TikTok Doc Sparks Controversy by Promoting Unproven "Liver Condom" Supplement

The unregulated supplement industry's latest cash grab

A liver condom?

Oh come on, you knew I couldn’t let that go without taking a closer look. So now join me as I take you on a journey to investigate a supplement, called Liver Shield, brought to you by a company called Avenir Nutrition. I first learned about the “liver condom” from Avenir Nutrition’s Co-Founder and Chief Medical Officer, Dr. Kunal Sood, an anesthesiologist who specializes in pain management. Dr. Sood has been leveraging some semi-viral fame on TikTok to shill for his supplements. If you are wondering why a pain anesthesiologist is selling a liver supplement, you are not alone.

Let’s take a closer look, shall we?

The Liver Shield, a.k.a the liver condom, claims it can do the following

I used a screenshot because I didn’t want to dirty myself typing that garbage. These three lines are a master class in alternative medicine chicanery. 

What you need to know is the over one hundred billion dollar a year supplement industry, which is the business of selling unregulated pharmaceuticals, is built around two interrelated concepts. The first is that your body is incapable of functioning correctly, and so the power of nature (which is always benevolent here) can be harnessed to help you. Except, the power of nature doesn’t come from walks or avoiding alcohol or eating fiber, no it comes from supplements designed in a lab and made in a factory. Look, no one here is grinding herbs with a mortar and pestle.

The second concept is that at any given time there are toxins accumulating in your body. These toxins are rarely, if ever, named. They are essentially evil humors and are the health version of Emmanuel Goldstein from George Orwell’s 1984, an ever present invisible enemy attacking from within that can be transformed in a myriad of ways to suit any agenda, and more importantly, sell any product. 

In medicine, there are actual toxins, which are not these evil humors. Rather, toxins are naturally occurring poisons made by a plant, bacteria, or animal that can cause harm even in low doses, like snake venom or botulinum toxin. Meaning, when you see the word toxin used incorrectly, for example to sell a supplement, it’s a huge red flag because the answer to real toxins is not milk thistle, it is to seek medical care.

Another key point is in the United States, the supplement industry has to be vague, so meaningless words like detox, cleanse, and the inappropriate use of toxins suit them very well. If you claim your product does something real, for example protects the liver against acetaminophen toxicity, you need good data backing up your claim. Making false claims can get you in trouble with the FDA. That is why every supplement in the United States has the following disclaimer, just like the Liver Shield: 

Why even take a product that can’t treat any conditions? But I digress. 

What The Liver Actually Does

People who shill supplements either don’t understand the medicine themselves or know it and are counting on the fact that you may not know it. The liver seems like a mystery to many, so let’s start with explaining what the liver does, so you are better able to evaluate medically nonsensical claims such as, “your liver needs support”. 

The liver has many functions. It makes important proteins, like those that help the blood clot. It produces cholesterol, which is vital for the health of cells and is the starting ingredient to make many hormones. It helps to regulate blood sugar. And it also sorts through blood that comes to it from the gut and from the blood that is circulating in the body and picks out nutrients and other important things for the “keep” pile and identifies waste that either goes out in the bile or is broken down into other substances that are easier to remove. For example, when we drink alcohol the liver uses the enzyme alcohol dehydrogenase to convert it to acetaldehyde, which is harmful and cancer causing, so acetaldehyde is then broken down by another enzyme to acetate, which is then broken down into carbon dioxide and water. Which we then breathe and pee out!

If you want to learn more about how the liver works, please check out this video I made with TED and my podcast, Body Stuff, also has a great episode on the liver and the false promise of cleanses, which features a liver expert. Unlike what you find at Avenir Nutrition, this video and podcast were fact checked by professional fact checkers. 

It is this job of taking harmful things and breaking them down for removal that is the basis for most detox and cleanse scams. The claim is that supplements can somehow make the liver work better, but the liver performs about 500 functions. So which function specifically do the supplements improve? Which enzyme? And which toxin do they help remove? This is never spelled out. 

It’s a mystery. I guess we’ll have to ask Emmanuel Goldstein. 

