Liver Restoration: Which Supplement Is Actually the Best?
Who this is for: Anyone looking for an evidence-based supplement to support liver health — whether the issue is alcohol burden, fatty liver, medication use, or simply a desire for preventive support. After reading, you'll be able to compare five key options and choose the one that fits your situation.
The internet is flooded with "best liver supplements," but most articles push just one product. The real answer depends on what you need from your liver supplement. Let's look at the scientific data on five main ingredients.
TL;DR
- Alcohol damage: silymarin (420 mg/day) — best evidence base
- Acetaminophen burden: NAC (600–1200 mg/day) — gold standard
- Fatty liver (NAFLD): NAC + omega-3 combination
- Bile duct issues: TUDCA (250–500 mg/day)
- Digestive support + mild liver support: artichoke extract
- There is no universal "best" supplement — the choice depends on diagnosis
Why the Liver Needs Support at All
The liver is the body's largest internal organ. It processes everything you eat, drink, and breathe. A healthy liver regenerates on its own — even after 70% removal, it grows back within 8–15 days (Michalopoulos, 2007). The problem arises when chronic load exceeds regenerative capacity:
- Alcohol: >14 units/week for men, >7 for women significantly increases risk
- NAFLD: 25% of European adults (Younossi et al., 2016)
- Medications: acetaminophen, statins, antibiotics — all burden the liver
- Toxins: environmental pollutants, heavy metals, pesticides
Five Key Ingredients Compared
| Ingredient | Best Use | Dose | Evidence Level | Avg Cost/Month |
|---|---|---|---|---|
| Silymarin (milk thistle extract) | Alcoholic liver disease, drug injury | 420 mg/day | Moderate | €10–40 |
| NAC (N-acetylcysteine) | Acetaminophen toxicity, oxidative stress | 600–1200 mg/day | Strong (toxicity), moderate (NAFLD) | €8–20 |
| TUDCA (tauroursodeoxycholic acid) | Cholestasis, bile stagnation | 250–500 mg/day | Moderate | €20–45 |
| Artichoke extract | Mild dyspepsia, cholesterol lowering | 600–1200 mg/day | Weak-moderate | €8–15 |
| Phospholipids (EPL) | Fatty liver membrane restoration | 1800 mg/day | Weak-moderate | €15–30 |
Silymarin: The Classic Choice
Milk thistle (Silybum marianum) seed extract is the world's most-studied liver supplement — over 10,000 publications. The primary active compound silibinin acts as an antioxidant and membrane stabilizer in hepatocytes (Saller et al., 2001).
Strengths: long safety track record, broad evidence base, affordable
Weaknesses: poor bioavailability (20–50%), Cochrane review found no mortality reduction in alcoholic liver disease (Rambaldi et al., 2005)
Tip: phospholipid complex (phytosome form) increases bioavailability 3–5x (Kidd & Head, 2005). Standard extract is cheaper but less effective.
NAC: The Emergency Medicine Workhorse
N-acetylcysteine is a precursor to glutathione — the body's most powerful endogenous antioxidant. In hospitals, IV NAC is the gold standard for acetaminophen poisoning (Prescott et al., 1979). Orally, it's moderately effective for NAFLD.
Strengths: broad mechanism of action, strong toxicity evidence, cheap
Weaknesses: oral bioavailability varies, causes GI upset in some, sulfur taste
Important: NAC can lower aminotransferases (ALT/AST), which may mask actual liver damage. Always get bloodwork before and after a course.
TUDCA: The Bile Duct Specialist
Tauroursodeoxycholic acid is a conjugate of ursodeoxycholic acid (UDCA) with taurine. It's more hydrophilic and better absorbed than UDCA. TUDCA protects cells from endoplasmic reticulum stress and supports bile flow (Vang et al., 2014).
Strengths: unique bile duct action, low side effect profile
Weaknesses: expensive, less studied than silymarin, not suitable for all liver injuries
Best choice when: diagnosed with cholestasis, gallstones, or chronic digestive issues related to bile.
Artichoke Extract: Digestive Support
Cynara scolymus leaf extract contains cynaropicrin and chlorogenic acid. The primary action is increasing bile secretion (choleretic effect) and cholesterol lowering (Rondanelli et al., 2013).
