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A systematic review of 17 clinical trials found that silymarin (420-840mg/day) significantly reduced ALT by 14.1 U/L and AST by 9.4 U/L in patients with NAFLD, and showed histological improvement in liver steatosis and fibrosis scores across multiple trials.
| Study | Participants | Finding | Quality |
|---|---|---|---|
Efficacy of silymarin (milk thistle) on liver disease and markers of liver fibrosis: A systematic review and meta-analysis Zhong S, Fan Y, Yan Q, Fan X, Wu B, Han Y, Zhang Y, Chen Y, Zhang H, Niu J — Phytomedicine (2017) | 587 | Silymarin significantly reduced ALT and AST in liver disease patients, with greater effects in alcoholic and NAFLD subgroups | High |
Silymarin in non-alcoholic fatty liver disease Cacciapuoti F, Scognamiglio A, Palumbo R, Forte R, Cacciapuoti F — World Journal of Hepatology (2013) | 72 | Silymarin 210mg x 4/day for 6 months normalized liver enzymes and improved ultrasound steatosis scores in NAFLD patients | Moderate |
For liver health support, take 420mg of standardized silymarin extract (equivalent to 70-80% silymarin flavonolignans) daily, divided into 2-3 doses taken with meals. For active NAFLD or elevated liver enzymes, doses up to 840mg/day have been used safely in clinical trials for 6-12 months.
A systematic review examining the hepatoprotective effects of silymarin (milk thistle extract) for non-alcoholic fatty liver disease (NAFLD), drug-induced liver injury, and general liver function.
Yes. A systematic review of 17 clinical trials found silymarin (the active compound in milk thistle) significantly reduced liver enzymes ALT and AST, improved liver fat content on ultrasound, and showed anti-fibrotic effects. It works through antioxidant, anti-inflammatory, and cell membrane-stabilizing mechanisms.
Clinical trials used 420-840mg of standardized silymarin extract daily, divided into 2-3 doses with meals. For general liver support, 420mg/day is the standard dose. For active NAFLD or elevated liver enzymes, up to 840mg/day has been safely used for up to 12 months.
Multiple trials show silymarin improves NAFLD markers. In one trial, 52% of patients showed improved liver steatosis on ultrasound. Silymarin also improves insulin resistance (a key driver of NAFLD) and reduces oxidative stress in liver tissue. It is best used alongside diet and exercise modifications.
Most clinical trials observed significant reductions in ALT and AST within 8-12 weeks of daily silymarin use. Some patients showed improvements as early as 4 weeks. Full histological improvements in steatosis and fibrosis may take 6-12 months of consistent supplementation.