Last chance to buy certain supplements (getting outlawed by EU)

Lotus-eater

I thought there was plenty of evidence that feverfew, valerian, St johns wort and horny goat weed works?
I can't be bothered to look for it though.

If they aren't allowed to sell them past 30th April, how come everywhere is still selling them?

aaarrrggghhh

Lotus-eater wrote: »

I thought there was plenty of evidence that feverfew, valerian, St johns wort and horny goat weed works?
I can't be bothered to look for it though.

If they aren't allowed to sell them past 30th April, how come everywhere is still selling them?

There's plenty of evidence, propogated by the homeopathic industry. If you can show me peer-reviewed studies, meta-analysis or, hell, even a simple double-blind study that prove the efficacy of anything mentioned above, I'll eat my hat.

a1cat

J Herb Pharmcother. 2002;2(2):11-7. Related Articles, Links


The Clinical Utility of Milk Thistle (Silybum marianum) in Cirrhosis of the Liver.

Boerth J, Strong KM.

144 Fogartu Hall.

Milk thistle (Silybum marianum) is a flowering herb utilized for its potentially protective effects on the liver. Although the mechanism of action is not fully understood, one explanation may be that it concentrates in the hepatocytes and competes with toxins for hepatocyte binding and penetration. Preliminary clinical evaluations of milk thistle for cirrhosis of the liver indicate potential benefits in healthier patients with alcoholic cirrhosis. However, major flaws in many of the studies make it difficult to draw solid conclusions. Milk thistle appears to be relatively safe, even with long-term use.

PMID: 15277093 [PubMed - in process]

a1cat

Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects


Summary..

Under its Evidence-based Practice Program, the Agency for Healthcare Research and Quality (AHRQ) is developing scientific information for other agencies and organizations on which to base clinical guidelines, performance measures, and other quality improvement tools. Contractor institutions review all relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities.


Overview Reporting the Evidence Methodology / Findings / Future Research / Availability of Full Report



Overview


This evidence report details a systematic review summarizing clinical studies of milk thistle in humans. The scientific name for milk thistle is Silybum marianum. It is a member of the aster or daisy family and has been used by ancient physicians and herbalists to treat a range of liver and gallbladder diseases and to protect the liver against a variety of poisons.


Two areas are addressed in the report:

Effects of milk thistle on liver disease of alcohol, viral, toxin, cholestatic, and primary malignancy etiologies.

Clinical adverse effects associated with milk thistle ingestion or contact.


The report was requested by the National Center for Complementary and Alternative Medicine, a component of the National Institutes of Health, and sponsored by the Agency for Healthcare Research and Quality.


Return to Contents


Reporting the Evidence


Specifically, the report addresses 10 questions regarding whether milk thistle supplements (when compared with no supplement, placebo, other oral supplements, or drugs):

Alter the physiologic markers of liver function.

Reduce mortality or morbidity, or improve the quality of life in adults with alcohol-related, toxin-induced, or drug-induced liver disease, viral hepatitis, cholestasis, or primary hepatic malignancy.


One question addresses the constituents of commonly available milk thistle preparations, and three questions address the common and uncommon symptomatic adverse effects of milk thistle.


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Methodology


Search Strategy


Eleven electronic databases, including AMED, CISCOM, the Cochrane Library (including DARE and the Cochrane Controlled Trials Registry), EMBASE, MEDLINE, and NAPRALERT, were searched through July 1999 using the following terms:

Carduus marianus.

Legalon.

Mariendistel.

Milk thistle.

Silybin.

Silybum marianum.

Silybum.

Silychristin.

Silydianin.

Silymarin.


An update search limited to PubMed was conducted in December 1999. English and non-English citations were identified from these electronic databases, references in pertinent articles and reviews, drug manufacturers, and technical experts.


Selection Criteria


Preliminary selection criteria regarding efficacy were reports on liver disease and clinical and physiologic outcomes from randomized controlled trials (RCTs) in humans comparing milk thistle with placebo, no milk thistle, or another active agent. Several of these randomized trials had dissimilar numbers of subjects in study arms, raising the question that these were not actually RCTs but cohort studies. In addition, among studies using nonplacebo controls, the type of control varied widely. Therefore, qualitative and quantitative syntheses of data on effectiveness were limited to placebo-controlled studies. For adverse effects, all types of studies in humans were used to assess adverse clinical effects.


