In a time when there are so many toxic substances in our environment, liver health is top of mind for many: A report from Grand View Research shows that the market has been growing, reaching $707.16 million in 2018, and is expected to register a CAGR of 4.32% from 2019 to 2025 (1). The CDC reports that 4.5 million adults in the U.S.—1.8% of the adult population—is diagnosed with liver disease, resulting in 13.5 deaths per 100,000 people in the population yearly as of 2019 (2).
There’s a reason for this, according to Tony Iracani, President of Viva Herbals. “More than ever before in the history of mankind, human beings need to have healthy livers to break down the chemicals that have crept into our environment,” Iracani maintains. “Thousands of chemicals are added to food. Plants are sprayed with toxic chemicals.” However, as Iracani points out, the liver’s job is to remove toxins from the body: The liver is the body’s own detox system, as long as it has “the correct nutritive support.”
Many people, however, don’t understand precisely what the liver does—which may be because, according to Johns Hopkins Medicine, over 500 vital functions have been identified with the liver (3). “The liver is our body’s detox engine,” explains Sébastien Bornet, VP Global Sales & Marketing at Horphag Research. “A healthy liver regulates blood sugar, proteins, and fat in the bloodstream, and plays a key role in removing toxins from it. It also processes nutrients absorbed by our intestines and ensures our body functions properly.”
Johns Hopkins lists the following functions as just a few things this organ does:
- Clearing the blood of drugs and poisonous substances;
- Making immune factors and removing bacteria from the bloodstream;
- Production of bile, which helps carry away waste and break down fats during digestion;
- Production of cholesterol and proteins that help carry fats through the body;
- Conversion of extra glucose into glycogen for storage, to be converted back to glucose as needed;
- Processing of hemoglobin for iron content;
- Conversion of ammonia to urea, an end product of protein metabolism.
Once the liver has broken down harmful substances, they are excreted as waste.
Clearly, liver health is important. Johns Hopkins Medicine offers a few lifestyle suggestions (4):
- Don’t drink alcohol in excess;
- Maintain weight, as weight gain can increase risk of developing nonalcoholic fatty liver disease (NAFLD), wherein fat accumulates in the liver, preventing it from properly doing its many jobs;
- If there is a family history of liver disease, talk to a healthcare practitioner about getting regular screenings in order to catch it early.
As stay-at-home orders began, many stressed and bored Americans increased their alcohol intake, according to an October 2020 study published in JAMA Network Open (7). The survey included 1,540 adults, with an average age of 56.6 years, 57.3% of whom were female. It found that the frequency of alcohol consumption increased 0.74 days overall; 0.78 days for women; 0.93 days for adults 30-59 years old; and 0.66 days for non-Hispanic White individuals. Women also saw an increase in heavy drinking days, as well as increased alcohol-related problems. The researchers stated: “These data provide evidence of changes in alcohol use and associated consequences during the COVID-19 pandemic.”
A more limited study found the same results. Published in WMJ in September 2020, this study was sent to a convenience sample of adults through social media and completed by 417 subjects, 83% of whom were women, and 44% of whom were between the ages of 35 and 44 years (8). Women had a statistically significant increase in Alcohol Use Disorders Identification Test scores. Interestingly, the study found that while fewer people were using alcohol during social distancing, those who did drink alcohol increased both frequency and quantity of alcohol drunk. The researchers identified three factors associated with increase in alcohol intake: A history of substance abuse, having children at home, and being a woman.
Alcohol abuse can cause several issues for the liver, ranging from dehydration to alcoholic cirrhosis (9). Certain diseases, such as alcoholic fatty liver disease and alcoholic hepatitis, are reversible: Cutting alcohol consumption can cure these diseases, as soon as within two weeks for alcoholic fatty liver diseases. Continuing to drink, however, can lead to worsening health, liver failure, or death.
While you should refer customers to their doctors if there are concerns of alcohol abuse and addiction, and to therapists for mental health disorders, there are things you can do to help. Offering products that can help decrease stress can help your customers feel less of a need to turn to alcohol for stress reduction; at the Naturally Informed event Mental Wellness: Mastering the Market, Uma Naidoo, M.D., suggested that dietary changes could make a major difference. (To view her session—and to find out what other experts think about mental health—head to www.NaturallyInformed.net and register to view the event on-demand.)
Customers may also appreciate mocktail options, particularly as the pandemic winds down and social events begin picking up. Hop Wtr offers an alcohol-free drink infused with hops as well as adaptogens and nootropics, to not only replace beer but to offer stress relief benefits. The drink comes in Classic (intended to remind the drinker of an IPA), mango, and blood orange.
