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Liver Habits Score

Why Cheers usage isn’t included in the Liver Habits Score.

Answering the burning question in many customers’ minds.

Brooks Powell

January 21, 2022

KEY TAKEAWAYS

Cheers launched the Liver Habits Score to coincide with the start of 2022. Our goal? Get people — myself and the Cheers team included — to adopt habits that are better for our livers. What a more fitting way to start 2022? Especially after the last two years, which have been abnormally stressful, and for many of us, a bit more boozy than typical years!

I am happy to report that the Liver Habits Score has been very well-received — by customers, employees, and investors alike.

A few days into the new year, I visited our Houston-based fulfillment center and was immediately approached by one of our fulfillment team’s best members. If you’re a Cheers customer, she has undoubtedly played a part in packing your orders through the years.

She said to me: “Brooks! I did the Liver Habits Score and started reading your blog posts. I had no idea that drinking everyday was so risky! Because of your blog post, I’m going to stop my habit of ending each day with a glass of bourbon and will only drink Thursday-Sunday!”

Hearing this was like witnessing a perfect sunrise. It just warms your soul. It is just one of many examples already affirming our goals behind the Liver Habits Score.

This lady, probably around 50 years old, has consumed “a glass of bourbon” at the end of each day for decades. It was part of her routine — like drinking after work while cooking dinner was for me — and now she is resolving to take a few days of drinking off per week. It’s not because she has a problem. Nor is it because alcohol gets in the way of her life or work (yes, she uses Cheers Restore).

It’s simply because the Liver Habits Score has shown her that the activity of drinking daily has health risks and, by simply taking a few days off from drinking alcohol each week, she can still enjoy her glass of bourbon without compromising her health nearly as much.

Life is about balance. And if we’re to have “a world where everyone can consume alcohol throughout a long, healthy, and happy lifetime” — Cheers’ vision statement — then we need to be smart about our liver-related habits. That starts with spreading knowledge about liver health and how to improve it through implementable habits.

Since launching the Liver Habits Score, one common question that has emerged from our customers is: “How do Cheers’ products affect my Liver Habits Score?”

This is a great question. I have to admit. In re-reviewing all of the materials we wrote, I can see that we did not adequately explain why Cheers’ product usage is not included within the scoring and educational content of the Liver Habits Score. This article seeks to answer that question.

The short answer: The Liver Habits Score is designed to be educational content that gives information and strategies about how to improve your liver health independent of using Cheers products.

As an analogy, consider what happens when someone is first diagnosed with high blood pressure. Often-times, before a doctor jumps straight into prescribing medication, they try to see what someone can do to lower their blood pressure with diet, exercise, and other lifestyle modifications — if the patient is willing to try. In the same way, the Liver Habits Score is not meant to recommend Cheers; instead, it recommends lifestyle modifications that are good for your liver health independent of using our products.

In other words, we purposefully designed the Liver Habits Score to not mention Cheers.

This, of course, then begs the followup question: “But why did Cheers design it that way?” That, as we will see, is a longer answer that involves a lot more background into the dietary supplement laws in the United States.

The long answer: We aren’t allowed to.

When you read the content of the Liver Habits Score, you can see that almost all of the motivation comes from a personal place — my own life. I believe that one of the reasons Cheers is so successful as a brand is because I myself, as well as the rest of the team, are customers and regular users of our products.

In many ways, I make Cheers’ products for myself. The same goes for our team –  our ideas for new products, new ways of describing things, initiatives, etc. come directly out of Cheers HQ because of our personal drinking experiences and usage of Cheers’ products. 

Even the Liver Habits Score itself was born from  our personal experiences and desires.

Cheers is very much a labor of love, and so we are very happy to see that the products we find interesting and helpful are also well-loved by our customers. We have people that have had such great experiences with Cheers’ products that they take time out of their busy lives to write to us — which we very much appreciate. Many times it will be about how Cheers’ products saved them the morning after a wedding, made for a better vacation, or were an awesome party favor after an event.

What's interesting, though, is that as time has gone on, we have started to receive more communication like the following:

Question/answers from our Cheers' Amazon product listing

An email sent from a customer to our customer service team.

Amazon review

Obviously, the above communications are not large-scale, double-blind, placebo-controlled studies. Nor are they claims of treating or preventing disease. The above screenshots are simply pointing to the fact that some people taking Cheers’ products saw improvements in their blood tests for biomarkers of liver health.

