Figure 1. Evidence model: <str<strong>on</strong>g>Milk</str<strong>on</strong>g> thistle <strong>and</strong> liver disease 10
The Plant <str<strong>on</strong>g>Milk</str<strong>on</strong>g> thistle is a tall plant that can grow up to 10 feet with thorny stems, dark glossy green leaves, <strong>and</strong> milky-white veins running throughout. Its most distinguishing feature is the large, bright purple flower sprouting at the top. 3,7,8 Historical Uses <strong>of</strong> <str<strong>on</strong>g>Milk</str<strong>on</strong>g> <str<strong>on</strong>g>Thistle</str<strong>on</strong>g> For centuries, nearly every part <strong>of</strong> the plant—from root to hull—has been used in some way. 4,6 In her famous book, Maud Grieve explained several ways the milk thistle can be eaten, including the heads like an artichoke, raw stalks (which are c<strong>on</strong>sidered palatable <strong>and</strong> nutritious), <strong>and</strong> the leaves as a salad. 8 She also quoted Bryant, who wrote in his Flora Dietetica, “The young shoots in the Spring, cut close to the root with part <strong>of</strong> the stalk <strong>on</strong>, is <strong>on</strong>e <strong>of</strong> the best boiling salads that is eaten, <strong>and</strong> surpasses the finest cabbage. They were sometimes baked in pies. The roots may be eaten like those <strong>of</strong> Salsify.” 8 <str<strong>on</strong>g>Milk</str<strong>on</strong>g> thistle has also historically been used for animal feed. Grieve wrote that in parts <strong>of</strong> Engl<strong>and</strong>, the leaves are called “pig leaves” because pigs liked them; also, the seeds are a favorite food <strong>of</strong> goldfinches. 8 In Scotl<strong>and</strong>, the leaves were used extensively as food for cattle <strong>and</strong> horses (the leaves were beaten <strong>and</strong> crushed to rid them <strong>of</strong> prickles) before the introducti<strong>on</strong> <strong>of</strong> special green crops. 8 The milk thistle prickles have also been used historically as a substitute for barbed wire. 9 Despite this wide spectrum <strong>of</strong> perceived value, farmers c<strong>on</strong>sidered it <strong>and</strong> other thistles a sign <strong>of</strong> untidiness <strong>and</strong> neglect. 8 Most sources <strong>on</strong> milk thistle, which is native to southern Europe (specifically Mediterranean areas) <strong>and</strong> Asia, 5 put its beginning at 2,000 years ago. 1,2,6,9 One <strong>of</strong> the earliest menti<strong>on</strong>s <strong>of</strong> thistles in general is in the Bible (Genesis 3:18). In this verse, God told Adam <strong>and</strong> Eve when they were banished from the Garden <strong>of</strong> Eden that “thorns also <strong>and</strong> thistles shall it bring forth to thee.” Some <strong>of</strong> the earliest people to use <strong>and</strong> write about milk thistle were ancient Greek <strong>and</strong> Roman physicians <strong>and</strong> herbalists, each <strong>of</strong> whom seemed to have their own name for the herb. Dioscorides called it “sillyb<strong>on</strong>,” Pliny the Elder called it “sillybum,” <strong>and</strong> Theophrastus called it “pternix.” 5 Dioscorides’ use <strong>of</strong> milk thistle is <strong>on</strong>e <strong>of</strong> the oldest known references to the medicinal use <strong>of</strong> this plant. He suggested preparing it in a tea “for those that be bitten <strong>of</strong> serpents.” 10 Another famous ancient herbalist, Pliny the Elder, wrote that mixing the juice <strong>of</strong> the plant with h<strong>on</strong>ey was good for “carrying <strong>of</strong>f bile.” 1,9 <str<strong>on</strong>g>Milk</str<strong>on</strong>g> thistle is menti<strong>on</strong>ed in several works from the Middle Ages, <strong>on</strong>e <strong>of</strong> the first being in a record <strong>of</strong> old Sax<strong>on</strong> remedies, which claimed that “this wort if hung up<strong>on</strong> a man’s neck it setteth snakes to flight.” 8 One <strong>of</strong> the best known herbalists from this time, John Gerard (1545-1612), recommended milk thistle for expelling melancholy <strong>and</strong> its related diseases (melancholy diseases were described in medicine in the Middle Ages as related to the liver <strong>and</strong> also called “black bile”). 8-10 Another well known English herbalist, Nicholas Culpeper (1616-54), recommended milk thistle for several maladies: breaking <strong>and</strong> expelling st<strong>on</strong>es, removing obstructi<strong>on</strong>s <strong>of</strong> the liver <strong>and</strong> spleen, treating jaundice <strong>and</strong> infecti<strong>on</strong>s <strong>of</strong> the plague, <strong>and</strong> cleansing the blood. 8,9 Maud Grieve, who compiled her book <strong>of</strong> herbal informati<strong>on</strong> in 1931, quoted several early English herbalists <strong>on</strong> their love for <strong>and</strong> use <strong>of</strong> milk thistle. She reports that in 1694 Westmacott wrote <strong>of</strong> milk thistle, “It is a friend to the liver <strong>and</strong> blood: the prickles cut <strong>of</strong>f, they were formerly used to be boiled in the spring <strong>and</strong> eaten with other herbs; but as the World decays, so 11
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Summary Table 1. Placebo-controlled
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Summary Table 2. Placebo-controlled
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Summary Table 4. Placebo-controlled
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Summary Table 6. Placebo-controlled
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Summary Table 8. Prophylactic milk
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Summary Table 10. Effect sizes and
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Blumenthal M (National Advisory Pan
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Fintelmann V. Zur Therapie der Fett
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Lang I, Deak G, Nekam K, et al. Hep
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Pifferi G. Silipide: A new bioavail
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Tittel G, Wagner H. High-performanc
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Appendix A. Milk <
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