Which silymarin/milk thistle?

NYBC has expanded its offerings of the key liver supportive supplement MilkThistle (Silymarin). The Jarrow product, which has good quality control, continues as the standard silymarin offering:

http://nybcsecure.org/product_info.php?cPath=57&products_id=92

We are also stocking Milk Thistle/Silybin Advanced, which is designed for enhanced absorption:

http://nybcsecure.org/product_info.php?cPath=57&products_id=392

And we are stocking the Milk Thistle/Thisilyn Pro product from MMS, which, while more expensive than the others, is produced according to the proverbially exacting standards of the German pharmaceutical industry. Milk thistle being one of the classic items in the German herbal pharmacopoeia, we feel assured that there is extra careful quality control behind this item:

http://nybcsecure.org/product_info.php?cPath=57&products_id=408

As background, we provide NYBC’s capsule summary of how to use silymarin/milk thistle, what cautions should be observed, and what other supplements might be useful along with it:

A potent liver-strengthening herb, it stimulates the liver to regenerate itself by producing new liver cells as well as having strong antioxidant action to help prevent lipid-peroxidation of cell membranes. Given to seven patients receiving tuberculosis drugs (INH and ethambutol), a standardized silymarin extract normalized elevated liver enzymes after three months treatment. Many people with hepatitis C use milk thistle. It is extremely safe. Some studies suggest it may help to reverse the scarring known as fibrosis. Chilean researchers have discovered that silymarin increases glutathione in the liver, stomach and intestines by over 50% although it was not shown to increase GSH levels in other organs. Milk thistle may interact with cytochrome P450–specifically the 3A4 enzyme. This is important since it is used by many AIDS drugs. A study by Piscitelli, et al., happily, found no effect on the plasma level of indinavir (Crixivan). Now we needa study evaluating the potential benefit against the liver toxicities of drugs like nevirapine and ritonavir (Norvir). Anecdotal reports suggest that it may delay CD4 increases with ARV. See also entries on Dandelion Root as well as Hepato-C, Hepato-Detox and Ecliptex (Chinese Herbal Formulae).

COMPLEMENTARY THERAPY USE IN HIV-POSITIVE PEOPLE: AN ONLINE COMMUNITY SURVEY

An online survey conducted by our friend, Nelson Vergel and published in Antiviral Therapy. Here is the abstract:

COMPLEMENTARY THERAPY USE IN HIV-POSITIVE PEOPLE: AN ONLINE COMMUNITY SURVEY Antiviral Therapy 2009; 14(Suppl. 2):A34 (abstract no. P-11)

NR Vergel
Program for Wellness Restoration, Houston, TX, USA

OBJECTIVES: To assess the use and types of complementary therapies (CT) and their perceived benefits in a sample of HIV-positive members of a community online health listserve.

METHODS: Members of pozhealth at yahoogroups.com were sent a link to a 13 point questionnaire related to demographics, length of HIV infection, type of CT use, and reasons and perceived benefits of CT use.

RESULTS: The majority of the 135 survey participants were white males over 40 years of age who live in the USA and with least 15 years of HIV infection. The top reported CTs and their perceived benefits were exercise, nutritional supplements, herbs, massage, prayer/ spirituality, meditation, acupuncture, chiropractic and yoga. The most popular supplements and their perceived or studied benefits were fish oils (improved lipids), coenzyme Q-10 (stamina), multivitamins (general health), selenium (immune system protection), N-acetyl cysteine (immune system protection), alpha lipoic acid (improved insulin sensitivity and neuropathy), niacin (improved lipids), whey protein (lean body mass enhancement), acetyl-l-carnitine (improved lipids, neuropathy and cognitive function), DHEA (stamina and sexual function), probiotics (gastrointestinal health and diarrhoea), calcium (bone health and diarrhoea), vitamin D (bone health) and milk thistle (liver protection). A total of 84% believed that they were benefitting from CTs, and 87% informed their physicians about their CT use. CTs were personally funded by 72% of patients, whereas the rest had access to them via community programmes.

CONCLUSION: The majority of this sample of HIV-positive people used CTs and derived perceived benefits. Unfortunately, there are little to no efficacycontrolled data available for most CTs. Also lacking are interaction studies between most nutritional/herbal supplements and HIV antiretrovirals (ARVs). As CT use seems to be common and pervasive in the self-management of adverse events and quality of life, the HIV-positive community would benefit from more controlled studies on popular CTs and supplement interaction data with ARVs.

