Silymarin, an inexpensive supplement from milk thistle seeds long used for liver health, most consistently brings modest blood sugar improvement, mainly in type 2 diabetes. It appears to reduce some drug-caused liver injury; blood-fat effects are less certain. Benefit is uncertain when liver and metabolic markers are already optimal. At usual doses, side effects are mostly mild digestive upset; the main concern is interactions, especially with the blood thinner warfarin. (Full Review)
| Marker | Target | Why |
|---|---|---|
| ALT | Men <25 U/L; women <19 U/L | Primary liver-injury marker |
| AST | <25 U/L | Liver and muscle injury |
| GGT | <20 U/L | Liver stress and alcohol effect |
| Total bilirubin | 0.3–1.2 mg/dL | Detects high-dose effects |
| Fasting glucose | 75–90 mg/dL | Glycemic response |
| HbA1c | <5.4% | Three-month glucose trend |
| Fasting insulin | 2–6 µIU/mL | Insulin resistance |
| LDL cholesterol | <100 mg/dL (many longevity practitioners target <70) | Lipid response |
| ApoB | <80 mg/dL (<60 for higher-risk individuals) | Atherogenic particle count |
| Triglycerides | <100 mg/dL | Lipid and liver-fat response |
| hs-CRP | <1.0 mg/L | Systemic inflammation |
| Liver stiffness and fat (elastography) | Stiffness <6 kPa; fat score <248 dB/m | Tracks scarring and fat |
| FIB-4 score | <1.3 | Low-cost scarring screen |
| INR (warfarin users only) | Individual target set by prescriber, usually 2.0–3.0 | Interaction safety |
| Urine albumin-to-creatinine ratio (diabetes) | <10 mg/g | Kidney response |
Cadence: Baseline before starting; liver panel and glucose markers at 8–12 weeks, then every 6 months while silymarin continues; INR 5–7 days after starting or stopping; liver scan after 12 months