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Milk Thistle

Milk thistle is one of the most powerful natural liver protector's known to man. It is one of the best examples of preventative medicine that we have today as it not only protects each cell of the liver from incoming toxins, but simultaneously encourages the liver to cleanse itself of damaging substances, such as alcohol, drugs, medications, mercury and heavy metals, pesticides, anesthesia, and even the most poisonous of mushrooms, the amanita or "death-cap" mushroom.

The scientific support for this 2000-year-old liver remedy is substantial, and evidence within animal, in vitro, and human clinical trials is strong. Considered a noxious or invasive roadside perennial weed in many horticultural circles, milk thistle is wonderful and appropriate for anyone who is under stress, uses alcohol, recreational drugs, prescription medications, or lives in today's modern times of pesticides, environmental toxins, and pollution - virtually everyone!
 
Browse Sections:
 Summary
 Other Names
 Description
 Traditional Internal Uses
 Traditional Topical Uses
 Indications
 Actions
 Constituents / Nutrients
 Pharmacological Summary
 Scientific Research / Actions
 Research
 Precautions / Contraindications
 Interaction with Medications
 Possible Side Effects
 Dosage
 References

Common Name
Milk Thistle
 
Botanical Latin Name / Classification
Carduus marianus, Silybum marianum
 
Parts Used
Fruits (referred to as seeds), herb
 
Other Names
Cardui mariae, Carduus marianum, Holy Thistle, Lady's Thistle, Legalon, Marian Thistle, Mariendistel, Mary Thistle, Our Lady's Thistle, Silimarina, Silybin, Silybum marianum, Silymarin, St. Mary Thistle.

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Description
Milk thistle, a member of the aster or daisy family, is an herbaceous annual or biennial plant with a dense prickly flower head consisting of purple tubular flowers. The fruit of the milk thistle plant is brown and spotted with white tufts of hair. The ripe seeds of the fruit are the medicinal part of the plant but virtually all parts of the plant have been used as food with no known toxicity.

Milk thistle grows throughout the world (including North America) in both cultivated and wild form. Many sources refer to the herb, by its botanical name, Silybum marianum, as well as by its active compounds, collectively known as silymarin. Concentrated stores of silymarin are found in the herb's shiny black fruits (seeds), which are typically collected at summer's end.

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Traditional Internal Uses
Medical use of milk thistle can be traced back more than 2,000 years. Nicholas Culpeper, the well-known 17th-century pharmacist, cited its use for opening "obstructions" of the liver and spleen and recommended it for the treatment of jaundice.

Traditionally, milk thistle fruits have been used for disorders of the liver, spleen and gall bladder such as jaundice and gall bladder colic. Milk thistle has also been used for nursing mothers for stimulating milk production, as a bitter tonic, for hemorrhoids, for dyspeptic complaints and as a demulcent in catarrah and pleurisy. It is stated to possess hepatoprotective, antioxidant and choleretic properties.(1,2)

Current interest is focused on the hepatoprotective activity of milk thistle and its use in the prophylaxis and treatment of liver damage and disease.

The leaves have also been used for the treatment of liver, spleen and gall bladder disorders and as an antimalarial, emmenagogue and for uterine complaints. Milk thistle leaf preparations are available today, although most research has been conducted with preparations of the fruit since the leaf does not contain the pharmacologically active component silymarin.

Although most widely associated with liver complaints, milk thistle is also being examined for treating a variety of other disorders, from gallstones and high cholesterol to skin cancers and allergy symptoms. As a potent antioxidant, the versatile milk thistle extract helps prevent highly reactive oxygen molecules called free radicals from damaging cells throughout the body, but especially in the liver, stomach, and intestines.

An injectable form of milk thistle is a powerful antidote to mushroom poisoning. And the oral extract shows promise for minimizing chemotherapy-associated liver damage. This is a function of the herb's antioxidant actions as well as its ability to accelerate the excretion of toxic compounds that can accumulate in the body.

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Traditional Topical Uses
Milk thistle is rich in the essential moisturizers and fatty acids making it useful for dry skin needs. Topical milk thistle is often used for mild skin irritations due to its anti-inflammatory effects. In research studies, silymarin, applied to the ears of mice with dermatitis, caused a decrease in inflammation. The antioxidant, free-radical scavenging, and regenerative properties of milk thistle make it a useful component in creams and skin formulations.

Since many health practitioners believe that some skin disorders, such as psoriasis, are the result of a "sluggish liver", it is no surprise that milk thistle is recommended for these conditions with both internal and external applications.

Milk thistle may one day prove to be an important weapon in the battle against skin cancer. Researchers at Case Western Reserve University in Cleveland found that when the active ingredient, silymarin, was applied to the skin of mice, 75% fewer skin tumors resulted following exposure to ultraviolet radiation. More studies are needed to see if it has a similar effect in humans.

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Indications
Primary Indications: Cirrhosis Support

Secondary Indications: Constipation

Other Indications: Depression Support

Secondary Indications: Dyspepsia

Other Indications: Eczema (Dermatitis), Edema (Dropsy)

Other Indications: Food Allergies / Sensitivities

Primary Indications: Gallbladder Disorders, Gallstones

Secondary Indications: Gastrointestinal Disorders

Primary Indications: Hepatitis

Primary Indications: Hypercholesterolemia

Secondary Indications: Immunity / Immune Disorders

Secondary Indications: Indigestion

Primary Indications: Jaundice

Other Indications: Kidney Disorders

Primary Indications: Liver Disorders, Liver Health

Other Indications: Memory Support

Other Indications: Psoriasis, Schizophrenia, Seasonal Allergies / Hay Fever Support, Skin Health, Skin Problems / Skin Ulcers, Spleen Disorders

Primary Indications: Toxicity / Toxemia

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Actions
Anti-Carcinogenic, Antidepressant, Antihepatotoxic, Antimalarial, Antirheumatic

Cholagogue

Depurative, Diuretic

Emmenagogue

Hepatoprotective

Immunity-enhancing

Laxative

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Constituents / Nutrients
Fruit

Flavolignans: 1.5-3% silymarin, a mixture containing approximately 50% silibinin (= silybin, silybinin), silichristin and silidianin, as well as silimonin, isosilichristin, isosilibinin, silandrin, silhermin, neosili hermins A and B, 2,3-dehydrosilibinin and tri- to pentamers of silibinin (silybinomers).(1)

Flavonoids: Quercetin, taxifolin and dehydrokaempferol.(1)

Lipids: 20-30% Linoleic acid, oleic acid and palmitic acid.