DISCUSSION: There are obvious limitations to this survey. The majority of participants were long-term survivor/white males over 40 years of age, which might represent those who access HIV-related health listserves on the internet. It is suggested that more information is obtained from other HIV patient populations via other outreach venues. A larger survey sample will be available at the conference.

Silymarin (milk thistle) for liver support

NYBC provides this description of the botanical Silymarin, also known as milk thistle:

Milk Thistle: Silymarin (Silybum Marianum). A potent liver-strengthening herb, it stimulates the liver to regenerate itself by producing new liver cells as well as having strong antioxidant action to help prevent lipid-peroxidation of cell membranes. Given to seven patients receiving tuberculosis drugs (INH and ethambutol), a standardized silymarin extract normalized elevated liver enzymes after three months treatment. Many people with hepatitis C use milk thistle. It is extremely safe. Some studies suggest it may help to reverse the scarring known as fibrosis. Chilean researchers have discovered that silymarin increases glutathione [a key intracellular antioxidant] in the liver, stomach and intestines by over 50%, although it was not shown to increase glutathione levels in other organs. Milk thistle may interact with cytochrome P450–specifically the 3A4 enzyme. This is important since it is the same pathway used by many AIDS drugs. A study by Piscitelli, et al., happily, found no effect of silymarin on the plasma level of indinavir (Crixivan). Now we need a study evaluating the potential benefit against the liver toxicities of drugs like nevirapine and ritonavir (Norvir). Anecdotal reports suggest that it may delay CD4 increases with ARV.

See also entries on Dandelion Root as well as Hepato-C, Hepato-Detox and Ecliptex (Chinese Herbal Formulas).

Note: NYBC stocks Milk Thistle/Silymarin 80% (Jarrow) [150mg/200 Caps]. Each capsule contains 150 mg of Milk Thistle standardized for 120 mg of Silymarin. This brand has smaller capsules since they do not use a turmeric base. Some find this more convenient to use. PWHIV and PWHCV use 3-6/day.

Suggested Usage: Take 1 to 3 capsules daily, or as directed by your qualified health consultant.

Milk Thistle in Latin is Silybum marianum. This 30:1 concentrate is standardized to contain 80% Silymarin from Milk Thistle seeds.

Silymarin is composed of three flavonoids: primarily Silybin and minor amounts of Silydianin and Silychristin, which support liver function by raising protective glutathione levels.

NEW! Managing and Preventing HIV Med Side-Effects

To mark its fifth anniversary, the New York Buyers’ Club has prepared a special edition of SUPPLEMENT. In it you will find a concise Guide to managing and preventing HIV medication side effects with supplements and other complementary and alternative therapies.

This is an invaluable introduction to how nutritional supplements can be used to counter those side effects that can make life miserable–or even disrupt treatment adherence–in people taking antiretroviral medications for HIV.

Read about approaches to dealing with diarrhea, nausea, heart health issues, diabetes, insomnia, fatigue, liver stress, lipodystrophy, anxiety and depression.

This FREE Guide is available online at:

http://newyorkbuyersclub.org/

On the NYBC website you can also SUBSCRIBE to the nonprofit co-op’s quarterly FREE newsletter, THE SUPPLEMENT, which continues to offer a unique perspective on current evidence-based use of supplements for chronic conditions including cardiovascular disease, diabetes/insulin resistance, hepatitis and other liver conditions, anxiety/depression, osteoarthritis, cognitive and neurorological issues, and gastrointestinal dysfunction.

Milk Thistle Component: CURE FOR HEP C??

A paper out of Austria has some of us at NYBC VERY excited. Researchers looked at varying doses of a component of milk thistle known as silbinin, from 5 to 20 mg/kg/day over a period of 14 days. During the first 7 days, only the silbinin, which was injected, was administered. Subsequently, on day 8, pegylated interferon and ribavirin were given.

Most astonishingly, by the end of the 7 days, those receiving the 15 mg/kg dose saw a 2.11 log drop in their hepatitis C viral load. Those in the 20 mg/kg arm saw a whopping 3.02 log drop!! This in just 7 days? STUNNING!!

