on September 29, 2026
The liver is one of the most metabolically complex organs in the body. Through an extremely intricate network of biochemical reactions, it participates in energy regulation, the metabolism of carbohydrates, lipids, and proteins, the synthesis of numerous plasma proteins, the transformation of drugs and foreign substances, and the elimination of metabolic byproducts.
One of its most characteristic functions is the production of bile. Bile is synthesized by hepatocytes and channeled through the biliary duct system to the gallbladder and duodenum. Its components, particularly bile acids, play a fundamental role in the digestion and absorption of lipids and fat-soluble vitamins.
Bile also represents one of the main routes through which the liver eliminates certain endogenous substances and metabolites. However, it is not correct to imagine the liver as a filter in which “toxins” accumulate until a cleansing treatment removes them. Liver physiology is much more complex: substances are transformed through enzymatic systems and subsequently eliminated through bile, urine, or other routes.
This distinction is also important when talking about phytotherapeutic products. Supporting normal liver and digestive physiology is a biologically plausible concept; claiming that a product “cleanses the liver of toxins” or treats liver disease is, on the other hand, a therapeutic claim that requires specific clinical evidence.
Bile: digestion, metabolism, and elimination
Bile contains bile acids, phospholipids, cholesterol, conjugated bilirubin, electrolytes, and water. Bile acids allow for the emulsification of dietary lipids and promote the formation of micelles, facilitating the intestinal absorption of fatty acids and fat-soluble vitamins A, D, E, and K.
The biliary system is also closely linked to cholesterol metabolism. Bile acids are largely reabsorbed in the intestine and return to the liver through enterohepatic circulation.
This continuous communication between the liver and intestine constitutes one of the main examples of the physiological integration between the two organs.
Bile also participates in the regulation of metabolism through signals mediated by the bile acids themselves. These molecules are therefore not simply biological detergents for fats: they also act as metabolic signals capable of interacting with cellular receptors and modifying glucose, lipid, and energy metabolism.
The liver and biotransformation systems
One of the functions most associated with the concept of “detoxification” is the biotransformation of substances foreign to the body.
The liver possesses specialized enzymatic systems, including the cytochrome P450 system, which modifies numerous molecules originating from the environment or introduced through food and drugs.
Traditionally, these reactions are described through the so-called phases I, II, and III of biotransformation.
Phase I reactions mainly include oxidation, reduction, and hydrolysis. Enzymes of the CYP450 family can transform a molecule into a more reactive metabolite primed for subsequent reactions.
Phase II reactions include conjugation processes that generally increase the solubility of molecules and facilitate their elimination.
Phase III includes transport systems that contribute to the excretion of metabolites.
This physiology explains why the term “detox” should be used with caution. Detoxification is not an occasional process that the liver activates in spring or autumn: it is a continuous physiological function.
Hepatic steatosis and metabolic dysfunction
One of the most important aspects of contemporary liver health concerns hepatic steatosis associated with metabolic dysfunction, now referred to by the acronym MASLD.
The condition is characterized by the excessive accumulation of fat in the liver in the presence of metabolic risk factors.
Overweight and visceral obesity, insulin resistance, type 2 diabetes, lipid metabolism alterations, and physical inactivity represent important risk determinants.
Alcohol can also contribute to liver damage and must be assessed separately in the clinical evaluation.
Updated international guidelines emphasize that the management of MASLD should focus primarily on lifestyle modification, weight reduction when indicated, physical activity, diet quality, and the control of metabolic comorbidities.
This point is fundamental: steatosis is not treated through a periodic “cleansing” of the liver, but through the reduction of the factors that determine its lipid accumulation and the progression of damage.
The role of physical activity
Physical activity represents one of the most important tools for improving metabolic health.
Regular exercise increases the oxidative capacity of the muscle, improves insulin sensitivity, and contributes to the control of body weight and body composition.
In patients with steatosis, physical activity can have favorable effects even when weight loss is not particularly high.
The goal should therefore not be a short “cleansing treatment,” but the creation of a more favorable metabolic condition maintained over time.