Sterols: Cholesterol, campesterol and stigmasterol.

Other Constituents: Mucilages, sugars (arabinose, rhamnose, xylose, glucose), amines and saponins.(1)

Leaves

Flavonoids: Apigenin, luteolin and kaempferol and their glycosides.(1)

Other Constituents: ß-Sitosterol and its glucoside, and a triterpene acetate.(1)

Silymarin is not found in the leaves.

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Pharmacological Summary
The chemistry of milk thistle is well-documented and there is good evidence that silymarin and its components, particularly silibinin, are responsible for the pharmacological effects.

Documented scientific evidence from in vitro and animal studies provides supportive evidence for some of the uses of milk thistle, particularly those relating to hepatoprotective properties.

There have been several controlled clinical trials investigating the effects of milk thistle in a range of liver disorders, including acute viral hepatitis, chronic hepatitis, alcoholic liver disease, cirrhosis and toxic liver damage. The results of these studies are not entirely consistent or conclusive. In addition, some trials have methodological shortcomings, for example the inclusion of patients with different liver disorders, small numbers of patients and failure to control or monitor alcohol intake.(67) Further, well-designed, clinical trials in clearly defined patient groups are required in order to establish the efficacy of milk thistle and its components in different liver disorders. In Germany, milk thistle is approved for the treatment of toxic liver disorders and as a supportive treatment in chronic inflammatory liver disease and hepatic cirrhosis.

Teas prepared from milk thistle fruits or herb are not commonly used as only a small proportion of silymarin gets into the aqueous extract such that pharmacologically active doses are not attained.(68) For this reason, in Germany teas are recommended only as supportive treatment in functional gall bladder disorders and not for antihepatotoxic effects. In Germany, milk thistle fruit (3-5 g) as an infusion three or four times daily is also indicated for mild digestive disorders.

There are some toxicity and safety data for milk thistle which, together with data on the adverse effects reported in clinical trials, provide good evidence for the safety of milk thistle when used at recommended doses in the short term. However, further data on the long-term safety of milk thistle use are required.

Patients wishing to use milk thistle should be advised to consult a pharmacist, doctor or other suitably trained healthcare professional for advice.

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Scientific Research and Pharmacologicial Actions
Silymarin acts as an antagonist in many experimental liver-damage models: phalloidin and -amanitin (death-cap toxins), lanthanides, carbon tetrachloride, galactosamine, thioacetamide, and the hepatotoxic virus FV3 of cold-blooded vertebrates.

The therapeutic activity of silymarin is based on two sites or mechanisms of action:

(a) It alters the structure of the outer cell membrane of the hepatocytes in such a way as to prevent penetration of the liver toxin into the interior of the cell;

(b) It stimulates the action of nucleolar polymerase A, resulting in an increase in ribosomal protein synthesis, and thus stimulates the regenerative ability of the liver and the formation of new hepatocytes.

Several pharmacological activities have been documented for milk thistle fruit, including hepatoprotective, antioxidant, anti-inflammatory, antifibrotic and antitumour properties, as well as inhibition of lipid peroxidation, stimulation of protein biosynthesis and acceleration of liver regeneration. Silymarin (an isomer mixture comprising mainly silibinin, silichristin and silidianin) is the pharmacologically active component of milk thistle fruit; silibinin is the main component of silymarin. There is an extensive literature on the pharmacological effects of silymarin and silibinin, particularly with regard to their hepatoprotective activity which provides supporting evidence for the clinical uses. The pharmacology and clinical efficacy of milk thistle have been reviewed.(1-3) The following represents a summary of selected publications on this subject.

There is a lack of research investigating the pharmacological effects of preparations of milk thistle leaf.


In Vitro and Animal Studies

Antioxidant Activity

Silymarin and silibinin (silybin) are antioxidants that react with free radicals (e.g. reactive oxygen species) transforming them into more stable and less reactive compounds.(1,4-6) Silymarin and silybin have been reported to inihibit lipid peroxidation induced by iron-linked systems in rat liver microsomes(7,8) and protect against phenylhydrazine-induced lipid peroxidation in rat erythrocytes.(1) Furthermore, in rats, intraperitoneal silymarin has been shown to increase total glutathione in the liver, intestine and stomach and to improve the reduced glutathione to oxidised glutathione ratio.(9) Silymarin has been shown to inhibit copper-induced oxidation of human low-density lipoprotein (LDL) in vitro in a concentration-dependent manner.(10) Silybin appears to be the constituent of silymarin responsible for the LDL antioxidant effect. In contrast, silichristin and silydianin appeared to act as pro-oxidants, but without significantly reducing the total LDL antioxidant capacity of silymarin.

Free radicals are recognised as having an important role in several pathological processes, including inflammation, necrosis, fibrosis, atherosclerosis, carcinogenesis and ageing and in the hepatotoxic mechanisms of various substances. The antioxidant activity of silymarin is thought to contibute to its hepatoprotective properties.(11)

Hepatoprotective Properties

In vitro studies using isolated hepatocytes have documented the protective activity of silymarin and several of its components against cell damage induced by various cytotoxic substances.(1)

In vivo studies in rats and mice have demonstrated the hepatoprotective activity of silymarin and silybin in acute liver toxicity induced by various toxic agents with different mechanisms of action, including carbon tetrachloride, galactosamine, thioacetamide, ethanol, paracetamol (acetaminophen), thallium, phalloidin and α-amanitin (the main toxic constituents of the mushroom A. phalloides).(1) Experimental studies in chronic liver toxicity induced by repeated administration of carbon tetrachloride, heavy metals, thioacetamide and several drugs, including azathioprine and indometacin, have also demonstrated that administration of silymarin and silybin protects against damage.(1) Other studies have reported protective effects of silymarin against liver injury induced by ischaemia(12) and gamma irradiation.(13)

Studies in rabbits fed a high-fat diet for 12 weeks have shown that histopathological alterations were least advanced in animals which also received a silymarin-phospholipid complex.(14) In rats, silymarin inhibited the development of diet-induced hypercholesterolaemia.(15) The hypocholesterolaemic effects of silymarin may be due to the effects of silymarin on lipoprotein metabolism.(16)

The effects of silymarin on biliary bile salt secretion have been seen in studies in rats.(17) Intraperitoneal silymarin (25, 50, 100 and 150 mg/kg/day) for five days induced a dose-dependent increase in bile flow and bile salt secretion. Stimulation of bile salt secretion was mainly accounted for by an increase in the biliary secretion of the hepatoprotective bile salts ß-muricholate and ursodeoxycholate.

