Milk thistle, a herbal seed-extract supplement, is taken to protect the liver and support blood sugar control. Small trials show lower blood sugar in type 2 diabetes and lower liver enzymes in fatty liver disease, but no proven disease reversal or longer survival. Side effects were no more common than with placebo. Gains look likeliest with raised blood sugar or liver enzymes; key concerns are daisy-family allergy and drug interactions. (Full Review)
| Marker | Target | Why |
|---|---|---|
| ALT | Men 29–33 U/L or lower; women 19–25 U/L or lower (ACG guideline) | Expected to change; safety check |
| AST | 10–40 U/L | Expected to change; safety check |
| Total bilirubin | 0.1–1.2 mg/dL | Safety check |
| Fasting glucose | 70–99 mg/dL | Expected to change in diabetes; safety check on glucose-lowering drugs |
| HbA1c | 4.0–5.6% | Expected to change in diabetes |
| LDL cholesterol | No established target for this use; track change from the individual's baseline | Expected to change (modest, uncertain) |
| INR (warfarin users only) | No established target for this use; track deviation from the individual's stable value | Safety check |
| Liver stiffness and fat (elastography) | No established target for this use; track change from the individual's baseline | Expected to change in fatty liver disease |
Cadence: Baseline before starting; INR at 1–2 weeks after starting for warfarin users; fasting glucose several times weekly during the first 4 weeks for people on insulin or sulfonylureas; liver enzymes, glucose markers and lipids at 8–12 weeks, then every 6–12 months while use continues; elastography after about 12 months if used.