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Debunking the world of wine

Discovering the world of wine

Demystifying the world of wine

Want to be brainy and avoid dementia? Become a wine expert as Sommeliers brains are larger, including parts of the brain responsible for memory

A year ago or so I was watching a fascinating documentary on the BBC by David Eagleman, "The Brain", and subsequently read his excellent books. It amazing that we take our brain for granted but experience from those experiencing a starvation of input and sensory information e.g. "the Hole" dark punishment cells in prisons such as Alcatraz and lack of developmental input e.g. kids in Romanian orphanages shows what can happen.

When we are born we have roughly the same number of brain cells as in later life but it is the way these cells are wired together is the key. The importance of nurturing the brain during childhood and teenage years helps the brain sort out what is important and what isn't.

Mental gymnastics, a rewarding job and rich social life all seem to delay or prevent dementia. Importantly we can  adapt our brains because of something called "plasticity" through what we do and for example specialists like a London Taxi driver, a concert piannist or even a wine expert all have important structural changes in their brains because of what they do, learn and practice.

Eagleman uses the analogy of the toolbox when overcoming deterioration in the brain and discusses a phenomenon to prevent dementia/Alzheimers called "celebral reserve". He says even if the wrench is broken, we can use a different spanner in the box to do the same task. So elderly sisters in a convent in the United States had physical signs of Alzheimer's disease in the brain when they died e.g. protein anomalies but exhibited no obvious symptoms since they led an active mental life and their brains were able to adapt and "use a different spanner".

Eagleman discusses the basis of reality and the fact that we see, feel, hear, smell is the brain's perception of reality called the "internal model". This brain simulation is like the movie the Matrix as it evokes its perception of the outside world.

The big lesson is that the more you put into your brain, just like training your muscles in a gym, the better the condition and resilience of your brain.

More on brain or "cerebral reserve"

cross word puzzle

The concept of brain or cebrealreserve refers to the ability to tolerate the age-related changes and the disease related changes in the brain without developing clear clinical symptoms or signs of dementia. A considerable amount of biological research has documented that a number of factors including education, work complexity, social network, and leisure activities may contribute to this reserve allowing cognitive brain function to be maintained in old age.  Epidemiological studies have suggest that intellectual challenges experienced across the whole life span may increase the brain reserve and be crucial for preventing the occurrence of dementia symptoms in late life.

The factors that can help boost your brain or cerebral reserve are high education, adult-life occupational work complexity, as well as a mentally and socially integrated lifestyle in late life. All these factors could postpone the onset of clinical dementia and Alzheimers Disease.

The relevance of physical activity itself remains in debate, as most physical activities include also social and mental stimulation. Leisure activities with all three components--physical, mental and social--seem to have the most beneficial effect. 

The Sommelier and brain study in detail

Several studies have assessed the development of new skills in adulthood and associated changes in brain structure. Areas of expertise such as taxi driving and hippocampal volume , juggling and visual and motor regions of the cortex, musicians and the auditory cortex and more recently expertise in perfume has been associated with olfactory regions of the frontal lobe

Similarly, there have been studies looking at distinct functional activation patterns in experts. For example, musicians show a distinct pattern of prefrontal activity compared with non-musicians when listening to different rhythms and sommeliers, or wine experts, showed enhanced regions of the memory network when tasting wines.

Sommeliers’ brains are of particular interest since their expertise is focused on the smell (olfaction ) and taste (gustation), and associated with multiple other functions including memory, judgement, and the amalgamation of this with other senses.

The olfactory regions of the brain are relevant to diseases such as Alzheimer’s and Parkinson’s, where initial degeneration of the brain cells called neurones are isolated to regions important in smell. Furthermore, given that sommeliers are experts not just in a single domain but combine these in an integrating sensory information system.

MRI scanner

In 2016, researchers from the University of Las Vegas in Nevada conducted MRI scans on Masters of Wine to access structural changes in their brain.