Could it just be correlation? Sure. Could it be causation? Sure. More time and studies could help tease out these answers more fully. These are initiatives we are looking to further pursue.

One of the coolest things about working at Cheers is that we get to hear from customers who kindly go out of their way to tell us about their experience using Cheers. These customers are from all walks of life and all sorts of professions ranging from bartenders, to professional athletes, to esteemed professors – many of whom have been customers for years.

In fact, many of our customers are doctors and other medical professionals. One of my good friends from Princeton has a husband who is a physician’s assistant, and when Cheers Restore was in its infancy of production, he would always give us the hardest time because he was a “medical professional” and didn’t believe in “dietary supplements”. That was, of course, until the physician he assisted became a diehard Cheers user… and then he was quick to proudly proclaim that he and his wife were good friends with me and that he also uses Cheers. It’s funny how fast some people change their opinions on something!

So, if we believe in and routinely use our own products, have many people that swear Cheers’ products support their liver health, and are used by medical professionals, why isn’t Cheers included within the Liver Habits Score?

Because Cheers is a dietary supplement, Cheers is not allowed to discuss its usage relative to any disease, according to the Dietary Supplements Health & Education Act of 1994 (“DSHEA”). This includes liver disease, which is a topic of the Liver Habits Score.

Understanding the laws around dietary supplements.

Many Americans view health products in terms of “drugs” or “dietary supplements” — as if everything in the field of health was clearly black and white. Even my friend’s husband, who was a physician’s assistant, thought this way. The problem with this logic, however, is that the terms “drug” and “dietary supplement” are nomenclature of regulation, not necessarily efficacy.

I can explain the peculiar nature of the US dietary supplement laws by pointing to health products classified as “drugs” in other countries but “dietary supplements” in the United States. One of the best examples of this is a product that I regularly take for my mood called SAM-e.

In Europe, SAM-e is used primarily as an antidepressant. Its history of research dates back to 1952 and it became available as a prescription drug in Italy in 1979. SAM-e is often used by itself, or is combined with other tricyclic antidepressants (e.g. amitriptyline) for a stronger effect. The European Medicines Agency (the European equivalent of the US’ FDA) believes that SAM-e is an effective and safe drug for use in depression while under the medical supervision of a doctor.

However, in the United States, SAM-e is not classified as a drug but can be legally bought and sold as a dietary supplement under “DSHEA” legislation. If you want, you can simply buy SAM-e from any reputable dietary supplement company that produces it. Personally, I get mine from a brand that is carried at Costco.

This begs the question — why is SAM-e a dietary supplement in the US but a drug in Europe?

My speculation is that drug companies have not found it practical to spend the necessary money to prove to the FDA that SAM-e could effectively treat depression when it is already freely sold as a dietary supplement. For context, a 2020 study estimated that the average cost of successfully bringing a new drug to market costs an average of about $1.3 billion – down from earlier research estimating about $2.8 billion. This cost creates a huge financial burden of proof, which disincentivizes health products to go through the process when they can already be sold over-the-counter as a dietary supplement legally.

The only utility in taking the drug classification route would be directly claiming and advertising that SAM-e is an effective antidepressant. This claim would allow it to be sold via prescription, ultimately charging significantly more for it — especially since insurance companies would be involved. But rarely is it reason enough to justify the costs involved.

To my knowledge, there is only one example of a pharmaceutical company putting forth the burden of proof to make something a drug that can already be bought and sold legally across the US. This is cannabidiol — or “CBD”— which Greenwich Biosciences was recently able to get successfully approved by the FDA as an epilepsy drug under the brand name EPIDIOLEX®.

Is SAM-e in the United States any different than the SAM-e in Europe? Does the efficacy somehow change depending on which side of the Atlantic it is consumed? Does standing on European soil when swallowing a SAM-e pill somehow magically make it more effective than when taking the same pill on US soil?

The preparation and inactive ingredients might be slightly different — such as varying generic drug manufacturers — but assuming reputable companies and proper manufacturing, the answer is materially “no”.

The difference between SAM-e in the United States and SAM-e in Europe is one of regulation, not necessarily product efficacy.

What does this functionally mean for consumers? Well, it means that in parts of Europe, companies selling SAM-e are legally able to claim the product as effective for depression but consumers can access it only with a prescription. But in the US, companies selling SAM-e may not legally advertise its potential antidepressant capabilities but consumers can freely buy it over-the-counter.