Unfortunately, adding the medication to these participants, who had already failed on IFN/riba therapy! resulted in the numbers deteriorating significantly. The silibinin treatment was very well tolerated.

Which raises a host of questions…would a higher dose work better? 25 or 30 mg/kg? What happens if the therapy is provided over a longer period?

This review wants to try it!

Ferenci P, Scherzer TM, Kerschner H, Rutter K, Beinhardt S, Hofer H, Schöniger-Hekele M, Holzmann H, Steindl-Munda P. Silibinin is a potent antiviral agent in patients with chronic hepatitis C not responding to pegylated interferon/ribavirin therapy. Gastroenterology. 2008 Nov;135(5):1561-7. Epub 2008 Aug 3.

Comment in: Gastroenterology. 2009 Jul;137(1):390-1.

Internal Medicine 3, Department of Gastroenterology and Hepatology, Medical University of Vienna, Vienna, Austria. peter.ferenci@meduniwien.ac.at

BACKGROUND & AIMS: Oral Silibinin (SIL) is widely used for treatment of hepatitis C, but its efficacy is unclear. Substantially higher doses can be administered intravenously (IV). METHODS: Pedigreed nonresponders to full-dose pegylated (Peg)-interferon/ribavirin (PegIFN/RBV) were studied. First, 16 patients received 10 mg/kg/day SIL IV (Legalon Sil; Madaus, Köln, Germany) for 7 days. In a subsequent dose-finding study, 20 patients received 5, 10, 15, or 20 mg/kg/day SIL for 14 days. In both protocols, PegIFN alpha-2a/RBV were started on day 8. Viral load was determined daily. RESULTS: Unexpectedly, in the first study, HCV-RNA declined on IV SIL by 1.32 +/- 0.55 log (mean +/- SD), P < .001 but increased again in spite of PegIFN/RBV after the infusion period. The viral load decrease was dose dependent (log drop after 7 days SIL: 0.55 +/- 0.5 [5 mg/kg, n = 3], 1.41 +/- 0.59 [10 mg/kg, n = 19], 2.11 +/- 1.34 [15 mg/kg, n = 5], and 3.02 +/- 1.01 [20 mg/kg, n = 9]; P < .001), decreased further after 7 days combined SIL/PegIFN/RBV (1.63 +/- 0.78 [5 mg/kg, n = 3], 4.16 +/- 1.28 [10 mg/kg, n = 3], 3.69 +/- 1.29 [15 mg/kg, n = 5], and 4.85 +/- 0.89 [20 mg/kg, n = 9]; P < .001), and became undetectable in 7 patients on 15 or 20 mg/kg SIL, at week 12. Beside mild gastrointestinal symptoms, IV SIL monotherapy was well tolerated. CONCLUSIONS: IV SIL is well tolerated and shows a substantial antiviral effect against HCV in nonresponders.

Compound of milk thistle (silymarin) has a significant anti-cancer effect

Milk thistle, or silymarin, has long been used as a botanical treatment for liver disease. In 2007, researchers at the University of California, Irvine, published a study showing that a biologically active component of milk thistle has significant effect against liver cancer cells (see brief summary below).

Compound of milk thistle (silymarin) has a significant anti-cancer effect
Dr. Ke-Qin Hu and his research team at the University of California, Irvine recently published a study showing the significant anti-cancer effects of silibinin, a major biologically active compound of milk thistle (aka silymarin). Milk thistle has a long tradition of use as a remedy for liver diseases, is generally safe and well-tolerated, and is also known to protect the liver from drug or alcohol-related injury. (Silibinin is purified from milk thistle, with a defined chemical structure and molecular weight.)

Dr. Hu is an experienced research scientist and physician in the field of hepatology. He has published over 70 scientific journal articles, many focused on viral hepatitis B and C, cirrhosis, and liver cancer.

Dr. Hu and his research team found that silibilin can significantly reduce the growth of several human hepatoma cell lines. These findings suggest that silibinin can be used to prevent the development of liver cancer, one of the most common cancers worldwide.

Citation:
Lah JJ, Cui W, Hu KQ. Effects and mechanisms of silibinin on human hepatoma cell lines.
World J Gastroenterol 2007; 13(40): 5299-5305