What is the Liver Shield?

It’s a supplement with 21 different ingredients, if you count everything listed as an ingredient on the package. It can apparently help you support your liver (no idea what that means), “whether you are a college student, working professional, or long-term drinker.”

It’s apparently formulated by a doctor, who I am assuming is Dr. Sood.

The big ingredient behind Liver Shield is apparently milk thistle. However, a Cochrane Review of milk thistle for alcoholic and/or hepatitis B or C virus liver diseases from 2007 concluded the following:

Our results question the beneficial effects of milk thistle for patients with alcoholic and/or hepatitis B or C virus liver diseases and highlight the lack of high‐quality evidence to support this intervention. Adequately conducted and reported randomised clinical trials on milk thistle versus placebo are needed. 

Hmmm, that doesn’t sound promising does it?

Avenir Nutrition cites six “studies” to support their use of milk thistle in Liver Shield, but there are some major issues. The actual names of the papers aren’t listed and there are no links, so it took Google searching to track them down. I guess if you aren’t proud of the data you might use that strategy?

Study #1 isn’t a study, it’s a review article. Oops! It is most concerned with summarizing animal data and small studies. It’s also published in Molecules, which most people now consider a predatory journal. Oops again! Read more about MDPI, the publisher of Molecules, here. 

Study #2 isn’t a study. It’s a website with information about alcohol related liver disease. Study #3 and #6 are rat studies. You can find them here and here. Studies #4 and 5 are not studies either, they are review articles of animal studies and small human studies and one of them even admits the data is controversial. 

Not promising at all. But hey, I’m a gynecologist and so it’s possible that I’m missing something, so I asked Dr. Abby Philips, a hepatologist (liver specialist) at the Liver Institute in Rajagiri Hospital, Cochin, Kerala, India. He told me, via email, “Milk thistle or silymarin does not have any proven or recommended use in acute or chronic liver disease. Its antioxidant and anti-inflammatory effects are mostly preclinical/lab based and without any clinically translated benefits. The potential (but unconfirmed) antifibrotic effects of silymarin in NAFLD was based on a single underpowered RCT on 49 patients in which the authors themselves suggest larger and better trials to confirm their possible findings. In the same study, silymarin was not beneficial in reducing fatty inflammation in the liver.” 

(NAFLD is nonalcoholic fatty liver disease)

And he added, “There is no good, quality evidence that silymarin is useful for any other liver diseases, including viral hepatitis which is why it is not recommended by any hepatology clinical societies in treatment guidelines.” 

I also asked Dr. Jeffrey Schwimmer, a hepatologist and Professor of Pediatrics at UC San Diego and Director of the Fatty Liver Clinic at Rady Children's Hospital San Diego. Regarding milk thistle, he wrote “the data from clinical trials is mixed, and there is insufficient evidence to recommend its use for any liver disease.”

Another huge issue is the research section only mentions milk thistle, but what about the other 20 ingredients? How do they all interact, especially considering supplements are a growing cause of liver failure? Dr. Phillips wrote many of the ingredients “have the potential to interact with prescription drugs” which could be dangerous, either by making those drugs less effective or even increasing levels of those drugs making them potentially harmful. 

Dr. Schwimmer added that turmeric, another ingredient in Liver Shield, is a popular supplement. “but there are growing numbers of cases in which turmeric supplements have caused drug-induced liver injury.”

Turmeric is indeed one of the most popular supplements, probably based on its use in traditional medicine and its supposedly bioactive compound curcumin. The data can be best summarized as zero effect. It seems to help nothing, and this isn’t for want of trying as it’s probably the most studied of all supplements. This isn’t surprising, considering curcumin is unstable and likely isn’t absorbed from the gut into the body. 

If curcumin isn’t absorbed, how can it cause liver failure? Well, turmeric is often mixed with multiple other ingredients and those might be the cause and turmeric can be contaminated with lead or something else. 

