Quick answer: A whole-food diet is the foundation of any elimination-support plan, but some supplements may support the nutrients your liver needs. Common choices include a micronutrient formula for elimination pathways, a greens drink, protein, milk thistle, N-acetyl cysteine (NAC), dandelion root, probiotics and chlorella. Evidence varies, and supplements can interact with medications, so choose them with your provider.
Key takeaways
Nutrient-dense whole foods supply most of what the liver’s clearance pathways need.
Formulas with B vitamins, minerals, antioxidants and amino acids, along with greens drinks and fiber, are among the types sometimes used.
Supplements are not reviewed by the FDA for safety or effectiveness before sale, and they can interact with medications such as blood thinners.
Food first
Nutrient-dense whole foods supply most of what elimination pathways need. See liver-friendly nutrition.
Supplement types sometimes used
Micronutrient formula
Provides B vitamins, minerals, antioxidants and amino acids used in phase 1 and phase 2 liver clearance.
Greens or superfood drink
A convenient way to add plant nutrients.
Protein drink
Adequate protein supplies amino acids for phase 2 and helps maintain muscle.
Milk thistle
Silymarin has antioxidant effects; human evidence for liver benefits is mixed.
N-acetyl cysteine (NAC)
A building block for glutathione.
Dandelion root
Traditionally used for liver and kidney support; it can act as a mild diuretic.
Probiotics
Support gut health, which plays a role in elimination. See probiotics and prebiotics.
Chlorella
An algae rich in chlorophyll and nutrients; research on elimination effects in people is limited.
Safety
Supplements are not evaluated by the FDA for safety or effectiveness before sale, and they can interact with medications, including blood thinners and diabetes drugs. They are not recommended during pregnancy or breastfeeding without guidance. Stay within NIH Office of Dietary Supplements general guidance and discuss doses with your provider.
Healthy aging lens
Glutathione and antioxidant defenses decline with age. Nutrients that support them may help protect cells from oxidative stress. See how liver clearance works.
When to see a naturopathic doctor
It may be time to see a naturopathic doctor if you have ongoing fatigue, headaches, skin or digestive symptoms, or known exposure to lead, mercury, mold or workplace chemicals. The same is true if you take medications or have liver, kidney or heart conditions and want to try an elimination-support plan, or if you are pregnant or breastfeeding (intensive cleansing protocols are not recommended).
See a medical provider promptly for signs of poisoning such as severe abdominal pain, vomiting, confusion, seizures or trouble breathing, or call Poison Control at 1-800-222-1222.
What the research shows
Milk thistle was tested in a 2017 trial by Wah Kheong and colleagues of 99 adults with biopsy-confirmed fatty liver inflammation who took 700 mg of silymarin or placebo three times daily for 48 weeks. The main goal was not met (32.7% versus 26.0%), though fewer people on silymarin had worsening scarring.
In the PIVENS trial, 247 adults with fatty liver inflammation took 800 IU of vitamin E, pioglitazone or placebo for 96 weeks. Liver biopsies improved in 43% with vitamin E versus 19% with placebo, but scarring did not improve significantly. High-dose vitamin E carries potential risks, so this is a clinician decision.
Some supplements can harm the liver. A 2020 United States Pharmacopeia review found case reports of liver injury from concentrated green tea extracts at EGCG intakes from about 140 mg to roughly 1,000 mg a day, especially on an empty stomach.
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Questions to bring to your clinician
These questions can help you get the most out of your next visit.
Do I actually need a liver support supplement, or can food cover it for me?
Is liver-support herbs or supplements a reasonable choice alongside my current medications and supplements?
Would it be worth checking any labs before I try liver-support herbs or supplements, or is my history enough to decide?
What would tell us that liver-support herbs or supplements is working well for me, and how long should we wait before reviewing it?
Frequently asked questions
Do liver-support supplements work?
Some support elimination pathways, but evidence varies and they can’t replace healthy organs.
Is milk thistle safe?
Generally well tolerated, but it can cause digestive upset and interact with some medications.
What does NAC do?
It helps the body make glutathione.
Should I take chlorella?
Discuss with your provider; evidence in people is limited.
Sources
- Wah Kheong C, Nik Mustapha NR, Mahadeva S. A Randomized Trial of Silymarin for the Treatment of Nonalcoholic Steatohepatitis. Clin Gastroenterol Hepatol 2017. PMID: 28419855. https://pubmed.ncbi.nlm.nih.gov/28419855/
- Sanyal AJ, Chalasani N, Kowdley KV, et al. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis. N Engl J Med 2010. PMID: 20427778. https://pubmed.ncbi.nlm.nih.gov/20427778/
- Oketch-Rabah HA, Roe AL, Rider CV, et al. United States Pharmacopeia (USP) comprehensive review of the hepatotoxicity of green tea extracts. Toxicol Rep 2020. PMID: 32140423. https://pubmed.ncbi.nlm.nih.gov/32140423/
- Atkuri KR, et al. N-Acetylcysteine–a safe antidote for cysteine/glutathione deficiency. Curr Opin Pharmacol 2007. PMID: 17602868. https://pmc.ncbi.nlm.nih.gov/articles/PMC4540061/
- Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev 2007. PMID: 17943794. https://pmc.ncbi.nlm.nih.gov/articles/PMC8724782/
- Asher GN, Corbett AH, Hawke RL. Common Herbal Dietary Supplement-Drug Interactions. Am Fam Physician 2017. PMID: 28762712. https://pubmed.ncbi.nlm.nih.gov/28762712/
- Bauer J, et al. Evidence-based recommendations for optimal dietary protein intake in older people: a position paper from the PROT-AGE Study Group. J Am Med Dir Assoc 2013. PMID: 23867520. https://pubmed.ncbi.nlm.nih.gov/23867520/
- Sekhar RV, et al. Deficient synthesis of glutathione underlies oxidative stress in aging and can be corrected by dietary cysteine and glycine supplementation. Am J Clin Nutr 2011. PMID: 21795440. https://pmc.ncbi.nlm.nih.gov/articles/PMC3155927/
This article is for educational purposes only and is not medical advice. It does not replace an individual evaluation. Talk with your healthcare provider before starting supplements or changing medications, especially if you are pregnant, nursing, or managing a health condition.
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