This was published in Front. Hum. Neurosci., 22 August 2016

Structural and Functional MRI Differences in Master Sommeliers: A Pilot Study on Expertise in the Brain

Sarah J. Banks*, Karthik R. Sreenivasan, David M. Weintraub, Deanna Baldock, Cleveland Clinic Lou Ruvo Center for Brain Health, Las Vegas, NV, USA

What does the Sommelier brain study show?

This study identified enhanced structural and functional patterns in the smell or olfactory network of sommeliers. These findings are consistent with the learning they undergo in achieving the status of Master Sommelier. Furthermore, the volume of a region of the brain involved in olfactory memory was associated with experience, suggesting that the continued training results in morphological changes of the brain. These results speak to the plasticity of the adult brain in response to sensory expertise. Future research into therapeutic sensory-cognitive training in individuals at risk from neurodegenerative diseases, such as Alzheimer’s or Parkinson’s, which impact the same regions of the limbic system and entorhinal cortex, might provide an important clinical application of these results.

Changes to the brain in sommeliers

Enhanced Volume of the Right Insula

The dorsal subregion of the insula was found to be larger in volume in sommeliers. This is thought to be due to the importance of this region in combining multisensory and higher order cognitive processes, activities that sommeliers practice throughout their training and work. 

Enhanced Activation in Sommeliers Compared with Controls

Multiple regions showed an interaction between group and task, that appeared to be driven by more activity in sommeliers than controls, specifically during the olfactory judgment task.

We assume that the enhanced, more widespread, activation in sommeliers implies more complex processing of the same information. Overall, there was somewhat more activation in the right hemisphere of sommeliers compared with controls. This is consistent with earlier studies that suggest right hemispheric dominance for olfaction and olfactory memory (Jones-Gotman and Zatorre, 1993). 

The visual region enhancements both in the main effect of group (sommeliers more than controls) and in the interaction are interesting, this could be due to training of master sommeliers to use multiple senses while learning about wine, and to use imagery (e.g., of the fruit and vegetable section of a grocery store) when blind tasting5. This might explain the apparently enhanced activation of these regions in sommeliers during the olfactory task.

There was no relationship between enhanced functional activation and years of experience. The regions that were different were more specifically related to olfactory memory and cross modal integration, and it might be that these are the particular strengths that are enhanced in sommeliers.

More about the Sommelier brain study for those interested

Design

After Institutional Review Board (IRB) approval from the University of Nevada Las Vegas (UNLV), a preliminary selection of possible stimuli was conducted with UNLV students. Twelve male participants between the ages of 21–33 were recruited to participate. Following informed consent, participants were given the wine knowledge test. For this pilot study, only participants scoring below 70% were included. Eight non-wine blends were made by mixing varying amounts of vodka, cognac, Fusion brand versus (a non-alcoholic grape juice made from the same grapes as many wines), fruit essences and in some cases water-soaked oak chips. Participants were blindfolded using a cloth sleep mask. The researcher held a glass jar containing either wine or a non-wine underneath the participant’s nose and instructed the participant to inhale through their nostrils. During the first task, participants were asked to tell the researcher if they smelled a wine or a non-wine.

During the second task, participants were asked to tell the researcher if they smelled a white or a red wine. Four white wines and four red wines were included. All jars during both tasks were chosen at random. Immediately following the olfaction tasks, participants were led to a computer and asked to rapidly categorise variably pixilated pictures of zebra patterns or fingerprints to allow the researchers to match this visual task with the olfactory tasks on difficulty of identification.

Participant Selection and Recruitment

Master Sommeliers were recruited with the assistance of JJ, Master Sommelier and extensively involved in both training of sommeliers and in the local community. After being approached informally by him and allowing their contact details to be shared, they were contacted by DB or SB to ascertain interest. All Master Sommeliers were considered eligible. The Court of Master Sommeliers provides a diploma to those who pass their four-stage examination process2. There are only 219 Master Sommeliers worldwide, all of whom have passed this process that takes several years. By including only individuals with this distinction, we could be assured that we were assessing true experts. However, this restriction did limit the number of sommeliers who we could include, and hence posed a limit to the potential sample size.