Nephroprotective Properties

Silibinin injected into rats prior to administration of cisplatin afforded protection of glomerular and proximal tubular function.(18,19) Silibinin does not affect the cytotoxic activity of cisplatin.(19) Intraperitoneal silibinin (5 mg/kg) administered to rats 30 minutes before ciclosporin decreased ciclosporin-induced lipid peroxidation but produced no protective effect on the glomerular filtration rate.(20)

Anticancer Activity

Silybin at concentrations of 0.1-20 µmol/L inhibited the growth of drug- resistant ovarian cancer cells and doxorubicin- resistant breast cancer cells in vitro.(21) Furthermore, silybin in the range of 0.1-1.0 µmol/L potentiated the effect of cisplatin and doxorubicin in experimental tumour cell lines. When applied to the skin of SENCAR mice, silymarin gave protection against the effects of the tumour promoters 12-O-tetradecanoylphorbol (TPA) and okaidic acid (OA).(22) Topical application of silymarin prior to that of TPA and OA completely inhibited induction of tumour necrosis factor α (TNFα) mRNA expression in the epidermis. Substantial protection from photocarcinogenesis in mice treated with phorbol ester or 7,12-dimethylbenz(a)anthracene has been demonstrated.(23) The antitumour effect is primarily at stage 1 tumour promotion and silymarin acts by inhibiting cyclo oxygenase 2 (COX-2) and interleukin 1α (IL-1α).(24) Such effects may involve inhibition of promoter-induced oedema, hyperplasia, the proliferation index and oxidant state.(25)

Treatment of serum-starved human prostate carcinoma DU145 cells with silymarin resulted in significant inhibition of transforming growth factor α (TGFα)-mediated activation of the epidermal growth factor receptor erbB1.(26) There was also a decrease in tyrosine phosphorylation of an immediate downstream target, the adaptor protein SHC, together with a decrease in binding to erbB1. In the silymarin-treated cell lines there was a significant induction of the cyclin-dependent kinase inhibitors (CDKIs) Cip1/p21 and Kip/p27 concomitant with a significant decrease in CDK4 expression, but no changes in the levels of CDK2 and CDK6 and their associated cyclins E and D1, respectively. Additional experiments showed that there was a significant inhibition of constitutive tyrosine phosphorylation of both erbB1 and SHC, but no changes in their protein levels. The results indicated that silymarin may exert a strong anticarcinogenic effect against prostate cancer and that this effect is likely to involve impairment of the erbB1-SHC-mediated signalling pathway, induction of CDKIs and resultant G1 arrest.(26)

There was a significant inhibition of mitogen-activated protein kinase (MAPK) ERK activity at lower doses in epidermal A431 cells treated with silymarin, whereas higher doses activated MAPK/JNK1.(27) Silymarin exerted a strong anticarcinogenic effect against human breast carcinoma cells MDA-MB468 with G1 arrest in cell cycle progression and also induction in protein expression of the CDKI Cip/p21.(28)

The cancer chemoprevention and anticarcinogenic effects of silymarin have been shown to be due to its major constituent silibinin.(29) Silibinin decreases prostate-specific antigen (PSA) in hormone-refractory human prostate carcinoma LNCaP cells and inhibits cell growth via G1 arrest.(30)

Silibinin was fed orally to SENCAR mice and its tissue distribution investigated.(31) Free silibinin mainly accumulated in the liver, although it was also distributed in other organs. Increases in glutathione-S-transferase and quinone reductase activities in the liver, lung, stomach, skin and small bowel were observed. The results demonstrated the bioavailability of and phase II enzyme induction of silibinin in different tissues where silymarin has been shown to be a strong cancer chemopreventive agent.

Anti-Inflammatory Activity

Silymarin administered orally reduced foot-pad abscesses in a dose-dependent manner in the carrageenan rat paw oedema test (ED50 = 62.4 mg/kg).(32) In the xylene-induced inflammation test, topically applied silymarin was comparable with indometacin.(32) Silymarin given intraperitoneally to mice resulted in inhibition of leukocyte accumulation in inflammatory exudates and reduced the neutrophil count.(32) Activation of NF-?B induced by TNF, phorbol ester, okaidic acid and ceramide was blocked by silymarin in a dose-dependent manner.(33) Silymarin also inhibited TNF-induced activation of mitogen-activated protein kinase and c-Jun N-terminal kinase.(33) The inhibition of activation of NF-?B and the kinases may provide part of the molecular basis for the anti-inflammatory and anticarcinogenic effects of silymarin.(33) Silymarin potently suppressed both NF-?B-DNA binding activity and its dependent gene expression induced by okaidic acid in the hepatoma cell line Hep G2. (34) In addition, silymarin inhibits COX-2 and IL-1α.(24)

Gastric Ulcer Protective Effects

Oral administration of silymarin to rats prevented gastric ulceration induced by cold-restraint stress.(35) Gastric secretion volume and acidity were not affected, but histamine concentration was significantly decreased. It was suggested that the anti-ulcerogenic effect of silymarin may be related to inhibition of enzymic peroxidation by the lipoxygenase pathway.(35) The protective effect of silymarin on gastric injury induced in rats by ischaemia-reperfusion and its effects on mucosal myeloperoxidase has been compared with that of allopurinol.(36) The mean ulcer indexes (4.75, 4.50 and 3.63 ui, respectively) of rats treated with 25, 50 and 100 mg/kg silymarin were significantly lower than in control rats, although allopurinol was considerably more potent (2.3 ui; 100 mg/kg).(36)

