bottle, which is the best cost-per-milligram-of-silymarin of any straight extract here.
StrongestValue per Effective Serving9.51WeakestForm & Bioavailability6.5- Silymarin load
- ~240 mg silymarin per capsule
- Supply
- 120 capsules = 120 servings
- Testing
- Brand-stated third-party tested; GMP/FDA-registered facility
All five scores, pros & cons, full label
What We Like- Real 80% standardization at a budget price (240 mg silymarin/cap)
- Outstanding cost-per-mg-silymarin — 120 servings for ~$16
- Cleaner spec than Nutricost's cheaper 4:1 non-standardized SKU
- Non-GMO and gluten-free
What You Live With- Third-party testing is brand-stated, not an independent NSF/USP seal
- Plain extract — absorption is the standard limitation
- Single 240 mg/day serving sits below the ~420 mg used in several trials
- Form
- Milk thistle extract, 80% silymarin (veg capsule)
- Suitability
- Non-GMO, gluten-free
Our take — This is the value winner and the sane default for most people — a legitimate 80% extract at a price that makes daily use painless. Two knocks keep it out of the top three: the testing is the brand's own word rather than an independent seal, and it's plain extract, so absorption is average. Quality-over-price is exactly why it's #4 and not #1 — but take two a day and it's still cheaper than most single-cap rivals, which earns it the Best Value badge.
- 05
Best Liver-Herb Blend: NOW Foods Silymarin Milk Thistle Extract 300 mg, Double Strength, with Artichoke & Dandelion, 200 Veg Capsules
7.3SAC Score™240 mg of 80%-standardized silymarin per cap bundled with artichoke and dandelion, in a 200-count bottle from a large, UL-audited GMP manufacturer — a lot of liver-herb coverage for around $22.
StrongestValue per Effective Serving8.52WeakestForm & Bioavailability6.5- Silymarin load
- ~240 mg silymarin per capsule
- Supply
- 200 veg capsules
- Testing
- UL-audited GMP facility; non-GMO
All five scores, pros & cons, full label
What We Like- 240 mg silymarin/cap from a double-strength 2:1 concentrate
- 200-count bottle = long supply at low cost
- Bundled artichoke + dandelion, two traditional liver-support herbs
- UL-audited GMP manufacturing from a large, trusted brand
What You Live With- It's a blend, so you can't cleanly attribute effects to milk thistle alone
- Plain (non-phytosome) extract — standard absorption ceiling
- No independent NSF/USP seal
- Form
- 80% silymarin extract (2:1 concentrate) + artichoke & dandelion (veg cap)
- Suitability
- Vegetarian/vegan
Our take — A strong-value big bottle if you actively want the traditional liver-herb stack — artichoke and dandelion ride along with a real silymarin dose. The trade-off is scientific tidiness: with three herbs in the capsule you lose clean attribution, which is why it sits behind the single-ingredient value pick. Great for a 'liver support' shelf staple, less ideal if you want to isolate what milk thistle is doing.
- 06
Best One-a-Day: Solaray Milk Thistle Seed Extract 350 mg, One Daily, Guaranteed 80% Silymarin, 60 VegCaps
7.2SAC Score™The highest silymarin-per-single-capsule of the plain extracts — 280 mg from a guaranteed-potency 80% extract, in a convenient once-daily vegan cap.
StrongestFormulation Suitability & Tolerability8.53WeakestForm & Bioavailability6.5- Silymarin load
- 280 mg silymarin per capsule
- Supply
- 60 VegCaps = 60 servings (one daily)
- Testing
- Non-GMO Project Verified; 'Lab Verified' = Solaray in-house lab; no NSF/USP seal
All five scores, pros & cons, full label
What We Like- Highest single-capsule silymarin of the plain extracts — 280 mg guaranteed in the extract line, one a day
- Guaranteed (not just labeled) 80% potency
- Convenient once-daily dosing, vegan caps
- Non-GMO Project Verified; Lab Verified badge is Solaray's own Utah lab
What You Live With- Plain extract — no absorption enhancement
- 280 mg/day still sits below the ~420 mg used in several liver studies
- Smaller 60-count bottle; no independent NSF/USP potency seal
- Form
- Milk thistle seed extract 350 mg (guaranteed 280 mg [80%] silymarin) plus 110 mg milk thistle seed (veg cap)
- Suitability
- Vegan, Non-GMO Project Verified
Our take — The easiest one-and-done pick — a single vegan capsule delivers the most silymarin per cap of any plain extract here, with a guaranteed-potency label. Two caveats keep it mid-pack: it's still plain extract, and even at 280 mg you're a touch under the classic trial dose. If a single daily capsule is what gets you to actually take it, that adherence edge is worth a lot.