Walking, aerobic exercise, strength training, and activities adapted to individual conditions can be integrated into personalized programs.
Diet and liver health
Diet represents another central element.
A dietary pattern characterized by an abundance of plant-based foods, legumes, whole grains, fruit, extra virgin olive oil, nuts, and adequate protein sources is consistent with the Mediterranean model and the nutritional strategies used in the management of metabolic risk.
The reduction of simple sugars, sugary beverages, ultra-processed foods, and excessive caloric intake is particularly important in individuals with overweight or metabolic dysfunction.
However, it is not necessary to attribute a generic “detox” effect to individual foods.
The liver benefits above all from the reduction of the factors that increase its metabolic load and the availability of nutrients necessary for normal cellular function.
The gut-liver axis
The relationship between the gut and the liver is today one of the most interesting areas of metabolic research.
Blood from the intestine reaches the liver through the portal vein, carrying nutrients, metabolites, and molecules produced by the microbiota.
The composition of the intestinal microbial community can influence the production of short-chain fatty acids, secondary bile acids, aromatic metabolites, and numerous other biologically active molecules.
When the intestinal barrier and the microbial ecosystem are altered, the signals reaching the liver may also change.
This has led to the development of the concept of the gut-liver axis, which is particularly studied today in MASLD and metabolic diseases.
Fiber and microbiota
Dietary fibers represent one of the main substrates through which diet interacts with the microbiota.
Indigestible fibers reach the colon, where they can be metabolized by intestinal microorganisms. Among the products of this fermentation are short-chain fatty acids, such as acetate, propionate, and butyrate.
These molecules can influence energy metabolism, intestinal barrier integrity, immune response, and communication between the intestine and liver.
For this reason, a diet rich in plant-based foods should not be considered simply a strategy to increase the intake of vitamins and minerals: it also represents a way to modify the metabolic environment in which the microbiota lives.
Probiotics and liver health
Scientific interest in probiotics stems precisely from the hypothesis that the modulation of the microbiota can influence the gut-liver axis.
A 2024 meta-analysis included 15 randomized clinical trials involving a total of 899 participants with NAFLD and observed a significant reduction in ALT and certain insulin resistance parameters with probiotic supplementation, while no significant effects were observed on all the metabolic parameters analyzed.
Another 2024 systematic review, comprising 34 studies and over 12,000 participants, reported favorable effects of probiotics, prebiotics, and synbiotics on certain markers of liver damage, lipid profile, and inflammation. However, the authors emphasize the need for further studies to clarify which strains, dosages, and durations are most effective.
These results are interesting, but do not authorize probiotics to be considered an independent therapy for steatosis.
The most important piece of data is probably another: intestinal health can be considered a component of the broader metabolic system that connects the intestine, liver, adipose tissue, and muscle.
Artichoke and digestive function
Among the plants traditionally used for digestive and hepatobiliary function is the artichoke, Cynara cardunculus L. (syn. Cynara scolymus L.).
The leaves contain several phenolic compounds, including caffeic acid derivatives, flavonoids, and phenolic acids.
Pharmacological interest mainly concerns digestive function and lipid metabolism.
The EMA has dedicated a monograph to artichoke leaves, recognizing its traditional use in the treatment of digestive disorders.
Clinical studies also exist.
In a multicenter, randomized, controlled, double-blind trial, 247 people with functional dyspepsia were treated for six weeks with an artichoke leaf extract or placebo. The treated group showed a significantly greater improvement in dyspeptic symptoms and quality of life compared to the placebo.
Another randomized controlled study observed, after 12 weeks, a modest reduction in total cholesterol in subjects with mild-to-moderate hypercholesterolemia.
These results support the interest in artichoke above all in relation to digestive function and lipid metabolism, but do not demonstrate that the extract “cleanses the liver” or treats steatosis.
Artichoke and bile
Artichoke is traditionally associated with biliary and digestive function.
This rationale is consistent with pharmacological interest in the plant's phenolic compounds and with phytotherapeutic tradition.