Results - Non scanner

Scores on the wine knowledge quiz ranged from 20 to 70% with a mean of 45%. Participants were able to distinguish between wines and non-wines with accuracy, ranging from 58 to 100%. Accuracy in distinguishing white wines from red wines varied from 25 to 91%. Accuracy at distinguishing between zebra patterns and fingerprints varied from 93 to 100%. Stimuli were selected based on participant accuracy. 

Interesting that for the UPSIT control and Sommelier scores were similar

Interesting that for the UPSIT control and Sommelier scores were similar

General olfactory ability was evaluated using the University of Pennsylvania Smell Identification Test (UPSIT; Doty et al., 1984). The test consists of a booklet containing a series of standardized microencapsulated odorants. Scratching the paper releases each odor, which must then be identified by the participant (i.e., “scratch and sniff”). Results of this test indicate the degree to which individuals can identify smells in a forced-choice scenario.

Wine knowledge was assessed using the wine quiz. The wine quiz is a 10-item questionnaire developed for this project by MEP. The quiz contains questions about varietals, terroir, origin and tasting techniques.

Results - MRI

Enhanced Volume of the Entorhinal Cortex

Given the importance of the region to olfactory memory, this finding was expected. Sommeliers spend years learning about the olfactory qualities and other aspects of wine, and no doubt draw on that memory whenever they make a judgment about wine. We further found a relationship between years of experience and cortical thickness of the right entorhinal cortex. In many ways, this finding echoes that of Maguire et al. (2000) in taxi drivers who show enlargement of hippocampal regions with driving experience. It is also similar to the earlier finding of Delon-Martin et al. (2013) in perfumers, who showed increased size of the piriform cortex, a region of olfactory cortex directly adjacent to the entorhinal cortex. Furthermore, although we larger volume of this region bilaterally, compared with controls, the volume of the right hemisphere was larger than the left, consistent with early research on hemispheric lateralization of olfactory memory (Jones-Gotman and Zatorre, 1993). The entorhinal cortex may additionally be involved in more primary odor perception or identification tasks in addition (Wilson et al., 2014), which would also be highly relevant to a sommelier’s experience and skills. Given this region’s sensitivity to aging and neurodegenerative disease, it is especially interesting that we found this result comparing an older group of sommeliers with younger controls.

Enhanced Volume of the Right Insula

The dorsal subregion of the insula was found to be larger in volume in sommeliers. This is thought to be due to the importance of this region in combining multisensory and higher order cognitive processes, activities that sommeliers practice throughout their training and work. The cortical thickness of this region had no relationship with experience, however, which is interesting in comparison to the finding with the entorhinal cortex. It may be that this region changes early in the training process and then plateaus, or that only part of this heterogeneous region responds to cross-modal sensory expertise. Longitudinal studies would be needed to further explore the relative impact of training on different regions. Further study regarding the particular role of subregions of the insula in cross-modal expertise would also be of interest.

Enhanced Activation in Sommeliers Compared with Controls

Multiple regions showed an interaction between group and task, that appeared to be driven by more activity in sommeliers than controls, specifically during the olfactory judgment task. Importantly, task performance was similar between the two groups, making us more confident in the activation differences. We made the tasks similar enough to sommeliers’ work to be meaningful, but also wanted the tasks to require a similar amount of attention in both groups, thus made the tasks entirely novel (i.e., not discriminating types of wine, but rather wine from non-wine). These regions included olfactory, limbic, visual imagery, and multimodal regions. They are similar to those reported in an earlier study with fewer subjects comparing the taste and after-taste of wine and water in sommeliers compared with controls (Delon-Martin et al., 2013; Pazart et al., 2014). We assume that the enhanced, more widespread, activation in sommeliers implies more complex processing of the same information. Overall, there was somewhat more activation in the right hemisphere of sommeliers compared with controls. This is consistent with earlier studies that suggest right hemispheric dominance for olfaction and olfactory memory (Jones-Gotman and Zatorre, 1993). There were some left hemisphere differences in the interaction, always with analogous differences in the right hemisphere, specifically, in the hippocampus, lingual gyrus and precuneus. Previous fMRI studies of taste in sommeliers have also shown mixed lateralization: one study comparing tasting of wine vs. glucose showed more left insula activity compared with controls during the after-taste period (Castriota-Scanderbeg et al., 2005), while the study by Pazart et al. (2014) showed enhanced right but not left anterior insula activation during tasting but not during aftertaste.

