WHAT is the deal with Milk Thistle?
WHY is it used to treat liver disease?
HOW does it work?
DOES it work?
ARE you ready for a #tweetorial?
🧵
#medtwitter #livertwitter
Milk Thistle, a history:
1⃣Use to treat snake bites (Dioscorides)
2⃣To carry off bile (Pliny the Elder)
3⃣Great for liver disease (1500's: Otto Brunfels)
4⃣In 19th Century 🇺🇸, the 'Eclectics' popularized herbology, especially milk thistle, for the liver
Fast forward to today:
1⃣Herbal supplements are a multibillion dollarindustry
2⃣A quarter of the population takes an herbal supplement
3⃣~5% of the US population is using Milk Thistle, including 12% of people with liver disease
What do they get out of it?
What does it do?
It has been shown in numerous mouse and cell-culture studies that Milk Thistle can stop lipid peroxidation and has both anti-oxidant and anti-fibrotic properties
But we are neither mice nor clumps of cells
So does it help actual people?
Milk thistle has been used to treat Amanita mushroom poisoning which can lead to acute liver failure.
It may very well help, but the data is not robust
Milk thistle for #cirrhosis?
One study found improved survival!
But the bigger the study, the weaker the effect. Pool them together and the effect overall is no improvement.
Next slide, please
Interestingly, in this (open label) RCT, there was a decrease in blood sugar and insulin needs among patients with alcohol-related cirrhosis and diabetes who got milk thistle
So this leads me to...
Milk thistle for fatty liver?
Two RCTs show there is no improvement in liver inflammation. But one had reduced fibrosis.
Is this a false discovery? Cause for celebration? Or a reason for future studies?
Milk thistle for #hepatitis C?
In this RCT, published in JAMA, of 154 patients with Hep C who were not cured with interferon, milk thistle did not improve the ALT level.
Bust
Why did I do this #tweetorial?
I took an uber to Pearson airport at 3am recently. And my driver asked me what I do. The next question was whether he should take Milk Thistle for his fatty liver. My answer is no. But he made me want to understand how Milk Thistle use is so common
Summary
⭐️Milk thistle has been used to treat liver disease for centuries.
⭐️12% of people with liver disease take it
⭐️Benefits unclear but harms unlikely.
This concludes a #tweetorial on the history and uses of Milk Thistle for chronic liver disease inspired by a midnight uber ride. I hope you enjoyed
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