Best Liver Health Supplements and Herbs, Ranked by What the Trials Show
The liver supplements with the best evidence are vitamin E (for biopsy-proven non-alcoholic steatohepatitis), milk thistle and berberine, with omega-3 fish oil and curcumin close behind for lowering liver fat and enzymes. Vitamin E is the only one that improved liver tissue under the microscope in a large NIH-funded trial. Milk thistle lowers enzymes modestly but did not change survival in a Cochrane review. Nothing on this page 'detoxes' the liver: the liver detoxes you, and the job is to take load off it.
This guide is for adults with fatty liver on a scan, mildly raised ALT or AST, heavy drinking they are cutting down, or a family history of liver disease. For fatty liver, the two interventions that beat every supplement are losing 7 to 10% of body weight and stopping or sharply reducing alcohol: in a 2015 study of 293 people, losing 10% of body weight resolved steatohepatitis in 90% and improved fibrosis in 45%. No capsule comes close.
See a doctor rather than a supplement shelf if you have yellow skin or eyes, dark urine, pale stools, a swollen abdomen, confusion, vomiting blood, or ALT more than three times the upper limit. And if you drink more than 14 units a week, the honest first step is that, not milk thistle.
Quick answer
- Vitamin E — 800 IU/day improved liver histology in 43% vs 19% on placebo in the 96-week PIVENS trial of NASH
- Milk thistle (silymarin) — lowers ALT and AST modestly in NAFLD trials; no effect on survival in a Cochrane review
- Berberine — 500 mg three times daily cut liver fat and improved insulin resistance in a 16-week RCT of 184 people
- Omega-3 — reduces liver fat by about 10 to 30% in meta-analyses, without changing scarring
- Curcumin — 500 mg/day of a phytosome form lowered liver fat grade and ALT in an 8-week RCT
- NAC — 600 mg twice daily lowered ALT in a small 3-month NAFLD trial; proven for paracetamol overdose
The 10 best herbs and supplements for liver health
Ranked by the strength of human evidence. Strong = multiple trials or a meta-analysis. Moderate = a few small trials. Preliminary = early or animal data.
In the NIH-funded PIVENS trial (247 adults without diabetes, 96 weeks), 800 IU/day of natural vitamin E improved liver histology in 43% of participants versus 19% on placebo, with lower steatosis, inflammation and ALT, but no change in fibrosis. AASLD guidance lists it as an option for non-diabetic adults with biopsy-confirmed steatohepatitis only, not for simple fatty liver, diabetics or cirrhosis. This is a clinician-supervised treatment, not a wellness supplement.
- Key evidence
- PIVENS RCT, NEJM 2010, n=247, 96 weeks
- Studied dose
- 800 IU/day of natural (RRR or d-alpha) tocopherol, only with confirmed NASH and medical supervision
- Best for
- Non-diabetic adults with confirmed steatohepatitis and persistent raised enzymes
- Cautions
- The SELECT trial found 400 IU/day raised prostate cancer risk by 17% in men, and meta-analyses link 400 IU/day or more to a small rise in haemorrhagic stroke and mortality. Increases bleeding with warfarin and other anticoagulants; stop before surgery and do not use long term if healthy.
A 2017 RCT in 99 people with biopsy-proven NASH (700 mg three times daily for 48 weeks) missed its primary histology endpoint but significantly improved fibrosis and liver stiffness. Meta-analyses in NAFLD find ALT and AST fall by roughly 10 to 25 U/L. The 2007 Cochrane review of 13 trials in alcoholic and viral liver disease found no effect on mortality or complications and rated most trials low quality.
- Key evidence
- 2017 RCT in NASH (Wah Kheong et al.), n=99, 48 weeks; 2007 Cochrane review
- Studied dose
- 140–420 mg/day of silymarin (extract standardised to 70–80%) for 8–12 weeks; the NASH trial used 2,100 mg/day
- Best for
- Mildly raised enzymes with fatty liver, people who want the safest long-term option
- Cautions
- Well tolerated; mild laxative effect and allergy in people sensitive to ragweed or daisies. Can lower blood sugar slightly with diabetes medication and may mildly affect warfarin via CYP2C9, so check INR after starting.