And, of course, offer supplement options that help your customers support their liver’s daily healthy function.
When it comes to liver health, experts point to milk thistle. Sigmund Brzostowski, Director of Sales at Yerba Prima, tells WholeFoods: “While there are always new liver health/detox formulations, Yerba Prima offers only one product in this category because in the end, science and nutrition always seem to come back to milk thistle as the one ingredient that works. The active ingredient in milk thistle is silymarin, which basically acts as an antioxidant. Medical research on milk thistle and liver health has shown that silymarin may help ease inflammation and promote cell repair. Cell repair is really the key when it comes to helping promote a healthy liver.” Yerba Prima uses milk thistle standardized to 80% silymarin in its products, which include Women’s Renew and Men’s Rebuild.
“It feels like milk thistle is still at the top of recognized liver support ingredients,” agrees Kim Hapke, N.D., Consultant to the R&D department at Metabolic Maintenance. “It exhibits antioxidant protective qualities as well as promoting cellular repair, and has positive effects on glutathione levels and inflammation.” Beyond milk thistle, Dr. Hapke says it gets personal. “Depending on patient presentation, I would perhaps be choosing to add more antioxidant support from nutrients like alpha lipoic acid or N-acetyl cysteine, or supporting normal inflammatory balance with curcumin, or aiding fat digestion and metabolism with ingredients like burdock and choline.” Metabolic Maintenance offers Metabolic Detox capsules containing silymarin from milk thistle, N-acetyl-L-cysteine, and alpha lipoic acid. The company also offers a Metabolic Detox Complete, which offers everything in the Metabolic Detox capsules, as well everything found in a multivitamin, omega-3s, the prebiotic inulin, and a blend of plant-based proteins, for complete nutrition.
Taking a deeper dive into milk thistle, David Winston, RH(AHG), Founder and President of Herbalist & Alchemist, notes that it is a hepatoprotective herb. “Hepatoprotective herbs such as milk thistle, turmeric, schisandra, licorice, or artichoke leaf contain antioxidant/anti-inflammatory compounds such as polyphenols, flavonoids, and flavonolignans, that protect against oxidative damage caused by hepatotoxic medications, alcohol, and industrial pollutants. These herbs also enhance production of hepatic glutathione, help repair damaged hepatocytes, and inhibit the development of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).”
Looking at another category of liver support ingredients, Winston points to hepatic tonics, “which mildly enhance normal liver function and may have mild hepatoprotective activity. Herbs such as dandelion root, chicory root, burdock root, blessed thistle, or elecampane are used to promote liver health in people with a high-fat diet, a sluggish bowel or a slow transit time, elevated LDL-C, or chronic skin conditions.”
For those who have a relatively healthy liver but inadequate bile secretion, Winston suggests cholagogues/choleretics, which stimulate both the liver and the gallbladder. This group of herbs includes Oregon grape root, barberry root, red alder bark, Chinese corydalis, and fringe tree bark. Winston explains that signs that may suggest use of these herbs include impaired fat absorption; nausea or dyspepsia when eating fats; abdominal bloating; or right-sided abdominal pain.
Herbalist & Alchemist offers a range of products that incorporate Winston’s recommendations, from single-herb extracts such as Schisandra and Milk Thistle to Original Bitters, a blend of herbs that includes dandelion root, artichoke, and peppermint.
The experts at Global Healing second Winston’s turmeric recommendation. “One of the most overlooked herbs for liver support is turmeric and especially turmeric with low oxalates,” says Jonathan Group, DC, RD, Senior Product Advisor. He explains, “People with kidney issues or repeated kidney stones can’t take a lot of turmeric because it is naturally high in oxalates, which can cause kidney stones.” Global Healing offers a raw turmeric extract low in oxalates—and for those curious about how it’s extracted, company Founder Edward Group, DC, NP, has a video on his YouTube channel (under “Dr. Group”) describing the process.
Another option comes from Enzymedica: Purify Liver Detox contains schisandra extract, milk thistle, and compounds including glutathione. Known as the “master antioxidant,” glutathione is used by the body to help eliminate toxins from cells; protect against the damaging effects of radiation, chemicals, and environmental pollutants; and utilize energy (5).
Offering antioxidant support from a different angle, HealthPlus Inc. sells Liver Detox, containing several liver-support ingredients including N-acetyl-L-cysteine, alpha lipoic acid, and astaxanthin.
