Inclusion Criteria:

• Age at least 18 years at the start of the lead-in period
• AST or ALT greater than 40 IU/L within one year of the start of the lead-in phase and at least once during the lead-in phase
• Successfully complete a 28-day lead-in phase. Successful completion of the lead-in phase will require the participant's BMI at the end of the lead-in period to be within +/- 10% of their BMI obtained at the initial lead-in visit, as well as adherence to the alcohol consumption guidelines.
• Have a liver biopsy performed within 18 days of completing the lead in phase demonstrating features consistent with NASH without cirrhosis; NAS score of at least 4.
• Negative urine pregnancy test (for women of childbearing potential) documented within the 24-hour period prior to the first dose of study medication. Females of childbearing potential must be using two reliable forms of effective contraception during the study (while on study drug and during follow-up)
• Demonstrated fatty liver on an imaging modality, either ultrasound, CT, or MRI, within 1 year of the start of the lead-in phase
• Participant agrees to discontinue use of other antioxidants such as vitamin E, vitamin C, glutathione, alpha-tocopherol, or non-prescribed complementary alternative medications (including dietary supplements, megadose vitamins, herbal preparations, and special teas) from the start of the lead-in phase through completion of the follow-up phase. A multivitamin at standard doses will be allowed.
• Participant agrees to discontinue use of silymarin or other milk thistle preparations, other than study medication, from the start of the lead-in phase through completion of the follow-up phase

Exclusion Criteria:

• BMI > 45 kg/m2 between the first lead-in visit and randomization
• Type 2 diabetes treated with oral agents other than the secretagogues or metformin; these include, thiazolidinediones, alpha-glucosidase inhibitors, exenatide, pramlintide between the start of the lead-in phase and randomization. Januvia (sitagliptin) is allowed.
• Evidence of poorly-controlled diabetes (Hba1c > 8%) between the first lead-in visit and randomization
• Known allergy/sensitivity to milk thistle or its preparations
• Use of drugs associated with a clinical or histological picture consistent with fatty liver disease or NASH for more than 12 consecutive weeks in the 1 year prior to start of the lead-in phase; these include amiodarone, tamoxifen, methotrexate, glucocorticoids, anabolic steroids, tetracyclines, estrogens at doses greater than those used for hormone replacement, valproate/valproic acid
• For patients using antihyperlipidemic agents or accepted anti-diabetic agents, any change of agent or dose from the start of the lead-in phase through randomization
• Use of warfarin, metronidazole, or acetaminophen (greater than 2 grams per day) from the start of the lead-in phase through randomization
• Lactose intolerance defined as patient reported inability to tolerate milk products
• History of other chronic liver disease, including metabolic diseases, documented by appropriate test(s)
• Previous liver biopsy that demonstrated presence of cirrhosis
• Radiologic imaging consistent with cirrhosis or portal hypertension
• Clinical or histological evidence of cirrhosis or, in the opinion of the investigator, the inability to safely obtain a liver biopsy due to technical reasons, such as body habitus.
• Evidence of decompensated liver disease defined as any of the following: serum albumin <3.2 g/dl, total bilirubin > 1.5 mg/dl, or PT/INR > 1.3 times normal from the start of the lead-in phase through randomization, or history or presence of ascites or encephalopathy, or bleeding from esophageal varices
• Platelet count < 130,000/mm3 at any time from the first lead-in visit through randomization
• Serum creatinine of 2.0 mg/dL or greater or CrCl ≤ 60cc/min, or on dialysis, at any time from the first lead-in visit through randomization. The creatinine clearance (CrCl) will be calculated according to Cockcroft-Gault.
• Average alcohol consumption of more than one drink or equivalent (>12 grams) per day or more than two (2) drinks on any one day over the 30 days prior to the start of the lead-in phase. Patients who met either criterion more than 30 days prior to the start of the lead-in phase must have consumed a monthly average of 12 grams or less per day of alcohol for at least six months prior to the start of the lead-in phase
• Evidence of drug abuse in the year prior to the start of the lead-in phase or prior to randomization
• History of immunologically mediated disease (e.g., inflammatory bowel disease, idiopathic thrombocytopenic purpura, lupus erythematosis, autoimmune hemolytic anemia, severe psoriasis, rheumatoid arthritis) that could affect the assessment of biomarkers of inflammation
• History of solid organ or bone marrow transplantation
• History of thyroid disease poorly controlled on prescribed medications
• Use of oral steroids for more than 14 days within 30 days of the start of the lead-in phase or prior to randomization
• Primary hepatic malignancy
• Secondary hepatic malignancy (metastatic disease) or extrahepatic malignancy
• Women with ongoing pregnancy or breast feeding, or contemplating pregnancy
• History of bariatric surgery, or undergoing evaluation for bariatric surgery.
• Participation in a research drug trial, exclusive of the SyNCH Phase I trial, within 30 days of the first lead-in visit
• History or other evidence of severe illness or any other conditions that would make the patient, in the opinion of the investigator, unsuitable for the study (such as poorly controlled psychiatric disease, coronary artery disease, or active gastrointestinal conditions that might interfere with drug absorption)
• Inability or unwillingness to give informed consent or abide by the study protocol