Berberine
Moderate evidenceA 16-week RCT of 184 adults with NAFLD compared lifestyle change alone, lifestyle plus pioglitazone, and lifestyle plus 500 mg berberine three times daily. Berberine produced the largest fall in liver fat on MRI (about 52% relative reduction versus 36% with lifestyle alone), plus greater weight loss and lower HOMA-IR and LDL. It works upstream on insulin resistance, the engine of fatty liver.
- Key evidence
- 2015 RCT in NAFLD (Yan et al.), n=184, 16 weeks
- Studied dose
- 500 mg two to three times daily with meals, 12–16 weeks
- Best for
- Fatty liver with insulin resistance, high triglycerides or prediabetes
- Cautions
- Inhibits CYP3A4, CYP2D6 and P-glycoprotein, raising levels of ciclosporin, tacrolimus, some statins and many other drugs, and adds to metformin and sulfonylureas. Avoid in pregnancy, breastfeeding and newborns; expect constipation or cramping in about 1 in 5 people.
Omega-3 fish oil
Moderate evidenceMeta-analyses of RCTs in NAFLD show omega-3 at 2 to 4 g/day lowers liver fat on imaging and reduces GGT and triglycerides over 6 to 12 months. The 15-to-18-month WELCOME trial (4 g/day of purified EPA + DHA) reduced liver fat in proportion to how much DHA was absorbed, but no trial has shown improved inflammation or fibrosis on biopsy. It is a triglyceride and liver-fat tool, not a repair tool.
- Key evidence
- WELCOME RCT (Scorletti et al., Hepatology 2014); meta-analyses of NAFLD trials
- Studied dose
- 2–4 g/day of combined EPA + DHA, 6–12 months
- Best for
- Fatty liver with high triglycerides
- Cautions
- Bleeding risk with anticoagulants above 1 g/day and an atrial fibrillation signal at 4 g/day; stop before surgery. Fish oil does not offset alcohol-related liver damage.
An 8-week RCT of 102 adults with NAFLD found 500 mg/day of phytosomal curcumin reduced ultrasound liver-fat grade in 79% of participants versus 28% on placebo, with falls in ALT, AST and BMI. Meta-analyses of about a dozen short trials confirm modest reductions in ALT and AST. The trials are small, and the same compound has a growing list of liver-injury reports at high doses, an awkward place for a liver supplement to be.
- Key evidence
- 2016 RCT in NAFLD (Rahmani et al.), n=102, 8 weeks
- Studied dose
- 500–1,000 mg/day of an enhanced-absorption curcumin, 8–12 weeks
- Best for
- Fatty liver with raised CRP or joint pain alongside
- Cautions
- Stop immediately if you develop jaundice, dark urine or itching: the US Drug-Induced Liver Injury Network reported 10 cases linked to turmeric products, mostly enhanced-absorption forms. Antiplatelet effect with blood thinners; avoid with gallstones.
A 2018 double-blind RCT of 100 adults with NAFLD found 600 mg/day of artichoke leaf extract for 2 months reduced ALT and AST, improved the ultrasound grade of liver fat, and lowered total and LDL cholesterol versus placebo. Artichoke increases bile flow and has older trials for dyspepsia and cholesterol. It is a single modern liver trial, so the tier reflects that.
- Key evidence
- 2018 RCT in NAFLD (Panahi et al.), n=100, 8 weeks
- Studied dose
- 600 mg/day of a standardised leaf extract, 8 weeks
- Best for
- Fatty liver with high cholesterol or bloating after fatty meals
- Cautions
- Do not use with bile-duct obstruction or gallstones, since increased bile flow can trigger colic. Allergy cross-reacts with ragweed and the daisy family; not studied in pregnancy.
N-acetylcysteine (NAC)
Moderate evidenceNAC is a proven hospital antidote for paracetamol (acetaminophen) overdose, where it replenishes glutathione and prevents liver failure. Outside that setting the evidence is thinner: a 3-month RCT of 30 people with NAFLD found 600 mg twice daily lowered ALT more than vitamin C, and a small NASH trial combined with metformin reduced steatosis. There is no good evidence it protects against alcohol, hangovers or 'toxins'.