The visual region enhancements both in the main effect of group (sommeliers more than controls) and in the interaction are interesting, this could be due to training of master sommeliers to use multiple senses while learning about wine, and to use imagery (e.g., of the fruit and vegetable section of a grocery store) when blind tasting5. This might explain the apparently enhanced activation of these regions in sommeliers during the olfactory task.

We did not demonstrate a difference in activation over the piriform [which we consider to be part of the olfactory cortex (Zatorre et al., 1992) although one cluster extended into the olfactory cortex though only by a few voxels.] in the interaction. Others have noted the inconsistency of imaging studies in olfaction to specifically demonstrate piriform involvement (Zald and Pardo, 2000) although an alternative explanation here might be that this primary olfactory cortex is equally activated by both groups.

From its comparison to activation during a complex visual discrimination task, our results support the specificity of the enhanced activation seen during the olfactory discrimination tasks, and particularly so in sommeliers. While the olfactory network enhancement makes intuitive sense, the result of the current study point to the specificity of this finding. Had we not included this visual control task, one could argue that the Master Sommeliers attended more to perceptual judgment tasks in general, and that this was not specific to tasks involving olfactory stimuli. Our use of a visual judgment task as a comparison provides evidence for the specificity of enhanced cortical activation during processes involving chemical senses in sommeliers.

There was no relationship between enhanced functional activation and years of experience. Future longitudinal studies will be important in learning more about the interrelationship between activation intensity and experience. There may be a causal relationship with those regions that show enhanced activity early in the training process showing enhanced volume or thickness over time. Similarly, we did not find any significant differences in certain parts of the olfactory network including the orbitofrontal cortex. The regions that were different were more specifically related to olfactory memory and cross modal integration, and it might be that these are the particular strengths that are enhanced in sommeliers, however, future research and direct comparison with other olfactory experts such as perfumers might be important to further disentangle the regions that could be specifically enhanced in one expert group over another.

 

 

Good news for drinkers! More evidence that alcohol (and especially wine) could prevent diabetes

wine glass with red wine

A new study has shown that drinking moderately three or four times a week may protect people against diabetes.

In this Danish study, the association between alcohol drinking patterns and diabetes risk in men and women from the general ]population were examined (based on data from the Danish Health Examination Survey 2007–2008). The Danish scientists, led by Professor Janne Tolstrup from the University of Southern Denmark, publishing their findings in the journal Diabetologia.

76,484 survey participants (28,704 men and 41,847 women) were followed for a median of 4.9 years. Self-reported questionnaires were used to obtain information on alcohol drinking patterns, i.e. frequency of alcohol drinking, frequency of binge drinking, and consumption of wine, beer and spirits, from which drink-specific and overall average weekly alcohol intake was calculated. Information on incident cases of diabetes was obtained from the Danish National Diabetes Register. The investigation did not distinguish between the two forms of diabetes, Type 1 (where insulin needs to be injected daily) and the much more common but less serious Type 2.

During follow-up, 859 men and 887 women developed diabetes. Compared to teetotallers, men who drink three to four days a week are 27 per cent less likely to develop the condition, and women 32 per cent less likely.

The lowest risk of diabetes was observed at 14 drinks/week in men (HR 0.57 [95% CI 0.47, 0.70]) and at 9 drinks/week in women (HR 0.42 [95% CI 0.35, 0.51]), relative to no alcohol intake. Compared with current alcohol consumers consuming <1 day/week, consumption of alcohol on 3–4 days weekly was associated with significantly lower risk for diabetes in men (HR 0.73 [95% CI 0.59, 0.94]) and women (HR 0.68 [95% CI 0.53, 0.88]) after adjusting for confounders and average weekly alcohol amount.