I also asked Dr. Ryan Marino, a toxicologist, about the Liver Shield. He told me, “There is no evidence to support any benefit for these supplements, and only risk for harms. The “proprietary blend” especially causes me concern. These herbal preparations are one of the top causes of acute liver failure in developed countries, likely just because they aren’t regulated and so they could actually contain none of the listed ingredients and all toxic ingredients or any combination in between. I see at least a couple people each year for liver injury from supplements each year.”

The Awful Promotion of Liver Shield

What’s even more egregious about this product is the marketing. It’s targeted to young people and with slogans like “play hard” the advertising implies that if you use Liver Shield you can keep on partying without concern, “So, take Liver Shield before you go out and party hard to avoid liver damage.” It’s even advertised as the price of two drinks!  

Dr. Schwimmer was especially concerned about this messaging. He wrote, “Although usually unrecognized, nonalcoholic fatty liver disease (NAFLD) is present in more than 10 percent of college-aged adults, with some already experiencing meaningful liver fibrosis. Binge drinking, which is all too common at college parties, is an important risk factor for the disease's progression to cirrhosis. By promoting excessive drinking, this supplement is only exacerbating an already serious public health issue.”  

It certainly seems from the Avenir Nutrition site that they are focused on college-aged individuals. 

And if you thought it couldn’t get any worse, there are allegations that Rob Greer, the CEO and Founder of Avenir Nutrition, has been posting on SubReddits devoted to alcoholism posing as a heavy drinker who takes Liver Shield, calling Avenir Nutrition a “cool new company.” You can find the video with the claims here. 

Dr. Sood seems to think his “liver condom” product is useful for protection against acetaminophen toxicity as well as non alcoholic fatty liver disease, as he posted this reply on my TikTok (he was angry I called the liver condom a scam, I am so not sorry about that).

Except, we’ve already reviewed the “research” on the Avenir Nutrition website and according to an actual liver expert, Dr. Phillips, “Milk thistle does not protect humans against the toxicity of acetaminophen. In fact, the major researches performed in this context were all in mice and not humans.” 

And Dr. Schwimmer told me that instead of a supplement for NAFLD. “We should focus on maintaining a balanced diet, engaging in regular physical activity, and avoiding excessive alcohol consumption. Additionally, we must work to raise awareness of the risks associated with supplements, particularly among young people who may already have unrecognized liver disease.”

Leveraging a Following of Social Media to Sell a Supplement

Dr. Sood appears to have spent some time creating a following on social media, which is his right. But his claims of caring about women with pain, which is the focus of many of his popular videos, seem to ring a bit hollow considering he designed a supplement that two hepatologists and a toxicologist advise against. If he cares about women’s pain, doesn’t he also care about their livers? I’ll also add, his videos about pain haven’t always been accurate, but that’s a whole different story.

Cleanse and detox are two powerful words that evoke health, but they are synonyms for scam.

The liver doesn’t need any help from a supplement, in fact, supplements are a growing cause of liver failure. 

And now, after having spent time researching, interviewing experts and writing this article, I’m left wondering if I have already spent more total hours of effort investigating the ingredients of Liver Shield than the team at Avenir Nutrition did creating it in the first place? 

For anyone interested in reporting concerns about the marketing of any supplement to the FDA, here is the page with the information.

References

Alcohol Metabolism, National Institute on Alcohol Use and Alcoholism. https://pubs.niaaa.nih.gov/publications/aa72/aa72.htm#:~:text=First%2C%20ADH%20metabolizes%20alcohol%20to,for%20easy%20elimination%20(2).

“Detoxes” and “Cleanses”: What you need to know. National Center for Complementary and Integrative Health https://www.nccih.nih.gov/health/detoxes-and-cleanses-what-you-need-to-know

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

Nelson KM, et. al. The Essential Medicinal Chemistry of Curcumin. J. Med. Chem. 2017, 60, 5, 1620–1637

Definition and facts of NFLD and NASH, NIDDK https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts#:~:text=Nonalcoholic%20fatty%20liver%20disease%20(NAFLD)%20is%20a%20condition%20in%20which,called%20alcohol%2Dassociated%20liver%20disease.