- Key evidence
- 2010 RCT in NAFLD (Khoshbaten et al.), n=30, 12 weeks
- Studied dose
- 600 mg twice daily, 12 weeks
- Best for
- Fatty liver with raised ALT, people who also want mucus-thinning or glutathione support
- Cautions
- Can cause nausea and, rarely, bronchospasm in asthma, and combines with nitroglycerin to cause severe headache and low blood pressure. Mild antiplatelet effect with anticoagulants; never rely on it as a 'drink safely' pill.
Schisandra lignans are the basis of bifendate and bicyclol, prescription liver drugs in China that lower ALT in hepatitis. Trials of the whole berry extract in Western populations are few and small; older Chinese trials reported ALT normalisation in viral hepatitis with weak designs. Animal and cell data show it raises glutathione and protects against paracetamol and alcohol injury. Promising lineage, limited direct human proof.
- Key evidence
- Mostly animal data plus small Chinese hepatitis trials of schisandrin-based drugs
- Studied dose
- 500–1,500 mg/day of dried fruit extract (or 20–30 mg/day of schisandrin B), 4–12 weeks
- Best for
- People who want a traditional adaptogen with some enzyme-lowering data
- Cautions
- Inhibits CYP3A4 and P-glycoprotein and has raised tacrolimus levels in transplant patients, so do not combine with immunosuppressants without specialist advice. Can worsen reflux; avoid in pregnancy.
Intravenous glycyrrhizin has been used in Japan for decades to lower ALT in chronic hepatitis, and one RCT of 66 adults with NAFLD found 2 g/day of oral licorice root extract for 2 months reduced ALT and AST versus placebo. The mechanism and hepatitis data are real, but the oral NAFLD evidence is a single small trial and the side-effect profile is the worst on the page.
- Key evidence
- 2012 RCT in NAFLD (Hajiaghamohammadi et al.), n=66, 8 weeks
- Studied dose
- 2 g/day of standardised licorice root extract, no more than 8 weeks at a time
- Best for
- Short courses under supervision in people with normal blood pressure and potassium
- Cautions
- Glycyrrhizin raises blood pressure, lowers potassium and causes fluid retention within weeks, and has caused hospital admissions for heart rhythm problems. Avoid with hypertension, heart failure, kidney disease, diuretics, digoxin, corticosteroids and in pregnancy.
Glutathione (oral)
Preliminary evidenceGlutathione is the liver's main antioxidant, which is why it sells. The human evidence is one open-label pilot of 29 adults with NAFLD taking 300 mg/day for 4 months, in which ALT fell, especially in those with less advanced disease, with no placebo group. Oral glutathione is largely broken down in the gut, though blood levels do rise at 500 to 1,000 mg/day over months. NAC and whey protein raise glutathione more cheaply.
- Key evidence
- 2017 open-label pilot in NAFLD (Honda et al.), n=29, 16 weeks
- Studied dose
- 300–500 mg/day of reduced glutathione (or liposomal form), 12–16 weeks
- Best for
- People who have already tried NAC and want to compare
- Cautions
- Few known interactions; inhaled forms can trigger asthma. Not studied in pregnancy or alongside chemotherapy, where antioxidants may blunt treatment, so ask your oncologist.
How to choose
- If you have fatty liver and are overweight, the plan is weight loss first (7 to 10% of body weight), then berberine or omega-3 to help the metabolic side; supplements alone will not fix fatty liver.
- If a biopsy or FibroScan shows steatohepatitis and you do not have diabetes, ask your hepatologist about vitamin E at 800 IU/day; it is the only supplement here with histology data, and the only one with serious long-term risks.
- If your enzymes are mildly raised and you want the safest long-term herb, milk thistle at 140 to 420 mg/day of silymarin has the best tolerability record, with modest expectations.
- If triglycerides are high as well, omega-3 at 2 to 4 g/day does double duty; if LDL and bloating are the extras, artichoke fits.