The study researchers concluded that "Our findings suggest that alcohol drinking frequency is associated with risk of diabetes and that consumption of alcohol over 3–4 days per week is associated with the lowest risk of diabetes, even after taking average weekly alcohol consumption into account."

Pancreas

They also found that wine had the most substantial effect, probably because it contains chemical compounds that improve blood sugar balance. For both men and women, seven or more glasses of wine per week lowered the risk of diabetes by 25 per cent to 30 per cent compared with having less than one drink of wine.

But gin and some other spirits had a negative effect on women, with just one drink a day increasing the risk of diabetes by 83 per cent. One to six beers per week reduced diabetes risk by 21 per cent in men but had no effect on women.

Janne Tolstrup, of the University of Southern Denmark, said that she conducted the research because of previous studies showing an apparent connection between drinking and diabetes. She said she wanted to see if the pattern of drinking as well as the absolute quantities played a role. “I’ve done a lot of research into the association between alcohol drinking patterns and the risk of coronary heart disease,” "It is very evident that if you compare two men drinking the same amount, the risk depends on how they spread it out.” She wanted to see if the same applied to diabetes.

The cause of the positive effect of alcohol and particularly wine is not clear, although some studies have suggested a link between alcohol and the length of time insulin remains in the blood when it is released by the pancreas in response to glucose/sugar.  Insulin is used to regulate blood sugar levels and those deficient in it need to inject it and monitor their glucose levels.

See more:

 

Of course the normal disappointing response to the results to avoid jeopardising future funding from the health authorities and sponsors. Professor Tolstrup said “I’ve been asked whether I would recommend drink. Of course not,” she said. “Alcohol is related to more than 50 diseases and conditions. We know among women for instance that the risk of breast cancer increases linearly with drinking. If you want to make any recommendations, you should look at everything.”

When he says “I’ve been asked whether I would recommend drink. Of course not,” but why not. The evidence is strong for a positive effect on health, particularly with wine. Don't be a slave to conventional prohibitioniest thinking!

Some public health bodies including Public Health England’s have an official alcohol guidance which states that there is “no safe level” of drinking. However this new evidence gives further complelling evidence that as well as protecting people from heart diease and stroke, it can help prevent diabetes. Therefore most epidemiologists argue that there appears to be an overall health benefit from a small amount of drinking, even if some government bodies tend to reject this view. 

Given the French Paradox, where moderate drinking in the French has helped to overcome bad habit like excessive cholesterol consumption and smoking and this new study, it appears the naysayers are getting it wrong. Some cancers like breast cancer risk is elevated at a relative level, but overall moderate alcohol, with exercise and good food, plus avoiding smoking seems like the ticket to a long and happy life! Abstaining from alcohol is just no fun at all!

Popular Milk Thistle products to help cleanse the liver

Examples Best Selling Milk Thistle products with customer reviews (Amazon):

Organic Cold-pressed Milk Thistle Oil 200ml

Organic Cold-pressed Milk Thistle Oil 200ml

Handpicked milk thistle fruit, cold pressed to extract the milk thistle oil.

A spoonful of Erbology milk thistle oil contains 7mg of vitamin E, over 8g of omega-6, and loads of phytonutrients that make it a powerful antioxidant It helps boost immunity and protect the body from the damaging free radicals. Enjoy a spoonful of Erbology milk thistle oil in salad, pasta and soup or apply a small amount to skin and hair

Schwabe Thisilyn Maximum Strength Milk Thistle Capsules

Schwabe Thisilyn Maximum Strength Milk Thistle - Pack of 30 Capsules

193 mg - 261 mg of standardised extract (as dry extract) from Milk Thistle fruits (Silybum marianum (L.) Gaertn.) (equivalent to 3.725 g - 10.818 g of Milk Thistle fruits) corresponding to 108 mg of silymarin, calculated as silibinin. 

