November 3, 2023 – The ten best-selling liver health supplements on Amazon are estimated to bring in $2.5 million every month. But none of them contain ingredients recommended by major groups of doctors who treat liver problems in the United States or Europe.
Like many supplements, popular online liver products are unregulated, meaning they don’t have to meet the same safety and effectiveness standards as prescription medications.
Sales of liver supplements are growing, especially in the last few years, says Ahmed Eltelbany, MD, MPH, a first-year gastrointestinal fellow at the University of New Mexico. One reason could be increased alcohol consumption during the COVID-19 pandemic, he said.
Some manufacturers are making bold claims on Amazon, says Eltelbany, author of a study that looked 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 detox formulation developed according to the latest scientific findings.”
While these claims may sound reassuring and scientifically sound to the average consumer, he said, most of them are not supported by rigorous clinical research.
Does natural mean safe?
Many supplements are marketed as “liver cleanses,” for “liver detoxification” or for “liver support,” Eltelbany said when he presented the study results recently at a major conference for gastrophysicians.
“People take these supplements because they believe they are natural and therefore safe,” said Paul Y. Kwo, MD, who led a session on the research at the American College of Gastroenterology conference, when asked for comment. “As 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 same time: “It’s not that every supplement is bad for you. Nevertheless, there is a dizzying array of these,” says Kwo, a professor of medicine at Stanford Medicine in Redwood, CA.
“We have to be very careful,” he said. For example, some people believe that “if a little bit of a supplement is good, then a huge amount must be really good.” The antioxidant turmeric, for example, has a pretty good safety record, he said. But in the past year, concerns arose about liver toxicity from preparations containing “very, very high concentrations” of turmeric.
The top 10 sellers
Eltelbany and colleagues studied prices for one-month supplies, monthly sales, and revenues for the top 10 liver supplements sold on Amazon on June 3, 2023:
Ranking by sales:
- Liver Cleansing Detox 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 Whole Body Wellbeing, Non-GMO, Freeze-Dried Liver Health Supplement, 180 Capsules
- Bronson Milk Thistle 1000mg Silymarin Marianum & Dandelion Root Liver Health Support, 120 Capsules
- PUREHEALTH RESEARCH Liver Supplement – Herbal Liver Cleanse, Detoxification and Recovery with Milk Thistle, Artichoke Extract, Dandelion Root, Turmeric, Berberine for Healthy Liver Renewal with 11 Natural Nutrients
- TUDCA Bile Salts Liver Support Supplement, 500mg Servings, Liver and Gallbladder Cleansing Supplement (60 Capsules 250mg) Real Bile Acid. TUDCA Strong Bitter Taste of Double Wood
- 28-in-1 Liver Cleanse Detox and Repair Fatty Liver Formula, Milk Thistle Silymarin, Artichoke Extract, Dandelion and Apple Cider Vinegar – Liver Health Supplement Support Pills – Vegan Capsules
- Vita-Liver Liver Health Supplement – Support Liver Cleansing and Detox – Liquid Administration for Absorption – Milk Thistle, Artichoke, Chanca Piedra, Dandelion and More
- Liver supplement with milk thistle, liver detox formula, artichoke and turmeric. Supports liver health defense and liver renewal. Liver Cleanse Detox and Repair for Fatty Liver Support. 60 capsules
- Liver cleansing detox and repair. Milk Thistle Extract with Silymarin 80%, Artichoke Extract, Dandelion Root, Chicory, 25+ Herbs – Premium Liver Health Formula, Liver Supporting Detox Health Formula – Liver Supporting Detox Cleansing Supplement
- Arazo Nutrition Liver Cleansing Detox and Repair Formula – Milk Thistle Herbal Support Supplement: Silymarin, Beet, Artichoke, Dandelion, Chicory Root
The researchers found a total of 65 unique ingredients. “Most of these ingredients have historical uses related to liver health. But our research has shown that there is currently no strong scientific evidence supporting the efficacy of these supplements,” Eltelbany said. They started the investigation by creating a new account on Amazon to ensure the search wouldn’t be affected by previous shopping or purchases. They then searched for supplements using the keywords “liver” and “cleanse.” To find out the sales figures, they used the proprietary analytics software AMZScout that Amazon sellers use to track sales.
Reviewing the reviews
The researchers discovered an average of 11,526 reviews for each supplement product. The average rating was 4.42 starts out of 5.
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 genuine.
“We felt it was crucial to investigate 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 is still no cure for liver cirrhosis, Eltelbany said.
The primary option for people with end-stage liver disease is a liver transplant. “Given the scarcity of donors and the large number of patients in need, many people unfortunately do not receive a transplant in a timely manner,” he said. “This void of treatment options and the desperation to find relief often drives patients to alternative therapies.”
Furthermore, online shopping has made obtaining these supplements ‘as easy as a click away. But what is more worrying is the trust our patients place in these products,” Eltelbany said.
“There is a strong need for rigorous scientific research into the actual health benefits of liver detox supplements,” he said. “Above all, patient education remains paramount, warning them of potential risks and unknowns associated with these supplements.”