Silymarin therapy combined with lifestyle interventions can reduce and normalize liver enzyme levels in patients with nonalcoholic fatty liver disease (NAFLD) and associated metabolic syndrome (MetS), a recent study has shown.
“Silymarin’s standardized formulation provides antioxÂidant, anti-inflammatory, and antifibrotic benefits as shown in previous studies,” said the researchers. [Food Sci Nutr 2024;12:3097-3111; Cureus 2024;16:e67083]
“Combined with lifestyle changes, silymarin appears effective and well tolerated for the management of NAFLD and MetS, supporting its role in routine clinical practice,” they added.
A total of 360 NAFLD patients with MetS participated in this observational study. They received standard of care (diet and physical exercise) and one capsule of silymarin 140 mg three times daily for 6 months. The researchers then assessed laboratory tests, noninvasive tests, ultrasonography, quality of life questionnaire, lifestyle changes, and safety at 3- and 6-month visits.
Of the patients, 315 (88 percent) completed the study. Baseline levels of aspartate transaminase (AST), alanine transaminase (ALT), and gammaglutamyl transferase (GGT) were elevated in 45 percent, 90 percent, and 47 percent of patients, respectively. [Drugs Context 2026;15:2025-12-5]
By the end of the study, 148 of 328 patients (45 percent) achieved normalization in one of the three enzymes (AST: 42 percent; ALT: 34 percent; GGT: 28 percent). Overall, most patients (78 percent) demonstrated decreased levels in at least one liver enzyme.
Moreover, 42 percent, 40 percent, and 34 percent of participants achieved clinically relevant reductions (>30 percent) in AST, ALT, and GGT levels, respectively. With regard to safety, silymarin use was well tolerated and did not result in any serious side-effects.
“Over 6 months, a substantial proportion of patients achieved normalization in liver enzymes, particularly for ALT levels, which showed the most pronounced improvement,” the researchers said. “This pattern aligns with previous studies that have highÂlighted the hepatoprotective properties of silymarin.” [Cureus 2023;15:e47608; Hepat Mon 2009;9:265-270]
Similarly, previous studies have shown the effectiveness of silymarin in reducing liver enzyme levels in NAFLD patients. [Hepat Mon 2008;8:191-195; Eur Rev Med Pharmacol Sci 2015;19:3118-3124; Oxid Med Cell Longev 2019;2019:8742075; World J Gastroenterol 2017;23:5004-5017; Medicina 2020;56:544]
Insulin sensitivity
Furthermore, treatment with silymarin improves insulin sensitivity in target tissues, potentially by promoting the expression of the glucose receptor and mediating cellular glucose absorption. [Int J Mol Sci 2024;25:2050]
“This might explain the small reductions in HbA1c and fasting glucose that were noted in this study,” according to the researchers.
Recent meta-analyses have also demonstrated significant reductions in fasting blood glucose levels in patients with glucose/lipid metabolic dysfunction following silymarin therapy. [Medicine 2020;99:e22249; Phytother Res 2022;36:842-856]
The present study “suggests that adding silymarin to everyday healthy habits might give the liver some extra support. It is not meant to replace diet or exercise, but it may offer a small boost, especially for people who feel their progress has slowed down,” the researchers said.
“Lower liver enzyme levels are a good sign, and they often mean less inflammation and less stress on the liver,” they added.
Further studies are warranted to understand how silymarin might affect long-term heart health and overall metabolic health, according to the researchers.