Alejandro Junger, M.D., also finds herbs helpful in his practice. “Science is only now catching up with what ancient cultures have been using for millennia. Ayurvedic medicine provides a deep well of knowledge and experience with powerful plants that have been used successfully for a long time. One such combination is a triad of powerful adaptogens—bhumyamalaki, katuki, and punarnava. This herbal combination is known in India not only to be liver protective but kidney protective as well. In India, it is used to treat inflammation and as a powerful antioxidant, and to treat and prevent fatty liver. Organic India USA produces a supplement called Liver Kidney that is exactly this formula. I have been using it myself, and have prescribed it to many of my patients. Its mechanism of action is at several levels. The ingredients provide antioxidants, essential for detox and for cellular health in general; they also provide nutrients in the form of minerals and vitamins.”
This combination of adaptogens also—as the name implies—helps the body adapt, Dr. Junger adds. “On the liver, this could mean promoting hepatocytes to upregulate the synthesis of the needed enzymes to deal with detox activity, the P450 enzymes in the liver. More scientific controlled studies are needed to fully understand what the ancient Ayurvedic texts explain so simply, clearly, and even in poetic ways.”
Also providing a blend with traditional herbs: Viva Herbals offers Chi-Tox Tea, which contains green tea extract; maitake, reishi, shiitake, and cordyceps mushrooms; goji berry; and several herbs used in Traditional Chinese Medicine (TCM)—schisandra, milk thistle, Chinese skullcap, and Chinese licorice.
An important note on herbal formulas: “Synergy studies over the last 15 years have clearly shown that carefully combining herbs can result in exponential improvements in herb activity, whereas incompatible herbs can create anti-synergy, or antagonism,” Winston explains. “It is not a matter of just throwing a bunch of herbs together. The key is looking at traditions that have found over long experience that certain herbal combinations enhance activity and promote healing. Examples include using turmeric with ginger to increase absorption and activity, the Eclectic use of fringe tree bark with culvers root, or in TCM combining rhubarb with gardenia fruit to clear liver heat.”
Moving on from herbs, Dr. Junger adds protein to the list of useful supplements: “Liver cells need protein to manufacture detox enzymes, so a good source of protein is a must. During detox times I have my patients supplement their protein intake with vegetable protein, mostly from rice and peas.”
Also beneficial: French oak wood extract, such as Robuvit, branded by Horphag. “Extensive research shows that Robuvit is effective for natural detox support, as it increases the liver’s enzyme capacity required to effectively neutralize toxins in the body,” Bornet says. “It is rich in polyphenols of the ellagitannin class, such as roburins and other flavonoids that are unique to oak wood, which enhance basic cellular function to combat aging, increase energy, and fend off fatigue. A 2016 study found that supplementation with Robuvit helps individuals recover from temporary hepatic damage from alcohol consumption faster than in control groups.”
The Power of Nutrition
At the end of the day, Dr. Hapke says, basic nutrition is key, and for many people it could be all that is needed to support liver health. “The role of the liver involves so many different biochemical transformations that overall nutrition is important, as many vitamins and minerals provide cofactors for those reactions or antioxidant protection for liver cells. If overall nutrition is lacking, a multivitamin would be a good start to cover the basics of liver protection with vitamins like A, C, and E, and providing nutrients the liver needs to do its many jobs such as folate, B12, and B6.”
When it comes to merchandising, Dr. Hapke identifies this area as a tricky one: “The liver’s role in the body is complex, whereas an organ like the heart is more easily understood. The best things for the liver involve the less-than-inspiring message of moderation in diet and alcohol over time. Also, the liver’s innate resilience may work against it, as it doesn’t create many symptoms or issues until it is quite compromised.” Pre-pandemic, she points out that NAFLD was getting more attention than ever, which could help boost awareness; now that immune health is getting more attention, she says it’s time to provide education regarding the fact that liver health is tied to things like inflammation. “A possible tip is to introduce the liver support idea via products that people already have strong awareness of for overall health, such as probiotics. Or tie it to issues people may have more front-of-mind, like hormone balancing or metabolic health.”
Specifically, Dr. Hapke suggests taking a page from the book of TCM, tying liver health to spring: “If I can, I like to get people interested in their liver health during the spring season, as the foods and behaviors that are beneficial arrive naturally during this time, such as fresh newly grown greens and sour foods, as well as greater physical activity, while perhaps supporting the liver with an herbal/nutrient blend. I like this seasonal approach to supporting health and find it fits in well with people’s intuitive understanding of how their body follows natural cues.”
