November 3, 2023 – The 10 best-selling liver supplements on Amazon usher in an estimated $2.5 million every month. But none of them contain ingredients really useful by large groups of doctors treating liver problems within the United States or Europe.
Like many supplements, popular online liver products usually are not regulated, meaning they usually are not required to satisfy the identical safety and effectiveness standards as prescription medications.
“Sales of liver supplements are increasing, especially in recent years,” said Ahmed Eltelbany, MD, MPH, a first-year gastrointestinal fellow on the University of New Mexico. One reason may very well be increased alcohol consumption in the course of the COVID-19 pandemic, he said.
“Some manufacturers are making bold claims on Amazon,” said Eltelbany, writer of a study taking a look at 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 formulation developed using the latest scientific evidence.”
While these claims may sound reassuring and scientifically sound to the typical consumer, most of them usually are not backed by rigorous clinical research, he said.
Does “natural” mean secure?
Many supplements are marketed as “liver cleanse,” “liver detoxification” or “liver support,” Eltelbany said as he presented the study results at a recent major conference for gastrointestinal doctors.
“People take these supplements because they believe they are natural and therefore safe,” said Paul Y. Kwo, MD, 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. Just because they’re natural doesn’t mean they’re safe.”
At the identical time, “it’s not that every supplement is bad for you. Yet there is just a dizzying variety out there,” said Kwo, a professor of medication at Stanford Medicine in Redwood, California.
“We have to be very careful,” he said. For example, some people might consider that “if a small amount of a supplement is good, then a large amount must be really good.” The antioxidant turmeric, for instance, has a reasonably good safety record, he said. But last 12 months there have been some concerns about liver toxicity with preparations containing “very, very high concentrations” of turmeric.
The top 10 sellers
Eltelbany and colleagues examined 1-month supply prices, monthly sales, and revenue for the ten top-selling liver supplements on Amazon as of June 3, 2023:
Ranking by sales:
- Liver Cleanse and 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 Total 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 and Repair with Milk Thistle, Artichoke Extract, Dandelion Root, Turmeric, Berberine for Healthy Liver Renewal with 11 Natural Nutrients
- TUDCA Bile Salts, Liver Support Supplement, 500 mg Servings, Liver and Gallbladder Cleanse Supplement (60 Capsules of 250 mg), Real Bile Acid. TUDCA Strong Bitter Taste from Double Wood
- 28-in-1 Liver Cleanse, Detox and Fatty Liver Repair Formula, 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 – Hydration for Absorption – Milk Thistle, Artichoke, Chanca Piedra, Dandelion and more
- Liver complement with milk thistle, liver detox formula, artichoke and turmeric. Supports liver health protection and liver renewal. Liver cleanse, detoxing and repair to support fatty liver disease. 60 capsules
- Liver cleanse, detoxing and 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, Beetroot, Artichoke, Dandelion, Chicory Root
In total, the investigators found 65 unique ingredients. “Most of these ingredients have historical uses related to liver health. But our research has shown that there is currently a lack of convincing scientific evidence supporting the effectiveness of these supplements,” said Eltelbany. They began the study by making a latest account on Amazon to make sure searches weren't influenced by previous purchases or purchases. Next, they looked for supplements using the keywords “liver” and “cleanse.” To determine the sales figures, they used the proprietary analytics software AMZScout, which Amazon sellers use to trace their sales.
Verification of reviews
Researchers found a mean of 11,526 reviews for every complement product. The average rating was 4.42 out of 5 stars.
Using Fakespot.com, Amazon's proprietary 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 critical to verify the authenticity of customer feedback,” Eltelbany said.
Some other options?
Liver disease stays a persistent and significant global health burden. Despite advances in lots of areas of gastroenterology, there stays no curative treatment for liver cirrhosis, Eltelbany said.
The primary option for individuals with end-stage liver disease is a liver transplant. “However, given the shortage of donors and the large number of patients in need, many people unfortunately do not receive transplants on time,” he said. “This lack of treatment options and desperation to find relief often drives patients to turn to alternative therapies.”
Plus, shopping online “makes it so easy to get these supplements with just one click.” But what’s much more concerning is the trust our patients place in these products,” Eltelbany said.
“There is an urgent need for a thorough scientific study of the actual health benefits of liver detoxification supplements,” he said. “Above all, patient education remains paramount to warn them of the potential risks and unknowns of these supplements.”