Other Effects

Silymarin has been shown to prevent alloxan-induced diabetes mellitus in rats, possibly due to its antioxidant activity and increases in plasma and pancreatic glutathione concentrations.(37)

It has been reported that Silybum marianum and silymarin beneficially affect skin elasticity. A phospholipid-silymarin complex (Silymarin-Phytosome) evaluated for its topical effects against croton oil dermatitis in mice and UV-induced erythema in humans showed reduction of oedema and inhibition of myeloperoxidase activity.(38) A standardised extract of S. marianum significantly inhibited porcine elastase in vitro.(39) An 80% ethanol extract of S. marianum aerial parts showed activity against Bacillus subtilis, Staphylococcus aureus, Streptococcus haemolyticus, Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa and Salmonella typhi.(40)

Clinical Studies

Clinical trials with milk thistle preparations have focused on their use in alcoholic liver disease, cirrhosis and acute viral and chronic hepatitis. However, several trials have included patients with liver disease of different aetiology, e.g. alcoholic and non-alcoholic cirrhosis. There is also interest in the use of silymarin in toxin- and drug-induced hepatitis, for example following ingestion of the death cap mushroom A. phalloides.

A randomised, double-blind, placebo-controlled, multicentre trial involving 200 alcoholic patients with histologically or laparoscopically proven liver cirrhosis investigated the effects of administration of silymarin (150 mg) three times daily.(41) The results indicated that silymarin had no effect on survival and the clinical course in these patients: 125 patients (silymarin n = 57 and placebo n = 68) completed the two-year study period, during which 29 died (n = 15 and 14 for silymarin and placebo, respectively; no statistically significant difference).

In a randomised, double-blind, placebo-controlled trial, patients with alcoholic (n = 91) or non-alcoholic (n = 79) cirrhosis received silymarin (140 mg) three times daily or placebo for two years.(42) The four-year survival rate was significantly higher in silymarin-treated patients than in placebo recipients (58 versus 39%, respectively, p = 0.036). Subgroup analysis indicated that the effect of silymarin on mortality was more pronounced in those patients with alcoholic cirrhosis.

Another randomised, double-blind, placebo-controlled trial carried out over four years reported a significantly higher survival rate in patients with alcoholic cirrhosis treated with silymarin (420 mg) daily compared with placebo recipients, although the effect in patients with non-alcoholic cirrhosis was less marked.(43)

Other controlled trials have investigated the effects of silymarin in patients with alcohol-related liver damage. Several of these,(44,45) but not all,(46) reported statistically significant benefits with silymarin, e.g. on serum transaminases, compared with placebo.(1)

In a randomised controlled trial, 60 patients with diabetes caused by alcoholic liver cirrhosis received silymarin (600 mg/day) or no silymarin treatment for six months.(47) At the end of the study period, the mean values for fasting blood glucose, daily blood glucose, daily glycosuria, glycosylated haemoglobin, daily insulin requirement, malondialdehyde and glucagon-stimulated C peptide were significantly lower in silymarin-treated patients than in those who did not receive silymarin treatment.

A pilot study involving 20 patients with chronic active hepatitis randomised to receive a silybin-phosphatidylcholine complex preparation (IdB1016; Silipide) (240 mg) twice daily or placebo for seven days reported significant reductions in the mean serum concentrations of aspartate aminotransferase (AST), alanine aminotransferase (ALT), ?-glutamyltranspeptidase (GGT) and total bilirubin in silybin complex-treated patients compared with values in placebo recipients.(48) The same preparation has been reported to reduce serum concentrations of liver enzymes (AST and ALT) in 65 patients with chronic persistent hepatitis in a randomised placebo-controlled trial.(49)

The hepatoprotective effects of silymarin in 222 de novo tacrine-treated patients with mild to moderate dementia of the Alzheimer type were investigated in a randomised, double-blind (for silymarin), placebo-controlled, multicentre, 12-week trial.(50) Patients received tacrine plus silymarin (420 mg/day) (n = 110) or tacrine plus placebo (n = 112); silymarin (and placebo) were initiated one week before tacrine (40 mg/day for six weeks then 80 mg/day for six weeks). An intention-to-treat analysis indicated that there was no difference in serum ALT concentrations between the two groups, but that silymarin-treated patients experienced significantly fewer gastrointestinal and cholinergic side-effects without any impact on cognitive status than did placebo recipients.(50)

The effects of silymarin in preventing psychotropic drug-induced hepatic damage have been investigated in a randomised, double-blind, placebo-controlled trial.(51) Sixty women aged 40-60 years who had been taking phenothiazines or butyrophenones for at least five years and who had AST and ALT activity twice normal values were randomised to continued treatment with psychotropic agents or suspension of treatment and to silymarin (800 mg/day) or placebo for 90 days. The findings indicated that treatment with silymarin reduced the lipoperoxidative hepatic damage associated with prolonged administration of butyrophenones and phenothiazines and that the protective effect was greater when treatment with these psychotropic agents was suspended for three months.(51)

There have been numerous case reports, many of which report favourable outcomes, on the therapeutic use of silymarin and silibinin, usually given in combination with standard treatment, in poisoning caused by ingestion of the death cap mushroom A. phalloides, although there are no controlled trials in this indication.(1,51-54,G55) Silibinin is usually given intravenously and case reports have indicated that early administration appears to be important.(55,56)

Pharmacokinetics

Studies of the pharmacokinetics of silymarin and its components and of a silibinin-phosphatidylcholine complex preparation (IdB 1016; Silipide) in both healthy volunteers and patients with cirrhosis and those who have undergone cholecystectomy have been reviewed.(1,G50 G55) Approximately 20-50% of silymarin is absorbed following oral administration and approximately 80% of the dose, whether administered orally or intravenously, is excreted in the bile.(57) Studies in healthy volunteers have reported an elimination half-life of approximately 6 hours following administration of single doses of silymarin corresponding to approximately 240 mg silibinin.(58,59) Other studies have compared the pharmacokinetics of different silymarin preparations and shown statistically significant differences in bioavailability.(60,61)

The bioavailability of a silybin-phosphatidylcholine complex preparation (IdB 1016) has been shown to be several times greater than that of silymarin in single-dose studies involving healthy volunteers(62) and patients with hepatic cirrhosis.(63)

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Research
"Milk Thistle and Nerve Regrowth"
"Milk Thistle: Hangover Buster May Cure You of Cancer"
"Milk Thistle Could Fight Prostate Cancer"

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Precautions / Contraindications
Milk thistle is contra-indicated for individuals with hypersensitivity to species of Asteraceae.