Proper product vetting is also essential. “Consumers are becoming increasingly savvy, and searching for the safest evidence-based, high-quality ingredients,” says Bornet. “Standard merchandizing practices are not enough anymore, and top-performing marketers must look beyond usual BOGO programs. Finished product distributors are developing comprehensive educational programs to help health-conscious consumers access relevant product information, making sure they understand the science behind what they buy. This is precisely why, at Horphag Research, we do not hesitate to go the extra mile and support our clients while they develop new, innovative education-focused merchandizing programs.”
Looking to the future, Dr. Hapke says there’s much to learn from research on non-alcoholic fatty liver disease. “I think the increase in NAFLD has led to a lot of research regarding the cycle of weight gain, insulin resistance, inflammation, fatty liver deposits, and where that cycle can be interrupted. The science has grown around some herbs such as curcumin that we know has anti-inflammatory properties as to how those qualities specifically benefit liver health. Probiotics addressing gut dysbiosis and resulting inflammation tied to NAFLD are an interesting area of research on this topic as well. As an ingredient, I would keep an eye on choline and the information that many of us are deficient in this important nutrient. Adequate choline is required to support normal fat metabolism in the liver, and as much as 90% of the population does not have adequate intake of this nutrient.”
At Horphag, new Robuvit findings are generating positive buzz. “We are taking exciting steps to understand the core mechanisms of action of our ingredients,” Bornet tells WholeFoods. “For the first time, the science behind Robuvit’s mechanisms of action—including its ability to support cellular mitochondria and ribosomes—is outlined in a new review article, showing how this potent antioxidant can increase energy, improve sports performance, and naturally detox the body” (6).
And at the end of the day, Yerba Prima’s Brzostowski says it’s all about education—and constantly updating customers. “Consumer education is key for our industry,” he says. “For instance, fiber has so many benefits that it is really the best known ‘super food.’ It goes far beyond just promoting regularity—it promotes heart health, helps regulate glucose levels, and so much more. Yet, because past generations were only educated about its regularity benefits, today there is little consumer awareness on the other benefits of getting enough daily fiber. The natural products industry has seen exponential growth for years, and now with COVID-19 we are seeing a whole new level of awareness. The key is to promote education of these products, so that consumers can make better, more well-informed health decisions.” WF
- Liver Health Supplements Market Size, Share & Trends Analysis Report by Product, By Dosage Form, By Region, and Segment Forecasts, 2019-2025,” Grand View Research. Published 12/2019. Accessed 03/01/2021. https://www.grandviewresearch.com/industry-analysis/liver-health-supplements-market
- “Chronic Liver Disease and Cirrhosis,” Centers for Disease Control and Prevention. Last reviewed 01/12/2021. Accessed 03/01/2021. https://www.cdc.gov/nchs/fastats/liver-disease.htm
- “Liver: Anatomy and Functions,” Johns Hopkins Medicine. Accessed 03/01/2021. https://www.hopkinsmedicine.org/health/conditions-and-diseases/liver-anatomy-and-functions
- Reviewed by Tinsay Ambachew Woreta, “Detoxing Your Liver: Fact Versus Fiction,” Johns Hopkins Medicine. Accessed 03/01/2021. https://www.hopkinsmedicine.org/health/wellness-and-prevention/detoxing-your-liver-fact-versus-fiction
- Nijer Reaves, “Glutathione: The Master Antioxidant,” WholeFoods Magazine. Posted 11/17/2019. Accessed 03/01/2021. https://wholefoodsmagazine.com/supplements/features-supplements/glutathione-the-master-antioxidant/
- Franziska Weichmann, Fabrice Avaltroni, and Carolina Burki, “Review of Clinical Effects and Presumed Mechanism of Action of the French Oak Wood Extract Robuvit,” Journal of Medicinal Food. Online ahead of print 01/28/2021. Accessed 03/01/2021. https://www.liebertpub.com/doi/10.1089/jmf.2020.0165
- Michael S. Pollard, Joan S. Tucker, Harold D. Green Jr., “Changes in Adult Alcohol Use and Consequences During the COVID-19 Pandemic in the U.S.,” JAMA Network Open. 3(9). 2020. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2770975
- Nicole Boschuetz et al., “Changes in Alcohol Use Patterns in the United States During COVID-19 Pandemic,” WMJ. 119(3). 171-176(2020). https://pubmed.ncbi.nlm.nih.gov/33091284/
- Nena Messina, “Liver Disease From Alcohol: Early Signs,” Addiction Resource. Last updated 04/09/2020. Accessed 03/01/2021. https://addictionresource.com/alcohol/effects/liver/