However, the stimulation of bile secretion or flow should not always be considered beneficial.
In the presence of biliary tract obstruction or certain gallbladder diseases, increasing biliary stimulation may be inappropriate.
The presence of gallstones, recurrent abdominal pain, or liver enzyme alterations therefore requires a medical evaluation before using products intended for biliary function.
Dandelion: a plant between tradition and research
Taraxacum officinale, commonly known as dandelion, is traditionally used as a bitter and diuretic plant.
The EMA has a monograph relating to the dandelion root with herb, within the scope of traditional use areas that include gastrointestinal and urinary disorders. In 2026, the periodic review process of the relevant European documentation is also underway.
The presence of bitter substances has contributed to the tradition of using the plant to support appetite and digestion.
However, the term “diuretic” must be interpreted physiologically: dandelion can be associated with an increase in diuresis within traditional uses, but this does not mean that it generally eliminates “toxins” from tissues.
The diuretic effect must also not be confused with liver detoxification.
Fumitory and digestive regulation
Fumaria officinalis is a plant traditionally used for digestive disorders and biliary function.
The EMA has an updated European monograph on Fumaria officinalis. The traditional indication is for relief from digestive disorders such as fullness, slow digestion, and flatulence. The same European assessment highlights that the indication is based on long-standing traditional use and not on a demonstration of clinical efficacy equivalent to that required for a medicine with well-established use.
This is an important example of how phytotherapy should be interpreted.
A plant may have a long tradition of use, pharmacological plausibility, and recognized use in traditional medicine without this being equivalent to a demonstration of efficacy for a specific liver disease.
Bitter plants and digestion
Artichoke, dandelion, and fumitory belong to a group of plants traditionally associated with digestion and hepatobiliary function.
Bitter substances can stimulate digestive responses through mechanisms involving bitter taste receptors present not only in the oral cavity but also throughout the gastrointestinal tract.
The interaction between bitter substances, digestive secretions, motility, and metabolism represents an interesting field of research.
However, it is necessary to distinguish the subjective sensation of improved digestion from a clinically relevant change in a liver disease.
Steatosis is not simply an “intoxication”
Hepatic steatosis is sometimes described in popular language as the result of a “toxic liver.”
The definition is evocative but biologically incomplete.
The accumulation of liver fat is closely linked to fatty acid metabolism, insulin resistance, the flow of fatty acids from adipose tissue to the liver, de novo lipid synthesis, fatty acid oxidation, and the liver's ability to export triglycerides via lipoproteins.
When these processes lose their balance, hepatocytes can accumulate excessive amounts of lipids.
In some individuals, steatosis can progress to inflammation, fibrosis, and cirrhosis.
For this reason, the diagnosis of steatosis should not be addressed with a simple “detoxification cure,” but with an assessment of metabolic risk and the possible progression of the disease.
Body weight and liver health
Body weight reduction in overweight or obese individuals represents one of the most important interventions.
The 2024 EASL guidelines place lifestyle modification at the center of MASLD management and include diet, physical exercise, weight loss, and reduced alcohol consumption.
Weight loss does not necessarily have to be achieved through drastic diets.
A gradual and sustainable change in dietary habits, combined with increased physical activity, can improve metabolism and reduce the amount of liver fat.
Personalization is essential because the approach must take into account age, body composition, comorbidities, medications, physical capacity, and nutritional status.
The correct meaning of “detoxification”
The concept of detoxification can be retained in a popular context if it is used to indicate the support of the body's normal physiological functions.
It should not, however, be used to suggest that:
- the liver periodically accumulates toxins that need to be eliminated;
- an herbal tea or supplement can replace liver therapy;
- a spring or autumn treatment can automatically prevent steatosis;
- a diuretic product can remove fat from the liver;
- a phytocomplex can “detoxify” a liver damaged by alcohol or medications.
This distinction makes the concept of detoxification more consistent with modern physiology.
Phytotherapy: a complement, not a replacement
The rational use of medicinal plants can be part of an integrated program aimed at digestive and metabolic well-being.