Don't try to self-diagnose or self-treat a liver problem. Such ailments require the attention of a medical professional who can closely monitor your care.

Avoid alcohol-based tinctures of milk thistle. Some of these contain considerable amounts of alcohol, which can damage the liver over time.

Pregnancy and Lactation

In view of the lack of toxicity data, use of milk thistle preparations during pregnancy and lactation should be avoided unless the expected benefit is thought to outweigh any unknown risks to the fetus.

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Interaction with Medications
If you are taking the drug Indinavi® to treat advanced HIV or AIDS, consult your doctor before taking milk thistle, an herb which may decrease the effectiveness of this drug.

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Possible Side Effects
Milk thistle extract is virtually devoid of any side effects and may be used by most people, including pregnant and breast-feeding women. In fact, it has been recommended as a treatment for itching due to poor gallbladder function during pregnancy. Since silymarin stimulates liver and gallbladder activity, it may have a mild, transient laxative effect in some people. This will usually cease within two to three days.

There is one case report of a 57-year-old Australian woman experiencing several episodes of nausea, abdominal pain, vomiting and weakness after taking a milk thistle preparation. This case is so atypical, however, that the Adverse Drug Reactions Advisory Committee of Australia questioned whether the product taken might not have contained other herbs or additives that could be responsible for the adverse reaction.

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Dosage
Fruit: Crude drug 12-15 g daily in divided doses (equivalent to silymarin 200-400 mg daily).

Herb: Approximately 1.5 g of finely chopped material as a tea, two or three cups daily.

The doses of silymarin used in clinical trials have ranged from 280 to 800 mg/day (equivalent to milk thistle extract 400-1140 mg/day standardised to contain 70% silibinin).(3)

For hepatic disorders, doses of up to 140 mg (equivalent to 60 mg silibinin) two or three times daily have been suggested. According to research and clinical experience, improvement should be noted in about eight to twelve weeks. For people with chronic liver disease, milk thistle extract may be considered a long-term therapy. For those who prefer, 12-15 grams of milk thistle dried fruits can be ground and eaten or made into a tea. This should not be considered therapeutic for conditions of the liver, however.

To work as effectively as indicated in dozens of clinical trials, milk thistle needs to be correctly prepared and standardized. Choose a supplement standardized to contain 70% to 80% silymarin, the active ingredient. This high concentration of silymarin is needed to ensure that a sufficient amount will reach the bloodstream and eventually the liver.

