Liver problems linked to supplements: What you need to know

You might reach for supplements to boost immunity, build muscle or support your overall health. They’re labeled as natural, available without a prescription and easy to find, so they must be safe, right?

Not always. Here’s something that might surprise you: supplements are linked to about 20% of liver injuries in the United States, and that number keeps rising.

If you’re among the millions taking supplements to support your health, understanding how they affect your liver isn’t just important; it’s essential.

Your liver is working behind the scenes every day, filtering toxins and keeping your body running smoothly. Let’s explore what you need to know to protect your liver while making smart choices about supplements.

Can supplements really damage the liver?

Your liver is one of the hardest-working organs in your body. Think of it as your body’s filtration system. It filters and removes toxins from your blood, including those from medications and supplements you take. When you take a supplement, your liver is the one responsible for breaking it down, just as it would a prescription medication.

When a supplement overwhelms or irritates your liver, it can cause damage. This type of liver damage is known as drug-induced liver injury or DILI. Despite the name, DILI isn’t limited to prescription medications. Herbal and dietary supplements can trigger it too, and in some cases, the damage can be severe.

What makes this tricky is that supplement-related liver damage is often unpredictable and doesn’t always relate to how much you’re taking. What’s a perfectly safe supplement for your friend might cause problems for you. It’s not about taking too much or using it the wrong way, it’s just how your individual body can process certain compounds.

Unlike prescription drugs, supplements aren’t evaluated by the FDA for safety or effectiveness before they are available to consumers. They’re classified as food, not medicine, which means the standards for testing, labeling and quality control are much looser. Research has found that roughly half of dietary supplements tested were mislabeled, meaning their contents didn’t match what was printed on the bottle.

5 popular supplements that can damage your liver

Not all supplements carry the same level of risk, but some have been more frequently linked to liver problems than others. Research shows that about 15.6 million adults regularly use at least one of six herbal supplements linked to liver damage.

Here are five of the most common ones to be aware of:

1. Turmeric

Turmeric is everywhere right now—in golden lattes, on supplement aisles or in your kitchen. While cooking with turmeric is considered safe, high-dose supplement forms pose more of a risk.

Turmeric supplements often contain concentrated curcumin, the compound behind turmeric’s anti-inflammatory property, and can cause liver damage when taken at high doses. The World Health Organization suggests a daily dose of no more than 200 mg for someone who weighs 150 pounds. Many turmeric supplement capsules contain 1,000 mg or more, well above what is considered safe.

2. Green tea extract

Green tea as a beverage is perfectly fine. But concentrated extracts, especially detoxes marketed for weight loss or boosting energy levels, have been linked to liver toxicity. The concentrated doses in pill form are far higher than what you would get from drinking tea, which can be especially dangerous when taken on an empty stomach or regularly for an extended period of time.

3. Ashwagandha

Ashwagandha has become increasingly popular as a stress-relief and sleep-supporting supplement, but it’s also one of the six supplements most frequently implicated in liver damage cases. The challenge with Ashwagandha is that, like other supplements, the dosages and formulations vary widely between brands, making it hard to know exactly what is in each product or how much is safe.

4. Bodybuilding and weight loss supplements

Many supplements marketed for muscle growth, athletic performance or fat loss have been associated with liver damage. These can include anything from pre-workout supplements to products containing anabolic steroids, which are known to be toxic to the liver. But even products without steroids on the label can contain unlisted ingredients or contaminants that put your liver at risk.

Because these products are largely unregulated, what’s listed on the label doesn’t always reflect what’s in the bottle.

5. Black cohosh

If you’ve ever dealt with hot flashes or night sweats during menopause, you may have come across black cohosh as a natural alternative to hormone therapy. Many people take it without any problems. But black cohosh has shown up in liver damage reports more than you might expect, and while many people use it without issues, it’s been linked to cases of liver damage serious enough to require a liver transplant.

How common are liver problems linked to supplements?

On an individual level, the odds of a supplement causing liver damage are low. Most people who take them won’t run into problems. However, a couple of decades ago, supplements accounted for less than 10% of drug-induced liver injuries in the United States. Today, that number is increasing.

Part of that increase stems from more people taking supplements than ever before, and there are now over 100,000 products on the market. But it also reflects how little regulation exists for an industry that’s grown so fast.

And the real numbers could be higher. Because supplement-related liver symptoms can often be vague, plenty of cases probably go unrecognized or get attributed to something else entirely.

What are the symptoms of liver damage from supplements?

One of the reasons supplement-related liver damage gets missed is that early symptoms can be subtle or nonexistent. In mild cases, the only sign may be elevated liver enzymes on routine blood work.

As damage progresses, signs of liver damage may include:

• Abdominal pain or tenderness
• Dark urine
• Confusion
• Fatigue or unusual tiredness
• Loss of appetite
• Nausea
• Yellowing of the skin or eyes, also known as jaundice

What to know before taking supplements

When it comes to supplements, there are a few important things to keep in mind:

1. Always talk to your doctor before starting any new supplement

This is especially important if you take any prescription medications, have a pre-existing liver condition or are pregnant. Your doctor can work with you to identify any potential interactions as well as help you weigh the actual benefits against the risks.

2. Choose the best quality supplement

Since the supplement industry isn’t regulated and the FDA doesn’t evaluate supplements before they’re sold, certifications from organizations like USP (United States Pharmacopeia), NSF International or Consumer Lab can give you more confidence in what’s actually in the bottle.

3. Don’t take more than the recommended dosage

If, after talking with your healthcare provider, you decide to take a supplement, remember that more isn’t always better. High-dose formulations, especially those of turmeric, green tea extract and ashwagandha, can be harmful to your liver if not used properly.

4. Be honest with your doctor about any supplements you are taking

Many people skip mentioning any supplements they are taking during regular visits with their healthcare provider, but your provider needs the full picture to keep you safe. Supplements can interact with medications in ways that aren’t always obvious.

5. Check LiverTox before adding any new supplements to your routine

LiverTox® is a trusted, regularly updated resource from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) that explains how certain medications, supplements and herbs can affect the liver. It can be a useful tool to reference if you ever have any questions or concerns about specific supplements.

When to see a doctor about liver problems linked to supplements

If you’re noticing symptoms that could be related to your liver, especially if you take supplements, it’s worth checking in with a doctor. Your primary care provider or a digestive specialist can help run the right tests and make sure your liver is doing its job.

And even if you feel fine, it’s still a good idea to mention any supplements you take at your next routine visit so your care team can keep your liver health in mind as part of your overall care.

Questions about supplements? Talk to your primary care provider or find one near you.