- 07
Best Budget Phytosome: Swanson Siliphos Milk Thistle Phytosome (Standardized) 300 mg, 60 Capsules
7.1SAC Score™The cheapest way into real phytosome bioavailability — the same patented Siliphos silybin-phospholipid tech premium brands use, at roughly $16.
StrongestForm & Bioavailability9.02WeakestThird-Party Testing & Quality Assurance5.0- Standardization
- 29–36% silybin (patented Siliphos raw material)
- Silybin load
- ~90–108 mg silybin per capsule (29–36% of 300 mg Siliphos)
- Supply
- 60 capsules (label: 1 cap 1–3× daily)
All five scores, pros & cons, full label
What We Like- Budget entry into phytosome (Siliphos) bioavailability — milk thistle's key absorption lever
- Standardized to the bioactive silybin isomer (~90–108 mg/cap)
- Lowest-cost phytosome option in the set
- Patented Siliphos raw material, same tech as premium brands
What You Live With- The only pick with no third-party testing claim — in-house GMP only
- Gelatin capsules, so not vegan
- Modest silybin per cap means 2–3 caps/day for a full dose
- Form
- Siliphos silybin phytosome (silybin-phosphatidylcholine), gelatin cap
- Testing
- In-house GMP facility only
Our take — If the phytosome form matters to you but the premium price tags don't, this is the honest budget route to the absorption tech that makes milk thistle worth taking. Be clear-eyed about the compromises: it's the only option here with no third-party testing claim, the capsule is gelatin, and the silybin per cap is modest. Best form-for-the-money on the page — just the weakest QC paper trail, which is exactly what keeps it out of the top tier.
- 08
Best Organic Full-Spectrum: Gaia Herbs Milk Thistle Seed, 120 Vegan Liquid Phyto-Caps
7.0SAC Score™A USDA-organic, whole-fruit extract in a liquid phyto-cap with lot-level traceability — and a disclosed 375 mg silymarin per serving. Premium price, three caps a day.
StrongestFormulation Suitability & Tolerability8.53WeakestValue per Effective Serving5.0- Herb load
- 22,500 mg dry-herb equivalent per 3-cap serving
- Silymarin
- 375 mg per 3-cap serving (750 mg extract, 50% silymarin)
- Supply
- 120 capsules = 40 servings (3 caps each)
All five scores, pros & cons, full label
What We Like- Whole-fruit, full-spectrum organic extract (Silactive) rather than an isolate
- Discloses 375 mg silymarin per serving on the Supplement Facts panel
- Liquid phyto-cap format the brand says aids delivery vs dry powder
- USDA Organic + non-GMO + lot-level traceability
- Vegan and cleanly formulated
What You Live With- Not a phytosome — the bioavailability edge of the top two picks
- Needs 3 caps per serving and costs the most per serving here
- Liquid phyto-cap delivery claim has no independent head-to-head data
- Form
- Organic Silactive whole-fruit liquid extract (vegan liquid phyto-cap)
- Certification
- USDA Organic, non-GMO, Meet Your Herbs traceability
Our take — Gaia states its silymarin outright — 375 mg per serving from a USDA Organic whole-fruit extract with lot-level traceability. That earns a solid mid-list score; what it doesn't earn is the phytosome bioavailability credit or a value win. Buy it if organic, whole-plant sourcing and a stated clinical-range dose matter more than cost.
- 09
Best Vegan Staple: Jarrow Formulas Milk Thistle 150 mg, 30:1 Extract, 80% Total Flavonoids, 200 Veggie Capsules
6.4SAC Score™A concentrated 30:1 extract standardized to 80% total flavonoids (120 mg per cap, silymarin not declared) at about $0.15 per capsule — a clean, vegan, allergen-free everyday option.
StrongestFormulation Suitability & Tolerability9.02WeakestSilymarin/Silybin Dose vs Clinical Range5.5- Flavonoid load
- 120 mg total flavonoids per capsule (150 mg extract); silymarin not declared
- Supply
- 200 veggie capsules (label: 1 cap 1–3× daily)
- Testing
- Non-GMO Project Verified; no NSF/USP seal on the panel
All five scores, pros & cons, full label
What We Like- 30:1 concentrated extract standardized to 80% total flavonoids
- Reasonable price per capsule — 200 caps for ~$29 (about $0.15 per cap)
- Vegan, Non-GMO Project Verified, allergen-free formulation
- Marketed around glutathione support for liver function
What You Live With- Only 120 mg total flavonoids per cap, with silymarin not declared — the lowest per-capsule dose here
- Reaching a trial-level ~420 mg/day means 3–4 capsules, not one
- Plain extract with the usual low oral bioavailability; no NSF/USP seal
- Form
- Milk thistle fruit/seed 30:1 extract, 80% total flavonoids (veggie cap)
- Suitability
- Vegan, Non-GMO Project Verified, gluten-free
Our take — A dependable, allergen-friendly vegan staple that's reasonably priced per capsule — but read the label math. The panel guarantees 120 mg total flavonoids per cap and prints no silymarin figure; even counting all of it, the 'one a day' habit lands well under the doses used in studies and you'll want three or four caps, which erodes the price edge. Fine as a low-dose maintenance option, underpowered as a single-cap solution.