Artichoke, dandelion, and fumitory are examples of botanicals with a long history of use and European documentation regarding traditional uses. Artichoke also has clinical studies on the improvement of dyspepsia and certain lipid parameters.
However, the evidence is not sufficient to state that these plants can treat MASLD, steatohepatitis, fibrosis, or other liver diseases.
Their use, if any, must therefore be contextualized in relation to the diagnosis, product composition, doses, and possible drug interactions.
When medical supervision is necessary
Persistent pain in the upper right abdomen, jaundice, very dark urine, very pale stools, generalized itching, fever associated with biliary pain, a significant increase in transaminases, or persistent abnormalities in liver tests require medical evaluation.
The same applies to those who take numerous medications, have gallstones or bile duct stones, have a diagnosed liver disease, or exhibit persistent abnormalities in ALT, AST, GGT, alkaline phosphatase, or bilirubin.
In these situations, it is not appropriate to resort independently to products defined as “detoxifying.”
An integrated strategy for liver health
Liver health therefore arises from the interaction of several factors.
A diet predominantly based on minimally processed foods, adequate fiber intake, maintenance of an appropriate body weight, regular physical activity, control of blood glucose and lipids, proper medication management, and moderation of alcohol consumption form the foundation.
In selected conditions, these elements can be complemented by the use of phytotherapeutic preparations with a known composition and a rationale consistent with the indication.
Research on the gut-liver axis also adds an important perspective: liver metabolism cannot be considered separately from intestinal metabolism.
The available evidence on probiotics is interesting but still heterogeneous. Recent meta-analyses have found improvements in certain liver enzymes and metabolic parameters, but the strains, dosages, duration of treatment, and clinical relevance of the effects remain to be clarified.
The true goal of “detoxification,” therefore, should be reinterpreted as maintaining the efficiency of the physiological systems of metabolism, transformation, and elimination, through a set of behaviors and interventions that are sustainable over time.
The liver does not need to be periodically “cleaned”: it needs to be placed in the best biological conditions to continuously perform its functions.
Bibliographic references
European Association for the Study of the Liver, European Association for the Study of Diabetes, European Association for the Study of Obesity. EASL-EASD-EASO Clinical Practice Guidelines on the management of metabolic dysfunction-associated steatotic liver disease (MASLD). Journal of Hepatology. 2024;81(3):492-542.
Holtmann G, Adam B, Haag S, et al. Efficacy of artichoke leaf extract in the treatment of patients with functional dyspepsia: a six-week placebo-controlled, double-blind, multicentre trial. Aliment Pharmacol Ther. 2003;18:1099-1105.
Bundy R, Walker AF, Middleton RW, Wallis C, Simpson HCR. Artichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomized, double blind placebo controlled trial. Phytomedicine. 2008;15:668-675.
Rondanelli M, Giacosa A, Opizzi A, et al. Beneficial effects of artichoke leaf extract supplementation on increasing HDL-cholesterol in subjects with primary mild hypercholesterolaemia: a double-blind, randomized, placebo-controlled trial. Int J Food Sci Nutr. 2013;64:7-15.
Pan Y, Yang Y, Wu J, et al. Efficacy of probiotics, prebiotics, and synbiotics on liver enzymes, lipid profiles, and inflammation in patients with non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomized controlled trials. BMC Gastroenterol. 2024;24:283.
Mozaffari S, Aliari M, Emamgholipour S, et al. The effect of probiotic consumption on lipid profile, glycemic index, inflammatory markers, and liver function in NAFLD patients: a systematic review and meta-analysis of randomized controlled trials. J Diabetes Complications. 2024;38(8):108780.
Fumaria officinalis L., herba. European Union herbal monograph, European Medicines Agency, 2024 revision.
Cynara cardunculus L. (syn. Cynara scolymus L.), folium. European Union herbal monograph, European Medicines Agency.
Taraxacum officinale Weber ex Wigg., radix cum herba. European Union herbal monograph, European Medicines Agency; periodic revision in progress in 2026.
