Liver & tonic

42 GBP per bottle

Possibly the only good thing about the bottle above is that it’s described as being “Alcohol free”. A tonic for the liver containing alcohol is the last thing anyone needs.

“Get behind thee, satanic ethanol!”

Dozens of products with names like “Liver Guard,” “Liver Rescue,” and “Liver Detox” claim they can get your liver in tip-top shape – and help you feel better in the process.

So do liver supplements work? And does the organ that detoxifies your body really need its own detox?

Given that my liver is in need of a reparative boost, I thought I should investigate.

The Victorians were particularly fond of quaffing chemist’s nostrums. Angelic children frolicked on the bottles of Ayer’s Cherry Pectoral, a mixture of alcohol and opium that would now be deemed a poison.

Coca leaf, from which cocaine is now obtained, was advertised as a nerve and muscle tonic, to “appease hunger and thirst” and to relieve sickness.

Bupleurum chinense, which resembles dill and fennel, has been used in Chinese medicine for more than 2000 years as a liver tonic. But that’s not evidence that it works. Some animal and culture studies suggest that bupleurum has an anti-fibrotic and anti-inflammatory effect on liver cells, but there’s no robust proof that this translates to a clinically relevant action.

Bupleurum or Thorow wax

A review of 77 randomised clinical trials of herbal medicines, including bupleurum, for treating fatty liver disease, judged that the findings were inconclusive, largely because of the widely varying doses and the small number of patients involved. The review also pointed out the risk of adverse side effects from unregulated herbal medicines, including interactions with prescribed drugs.

One plant that gets a cautious thumbs up from some liver specialists is Silybum marianum, commonly known as milk thistle. A study published in the journal Medicine, in 2018, analysed 8 randomised clinical trials involving patients with non-alcoholic fatty liver disease (NAFLD) who took silymarin, the active extract of milk thistle.

Silybum marianum or Milk thistle

The results from these trials suggest that silymarin may lower the levels of two liver enzymes – AST (aspartate transaminase) and ALT (alanine transaminase) – which tend to be elevated in liver disease.

Other studies examining the effect of silymarin on alcohol-related liver disease, including cirrhosis, are contradictory, although silymarin appears to be hepatoprotective through an antioxidant effect and is well tolerated in high doses.

A paper in the Journal of Viral Hepatitis suggests that silymarin may have the potential to help resolve carbon tetrachloride‐induced liver fibrosis in rats. But humans don’t usually ingest carbon tetrachloride and we’re hardly related to rats.

Milk thistle efficacy? Not proven yet

Some of the strongest evidence for a liver tonic comes in the form of coffee, or rather, it’s principal component, caffeine.

Paraxanthine, one of caffeine’s main metabolites, suppresses the synthesis of connective tissue growth factor, which slows down connective tissue growth. This, in turn, may decelerate the development of liver fibrosis, alcoholic cirrhosis, and liver cancer.

And it doesn’t seem to matter in what form the coffee is consumed, as long as one drinks enough: low coffee consumers achieve an average risk reduction of 25-30 percent of developing chronic liver disease and avid coffee guzzlers attain 65 percent.

“Liver disease is a silent killer as often there are no symptoms until it’s too late. Coffee is something that’s easily accessible to everyone, and regularly drinking it – filtered, instant or espresso – may make a difference in preventing and, in some cases, slowing down the progression of liver disease. It’s an easy lifestyle choice to make.”

Judy Rhys, British Liver Trust

As any regular gym goer knows, exercise is an excellent destresser and all-around good guy tonic for health. The liver seems to benefit in particular. An overview of 21 randomised trials demonstrated that exercise programmes with an aggregate calorie expenditure of >10,000 kcal achieved a dramatic reduction of hepatic fat in overweight and obese participants.

Another study published in Biomolecules showed that ‘runner rats’ (rats bred for high physical activity) seemed to be protected against irreversible liver damage even if they were exposed to large amounts of alcohol. Sadly, it’s wishful thinking to believe the same applies to humans. A Japanese study published in the British Medical Journal showed that, in heavy alcohol drinkers, there were no significant associations between physical activity and incidence of fatty liver.

So what’s my holistic prescription? Well, I’m hoping that 2 cups of coffee per day should do the trick, along with a generous helping of milk thistle extract and an hour of cardio and weights. But I’m realistic. If you’ll pardon the misused adage, my fibrotic liver wasn’t built in a day and will take time to repair.

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