Data Collection and Analysis


Abstractors (physicians, methodologists, pharmacists, and a nurse) independently abstracted data from trials; a nurse and physician abstracted data about adverse effects. Data were synthesized descriptively, emphasizing methodologic characteristics of the studies, such as populations enrolled, definitions of selection and outcome criteria, sample sizes, adequacy of randomization process, interventions and comparisons, cointerventions, biases in outcome assessment, and study designs. Evidence tables and graphic summaries, such as funnel plots, Galbraith plots, and forest plots, were used to examine relationships between clinical outcomes, participant characteristics, and methodologic characteristics. Trial outcomes were examined quantitatively in exploratory meta-analyses that used standardized mean differences between mean change scores as the effect size measure.


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Findings


Mechanisms of Action


Evidence exists that milk thistle may be hepatoprotective through a number of mechanisms: antioxidant activity, toxin blockade at the membrane level, enhanced protein synthesis, antifibriotic activity, and possible anti-inflammatory or immunomodulating effects.


Preparations of Milk Thistle


The largest producer of milk thistle is Madaus (Germany), which makes an extract of concentrated silymarin. However, numerous other extracts exist, and more information is needed on comparability of formulations, standardization, and bioavailability for studies of mechanisms of action and clinical trials.


Benefit of Milk Thistle for Liver Disease

Sixteen prospective trials were identified. Fourteen were randomized, blinded, placebo-controlled studies of milk thistle's effectiveness in a variety of liver diseases. In one additional placebo-controlled trial, blinding or randomization was not clear, and one placebo-controlled study was a cohort study with a placebo comparison group.

Seventeen additional trials used nonplacebo controls; two other trials studied milk thistle as prophylaxis in patients with no known liver disease who were starting potentially hepatotoxic drugs. The identified studies addressed alcohol-related liver disease, toxin-induced liver disease, and viral liver disease. No studies were found that evaluated milk thistle for cholestatic liver disease or primary hepatic malignancy (hepatocellular carcinoma, cholangiocarcinoma).

There were problems in assessing the evidence because of incomplete information about multiple methodologic issues, including etiology and severity of liver disease, study design, subject characteristics, and potential confounders. It is difficult to say if the lack of information reflects poor scientific quality of study methods or poor reporting quality or both.

Detailed data evaluation and syntheses were limited to the 16 placebo-controlled studies. Distribution of durations of therapy across trials was wide (7 days to 2 years), inconsistent, and sometimes not given. Eleven studies used Legalon®, and eight of those used the same dose. Outcome measures varied among studies, as did duration of therapy and the followup for which outcome measures were reported.

Among six studies of milk thistle and chronic alcoholic liver disease, four reported significant improvement in at least one measurement of liver function (i.e., aminotransferases, albumin, and/or malondialdehyde) or histologic findings with milk thistle compared with placebo, but also reported no difference between groups for other outcome measures.

Available data were insufficient to sort six studies into specific etiologic categories; these were grouped as chronic liver disease of mixed etiologies. In three of the six studies that reported multiple outcome measures, at least one outcome measure improved significantly with milk thistle compared with placebo, but there were no differences between milk thistle and placebo for one or more of the other outcome measures in each study. Two studies indicated a possible survival benefit.

a1cat

Three placebo-controlled studies evaluated milk thistle for viral hepatitis. The one acute viral hepatitis study reported latest outcome measures at 28 days and showed significant improvement in aspartate aminotransferase and bilirubin. The two studies of chronic viral hepatitis differed markedly in duration of therapy (7 days and 1 year). The shorter study showed improvement in aminotransferases for milk thistle compared with placebo but not other laboratory measures. In the longer study, milk thistle was associated with a nonsignificant trend toward histologic improvement, the only outcome measure reported.

Two trials included patients with alcoholic or nonalcoholic cirrhosis. The milk thistle arms showed a trend toward improved survival in one trial and significantly improved survival for subgroups with alcoholic cirrhosis or Child's Group A severity. The second study reported no significant improvement in laboratory measures and survival for other clinical subgroups, but no data were given.

Two trials specifically studied patients with alcoholic cirrhosis. Duration of therapy was unclear in the first, which reported no improvement in laboratory measures of liver function, hepatomegaly, jaundice, ascites, or survival. However, there were nonsignificant trends favoring milk thistle in incidence of encephalopathy and gastrointestinal bleeding and in survival for subjects with concomitant hepatitis C. The second study, after treatment for 30 days, reported significant improvements in aminotransferases but not bilirubin for milk thistle compared with placebo.

Three trials evaluated milk thistle in the setting of hepatotoxic drugs: one for therapeutic use and two for prophylaxis with milk thistle. Results were mixed among the three trials.

Exploratory meta-analyses generally showed positive but small and nonsignificant effect sizes and a sprinkling of significant positive effects.

No studies were identified regarding milk thistle and cholestatic liver disease or primary hepatic malignancy.