Milk Thistle In Two Short Lessons
Read the silymarin, not the milk thistle weight.
A label boasting 1,000 mg of milk thistle can contain less silymarin than a 300 mg capsule standardized to 80%. The standardization percentage gives you the real number.
Consider a phytosome form.
Silymarin is poorly absorbed by mouth. Binding silybin to a phospholipid improves uptake and is the biggest formulation lever on this page.
Dose to about 420 mg of silymarin a day.
That is the classic hepatology dose, split across the day; a 240-280 mg capsule once daily falls short. The evidence itself is mixed, so treat it as supportive care.
Rambaldi 2007 Cochrane review, no mortality benefit (PMID 17943794); Rambaldi 2005 Am J Gastroenterol, same null in high-quality trials (PMID 16279916); Wah Kheong 2017 NASH RCT, primary endpoint missed at 2,100 mg/day (PMID 28419855); Gillessen 2020 Adv Ther narrative review, more favorable but lower evidence tier (PMID 32065376).
Milk thistle lives or dies on two numbers most labels bury: how much actual silymarin (the active flavonolignan complex) you're getting, and how much of it your body can absorb. Plain seed extract is notoriously poorly absorbed, so a phospholipid-bound 'phytosome' form can matter more than a bigger milligram number. We scored every product on five weighted axes built for this specific compound, then reconciled each pick's axis scores into a single SAC Efficacy Score out of 10. Price is only a tie-breaker — quality and absorption outrank the sticker, so the cheapest bottle is our 'Best Value,' never our #1.
Form & Bioavailability · 30%
Milk thistle's central problem is poor oral absorption. Phospholipid/phytosome forms (Siliphos, silybin-phosphatidylcholine) that improve silybin uptake score highest; high-percentage standardized extracts sit in the middle; non-standardized full-spectrum products score lowest on this axis.
Silymarin/Silybin Dose vs Clinical Range · 25%
Classic hepatology trials used about 420 mg silymarin per day (140 mg silybin, three times daily), and some NASH work went far higher. We reward products that disclose actual silymarin/silybin milligrams and can reach a meaningful daily dose without a fistful of capsules; undisclosed potency is penalized.
Third-Party Testing & Quality Assurance · 20%
Independent seals (NSF/USP) and elite brand testing programs (Thorne, Pure Encapsulations, NSF-registered facilities) rank above brand-stated testing, which ranks above in-house GMP alone. We never treat a manufacturer's own claim as an independent certification.
Value per Effective Serving · 15%
Cost measured against the dose you actually need — not per bottle, but per day at a real silymarin dose. This is a tie-breaker, not a throne-maker: a great price lifts a strong product but never rescues a weak one.
Formulation Suitability & Tolerability · 10%
Vegan vs gelatin capsules, allergen load (soy is common in phospholipid softgels), excipient minimalism, and single-ingredient clarity vs multi-herb blends. Silymarin is very well tolerated, so this axis rewards purity and suitability more than safety.
The bottom line
The winner: Thorne Milk Thistle Phytosome
It leads with the form the science favors — silybin bound to a sunflower phospholipid for better absorption — from the brand with the strongest third-party QC reputation in this set, and it stays soy-, gluten- and dairy-free. The per-capsule silybin is modest and you'll take 2–3 a day, so it isn't the cheapest path. But for a supplement whose entire challenge is bioavailability, paying for a real phytosome from Thorne is the most defensible choice.
Pick by need, not by rank
Want the biggest dose plus an absorption boost in one serving? Life Extension. Cheapest legitimate 80% extract? Nutricost, our Best Value. Sensitive to fillers? Pure Encapsulations. One capsule a day? Solaray. Phytosome tech on a budget? Swanson. Organic, whole-plant sourcing over a lab number? Gaia. The right bottle depends on which trade-off you're willing to make.
The honest rule: calibrate your expectations
Milk thistle is remarkably well tolerated and biologically plausible as antioxidant liver support, and it's cheap enough to try. But the highest-quality randomized evidence does not show it changes hard liver outcomes, so it is supportive care — not a treatment for alcohol use, viral hepatitis, or metabolic liver disease. Buy a standardized, bioavailable form, dose it to the studied range, and never let it replace addressing the underlying cause.