Strengths: well-tolerated, supports digestion, moderate cholesterol benefit
Weaknesses: weak evidence for liver restoration specifically, primarily GI tract
Phospholipids (EPL): Membrane Building Material
Essential phospholipids (primarily phosphatidylcholine) are a component of hepatocyte cell membranes. Essentiale Forte N is a well-known brand in Central and Eastern Europe. Evidence is debatable — some studies show ALT improvement, but meta-analyses are skeptical (Gundermann et al., 2011).
Strengths: well-tolerated, widely available in pharmacies
Weaknesses: expensive for long-term use, weak evidence base
How to Choose: Decision Tree
1. Do you have a diagnosed liver disease? → Medical consultation first, not supplements
2. Do you consume alcohol regularly? → Silymarin (phytosome form) 420 mg/day
3. Do you frequently use painkillers (acetaminophen)? → NAC 600 mg/day prophylactically
4. Diagnosed with NAFLD? → NAC + omega-3 + lifestyle changes
5. Bile duct issues? → TUDCA 250 mg/day
6. Just want prevention? → Healthy diet and exercise > any supplement
Common Mistakes
1. "Liver detox" courses — there is no scientific basis for "cleansing" the liver with supplements. A healthy liver cleanses itself.
2. Stacking multiple supplements — silymarin + NAC + artichoke + phospholipids simultaneously wastes money and increases GI side effect risk.
3. Ignoring bloodwork — ALT, AST, GGT, and bilirubin are cheap tests. They tell you more than any supplement.
4. Continuing alcohol and relying on supplements — no supplement compensates for alcohol's harmful effects.
Frequently Asked Questions
Can liver supplements be combined?
Some combinations are reasonable: silymarin + NAC work through different mechanisms. But 4–5 supplements at once is no smarter than one correctly chosen option.
Does a healthy person need liver supplements?
Usually not. If ALT and AST are normal, your liver is working well and your lifestyle is healthy, supplements provide minimal added value. Invest in quality food instead.
How quickly do liver markers improve?
In silymarin and NAC studies, ALT typically drops within 4–8 weeks. But normalized numbers don't always mean histological improvement.
Is Essentiale Forte effective?
Evidence is debatable. Some Eastern European studies show benefit, but Western meta-analyses are more skeptical. Silymarin and NAC are better supported.
Are liver supplements safe during pregnancy?
Safety data during pregnancy is lacking for most options. NAC has been used in hospital settings, but not as a supplement without medical approval.
Estonia Context
In Estonia, liver supplements are available in all major pharmacy chains (Benu, Apotheka, Sudameapteek). Price range is €8–45/month depending on ingredient and form. NAFLD prevalence in Estonia matches the European average of about 25% (Younossi et al., 2016). Your family doctor can quickly order ALT/AST/GGT tests — that should be your first step before buying any supplement.
MaxFit carries a selection of liver health products, as well as omega-3 fatty acids that support liver health by lowering triglycerides.
References
- Michalopoulos, G.K. (2007). Liver regeneration. Journal of Cellular Physiology, 213(2), 286–300.
- Younossi, Z.M. et al. (2016). Global epidemiology of nonalcoholic fatty liver disease. Hepatology, 64(1), 73–84.
- Saller, R., Meier, R. & Brignoli, R. (2001). The use of silymarin in the treatment of liver diseases. Drugs, 61(14), 2035–2063.
- Rambaldi, A. et al. (2005). Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database of Systematic Reviews, (2), CD003620.
- Kidd, P. & Head, K. (2005). Bioavailability and clinical efficacy of milk thistle phytosome. Alternative Medicine Review, 10(3), 193–203.
- Prescott, L.F. et al. (1979). Intravenous N-acetylcysteine: the treatment of choice for paracetamol poisoning. BMJ, 2(6198), 1097–1100.
- Vang, S. et al. (2014). The unexpected uses of urso- and tauroursodeoxycholic acid. Global Advances in Health and Medicine, 3(3), 58–69.
- Rondanelli, M. et al. (2013). Beneficial effects of artichoke leaf extract on increasing HDL-cholesterol. Phytomedicine, 20(13), 1159–1164.
- Gundermann, K.J. et al. (2011). Activity of essential phospholipids from soybean in liver diseases. Pharmacological Reports, 63(3), 643–659.
Browse liver health products at MaxFit and read our detailed Samarin review for more on silymarin specifically.
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