Beware of Popular Online Liver Supplements, Doctors Say

The 10 best-selling liver health supplements on Amazon bring in an estimated $2.5 million each month. But none of them contain ingredients recommended by major groups of doctors who treat liver issues in the United States or Europe.

Like many supplements, popular online liver products are unregulated, meaning they do not have to meet the same safety and effectiveness standards as prescription medications.

Sales of liver supplements are growing, particularly in the last few years, said Ahmed Eltelbany, MD, MPH, a first-year gastrointestinal fellow at the University of New Mexico. One reason could be increased alcohol use during the COVID-19 pandemic, he said.

Some manufacturers make bold claims on Amazon, said Eltelbany, author of a study that looked into the supplements. "The most recurrent claims were that their supplements maintain normal liver function, are scientifically formulated, and – my personal favorite – are a highly effective liver detox formulation developed according to the latest scientific findings."

While these claims might sound reassuring and scientifically grounded to an average consumer, he said, most of them are not backed up by rigorous clinical research.

Does Natural Mean Safe?

Many supplements are marketed as "liver cleansing," for "liver detox," or for "liver support," Eltelbany said as he presented the study results at a major conference for gastro doctors recently.

"People take these supplements because they believe they're natural and therefore they're safe," said Paul Y. Kwo, MD, who moderated a session on the study at the American College of Gastroenterology conference, when asked to comment. "As I tell every patient in clinic, a great white shark is natural, a scorpion is natural, and so is a hurricane. So just because they're natural doesn't mean they're safe."

At the same time, "it's not that every supplement is bad for you. Nonetheless, there's just a dizzying array of these out there" said Kwo, a professor of medicine at Stanford Medicine in Redwood, CA.

"We have to be very cautious," he said. For example, some people might believe that "if a little bit of a supplement is good, a tremendous amount must be really good." The antioxidant turmeric, for example, has a pretty good safety record, he said. But this past year, some liver toxicity concerns arose about preparations with "very, very high concentrations" of turmeric.

The Top 10 Sellers

Eltelbany and colleagues studied prices for 1-month supplies, monthly sales, and revenue for the top 10 liver supplements sold on Amazon on June 3, 2023:

Ranking by sales:

Liver Cleanse Detox & Repair Formula – Herbal Liver Supplement with Milk Thistle, Dandelion Root, Organic Turmeric and Artichoke Extract for Liver Health – Silymarin Milk Thistle Detox Capsules
Ancestral Supplements Grass Fed Beef Liver Capsules. Supports Energy Production, Detoxification, Digestion, Immunity and Full Body Wellness, Non-GMO, Freeze Dried Liver Health Supplement, 180 Capsules
Bronson Milk Thistle 1000 mg Silymarin Marianum & Dandelion Root Liver Health Support, 120 Capsules
PUREHEALTH RESEARCH Liver Supplement – Herbal Liver Cleanse Detox & Repair with Milk Thistle, Artichoke Extract, Dandelion Root, Turmeric, Berberine to Healthy Liver Renew with 11 Natural Nutrients
TUDCA Bile Salts Liver Support Supplement, 500 mg Servings, Liver and Gallbladder Cleanse Supplement (60 Capsules 250 mg) Genuine Bile Acid. TUDCA Strong Bitter Taste by Double Wood
28-in-1 Liver Cleanse Detox & Repair Fatty Liver Formula, Milk Thistle Silymarin, Artichoke Extract, Dandelion & Apple Cider Vinegar – Liver Health Supplement Support Pills – Vegan Capsules
Vita-Liver Liver Health Supplement – Support Liver Cleanse & Detox – Liquid Delivery for Absorption – Milk Thistle, Artichoke, Chanca Piedra, Dandelion & More
Liver Supplement with Milk Thistle, Liver Detox Formula, Artichoke and Turmeric. Supports Liver Health Defense & Liver Renew. Liver Cleanse Detox & Repair for Fatty Liver Support. 60 Capsules
Liver Cleanse Detox & Repair. Milk Thistle Extract with Silymarin 80%, Artichoke Extract, Dandelion Root, Chicory, 25+ Herbs – Premium Liver Health Formula, Liver Support Detox Health Formula – Liver Support Detox Cleanse Supplement
Arazo Nutrition Liver Cleanse Detox & Repair Formula – Milk Thistle Herbal Support Supplement: Silymarin, Beet, Artichoke, Dandelion, Chicory Root

The investigators found a total of 65 unique ingredients. "Most of these ingredients have historical uses linked to liver health. But our research revealed that strong scientific evidence supporting the efficacy of any of these supplements is currently lacking," Eltelbany said. They started the study by creating a new account on Amazon to make sure the search would not be influenced by prior shopping or purchases. They next searched for supplements using the keywords "liver" and "cleanse." To figure out sales numbers, they used the AMZScout proprietary analytics software that Amazon sellers use to track sales.

Reviewing the Reviews

The researchers discovered an average 11,526 reviews for each supplement product. The average rating was 4.42 stars out of 5.

Using Fakespot.com, proprietary Amazon customer review software that analyzes the timing and language of reviews, they found that only 65% of product reviews were genuine.

"We felt it was crucial to vet the authenticity of customer feedback," Eltelbany said.

Few Other Options?

Liver disease remains a persistent and significant global health burden. Despite advances in many areas of gastroenterology, there remains no curative treatment for liver cirrhosis, Eltelbany said.

The primary option for people with end-stage liver disease is a liver transplant. "However, given the scarcity of donors and the vast number of patients in need, many individuals, unfortunately, do not get a timely transplant," he said. "This void of treatment options and the desperation to find relief often drives patients towards alternative therapies."

Also, online shopping has made getting these supplements "as simple as a click away. But what's more concerning is the trust placed in these products by our patients," Eltelbany said.

"There's a strong need for rigorous scientific investigation into the actual health benefits of any liver detox supplements," he said. "Above all, patient education remains paramount, warning them of potential risks and unknowns of these supplements."

Sources:

American College of Gastroenterology (ACG) 2023 Annual Scientific Meeting, Oct. 20-25, 2023, Vancouver, Canada.

Ahmed Eltelbany, MD, MPH, gastroenterology fellow, University of New Mexico, Albuquerque.

Paul Y. Kwo, MD, professor of medicine, Stanford Medicine, Redwood, CA.

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