Quick Answers
What is the best milk thistle pick overall?
Thorne Milk Thistle Phytosome (Formerly Siliphos), 90 Capsules by Thorne is our #1 pick (SAC score 8.6/10). If you want the form the bioavailability science actually points to, from the brand with the strongest quality reputation in this list, this is it. You are paying a premium and the per-capsule silybin is modest — plan on 2–3 capsules a day to reach a meaningful dose. But for a supplement whose entire problem is absorption, paying for a real phytosome from Thorne is the most defensible splurge on this page.
What is the best budget option?
Nutricost Milk Thistle 300 mg (80% Silymarin), 120 Capsules at ~$16. This is the value winner and the sane default for most people — a legitimate 80% extract at a price that makes daily use painless. Two knocks keep it out of the top three: the testing is the brand's own word rather than an independent seal, and it's plain extract, so absorption is average. Quality-over-price is exactly why it's #4 and not #1 — but take two a day and it's still cheaper than most single-cap rivals, which earns it the Best Value badge.
How much do these picks cost?
Across our ranked picks, prices run from about $16 to $42 — exact price and cost per serving are listed on every pick card above.
How were these picks ranked?
Milk thistle lives or dies on two numbers most labels bury: how much actual silymarin (the active flavonolignan complex) you're getting, and how much of it your body can absorb. Plain seed extract is notoriously poorly absorbed, so a phospholipid-bound 'phytosome' form can matter more than a bigger milligram number. We scored every product on five weighted axes built for this specific compound, then reconciled each pick's axis scores into a single SAC Efficacy Score out of 10. Price is only a tie-breaker — quality and absorption outrank the sticker, so the cheapest bottle is our 'Best Value,' never our #1.
Every Claim Ranked Above Traces Back To One Of These
6 sources — studies link to PubMed, product specs to the manufacturer
- [1] Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007;(4):CD003620. PMID 17943794 — Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. In 18 randomized trials (1,088 patients), milk thistle had no significant effect on all-cause mortality (RR 0.78, 95% CI 0.53–1.15); the apparent liver-related mortality benefit disappeared when only high-quality trials were analyzed.
- [2] Rambaldi A, Jacobs BP, Iaquinto G, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C liver diseases—a systematic Cochrane hepato-biliary group review with meta-analyses of randomized clinical trials. Am J Gastroenterol. 2005;100(11):2583-91. PMID 16279916 — Milk thistle for alcoholic and/or hepatitis B or C liver diseases—a systematic Cochrane hepato-biliary group review with meta-analyses of randomized clinical trials. Across 13 trials in 915 patients, milk thistle did not significantly reduce mortality or liver-disease complications when all trials or only high-quality trials were combined.
- [3] Wah Kheong C, Nik Mustapha NR, Mahadeva S. A Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol. 2017;15(12):1940-1949.e8. PMID 28419855 — A Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis. In 99 NASH patients, silymarin 700 mg three times daily (2,100 mg/day) for 48 weeks did not achieve the primary histologic endpoint versus placebo, though it hinted at a possible reduction in liver fibrosis.
- [4] Gillessen A, Schmidt HH. Silymarin as Supportive Treatment in Liver Diseases: A Narrative Review. Adv Ther. 2020;37(4):1279-1301. PMID 32065376 — Silymarin as Supportive Treatment in Liver Diseases: A Narrative Review. This narrative review concluded silymarin can reduce oxidative stress and is well tolerated, and reported that a pooled analysis in cirrhosis was associated with reduced liver-related deaths — but as a narrative review it sits below Cochrane-level evidence.
- [5] Tao L, Qu X, Zhang Y, Song Y, Zhang SX. Prophylactic Therapy of Silymarin (Milk Thistle) on Antituberculosis Drug-Induced Liver Injury: A Meta-Analysis of Randomized Controlled Trials. Can J Gastroenterol Hepatol. 2019;2019:3192351. PMID 30733935 — Prophylactic Therapy of Silymarin (Milk Thistle) on Antituberculosis Drug-Induced Liver Injury: A Meta-Analysis of Randomized Controlled Trials. A meta-analysis of 5 RCTs (1,198 patients) found prophylactic silymarin significantly reduced anti-tuberculosis drug-induced liver injury at week 4, with the benefit attenuating over longer treatment.
- [6] SAC News — Milk Thistle vs the Liver Detox Claim: 20 Best-Sellers, $38.8M a Year, Zero Trials. Researchers pulled the 20 best-selling liver cleanse supplements on Amazon — 1,420,584 units and $38,783,937 a year. Every one promised to eliminate toxins and 85% promised better liver function, against evidence the paper calls limited and inconclusive. Milk thistle was in 19 of the 20, and it is the one part of the bottle with real randomised trials behind it.
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