From the Guidelines
Silymarin should not be used as a primary adjuvant treatment for hepatic steatosis, as the current evidence prioritizes lifestyle modifications and pharmacological treatments like pioglitazone and GLP-1 RAs over silymarin for improving liver health and reducing morbidity and mortality. When considering adjuvant treatments for hepatic steatosis, it's essential to focus on the most recent and highest quality studies that prioritize morbidity, mortality, and quality of life as outcomes. The most recent evidence from 2023 1 suggests that pioglitazone improves glucose and lipid metabolism, reverses steatohepatitis, and may improve fibrosis in people with type 2 diabetes and NASH. Additionally, GLP-1 RAs like semaglutide have shown promise in inducing weight loss, ameliorating elevated plasma aminotransferases and steatosis, and delaying the progression of fibrosis in individuals with NASH 1. In contrast, silymarin's effectiveness in treating hepatic steatosis is not as well-established, and its use should be considered on a case-by-case basis, taking into account potential interactions with other medications and individual patient needs. Key considerations for managing hepatic steatosis include:
- Lifestyle modifications such as weight loss, regular exercise, and dietary changes (reducing sugar, processed foods, and alcohol) 1
- Pharmacological treatments like pioglitazone and GLP-1 RAs for improving liver health and reducing disease progression 1
- Individualized treatment plans that prioritize patient safety, efficacy, and quality of life.
From the Research
Silymarin as Adjuvant Treatment for Hepatic Steatosis
- Silymarin has been studied for its potential in treating nonalcoholic fatty liver disease (NAFLD) and nonalcoholic steatohepatitis (NASH), with some evidence suggesting its efficacy in reducing liver fibrosis and improving liver function 2, 3.
- A randomized trial found that silymarin did not reduce NAFLD activity score (NAS) by 30% or more in a significantly larger proportion of patients with NASH than placebo, but it may reduce liver fibrosis 2.
- Another study found that silymarin attenuated hepatic steatosis through regulation of lipid metabolism and oxidative stress in a mouse model of NAFLD 4.
- A systematic review and meta-analysis found that silymarin significantly reduced the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and triglyceride (TG), and improved high-density lipoprotein (HDL) in patients with metabolic dysfunction-associated steatotic liver disease (MASLD) 3.
- Silymarin has also been shown to have antioxidant and anti-inflammatory effects, and may be useful in the treatment and prevention of various diseases, including liver diseases 5.
Mechanism of Action
- Silymarin has been found to regulate lipid metabolism and oxidative stress, which may contribute to its potential in reducing hepatic steatosis 4.
- It has also been suggested that silymarin acts as a modulator of signaling pathways, which may be involved in its beneficial effects on liver function and disease prevention 5.
Safety and Efficacy
- Silymarin has been found to be safe and well-tolerated in clinical trials, with no significant difference in adverse events between silymarin and placebo groups 2.
- However, more research is needed to confirm the efficacy of silymarin in treating hepatic steatosis and other liver diseases, and to determine the optimal dosage and treatment duration 2, 5.