- If you drink, the only liver supplement that works is drinking less. Alcohol-related liver disease improves within weeks of stopping; milk thistle did not change outcomes in the Cochrane review.
- Pick one or two, recheck liver enzymes after 12 weeks, and stop anything that does not move the numbers. If you are unsure which fits your blood results, ask AskMN and bring the answer to your doctor.
What to skip
Liver 'detox' or 'cleanse' kits
'Detox' is a marketing word with no measurable endpoint. Your liver and kidneys clear metabolic waste continuously; no trial shows a cleanse product lowers enzymes, liver fat or any toxin. Many contain senna, cascara or high-dose herbs that cause cramps and, occasionally, liver injury of their own.
Dandelion root
Dandelion appears in almost every liver blend on the strength of animal studies and a diuretic effect in one small human trial. There is no controlled human trial for any liver outcome. Harmless as a tea; not evidence-based for the liver.
High-dose green tea extract and 'fat burner' blends
EGCG capsules above about 800 mg/day, especially fasted, are one of the most common causes of supplement-induced liver injury in US and European registries, and stimulant weight-loss blends built on them have caused liver failure. Drink brewed tea instead.
Alpha-lipoic acid for liver
A 2021 meta-analysis found ALA did not significantly change ALT or liver fat in NAFLD trials. It has better evidence for diabetic neuropathy; skip it for this purpose.
Safety and when to see a clinician
- See a clinician now if you have yellowing of the skin or eyes, dark urine, pale stools, swelling of the abdomen or legs, confusion, vomiting blood or black stools, or severe pain under the right ribs. These signal serious liver disease and no supplement is appropriate until it is diagnosed.
- Get ALT, AST, GGT and a FibroScan or ultrasound before you start, and repeat enzymes after 12 weeks. Taking liver supplements without a baseline is guessing.
- Supplements can injure the liver: green tea extract, high-dose curcumin, kava, comfrey, chaparral, germander, 'natural' bodybuilding products and many multi-herb blends appear in liver-injury registries. If you develop any symptom above while taking a supplement, stop everything and get tested.
- Drug interactions: berberine and schisandra raise levels of immunosuppressants and many other drugs; vitamin E, omega-3, curcumin and NAC add to anticoagulants; licorice interacts with diuretics, digoxin and steroids. After a transplant, on warfarin or with heart disease, clear every addition with your pharmacist.
- Pregnancy: avoid berberine, licorice, schisandra and vitamin E above 400 IU/day. Milk thistle has limited but reassuring data; food-dose artichoke is fine.
- Alcohol: no supplement on this list protects the liver from alcohol or makes drinking safer. If cutting down is hard, that is a medical problem with good treatments; ask for help rather than adding capsules.
What matters as much as any herb
- Weight loss of 7 to 10%: the only intervention shown to reverse steatohepatitis and fibrosis in a large proportion of people; even 5% reduces liver fat substantially.
- Alcohol reduction: the liver begins repairing within 2 to 4 weeks of stopping, and alcohol-related fatty liver resolves in most people within 6 weeks of abstinence if there is no scarring yet.
- Cut sugary drinks and fructose: liquid sugar is converted to fat in the liver more directly than any other food, and trials replacing sugary drinks with water lowered liver fat within 8 weeks.
- Coffee, 2 to 3 cups a day: observational studies and a meta-analysis link regular coffee to roughly 30 to 40% lower risk of fibrosis and cirrhosis. It is the best-supported 'liver supplement' and it comes in a mug.
- Exercise, 150 minutes a week: aerobic and resistance training both reduce liver fat by 20 to 30% in trials even without weight loss.
Frequently asked questions
What is the best supplement for fatty liver?
For confirmed steatohepatitis in non-diabetics, vitamin E at 800 IU/day has the strongest trial data but needs medical supervision because of cancer and bleeding signals. For ordinary fatty liver, berberine or omega-3 have the most useful data, and both work best alongside weight loss, which beats every supplement.
Does milk thistle actually work?
Partly. In fatty liver it lowers ALT and AST modestly and improved fibrosis measures in a 48-week trial, though it missed its main histology target. In alcoholic and viral liver disease a Cochrane review found no effect on survival or complications. It is safe and cheap, but not a treatment for serious liver disease.