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References
1. Morazzoni P, Bombardelli E. Silybum marianum (Carduus marianus). Fitoterapia 1995; 66: 3-42.
2. Awang D. Milk thistle. Can Pharm J 1993; 403-404, 422.
3. Pepping J. Milk thistle: Silybum marianum. Am J Health-Syst Pharm 1999; 56: 1195-1197.(PubMed)
4. Leng-Peschlow E. Properties and medical use of flavolignans (silymarin) from Silybum marianum. Phytother Res 1996; 10: S25-26.
5. Pascual C et al. Effect of silymarin and silybinin on oxygen radicals. Drug Dev Res 1993; 29: 73-77.
6. Mira L et al. Scavenging of reactive oxygen species by silibinin dihemisuccinate. Biochem Pharmacol 1994; 48: 753-759.(PubMed)
7. Bindoli A et al. Biochem Pharmacol 1977; 26: 2045.
8. Valenzuela A et al. Antioxidant properties of the flavonoids silybin and (+)-cyanidanol-3: comparison with butylated hydroxyanisole and butylated hydroxytoluene. Planta Med 1986; 19: 438-440.
9. Valenzuela A et al. Selectivity of silymarin on the increase of the glutathione content in different tissues of the rat. Planta Med 1989; 55: 20-422.(PubMed)
10. Skottova N et al. Activities of silymarin and its flavolignans upon low density lipoprotein oxidizability in vitro. Phytother Res 1999; 13: 535-537.(PubMed)
11. Valenzuela A, Garrido A. Biochemical basis of the pharmacological action of the flavonoid silymarin and its structural isomer silibinin. Biol Res 1994; 27: 105-112.(PubMed)
12. Wu CG et al. Protective effect of silymarin on rat liver injury induced by ischaemia. Virchows Arch B Cell Pathol Mol Pathol 1993; 64: 259-263.
13. Kropacova K et al. Protective and therapeutic effect of silymarin on the development of latent liver damage. Radiat Biol Radioecol 1998; 38: 411-415.
14. Drozdzik M et al. Effect of silymarinphospholipid complex on the liver in rabbits maintained on a high-fat diet. Phytother Res 1996; 10: 406-409.
15. Krecman V et al. Silymarin inhibits the development of diet-induced hypercholesterolemia in rats. Planta Med 1998; 64: 138-142.(PubMed)
16. Skottova N, Krecman V. Silymarin a potential hypocholesterolaemic drug. Physiol Res 1998; 47: 1-7.(PubMed)
17. Crocenzi FA et al. Effect of silymarin on biliary bile salt secretion in the rat. Biochem Pharmacol 2000; 59: 1015-1022.(PubMed) 18. Gaedeke J et al. Cisplatin nephrotoxicity and protection by silibinin. Nephrol Dial Transplant 1996; 11: 55-62.(PubMed)
19. Bokemeyer C et al. Silibinin protects against cisplatin-induced nephrotoxicity without compromising cisplatin or ifosfamide anti-tumour activity. Br J Cancer 1996; 74: 2036-2041.(PubMed)
20. Zima T et al. The effect of silibinin on experimental cyclosporine nephrotoxicity. Renal Failure 1998; 20: 471-479.(PubMed)
21. Scambia G et al. Antiproliferative effects of silybin on gynaecological malignancies: synergism with cisplatin and doxorubicin. Eur J Cancer 1996; 32A: 877-882.(PubMed)
22. Zi X et al. Novel cancer chemopreventative effects of a flavonoid constituent silymarin: inhibition of mRNA expression of an endogenous tumour promoter TNFalpha. Biochem Biophys Res Commun 1997; 239: 334-339.(PubMed)
23. Katiyar SK et al. Protective effects of silymarin against photocarcinogenesis in a mouse skin model. J Natl Cancer Inst 1997; 89: 556-566.(PubMed)
24. Zhao J et al. Significant inhibition by the flavonoid antioxidant silymarin against 12-O-tetradecanoylphorbol 13-acetate caused modulation of anti oxidant and inflammatory enzymes and cyclooxygenase 2 and interleukin-1 alpha expression in SENCAR mouse epidermis: implications in the prevention of stage I tumour promotion. Mol Carcinogen 1999; 26: 321-333.
25. Lahiri-Chatterjee M et al. A flavonoid antioxidant, silymarin, affords exceptionally high protection against tumour promotion in the SENCAR mouse skin tumorigenic model. Cancer Res 1999; 59: 622-632.(PubMed)
26. Zi X et al. A flavonoid antioxidant, silymarin, inhibits activation of erbB1 signaling and induces cyclin-dependent kinase inhibitors, G1 arrest and anticarcinogenic effects in human prostate carcinoma DU145 cells. Cancer Res 1998; 58: 1920-1929.(PubMed)
27. Zi X, Agarwal R. Modulation of mitogen-activated protein kinase activation and cell cycle regulators by the potent skin cancer preventative agent silymarin. Biochem Biophys Res Commun 1999; 263: 528-536.(PubMed)
28. Zi X et al. Anticarcinogenic effect of a flavonoid antioxidant, silymarin, in human breast cancer cells MDA-MB468: induction of G1 arrest through an increase in Cip1/p21 concomitant with a decrease in kinase activity of cyclin-dependent kinases and associated cyclins. Clin Cancer Res 1998; 4: 1055-1064.(PubMed)
29. Bhatia N et al. Inhibition of human carcinoma cell growth and DNA synthesis by silibinin, an active constituent of milk thistle: comparison with silymarin. Cancer Lett 1999; 147: 77-84.(PubMed)
30. Zi X et al. Silibinin decreases prostate-specific antigen with cell growth inhibition via G1 arrest, leading to differentiation of prostate carcinoma cells: implications for prostate cancer intervention. Proc Natl Acad Sci USA 1999; 96: 7490-7495.(PubMed)
31. Zhao J, Agarwal R. Tissue distribution of silibinin, the major active constituent of silymarin, in mice and its association with enhancement of phase II enzymes: implications in cancer chemoprevention. Carcinogenesis 1999; 20: 2101-2108.(PubMed)
32. De La Puerta R et al. Effect of silymarin on different acute inflammation models and in leukocyte migration. J Pharm Pharmacol 1996; 48: 968-970.(PubMed)
33. Manna SK et al. Silymarin suppresses TNF-induced activation of NF-kappaB, c-Jun N-terminal kinase and apoptosis. J Immunol 1999; 163: 6800-6809.(PubMed)
34. Saliou C et al. Selective inhibition of NF-kappaB activation by the flavonoid hepatoprotector silymarin in HepG2. FEBS Lett 1998; 440: 8-12.(PubMed)
35. De La Lastra C et al. Gastric antiulcer activity of silymarin, a lipoxygenase inhibitor, on rats. J Pharm Pharmacol 1992; 44: 929-931.(PubMed)
36. De La Lastra C et al. Gastroprotection induced by silymarin, the hepatoprotective principle of Silybum marianum in ischaemia-reperfusion mucosal injury: role of neutrophils. Planta Med 1995; 61: 116-119.(PubMed)
37. Soto CP et al. Prevention of alloxan-induced diabetes mellitus in the rat by silymarin. Comp Biochem Physiol 1998; 119C: 125-129.
38. Bombardelli E et al. Ageing skin: protective effect of silymarin-Phytosomer. Fitoterapia 1991; 62: 115-122.
39. Benaiges A et al. Study of the refirming effect of a plant complex. Int J Cosmet Sci 1998; 20: 223-233.
40. Izzo AA et al. Biological screening of Italian medicinal plants for antibacterial activity. Phyto ther Res 1995; 9: 281-286.
41. Pares A et al. Effects of silymarin in alcoholic patients with cirrhosis of the liver: results of a controlled, double-blind, randomized and multicenter trial. J Hepatol 1998; 28: 615-621.(PubMed)
42. Ferenci P et al. Randomized controlled trial of silymarin treatment in patients with cirrhosis of the liver. J Hepatol 1989; 9: 105-113.(PubMed)
43. Benda L et al. The influence of therapy with silymarin on the survival rate of patients with liver cirrhosis. Wien Klin Wschr 1980; 92: 678-683.(PubMed)
44. Salmi H, Sarna S. Effect of silymarin on the chemical, functional and morphological alterations of the liver. Scand J Gastroenterol 1982; 17: 517-521.(PubMed)
45. Feher J et al. Hepatoprotective activity of silymarin Legalonr therapy in patients with chronic alcoholic liver disease. Orv Hetil 1989; 130: 2723-2727.(PubMed)
46. Trinchet JC et al. Traitement de l'h‚patite alcoolique par la silymarine. Une ‚tude comparative en double insu chez 116 malades. Gastroenterol Clin Biol 1989; 13: 120-124.(PubMed)
47. Velussi M et al. Silymarin reduces hyperinsulinaemia, malondialdehyde levels, and daily insulin need in cirrhotic diabetic patients. Curr Ther Res 1993; 53: 533-545.
48. Buzzelli G et al. A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol 1993; 31: 456-460.(PubMed)
49. Marcelli R et al. Cited by Morazzoni P et al. Silybum marianum (Carduus marianus). Fitoterapia 1995; 66: 3-42. Eur Bull Drug Res 1992; 1: 131-135.
50. Allain H et al. Aminotransferase levels and silymarin in de novo tacrine-treated patients with Alzheimer's disease. Dementia Geriat Cogn Disord 1999; 10: 181-185.
51. Palasciano G et al. The effect of silymarin on plasma levels of malon-dialdehyde in patients receiving long-term treatment with psychotropic drugs. Curr Ther Res 1994; 55: 537-545.
52. Klein AS et al. Amanita poisoning: treatment and the role of liver transplantation. Am J Med 1989; 86: 187-193.(PubMed)
53. Floersheim GL et al. Die Klinische Knollenblatterpilzverg; Ftung: prognostische faktoren und therapeutische massnahmen. Schweiz Med Wochenschr 1982; 112: 1164-1177.(PubMed)
54. Carducci R et al. Silibinin and acute poisoning with Amanita phalloides. Minerva Anestesiol 1996; 62: 187-193.(PubMed)
55. Hruby K et al. Pharmacotherapy of Amanita phalloides poisoning using silybin. Wien Klin Wochenschr 1983; 95: 225-231.(PubMed)
56. Hruby K et al. Chemotherapy of Amanita phalloides poisoning with intravenous silibinin. Hum Toxicol 1983; 2: 183-190.(PubMed)
57. Mennicke WH. Zur biologischen Verfgbarkeit und Verstoffwechselung von Silybin. Dtsch Apoth Ztg 1975; 115: 1205-1206.
58. Lorenz D et al. Pharmacokinetic studies with silymarin in human serum and bile. Meth Find Exp Clin Pharmacol 1984; 6: 655-661.
59. Weyhenmeyer R et al. Study on the dose-linearity of the pharmacokinetics of silibinin diastereomers using a new stereospecific assay. Int J Clin Pharmacol Ther Toxicol 1992; 30: 134-138.(PubMed)
60. Cho J-Y et al. Pharmacokinetic evaluation of two formulations containing silymarin: Legalon 140T cap and SilymarinT. J Korean Soc Clin Pharmacol Ther 1998; 6: 119-127.
61. Schulz H-U et al. Untersuchungen zum Freisetzungsverhalten und zur Bio„quivalenz von Silymarin-Pr„paraten. Arzneimittelforschung 1995; 45: 61-64.(PubMed)
62. Barzaghi N et al. Pharmacokinetic studies on IdB 1016, a silybin-phosphatidylcholine complex, in healthy human volunteers. Eur J Drug Metab Pharmacokinet 1990; 15: 333-338.(PubMed)
63. Orlando R et al. Silybin kinetics in patients with liver cirrhosis: a comparative study of silybin-phosphatidylcholine complex and silymarin. Med Sci Res 1990; 18: 861-863.
64. Albrecht M, Fredrick H. Therapy of toxic liver pathologies with Legalon. Z Klin Med 1992; 47: 87-92.
65. Anon. An adverse reaction of the herbal medication milk thistle (Silybum marianum). Adverse Drug Reactions Advisory Committee. Med J Aust 1999; 170: 218-219.(PubMed)
66. Geier J et al. Anaphylactic shock due to an extract of Silybum marianum in a patient with immediate-type allergy to kiwi fruit. Allergologie 1990; 13: 387-388.
67. Flora K et al. Milk thistle (Silybum marianum) for the therapy of liver disease. Am J Gastroenterol 1998; 93: 139-143.(PubMed)
68. Merfort E, Willuhn G. Cited by ref. G2. Dtsch Apoth Ztg 1985; 125: 695.

