Popular Supplements and Liver Toxicity

A recent survey finds that about 5% of adults in the US report using a supplement that's linked with liver toxicity. This is a good time to revisit the risks associated with some popular supplements on the market.

While it’s likely safe for most people when used short-term, there have been at least 70 reports of liver damage linked with turmeric supplements. And taking turmeric with hepatotoxic drugs might increase the risk of liver damage – especially when highly bioavailable turmeric formulations, such as those containing piperine, are used in high doses. Turmeric is traditionally used for liver health – it’s possibly effective for nonalcoholic fatty liver disease (NAFLD), but watch out for symptoms of liver damage, including stomach pain, dark urine, and fatigue. And avoid turmeric in patients with cholestasis or hepatitis.

Ashwagandha is also creeping into headlines for its potential adverse effects. It seems to be well-tolerated when used for up to six months, but several health agencies in Europe have recently issued safety warnings due to concerns about hepatotoxicity. Although rare, there are reports of serious liver injury, including liver failure and death related to ashwagandha use. Tell patients to be aware of symptoms of liver damage, such as jaundice, weight loss, nausea, and stomach pain. And advise patients with existing liver disease, such as hepatitis, to avoid ashwagandha altogether.

Lastly, watch out for black cohosh. It’s especially popular for menopause as it seems to modestly improve some physical symptoms like hot flashes. While it’s been used safely in some studies for up to one year, there are concerns about liver damage due to multiple case reports of abnormal liver function, liver toxicity, and even liver failure requiring an immediate liver transplant. If patients want to take black cohosh, consider monitoring liver function.

Reports of liver injury from supplements certainly aren’t new, but it’s important to continue reminding patients about these risks – just because an ingredient is “natural” doesn’t mean it’s safe. Review the safety and adverse effects sections of our monographs to learn more. And take advantage of our charts to learn about the many other ingredients with potential hepatotoxic effects.