The idea that “drugs are effective but dietary supplements are not” is a false dichotomy that is often wrongly held by otherwise well-informed people—such as my friend’s husband who is a physician’s assistant.

Even in the US FDA’s own literature they state that: “Dietary Supplements can be beneficial to your health” but that they simply do “not have the authority to review dietary supplement products for safety and effectiveness before they are marketed.” The US FDA even goes so far as to state: “Many supplements contain active ingredients that have strong biological effects in the body.”


In the US, you can’t say: “SAM-e is effective for depression” like they do in Europe. This would be illegal because as a dietary supplement it must be labeled with the disclaimer that “This product is not intended to diagnose, treat, cure, or prevent any disease.” Instead, US companies will say that “SAM-e naturally supports a healthy mood and emotional well being” — as is the case with the SAM-e product that I buy at Costco.

So how does all of this discussion about SAM-e apply to Cheers and the Liver Habits Score?

As alluded to before, excluding  Cheers’ usage from the Liver Habits score does not mean that Cheers isn’t effective for liver health. Instead, what it means is that the Liver Habits Score mentions disease, and as a dietary supplement in the United States, Cheers’ products are prevented from discussing those topics in that context.

Is this a problem? Not at all!

The way we see it, this is actually an opportunity. We did not make the Liver Habits Score to sell our products or make money — it is inherently non-promotional. We made it to help people.

As we were looking through our data in 2020, we realized that Cheers services hundreds of thousands of customers and our website is visited by millions of people every year. Almost every single one of these people — myself and the Cheers team included — are drinkers, and therefore, at greater risk for liver health problems at some point in our lives.

By not including Cheers’ products, it allows us to freely discuss how various habits relate to liver health and disease within the Liver Habits Score.

We do not believe that major alcohol companies would ever provide this information or do something like this — to do so would be to admit that they sell something that is inherently toxic. And most dietary supplement companies don’t have customer bases that are primarily comprised of drinkers. This means that we have a unique position and obligation in the market that no one else has.

We feel that Cheers has a unique opportunity and duty to educate drinkers such as ourselves how to better take care of our livers — independent of using Cheers’ products.

The Liver Habits Score can be summed up as being a system that shows how drinking less, eating better, and exercising more can improve liver health and ultimately reduce risk. I don’t think there is a doctor in the world who would argue against those conclusions!

Have I started drinking less, eating better, and exercising more due to the Liver Habits Score? Yes. Do I still use Cheers products for liver support and to feel better the day after drinking? Also yes. At the end of the day, when it comes to the Liver Habits Score, it does not need to be one or the other – it can be both.

So, with the above background about the peculiar nature of dietary supplement laws in the United States, how do we respond to the question: “How do Cheers’ products affect my Liver Habits Score?”

The direct answer is: “If the Liver Habits Score did not discuss liver disease, the usage of Cheers products would definitely lead to supporting liver health, and thus would lead to an increase of points on the Liver Habits Score.”

In the future, as we find ways to respect the laws surrounding dietary supplements in the United States and yet also objectively discuss the research behind our product formulations, we will write articles on how Cheers’ products were formulated with ingredients that have ample evidence of liver support.


References

About Cheers

Cheers is the leading alcohol-related health brand focused on developing products that support your liver and help you feel great the next day. As a student at Princeton, Cheers’ founder Brooks Powell discovered the potential advantage of incorporating the natural plant extract Dihydromyricetin (DHM) into an after-alcohol consumption regimen and began working with his professors to make products that addressed the unique challenges of alcohol-related health. . Since its official launch in 2017, Cheers has sold more than 13 million doses  to over 300 thousand customers. The research-backed line of products includes three versions of supplemental pills and powders – Restore, Hydrate and Protect. Cheers is now releasing read-to-drink versions of their products—starting with Cheers Restore. Each product is equipped to meet different health needs such as rehydration, liver support, and acetaldehyde exposure. Cheers places an equal emphasis on the responsibility and health aspects of its mission and vision. The brand’s mission is bringing people together by promoting fun, responsible, and health-conscious alcohol consumption. The vision is a world where everyone can enjoy alcohol throughout a long, healthy, and happy lifetime. For more information, visit cheershealth.com or join the social conversation at @cheershealth.