Our thanks to the following information resources: MedicinesComplete.com, American Botanical Council (Herbalgram.org), WholehealthMD.com, Botanical.com, Vitacost.com, Purplesage.org, Skyeherbals.com.

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Milk Thistle - Herbal Plant Supplements

Click on any of the products below for detailed product information!
 

Milk Thistle Herb Tea

Milk Thistle Herb Tea

Milk Thistle Herb Tea

Milk Thistle Herb Tea

Milk Thistle Herb Tea (Loose)

Milk Thistle Herb Tea (Loose)

Milk Thistle Herb Tea (Loose)

Milk Thistle Herb Tea (Loose)

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Seed - Salve Ointment

Milk Thistle Seed - Salve Ointment

Milk Thistle Seed - Cream

Milk Thistle Seed - Cream

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle Seed - Glycerite Liquid Extract (1:5) - Mint Flavored

Senna 11-Herb Cleansing Formula Tea

Senna 11-Herb Cleansing Formula Tea

Senna 11-Herb Cleansing Formula Tea

Senna 11-Herb Cleansing Formula Tea

Senna 11-Herb Cleansing Formula Tea (Loose)

Senna 11-Herb Cleansing Formula Tea (Loose)

Senna 11-Herb Cleansing Formula Tea (Loose)

Senna 11-Herb Cleansing Formula Tea (Loose)

Senna 11-Herb Cleansing Formula Powder

Senna 11-Herb Cleansing Formula Powder

Senna 11-Herb Cleansing Formula Powder

Senna 11-Herb Cleansing Formula Powder

Milk Thistle Powder

Milk Thistle Powder

Milk Thistle Powder

Milk Thistle Powder

Milk Thistle Herb Powder

Milk Thistle Herb Powder

Milk Thistle Herb Powder

Milk Thistle Herb Powder

Milk Thistle Plant Powder

Milk Thistle Plant Powder

Milk Thistle Plant Powder

Milk Thistle Plant Powder

Milk Thistle Plant Tea (Loose)

Milk Thistle Plant Tea (Loose)

Milk Thistle Plant Tea (Loose)

Milk Thistle Plant Tea (Loose)

Milk Thistle Plant Tea

Milk Thistle Plant Tea

Milk Thistle Plant Tea

Milk Thistle Plant Tea

Milk Thistle Seed Powder

Milk Thistle Seed Powder

Milk Thistle Seed Powder

Milk Thistle Seed Powder

Milk Thistle Seed Tea (Loose)

