Letters from Readers
April 1, 1999 less than 1 minute read
Letters from Readers
Dear Editor:
The following sentence from the Formulation and Dosage section in your article on milk thistle (Alternative Medicine Alert, October 1998, pp. 113-116) seems contradictory since 12-15 g is much more than 200-400 mg: "Unless otherwise prescribed, the Commission E recommends a daily dose of 12-15 g, or a formulation equivalent to 200-400 mg of at least 70% silymarin." Please clarify.
In addition, why didn’t you include the European studies of milk thistle as an IV therapy for poisonous mushrooms in this article?
Daniel Smiley, MD
Bristol, CT
Response: The dosage of milk thistle in the Commission E monographs is 12-15 g for the dried herb and for 200-400 mg of silymarin which is a mixture of four isomers (silybinin, isosilybinin, silydianin, and silychristin) that are considered the active ingredients.
I focused my discussion on the most likely use of milk thistle in the United States, i.e. chronic liver disease. I reviewed the evidence for acute poisoning and it is intriguing. However, none of the reports are controlled. Publication bias (negative reports are less likely to be published) and improved supportive care are important considerations here.
E-P. Barrette, MD
Assistant Professor of Medicine
Section of General Internal Medicine
University of Washington Medical School
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