Amazon review example: used for my son who has gilberts syndrome, his skin is definitely less yellow on this product so its definitely cleansing the liver. Ms. S. Bondon

Natures Aid DigestEeze 150mg

amazon 4.5
DigestEeze milk thistle

ne tablet contains 137.5mg - 165mg of standardised extract (as dry extract) from Milk Thistle fruits (Silibum marianum (L) Gaertner), (Equivalent to 2750mg - 6600mg of Milk Thistle fruit.) corresponding to 82.5mg of silymarin

Amazon review: "I'm over 50 and for the last year or so I noticed that any alcoholic drink left me with a terrible headache and queasy stomach the following day. I'm not a heavy drinker by any means but a small glass of wine in the evening whilst cooking dinner was one of life's simple pleasures. I stopped drinking wine completely for several months and switched to the odd cider or stubby lager at 4% when I fancied a drink - not my favourite! After a bit of online research I came upon milk thistle and thought I'd give it a try. It seems to do the trick, a small (175ml) glass of red followed by two of these tablets after my meal leaves me with no hangover symptoms the next morning. I'm still being very careful, choosing lighter wines than the full bodied tipple I used to enjoy, and I don't drink every day, but it would seem that milk thistle does help to process whatever nasties are in the wine so I am going to purchase some more when my current supply gets low." Muddy Boots November 2016

Bio Health Silamarie Milk Thistle Capsules 450mg

Bio Health Silamarie Milk Thistle Capsules 450mg

Amazon review: Seems to detox the liver - my friend takes it and recently had a liver function test. She had a poor result before taking these and has seen a four-fold improvement. Can't say fairer than that! Pamela March 2017

Amazon review: Love these tablets. These brought my liver back to full health after a health scare where I was jaundiced. I took these daily and my liver functioning returned to normal after the doctor saying that they were probably just a placebo. Definitely not. Highly recommend these Claire May 2017

Is Milk Thistle beneficial to your liver if you drink too much alcohol?

milk.jpeg

About Milk Thistle

Milk thistle (silymarin) is a dietary supplement traditionally used to treat and prevent damage to the liver. There has been some research of mixed quality to assess the potential of Milk Thistle in treating and preventing liver damage from alcohol and from other causes which have shown a very positive potential benefit. However it is clear more robust, placebo controlled clinical studies involving human volunteers are needed.

What is Milk Thistle or Silybum marianum?

Milk Thistle or Silybum marianum as it is known in more technical botanical circles, is an annual or biannual plant of the Asteraceae family. This fairly typical thistle is a thorny plant, has red to purple flowers and shiny pale green leaves with white veins. The medical parts of the plant are the ripe seeds not the leaves. 

The flower heads are 4 to 12 cm long and wide, of red-purple colour. They flower from June to August in the North or December to February in the Southern Hemisphere (Summer through Autumn).  

Thistle is an old English word and Milk Thistle gets its name from the milky sap that comes out of the leaves when they are broken. The leaves also have unique white markings that, according to legend, were the Virgin Mary’s milk. Thistles describe a a large family of plants occurring in Europe and Asia under the botanical groups Carduus, Carlina, Onopordon and Carbenia, or Cnicus.

Many people get confused with all the different, very similar sounding names. Milk Thistle is often called Blessed Milk Thistle, Marian Thistle, Mary Thistle, Saint Mary's Thistle, Mediterranean milk thistle, Variegated Thistle and Scotch thistle. However, Milk thistle should not be confused with Holy or Blessed Thistle (Cnicus benedictus) and the Scotch Thistle (Onopordum acanthium), it is a different species with different medicinal properties. Whereas Holy Thistle cannot be eaten, Scotch Thistle and Milk Thistle are edible and used by foragers as ‘bush food’.

The Silybum species as a whole is native to the Mediterranean regions of Europe, North Africa, and the Middle East; and the most widespread species is Silybum marianum.  The plants in Silybum group include:

  • Silybum eburneum Coss. & Dur., known as the Silver Milk Thistle, Elephant Thistle, or Ivory Thistle (Algeria, Morocco, Tunisia, Spain)
  • Silybum eburneum Coss. & Dur. var. hispanicum
  • Silybum marianum (L.) Gaertner

Where does Milk Thistle grow and naturally found?

