Our liver is the second largest organ in the body (skin is the largest) and certainly the most metabolically complex. Its many functions include formation and excretion of bile; carbohydrate regulation; cholesterol, lipids and lipoprotein formation and regulation; protein, enzyme and clotting factor formation and distribution; immune system filtering of infectious foreign bacteria, viruses, fungi, parasites and their toxins; and detoxification of drugs and most foreign substances. This hard-working and exquisitely complex organ orchestrates and performs all its myriad functions of homeostasis or internal balance throughout the day and night as one of the many important players in harmony with the larger symphony of our total being.

An organ so complex and busy, facing an infinite variety of challenges every day, can also be susceptible to injury, dysfunction and disease. Virtually anything that the liver processes, ranging from infectious agents and chemicals to toxins and alcohol, can all potentially damage it, given enough quantity, time, use and abuse. We have all heard of liver conditions such as fibrosis, cirrhosis, hepatitis and various cancers. Did you know that liver diseases are the tenth leading cause of deaths in America? Did you know that there is a true epidemic in America now of hepatitis C, and that there are more cases of hepatitis C and more deaths from hepatitis C than from HIV/AIDS? So, how can we take good care of this very important part of us, and what can we do to treat it when necessary?

We can always start with the huge subject of diet and exercise because the quantity and quality of what we put into our bodies is first and foremost. A healthy, fresh diet—free of chemicals, additives, preservatives and toxins—is basic and an enormous challenge in our world today. Knowing the risks and abstaining from harmful things that we eat, inhale or ingest in any form, such as alcohol, tobacco, and illegal substances, are a must. Identifying, understanding and positively changing the behavior patterns that lead to destructive health habits are vital. Proper exercise, breathing, strengthening and stretching are also part of a good health formula. The appropriate health professionals, books and literature and even legitimate websites on the internet can offer a wide variety of facts, opinions and solutions to the many aspects of diet and exercise available to us.

I wish to highlight one remedy in particular today, and that is milk thistle. Milk thistle (silybum marianum) contains silymarin, one of the most liver-protecting substances known. Silymarin acts as an antioxidant and free radical scavenger, increases certain liver enzymes used in metabolism, and stimulates hepatocyte or liver cell regeneration. It has been used since ancient Greek times for conditions ranging from snakebite (a toxin) to gallstones (bile). Ancient and more modern physicians used it for “melancholy”, or what we would today call depression, as the liver was associated with the emotions of anger and depression. More modern research has been conducted in our times throughout Europe, Asia and America with good results for conditions such as hepatitis A, B and C, cirrhosis and alcoholic liver diseases. Silymarin reduced levels of liver enzymes and bilirubin that were too high in these patients, increasing their liver functions and even survival time compared to untreated group.

If you have a liver condition, after consulting with the appropriate healthcare professional, silymarin in doses of approximately 200 to 400 milligrams per day seems to be safe with few side effects. Patients who are allergic to plants in the Asteraceae family, such as thistles, daisies and artichokes, may have to avoid it due to allergic cross-reactivity. There is also no data that milk thistle is safe in pregnancy and lactation, therefore, it should not be used by mothers who are pregnant or nursing. Several herbs that have shown hepatotoxic reactions in some people and should generally be avoided by those with liver disease include chaparral, comfrey, germander, ma huang, mistletoe, senna, skullcap and valerian.

William H. Stager, DO, MS, MPH, FAAFP, FAMA, FAAO, FACOFP AOBNMM Board Certified: Neuromusculoskeletal Medicine/Osteopathic Manipulative Medicine. AOBFP Board Certified: Family Medicine. Medical Acupuncture. Clinical Professor, Department of Family Medicine, NSUCOM. Clinical Associate Professor, Department of Family Medicine, LECOM. Medical Director, Flagler Institute for Rehabilitation, Inc., 311 Golf Rd., Ste. 1100, West Palm Beach. To contact the author, call 561-832-1894.