November 3, 2023 – The 10 best-selling liver health supplements on Amazon herald an estimated $2.5 million a month. But none of them contain ingredients advisable by major physician groups that treat liver problems within the United States or Europe.
Like many dietary supplements, popular liver products purchased online are unregulated, meaning they would not have to satisfy the identical safety and effectiveness standards as prescribed drugs.
Sales of liver supplements are growing, especially lately, said Ahmed Eltelbany, MD, MPH, a first-year gastroenterologist on the University of New Mexico. One reason for this may occasionally be increased alcohol consumption through the COVID-19 pandemic, he said.
Some manufacturers make daring claims on Amazon, says Eltelbany, creator of a study that checked out the supplements. “The most common claims were that their supplements maintain normal liver function, are scientifically formulated and – my personal favorite – are a highly effective liver detoxification formula developed using the latest scientific evidence.”
While these claims may sound reassuring and scientifically sound to the typical consumer, most of them should not supported by rigorous clinical research, he said.
Does “natural” mean “safe”?
Many dietary supplements are marketed as “liver cleanse,” “liver detox” or “liver support,” Eltelbany said as he presented the study results recently at a serious conference for gastroenterologists.
“People take these supplements because they think they are natural and therefore safe,” said Dr. Paul Y. Kwo, who moderated a session on the study on the American College of Gastroenterology conference, when asked for comment. “I tell every patient in the clinic, a great white shark is natural, a scorpion is natural and so is a hurricane. So just because they are natural doesn't mean they are safe.”
At the identical time, it's not the case that each dietary complement is bad for you. Still, there are a dizzying array of them, said Kwo, a professor of medication at Stanford Medicine in Redwood, California.
“We have to be very careful,” he said. Some people consider, for instance, that “if a small amount of a supplement is good, a huge amount must be really good.” The antioxidant turmericfor instance, has a fairly good safety record, he said. But last 12 months some concerns arose about liver toxicity in preparations containing “very, very high concentrations” of turmeric.
The Top 10 Sellers
Eltelbany and colleagues examined the costs of 1-month supplies, monthly sales, and revenue of the ten best-selling liver supplements on Amazon on June 3, 2023:
Ranking by sales:
- Liver Cleansing, Detoxification and Repair Formula – Herbal Liver Supplement with Milk Thistle, Dandelion Root, Organic Turmeric and Artichoke Extract for a Healthy Liver – Milk Thistle Detox Capsules with Silymarin
- Ancestral Supplements – Grass-Fed Beef Liver Capsules. Supports energy production, cleansing, digestion, immunity and total body wellness. Non-GMO, freeze-dried liver health complement, 180 Capsules
- Bronson Milk Thistle 1000 mg Silymarin Marianum & Dandelion Root to Support Liver Health, 120 Capsules
- PUREHEALTH RESEARCH Liver Supplement – Herbal Liver Cleansing, Detoxification and Repair Agent with Milk Thistle, Artichoke Extract, Dandelion Root, Turmeric and Berberine for Healthy Liver Renewal with 11 Natural Nutrients
- TUDCA Bile Salts, Liver Support Supplement, 500 mg Servings, Liver and Gallbladder Cleansing Supplement (60 Capsules 250 mg) True Bile Acid. TUDCA Strong Bitter Taste of Double Wood
- 28-in-1 Liver Cleanse, Detox and Repair Formula for Fatty Liver, Milk Thistle Silymarin, Artichoke Extract, Dandelion and Apple Cider Vinegar – Dietary Supplement to Support Liver Health – Vegan Capsules
- Vita-Liver Liver Health Supplement – Supports Liver Cleansing and Detoxification – Liquid Administration for Ingestion – Milk Thistle, Artichoke, Chanca Piedra, Dandelion and More
- Liver complement with milk thistle, liver detox formula, artichoke and turmeric. Supports liver health defense and liver renewal. Liver cleansing, cleansing and repair to support fatty liver. 60 capsules
- Liver Cleanse, Detox and Repair. Milk Thistle Extract with 80% Silymarin, Artichoke Extract, Dandelion Root, Chicory, 25+ Herbs – Premium Liver Health Formula, Liver Support Detox Formula – Liver Support Detox Cleanse Supplement
- Arazo Nutrition Liver Cleanse Detox & Repair Formula – Milk Thistle Herbal Supplement: Silymarin, Beetroot, Artichoke, Dandelion, Chicory Root
The researchers found a complete of 65 unique ingredients. “Most of these ingredients have been used in the past for liver health, but our research found that there is currently no compelling scientific evidence to support the effectiveness of these supplements,” Eltelbany said. They began the study by establishing a brand new account on Amazon to make sure searches weren't influenced by previous purchases or purchases. They then looked for supplements using the keywords “liver” and “cleanse.” To determine sales numbers, they used proprietary analytics software AMZScout, which Amazon sellers use to trace sales.
Reviewing reviews
The researchers discovered a mean of 11,526 reviews for every complement. The average rating was 4.42 out of 5 stars.
Using Fakespot.com, a proprietary Amazon customer review software that analyzes the timing and language of reviews, they found that only 65% of product reviews were real.
“We felt it was crucial to verify the authenticity of customer feedback,” said Eltelbany.
Hardly every other options?
Liver disease stays a persistent and significant global health burden. Despite advances in lots of areas of gastroenterology, there remains to be no curative treatment for liver cirrhosis, Eltelbany said.
The first alternative for patients with end-stage liver disease is a liver transplant. “Unfortunately, given the shortage of donors and the large number of patients who need one, many people do not receive a transplant in time,” he said. “This lack of treatment options and desperation to find relief often drives patients to alternative therapies.”
Plus, online shopping has made it really easy to get these supplements “with the click of a mouse. But what's even more worrying is the trust our patients place in these products,” Eltelbany said.
“There is an urgent need for thorough scientific investigation into the true health benefits of liver detoxification supplements,” he said. “Most importantly, patient education is paramount to warn them of the potential risks and unknowns of these supplements.”