Originally a native of Southern Europe, Silybum marianum was probably first found around the coast of southeast England (perhaps brought by the Romans) or from the mountains of the Mediterranean region. It is now found throughout the world including the United States, North, Australia and New Zealand where it is considered a weed.

Milk Thistle is grown by the pharmaceutical and herbal supplements industry in areas such as Waldviertel in Austria, Germany (Milk Thistle is called Mariendistel in German), Hungary, Poland, Argentina and China.

In Europe it is sown yearly in March–April. The harvest in two steps (cutting and threshing) takes place in August, about 2–3 weeks after the flowering.

milk thistle in field

Milk Thistle extract and its chemistry

Traditional milk thistle extract is made from the seeds, which contain approximately 4–6% silymarin. The extract consists of about 65–80% silymarin (a flavonolignan complex) and 20–35% fatty acids, including linoleic acid.

Silymarin is a complex mixture of polyphenolic molecules, including seven closely related flavonolignans (silybin A, silybin B, isosilybin A, isosilybin B, silychristin, isosilychristin, silydianin) and one flavonoid (taxifolin). 

Origins of Medicinal use of Milk Thistle and use as Liver Tonics and Liver Detoxifiers

Silymarin marianum has been used by humans probably for thousands of years for its medicinal effects. The liver protective effects, for example, were known and written about in ancient times in Roman and Greek texts.  It is possible that as a whole  the plant has anti-bacterial, anti-fungal, anti-viral and anti-parasitic action. 

liver

The liver has a wide range of functions in the human body and we cannot live without it functioning properly. Lobules are the functional units of the liver and each lobule is made up of millions of hepatic cells (hepatocytes) which are the basic metabolic cells. It is pivotal in the detoxification of various metabolic by products of food, protein synthesis, and the production of biochemicals necessary for digestion. It also plays a role in metabolism, regulation of glycogen (energy related) storage, decomposition of red blood cells and hormone production. So your liver is a pretty important organ!

Therefore it is not surprising that any drug which helps the liver to cleanse more effectively can be useful in treating liver diseases such as liver cirrhosis, chronic hepatitis (liver inflammation) and jaundice. Cirrhosis is a condition in which the liver does not function properly due to long-term damage with scarring. Cirrhosis is most commonly caused by alcohol or the viruses hepatitis B and hepatitis C. Jaundice is the medical term that describes yellowing of the skin and eyes caused when there is too much bilirubin in the body. Bilirubin is a yellow pigment that is formed by the breakdown of dead red blood cells in the liver. Normally, the liver gets rid of bilirubin along with old red blood cells.

For many centuries extracts of milk thistle were used  as "liver tonics"  used to treat alcohol and toxin related liver damage.  The plant was even used for the prevention of severe liver damage from the accidental eating of Death Cap mushroom (Amanita phalloides) in days gone by .

The plant also appears to have some ability to remove toxins. The physician Wiliam Westmacott, writing in 1694 in "The education of a puritan Country Physician" said of Milk Thistle: 'It is a Friend to the Liver and Blood” .

Traditionally it was has also been used as a hangover cure (and some swear by its effectivensss here)and is still used in traditional Chinese medicine to “clear heat and relieve toxic material”, to soothe the liver and to promote bile flow.  

These anecdotal medicinal properties led to research being conducted by German scientists beginning in the 1950's to assess its active chemical, pharmacological, and safety leading to the commercial growing of the plant for pharmaceutical purposes. 

Dosage of Milk Thistle

In clinical trials silymarin has typically been administered in amounts ranging from 420–480 mg per day in two to three divided doses. However higher doses have been studied, such as 600 mg daily in the treatment of type II diabetes and 600 or 1200 mg daily in patients chronically infected with hepatitis C virus.

An optimal dosage for milk thistle preparations has not been established. 

Clinical efficacy of Milk Thistle - does Milk Thistle work and is it safe? Does it harm the liver?

