February 2020

Growing Concern about Liver Injury from Supplements

It’s a New Year. A time when a lot of people go to extremes to lose weight, consider new health trends, and possibly try new supplements to help meet their goals. This is a crucial time to remind your patients that some of these products can pose major safety concerns. Reports of liver injury from supplements certainly aren’t new, but they don’t appear to be slowing down. Some studies suggest that 20-30% of acute liver failure cases are due to supplements. This is a shockingly high number. So, which supplements are the major culprits?

Most supplements linked to liver injury aren’t single ingredient products. They tend to have a long list of ingredients, and are usually marketed for weight loss, bodybuilding, or sexual function. But there are a few ingredients that tend to stand out.

Green tea extract is available in many forms such as tinctures, capsules, and tablets. Often these forms are standardized to different active constituents. Even among similar formulations, green tea extract often contains varied amounts of active constituents. One of these constituents is epigallocatechin gallate (EGCG). The amount of EGCG in green tea extract can range from 5 mg to 1000 mg. Research shows that taking more than 800 mg of EGCG daily may increase the risk of liver injury. But the amount contained in a product isn’t always clearly or accurately stated. Tell patients that drinking green tea should still be fine, but extracts tend to contain significantly more EGCG – particularly those marketed for weight loss. Best to steer clear of these.

Garcinia is another product to avoid. It contains the constituent hydroxycitric acid (HCA), which might aid in weight loss. But there’s a lot of conflicting evidence on whether it actually helps - benefits have been very modest at best. Regardless, numerous cases of liver toxicity have been linked to garcinia supplements, and several have required liver transplants. Tell patients it’s not worth the risk.

Black cohosh is also concerning. It’s used for a variety of conditions, but particularly by women with menopausal symptoms. While it might offer some benefits, there are some concerns about liver problems. If patients want to try a black cohosh supplement, make sure to monitor liver function.

Regardless of what’s listed on a product label, remind patients that a growing number of products are adulterated with other ingredients. Even if they think what’s listed on the label is safe, a recent review suggests that over 25% of supplement products are adulterated worldwide. Stick to products verified by a third party like USP. Caution is key.

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The information in this brief report is intended for informational purposes only, and is meant to help users better understand health concerns. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions. Copyright © 2023 NatMed. Commercial distribution or reproduction prohibited. NatMed is the leading provider of high-quality, evidence-based, clinically-relevant information on natural medicine, dietary supplements, herbs, vitamins, minerals, functional foods, diets, complementary practices, CAM modalities, exercises and medical conditions. Monograph sections include interactions with herbs, drugs, foods and labs, contraindications, depletions, dosing, toxicology, adverse effects, pregnancy and lactation data, synonyms, safety and effectiveness.