Can you repair your liver with herbs?
The liver repairs itself remarkably well once the cause is removed: fatty liver can resolve and early fibrosis can regress. Herbs do not do the repairing; removing alcohol, excess calories and injuring drugs does. Vitamin E, berberine and milk thistle can nudge enzymes and fat in the right direction while you do that.
Do liver detox supplements work?
No. There is no clinical trial showing any 'detox' product removes toxins, lowers liver enzymes or improves liver fat; the word has no medical meaning here. Several cleanse products have caused liver injury, which is the opposite of the claim.
Is turmeric good for the liver?
Curcumin at 500 to 1,000 mg/day lowered liver fat and ALT in small 8-week trials, but high-dose enhanced-absorption curcumin has also caused documented liver injury in at least 10 US cases. It is reasonable at studied doses for 8 to 12 weeks with enzymes checked, and should be stopped at the first sign of jaundice.
How long does it take for liver enzymes to go down?
With weight loss or stopping alcohol, ALT often falls noticeably within 4 to 8 weeks, and supplement trials saw enzyme changes by 8 to 12 weeks. If ALT has not improved after 3 months of a studied dose plus lifestyle change, the supplement is not the lever; ask for further investigation.
References
- Sanyal AJ, Chalasani N, Kowdley KV, et al.. Pioglitazone, vitamin E, or placebo for nonalcoholic steatohepatitis (PIVENS). New England Journal of Medicine (2010)View source
- Rambaldi A, Jacobs BP, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database of Systematic Reviews (2007)
- Wah Kheong C, Nik Mustapha NR, Mahadeva S. A randomized trial of silymarin for the treatment of nonalcoholic steatohepatitis. Clinical Gastroenterology and Hepatology (2017)
- Yan HM, Xia MF, Wang Y, et al.. Efficacy of berberine in patients with non-alcoholic fatty liver disease. PLoS One (2015)
- Scorletti E, Bhatia L, McCormick KG, et al.. Effects of purified eicosapentaenoic and docosahexaenoic acids in nonalcoholic fatty liver disease: results from the WELCOME study. Hepatology (2014)
- Rahmani S, Asgary S, Askari G, et al.. Treatment of non-alcoholic fatty liver disease with curcumin: a randomized placebo-controlled trial. Phytotherapy Research (2016)
- Panahi Y, Kianpour P, Mohtashami R, et al.. Efficacy of artichoke leaf extract in non-alcoholic fatty liver disease: a pilot double-blind randomized controlled trial. Phytotherapy Research (2018)
- Khoshbaten M, Aliasgarzadeh A, Masnadi K, et al.. N-acetylcysteine improves liver function in patients with non-alcoholic fatty liver disease. Hepatitis Monthly (2010)
- Hajiaghamohammadi AA, Ziaee A, Samimi R. The efficacy of licorice root extract in decreasing transaminase activities in non-alcoholic fatty liver disease: a randomized controlled clinical trial. Phytotherapy Research (2012)
- Honda Y, Kessoku T, Sumida Y, et al.. Efficacy of glutathione for the treatment of nonalcoholic fatty liver disease: an open-label, single-arm, multicenter, pilot study. BMC Gastroenterology (2017)
- Vilar-Gomez E, Martinez-Perez Y, Calzadilla-Bertot L, et al.. Weight loss through lifestyle modification significantly reduces features of nonalcoholic steatohepatitis. Gastroenterology (2015)
- Halegoua-DeMarzio D, Navarro V, Ahmad J, et al.. Liver injury associated with turmeric: a growing problem. Ten cases from the Drug-Induced Liver Injury Network. American Journal of Medicine (2023)
- National Center for Complementary and Integrative Health. Milk Thistle: Usefulness and SafetyView source
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Ask about liver healthThis guide is educational and is not medical advice. Herbs and supplements can interact with prescription medicines and are not regulated like drugs. Talk with a clinician or pharmacist before starting anything new, especially if you are pregnant, breastfeeding, have a chronic condition, or take medication.