At recommended doses:

  • Does Milk Thistle work - Yes
  • Is Milk Thistle safe - Yes
  • Does Milk Thistle harm the liver - No
  • Does Milk Thistle have harmful side effects - No

A thorough review of the literature on milk thistle current to the year 2000 can be found at Milk Thistle: Effects on Liver Disease and Cirrhosis and Clinical Adverse Effects whose link is located below:

This review finds that the evidence to date is strongly suggestive that milk thistle helps heal or cleanse the liver, although studies to date are not yet fully conclusive. However, Milk Thistle is very likely not to harm the liver.

A more recent review of the literature can be found in Saller (2008)  "An updated systematic review with meta-analysis for the clinical evidence of silymarin" which concluded, "Based on the available clinical evidence it can be concluded - concerning possible risks /probable benefits - that it is reasonable to employ silymarin as a supportive element in the therapy of Amanita phalloides poisoning but also (alcoholic and grade Child 'A') liver cirrhosis. A consistent research programme, consolidating existing evidence and exploring new potential uses,would be very welcome."

Side effects of Milk Thistle

On the available evidence, which is not exhaustive, Milk Thistle (Silymarin) is likely to be safe for most adults. However, it sometimes causes minor side effects such as a laxative effect. Other less common side effects are nausea, diarrhoea, indigestion, intestinal gas, bloating, fullness or pain, and loss of appetite.

Special Precautions & Warnings:

Pregnancy and breast-feeding: Not enough is known about the use of milk thistle during pregnancy and breast-feeding. Stay on the safe side and avoid use.

Allergy to ragweed and related plants: Milk thistle may cause an allergic reaction in people who are sensitive to the Asteraceae/Compositae plant family. Members of this family include ragweed, chrysanthemums, marigolds, daisies, and many others. If you have allergies, be sure to check with your doctor or pharmacist before taking milk thistle.

Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: Extracts from Milk Thistle plant might act like oestrogen. If you have any condition that might be made worse by exposure to estrogen, don’t use these extracts. In contrast, the more commonly used milk thistle seed extracts do not seem to act like oestrogen.

Milk Thistle Products

You can buy Milk Thistle in the form of tablets, capsules and drops either as a single ingredient in different strengths or as a combination with other liver cleansing herbs. Popular brands include Natures Aid, Vogel, Solgar and Schwabe.

thistle 4.jpg
Bio Health Silamarie Milk Thistle Capsules 450mg
thistle 2.jpg

Should I take Milk Thistle supplements regularly?

The jury is still out on whether it really works, but Milk Thistle appears to have low toxicity and studies are suggestive of a positive effect on the liver and it having a protective effect against excessive drinking of alcohol. The benefits therefore seem to outweigh any very limited risks. The editor of the Fermented Grape uses Milk Thistle personally, but do your own research before taking this supplement and if in doubt talk to your doctor. They could be associated with a placebo effect, but the evidence suggests not. 

Using Dandelion root with Milk Thistle

Dandelion Root

Dandelion Root

In addition to Milk Thistle other herbs and vitamins are said to help the liver cleanse itself. Antioxidant vitamins such as C, E, and beta-carotene; minerals such as zinc and selenium; B-vitamins that aid alcohol metabolism. Dandelion root and schizandra are traditionally held to have liver cleansing actions.

About the author

This article is written by Richard Norton, trained in Pharmacy and working in the healthcare industry since 1994. He has no affiliation with any Milk Thistle or herbal supplements company and views are his own, not his employer, based on the available evidence.

References

Lawrence V, Jacobs B, Dennehy C, et al. (2000) Milk thistle: effects on liver disease and cirrhosis and clinical adverse effects. Evidence Report/Technology Assessment No. 21. AHRQ Publication No. 01-E025. Rockville, MD. 

Rainone F. (2005).Milk thistle. Am Fam Physician. 72(7), 1285-8. 

Saller R, Brignoli R, Melzer J, Meier R. (2008). An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplementmed. 15(1), 9-20. 

Tamayo C, Diamond S. (2007). Review of clinical trials evaluating safety and efficacy of milk thistle (Silybum marianum [L.] Gaertn.). Integr Cancer Ther. 6(2), 146-57.