Available evidence does not establish whether effectiveness of milk thistle varies across preparations. One Phase II trial suggested that effectiveness may vary with dose of milk thistle.


Adverse Effects


Adverse effects associated with oral ingestion of milk thistle include:

Gastrointestinal problems (e.g., nausea, diarrhea, dyspepsia, flatulence, abdominal bloating, abdominal fullness or pain, anorexia, and changes in bowel habits).

Headache.

Skin reactions (pruritus, rash, urticaria, and eczema).

Neuropsychological events (e.g., asthenia, malaise, and insomnia).

Arthralgia.

Rhinoconjunctivitis.

Impotence.

Anaphylaxis.


However, causality is rarely addressed in available reports. For randomized trials reporting adverse effects, incidence was approximately equal in milk thistle and control groups.

Conclusions


Clinical efficacy of milk thistle is not clearly established. Interpretation of the evidence is hampered by poor study methods and/or poor quality of reporting in publications. Problems in study design include heterogeneity in etiology and extent of liver disease, small sample sizes, and variation in formulation, dosing, and duration of milk thistle therapy. Possible benefit has been shown most frequently, but not consistently, for improvement in aminotransferases and liver function tests are overwhelmingly the most common outcome measure studied. Survival and other clinical outcome measures have been studied least often, with both positive and negative findings. Available evidence is not sufficient to suggest whether milk thistle may be more effective for some liver diseases than others or if effectiveness might be related to duration of therapy or chronicity and severity of liver disease. Regarding adverse effects, little evidence is available regarding causality, but available evidence does suggest that milk thistle is associated with few, and generally minor, adverse effects.


Despite substantial in vitro and animal research, the mechanism of action of milk thistle is not fully defined and may be multifactorial. A systematic review of this evidence to clarify what is known and identify gaps in knowledge would be important to guide design of future studies of the mechanisms of milk thistle and clinical trials.

Bailey_Bear_2

adammccance wrote: »

There's plenty of evidence, propogated by the homeopathic industry. If you can show me peer-reviewed studies, meta-analysis or, hell, even a simple double-blind study that prove the efficacy of anything mentioned above, I'll eat my hat.

Homeopaphy is different again. It basically has 0% of the active ingredient because of the way it's 'distilled'. Homeopathy is rubbish. However, herbal medicine can work, if the correct dosage is given. As previously mentioned by another poster Aspirin is derived from willow bark.

I recently read Bad Science by Ben Goldacre which outlined the main problems with homeopathy. I highly recommend it!

imposter

Slightly off-topic, but adammccance, antrobus, mahri (and others) - please take ten minutes out of your day to watch this video about new age quackery, which will have you weeing with laughter! http://www.youtube.com/watch?v=HhGuXCuDb1U

flying_stamp

Unlicensed herbal medicines can still be sold by retailers - they just can't be bought from manufacturers or wholesalers so retailers are completely legally allowed to sell until stocks run out. Also there are licensed herbal medicines on the market to help sleeping problems - the ones I have in mind have been through the same rigorous testing as pharmaceutical drugs, the benefits are much less side effects than some commonly prescribed drugs. Just cos it's herbal though doesn't mean it doesn't interact with other meds, always check the label

French_Knickers

adammccance wrote: »

There's plenty of evidence, propogated by the homeopathic industry. If you can show me peer-reviewed studies, meta-analysis or, hell, even a simple double-blind study that prove the efficacy of anything mentioned above, I'll eat my hat.

I knew given time you'd show your complete and utter ignorance on the subject!!

Homeopathy is not herbalism, they are entirely different things!

Tons and tons of proven studies regarding herbal suppliments and their efficacy.

antrobus

imposter wrote: »

Slightly off-topic, but adammccance, antrobus, mahri (and others) - please take ten minutes out of your day to watch this video about new age quackery, which will have you weeing with laughter! http://www.youtube.com/watch?v=HhGuXCuDb1U

Only slightly off-topic. I liked the bit:

Q: What do you call an alternative medicine that's been proved to work?
A: Medicine.

I think that sums up my attitude pretty well. I don't think it matters how any particular medicine has come into being; what matters is whether it works or not. For stuff like Milk Thistle, Valerian, St John's wort, palmetto berries, Echinacea etc, there is evidence that they do 'work' and thus various products have been licensed.

adammccance wrote: »

There's plenty of evidence, propogated by the homeopathic industry...

Homeopathy is something quite different. Homeopaths scorn both herbal and modern medicine. The best that can said about homeopathy is that all their remedies are nothing but water, and thus are capable of doing very little harm, since the lethal dose for water is pretty high.