Is there any evidence milk thistle can help promote liver well being and maybe reduce isolated alt raise of unknown origin ? (no hep, ebv, meds etc)

Milk Thistle: While milk thistle is used all over the world for liver health there is no western scientific proof that it does provide healing. I still often recommend it to my patients despite this.

It's really weak: Milk thistle competes with other molecules at the drug detox centers in the liver, and has shown minimal benefit in a couple of studies; it failed miserably as a treatment for some other common liver problems. I trust you have been checked for hemochromatosis, myopathy, wilson's and autoimmune hepatitis. I'd urge you to stay very physically fit and skip the milk thistle.