Milk Thistle & Amanita muscaria Poisoning

The common wild mushroom, Amanita phalloides, is known as the “death cap” for a good reason. It takes only a handful of this widely distributed fungus to kill an adult, less to kill a child. Standard medical treatment – activated charcoal – is not particularly effective. Amanita phalloides mushroom ingestion proves fatal in about half of the cases. Twenty years ago, pilot studies showed that silymarin [milk thistle extract] treatment substantially reduced amanita-poisoning deaths in animals fed the mushroom. Subsequently, several human studies were launched. In one German hospital test, 60 consecutive people with amanita poisoning were given intravenous silymarin [milk thistle extract]. None died. Other studies have produced results that are similar, though not as spectacular. (However, the success of silymarin [milk thistle extract] in treating amanita poisoning should not encourage anyone to go mushroom hunting without training in amanita avoidance. Unless your an experienced hunter, the only place to pick mushrooms is at a produce market.) If accidental ingestion of the non-deadly Amanita muscaria occurs, it has been reported in several places that Milk Thistle can be a dramatic help in such situations. Studies in small animals have shown that silymarin exerts a liver protective effect against a variety of toxins, including the phallotoxins of the deadly amanita phalloides, and is considered the only antidote to amanita poisoning. Human trials have also been encouraging for conditions including hepatitis and cirrhosis of various origins. The results of numerous studies suggest that silymarin has considerable therapeutic potential, protecting intact liver cells, or cells not yet irreversibly damaged, by acting on the cell membranes to prevent the entry of toxic substances. Protein synthesis is also stimulated, thereby accelerating the regeneration process and the production of liver cells. As a result of this information, German health authorities have endorsed the use of milk thistle as a supportive treatment for inflammatory liver conditions and cirrhosis. Unfortunately, silymarin is very poorly soluble in water, so milk thistle is not effective in the form of a tea. Studies show that such a beverage contains less than 10 percent of the initial activity in the plant material. This poor solubility, coupled with the fact that silymarin is relatively poorly absorbed (20 to 50 percent) from the gastrointestinal tract, make it obvious that the active principles are best administered parenterally, that is, by injection. Oral use requires a concentrated product. Milk thistle is marketed in this country as a dietary supplement in the form of capsules containing 200 mg of a concentrated extract representing 140 mg of silymarin. Toxic effects resulting from the consumption of milk thistle have apparently not been reported. Twenty-one cases out of 2,169 (1 percent) in an observational study did report transient gastrointestinal side effects. Otherwise, it is considered very well-tolerated and quite effective. Milk thistle was brought to the United States and has adapted to life in the wild in California and along the East Coast. The sap is white and milky, perhaps explaining at least one of its common names. The white spots along the ribs of the leaves were said to have been drops of the Virgin Mary’s milk. The herb was used in times past to help encourage milk production, but this may have been due to the name and the association. The medicinal use of milk thistle goes back two thousand years. Pliny the Elder wrote of it, praising its value for “carrying off bile.” Medieval herbalists also made use of this property, and in the sixteenth century English herbalists adopted it. It did not maintain its popularity, however, and by the early twentieth century only homeopaths were familiar with it. With a renewal of interest in herbal medicines, researchers started to investigate milk thistle scientifically in the 1950s. The part of the plant that is used is the small hard fruit with the fuzz (technically called “pappus”) removed. Milk thistle is native to the Kashmir region of India and Pakistan, but now grows throughout the temperate world. The plant grows from five to ten feet tall, and has large prickly leaves and reddish purple flowers with sharp spines that resemble artichokes. When de-spined, milk thistle leaves are edible, and some vegetable gardeners cultivate the plant as a substitute for spinach. When broken or crushed, the stems and leaves exude a milky white juice, hence this herbs’s name. Milk thistle’s specific name, marianum, comes from an ancient legend that its leaf veins turned white after being touched by a drop of the Virgin Mary’s breast milk. Milk thistle has been used in traditional herbal medicine since the first century, when the Roman naturalist, Pliny the Elder (AD. 23-79), wrote that the plant’s milky juice was good for “carrying off bile.” (Today “bile” denotes a product of the gall bladder, part of the liver, which assists in the digestion of fats, but in ancient times, bile was used more generally to describe any internal fluid.) The noted 16th century British herbalist, John Gerard, was the first to recommend milk thistle for liver problems, though his prescription was oblique. He actually suggested the herb for “expelling melancholy,” which physicians at the time considered a liver ailment. Half a century later, Britain’s most famous herbalist, Nicholas Culpepper, was the first to recommend milk thistle specifically for liver disorders. By the 19th century, German physicians were using a tincture prepared from milk thistle seeds (actually the plants seed like fruits) to treat jaundice and other liver diseases. America’s 19th century eclectic physicians, who specialized in botanical medicines, adopted the herb for liver ailments and for intestinal cleansing. With the rise of the modem pharmaceutical industry, U.S. research of herbal medicines declined considerably. Fortunately, this did not happen in Germany, where in 1949, scientists noticed that milk thistle seemed to protect animal livers from poisoning with highly toxic carbon tetrachloride. In 1968, scientists isolated the three specific liver-protective molecules in milk thistle – silibinin, silidianin, and silicristin – now known collectively as silymarin [milk thistle extract].

How Much to Take

Many people with liver disease and impaired liver function take 420 mg of silymarin per day from an herbal extract of milk thistle standardized to 70-80% silymarin content. According to research and clinical experience, improvement should be noted in about eight to twelve weeks. Once that occurs, intake is often reduced to 280 mg of silymarin per day. This lower amount may also be used for preventive purposes. For those who prefer, 12-15 grams of milk thistle seeds can be ground and eaten or made into a tea. This should not be considered therapeutic for conditions of the liver, however.

Side Effects & Cautions

Milk thistle extract is virtually devoid of any side effects and may be used by a wide range of people, including pregnant and lactating women. Since silymarin does stimulate liver and gallbladder activity, it may have a mild, transient laxative effect in some individuals. This will usually cease within two to three days.