Positives

• One patient with MCAS experienced a significant improvement in screen tolerance, increasing from just five minutes to over an hour daily after starting milk thistle, expressing relief that “something finally is working” Reddit.
  
  

Negatives

• Patients on milk thistle commonly describe diarrhea, bloating, gas, and an upset stomach, often when starting at higher doses or taking it on an empty stomach Drugs.com.
• Patients on milk thistle for hepatitis C-related liver issues commonly see no improvement in liver function compared with placebo, suggesting the “detox” benefit some Long COVID patients chase may not materialize WebMD.
• Standard milk thistle has poor absorption without a phospholipid-bound (phytosome) formulation, meaning the active silymarin may never reach systemic circulation in meaningful amounts RTHM.

Hurdles & Side Effects

• One individual noted the challenge of balancing milk thistle intake with managing post-exertional malaise (PEM), as they experienced differences in symptoms when “not taking it” Reddit.