arrow11 Comments
  1. Melody Bomgardner
    Nov 04 - 11:45 AM

    Very nice! I had read about the milk thistle treatment of the two patients at Georgetown in the Washington Post. Good to get more background on what sounded very mysterious in the paper. For those interested in more background on the victims – if that’s what we call them – here’s the link:
    (you may need a free registration)

    One key take-away, do not stir-fry random mushrooms in your yard and serve them with noodles. Also do not serve them to your wife.

    The story was followed up two days later when two more patients went to G’town for the milk thistle treatment. Doctors think both consumed Amanita bisporigera, also known as “Avenging Angel.”

    • Jim Parsons
      Nov 20 - 5:57 PM

      This is an interesting development. I haven’t heard of this treatment. Do you have any idea about when the extract will become available?

  2. Marilyn Shaw
    Nov 04 - 12:42 PM

    A most interesting and mostly accurate article, but it contains a few inaccuracies / misunderstandings that should be corrected, including in the excerpt from Dr. Rania Habal’s Medscape article. His inclusion of psilocybin in the GI irritants group is incorrect. This toxin affects the central nervous system, not the GI tract.

    Less important is the use of the term “bloom” in discussing the appearance of mushrooms. The usual more accurate term is “fruiting”, and the mushrooms are referred to as “fruit bodies”.

    Dr. Habal in discussing coprine states that ” coprine-containing mushrooms cause severe illness only when combined with alcohol (ie, Coprinus syndrome).” It would be more accurate if it were stated that alcohol consumption following the ingestion of coprine-containing mushrooms produces the syndrome. The coprine sensitizes the body to alcohol for a period of up to 5 days.

    Regarding the use of Legalon SIL: This is for use in amatoxin poisonings, not “mushroom poisonings” in general. I have followed this treatment from the first use in the U.S. in Jan. 2007, and was contacted by the U.S. branch of the firm, Madaus, in March, 2010, asking me to spread the word about the clinical trials of Legalon SIL in the U.S. I have also discussed this use in detail with the Principle Investigator, Dr. Todd Mitchell. He states that unless prompt aggressive fluid replacement is undertaken before the kidneys are affected, not much can be done. (Personal communication.)

    It should be noted that most members of the genus Amanita do not contain amatoxins. Many are non-toxic, some edible, but there are at least 3 other toxins present in certain Amanita species. Treatment of these other Amanita toxic syndromes would not include silibinin.

    It is important to note that for over the last 100 years in the U.S. the mortality rate from mushroom poisonings (most from amatoxins) has averaged fewer than 1.5 per year. Mortality in amatoxin poisonings is about 50%, but this can be reduced to about 12% with prompt (within 36 hours) Intensive supportive care. These cases are fairly rare in the U.S. so it is difficult to draw meaningful conclusions on the real effectiveness of silibinin. However, since it seems to have no adverse effects and is supplied without charge during the current trials it is to be recommended.

    In Europe where it has been used for many years and where there are far more amatoxin poisonings, according to Dr. Thomas Zilker, Munich, there have not been enough cases to be statistically meaningful. (ClinTox_2005-43-438.pdf).

    It should be noted that deaths from amatoxins in other parts of the world are astronomically higher than in the U.S.

  3. Marilyn Shaw
    Nov 08 - 2:48 PM

    Regarding the links in Melody’s comment: There were numerous newspaper articles, TV and radio broadcasts, etc. in the eastern U.S. over the last several weeks about these poisonings. Nearly all contained the erroneous statement, “There is no authorized treatment for mushroom poisonings.” A more accurate statement would have been, “There are no specific antidotes for most types of mushroom poisoning.” However, all mushroom poisonings can be treated, usually quite successfully, by treating the symptoms.

    • Hugh Cavallaro
      Nov 13 - 11:18 PM

      Hello Marilyn, You seem very knowledgeable about Mushrooms and , treatment for mushroom poisoning! Do you have a website or someway of contacting you? I recently had a close call with mushroom poisoning, and would value input from a person such as you. Thanks, Hugh

      • Marilyn Shaw
        Nov 17 - 5:33 PM

        I would be happy to discuss your case with you, but hesitate to give my contact information online here. You can go to and find it there.

  4. Frank R. Stermitz
    Nov 22 - 12:08 PM

    In the Journal of Medicinal Chemistry 2001, in collaboration with Kim Lewis and Nathan Guz, we published a study on synthetic flavonolignans from milk thistle and other plants which showed these compounds to be very active multidrug-resistant inhibtors of bacteral drug efflux mechanisms. Maybe this type of activity has some relationship to the mechanism of antipoisoning effects. This was preceded and followed up by several other publications in this area.

    • David Kroll
      Nov 27 - 11:33 AM

      Thanks, Professor Stermitz. What a delight to see you here at the blog! I’ve long been a fan of your work, especially on the antimicrobial synergy of berberine and 5′-methoxyhydnorcarpin (DOI: 10.1073ypnas.03054059).

      I must look into theses effects of flavonolignans. On one hand, such an efflux antagonizing effect might be counterintuitive but I don’t know much about how α-amanitin is taken up by hepatocytes. Thank you so much for leaving this comment!

  5. Susan Kirk
    May 21 - 8:17 PM

    Wooful or woeful?

  6. Susan Kirk
    May 21 - 8:22 PM

    Sorry I meant to add more…to Marilyn, perhaps the authors meant that there is nothing ‘legal’ to administer. Also I believe the problem with treating the symptoms are one; the inadequacies of the diagnosis and the window of opportunity for treatments due to the insidious spread of the poison, ie by the time you treat the symptoms affecting liver and kidney, its too late.

  7. Marilyn Shaw
    Aug 21 - 12:43 PM

    I have not been following this thread since I first commented Nov. 4. I’m not sure what Susan meant by “‘legal’”. Legalon SIL is a concentration of derivatives of some species of milk thistle and is potentially useful only when injected. It has not yet been approved by the FDA, but has been accepted for a Clinical Trial administered by Dr. Todd Mitchell,MD, Dominican Santa Cruz Hospital, Santa Cruz, CA. Oral milk thistle is not effective in treating amatoxin poisonings, which are acute events.

    Susan states, ” the inadequacies of the diagnosis and the window of opportunity for treatments due to the insidious spread of the poison, ie by the time you treat the symptoms affecting liver and kidney, its too late.” Actually, timely (within 36 hours) and aggressive supportive care reduces the mortality rate in amatoxin poisonings from 50% to 10% or fewer. The mortality rate for the last 100+ years in the U.S. has averaged fewer than 1.5 per year. Most of these are from amatoxins. So supportive care has been effective for a long time. Deaths from amatoxins are not rapid, but usually occur from 5 to 7 days after the ingestion.

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