Milk Thistle Seed Tea (Loose)

Milk Thistle Seed Tea (Loose)

Milk Thistle Seed Tea (Loose)

Milk Thistle Seed Tea

Milk Thistle Seed Tea

Milk Thistle Seed Tea

Milk Thistle Seed Tea

Milk Thistle Seed and Plant Powder

Milk Thistle Seed and Plant Powder

Milk Thistle Seed and Plant Powder

Milk Thistle Seed and Plant Powder

Milk Thistle Seed and Plant Tea (Loose)

Milk Thistle Seed and Plant Tea (Loose)

Milk Thistle Seed and Plant Tea (Loose)

Milk Thistle Seed and Plant Tea (Loose)

Milk Thistle Seed and Plant Tea

Milk Thistle Seed and Plant Tea

Milk Thistle Seed and Plant Tea

Milk Thistle Seed and Plant Tea

Milk Thistle and Dandelion Combination Powder

Milk Thistle and Dandelion Combination Powder

Milk Thistle and Dandelion Combination Powder

Milk Thistle and Dandelion Combination Powder

Milk Thistle and Dandelion Combination Tea (Loose)

Milk Thistle and Dandelion Combination Tea (Loose)

Milk Thistle and Dandelion Combination Tea (Loose)

Milk Thistle and Dandelion Combination Tea (Loose)

Milk Thistle and Dandelion Combination Tea

Milk Thistle and Dandelion Combination Tea

Milk Thistle and Dandelion Combination Tea

Milk Thistle and Dandelion Combination Tea

Milk Thistle and Dandelion Combination Cream

Milk Thistle and Dandelion Combination Cream

Milk Thistle and Dandelion Combination - Salve Ointment

Milk Thistle and Dandelion Combination - Salve Ointment

Kudzu and Milk Thistle Combination Powder

Kudzu and Milk Thistle Combination Powder

Kudzu and Milk Thistle Combination Powder

Kudzu and Milk Thistle Combination Powder

Kudzu and Milk Thistle Combination Tea (Loose)

Kudzu and Milk Thistle Combination Tea (Loose)

Kudzu and Milk Thistle Combination Tea (Loose)

Kudzu and Milk Thistle Combination Tea (Loose)

Kudzu and Milk Thistle Combination Tea

Kudzu and Milk Thistle Combination Tea

Kudzu and Milk Thistle Combination Tea

Kudzu and Milk Thistle Combination Tea

Kudzu and Milk Thistle Combination Cream

Kudzu and Milk Thistle Combination Cream

Kudzu and Milk Thistle Combination - Salve Ointment

Kudzu and Milk Thistle Combination - Salve Ointment

Whole Body Detox Tea (Loose)

Whole Body Detox Tea (Loose)

Whole Body Detox Tea (Loose)

Whole Body Detox Tea (Loose)

Whole Body Detox Tea

Whole Body Detox Tea

Whole Body Detox Tea

Whole Body Detox Tea

Cirrhosis Support Powder - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Powder - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Powder - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Powder - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea (Loose) - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea (Loose) - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea (Loose) - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea (Loose) - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea - Milk Thistle, Dandelion and Vervain

Cirrhosis Support Tea - Milk Thistle, Dandelion and Vervain

Liver Disease Support Powder

Liver Disease Support Powder

Liver Disease Support Powder

Liver Disease Support Powder

Liver Disease Support Tea (Loose)

Liver Disease Support Tea (Loose)

Liver Disease Support Tea (Loose)

Liver Disease Support Tea (Loose)

Liver Disease Support Tea

Liver Disease Support Tea

Liver Disease Support Tea

Liver Disease Support Tea

Milk Thistle Seed (Certified Organic) Powder

Milk Thistle Seed (Certified Organic) Powder

Milk Thistle Seed (Certified Organic) Powder

Milk Thistle Seed (Certified Organic) Powder

Milk Thistle Seed (Certified Organic) Tea (Loose)

Milk Thistle Seed (Certified Organic) Tea (Loose)

Milk Thistle Seed (Certified Organic) Tea (Loose)

Milk Thistle Seed (Certified Organic) Tea (Loose)

Milk Thistle Seed (Certified Organic) Tea

Milk Thistle Seed (Certified Organic) Tea

Milk Thistle Seed (Certified Organic) Tea

Milk Thistle Seed (Certified Organic) Tea

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - No Flavor

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - No Flavor

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Strawberry Flavored

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Strawberry Flavored

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Vanilla Flavored

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Vanilla Flavored

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Chocolate Flavored

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Chocolate Flavored

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Mint Flavored

Kudzu & Milk Thistle Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle & Dandelion Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle Leaf Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle Plant Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle Plant Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - No Flavor

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Strawberry Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Vanilla Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Chocolate Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Mint Flavored

Milk Thistle Seed & Plant Glycerite Liquid Extract (1:5) - Mint Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - No Flavor

Liver Disease Support Glycerite Liquid Extract (1:5) - No Flavor

Liver Disease Support Glycerite Liquid Extract (1:5) - Strawberry Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - Strawberry Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - Vanilla Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - Vanilla Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - Chocolate Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - Chocolate Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - Mint Flavored

Liver Disease Support Glycerite Liquid Extract (1:5) - Mint Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - No Flavor

Cirrhosis Support Glycerite Liquid Extract (1:5) - No Flavor

Cirrhosis Support Glycerite Liquid Extract (1:5) - Strawberry Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - Strawberry Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - Vanilla Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - Vanilla Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - Chocolate Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - Chocolate Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - Mint Flavored

Cirrhosis Support Glycerite Liquid Extract (1:5) - Mint Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - No Flavor

Whole Body Detox Glycerite Liquid Extract (1:5) - No Flavor

Whole Body Detox Glycerite Liquid Extract (1:5) - Strawberry Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - Strawberry Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - Vanilla Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - Vanilla Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - Chocolate Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - Chocolate Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - Mint Flavored

Whole Body Detox Glycerite Liquid Extract (1:5) - Mint Flavored
    


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