The liver is a marvelously sophisticated chemical laboratory, capable of carrying out thousands of chemical transformations on which the body depends. The liver produces important chemicals from scratch, modifies others to allow the body to use them better, and neutralizes an enormous range of toxins. Without a functioning liver, you can't live for very long.

Unfortunately, a number of influences can severely damage the liver. Alcoholism is the most common. Alcohol is a powerful liver toxin that harms the liver in three stages: alcoholic fatty liver, alcoholic hepatitis, and alcoholic cirrhosis. Although the first two stages of injury are usually reversible, alcoholic cirrhosis is not. Generally, more than 10 years of heavy alcohol abuse is required to cause liver cirrhosis. Other causes include hepatitis C infection, primary biliary cirrhosis, and liver damage caused by occupational chemicals and drugs.

A cirrhotic liver is firm and nodular to the touch, and, in advanced cases, is shrunken in size. These changes reflect severe damage to its structure. A high percentage of liver cells have died, and fibrous scar-like tissue permeates the organ.

A cirrhotic liver cannot perform its chemical tasks, leading to wide-ranging impairment of bodily functions, such as the development of jaundice (yellowing of the skin due to unprocessed toxins), mental confusion, emaciation, and skin changes. In addition, the fibrous tissue impedes blood that is supposed to pass through the liver. This leads to abdominal swelling as fluid backs up (ascites), and to bleeding in the esophagus as veins expand to provide an alternative fluid path. Ultimately, coma develops, often triggered by internal bleeding or infection.

Treatments for liver cirrhosis begin with stopping the use of alcohol and all other liver-toxic substances. A number of treatments such as potassium-sparing diuretics can ameliorate symptoms to some extent, but they do not cure the disease.

The liver is too complex for a man-made machine to duplicate its functions, so there is no equivalent of kidney dialysis for liver cirrhosis. Only a liver transplant can help. Unfortunately, this is a very difficult operation, with a high failure rate. In addition, the supply of usable livers is inadequate to meet the need.

Note: Individuals with cirrhosis of the liver should not take any medications, herbs or dietary supplements without first consulting a physician. The liver is in charge of processing many substances taken into the body, and when it is severely damaged, as in liver cirrhosis, ordinarily benign substances may become toxic.

The herb milk thistle might offer various liver-protective benefits. In Europe, it is used to treat viral hepatitis, alcoholic fatty liver, alcoholic hepatitis, liver cirrhosis and drug- or chemical-induced liver toxicity. An intravenous preparation made from milk thistle is used as an antidote for poisoning by the liver-toxic deathcap mushroom, Amanita phalloides. However, the supporting evidence for its use in any of these conditions remains far from definitive.

A double-blind, placebo-controlledstudy of 170 individuals with alcoholic or non-alcoholic cirrhosis found that in the group treated with milk thistle, the 4-year survival rate was 58% as compared to only 38% in the placebo group.1 This difference was statistically significant.

A double-blind, placebo controlled trial that enrolled 172 individuals with cirrhosis for 4 years also found reductions in mortality, but they just missed the conventional cutoff for statistical significance.2And a 2-year, double-blind, placebo-controlled study of 200 individuals with alcoholic cirrhosis found no reduction in mortality attributable to the use of milk thistle.3

Other double-blind studies of cirrhotic individuals have found improvements in tests of liver function,34,35although one did not.36

A 2007 review of published and unpublished studies on milk thistle as a treatment for liver disease concluded that benefits were seen only in low-quality trials, and, even in those, milk thistle did not show more than a slight benefit.51However, in a 2008 analysis of 19 randomized trials, researchers concluded that milk thistle was significantly more effective at reducing mortality from liver cirrhosis (mostly alcohol-related) compared to placebo, but no more effective at reducing mortality from any cause.54

For more information, including dosage and safety issues, see the full Milk Thistle article.