Why These 6 Supplements May Lead to Liver Damage

Dietary and herbal supplements may seem harmless, but a recent study shows that six popular supplements are linked to liver damage.

The survey study estimated that, during a one-month period, over 15 million U.S. adults took supplements containing ingredients that may harm the liver. These include turmeric, green tea, ashwagandha, garcinia cambogia, red yeast rice, and black cohosh.

The liver helps break down medications and supplements. While medications undergo extensive testing before receiving Food and Drug Administration (FDA) approval, supplements do not. For example, Tylenol carries a required liver warning label with information about risks and safe dosages. However, supplements can reach store shelves without having to go through rigorous testing for safety and efficacy.

However, this doesn’t mean everyone taking these supplements will have liver damage.

“Not every liver will get injured. It also depends on each patient and what else they are taking and other prescriptions they are taking. It’s really something that’s unpredictable,” said Alisa Likhitsup, MD, MPH, clinical assistant professor at the University of Michigan Health and lead author of the study.

Here’s what you should know about the six supplements linked to liver toxicity.

1. Turmeric

Turmeric is a popular dietary supplement for managing arthritis, digestive problems, and liver disease. However, some evidence suggests that turmeric supplements may damage the liver. Supplements with black pepper may cause additional harm since this enhances turmeric absorption.

A 2023 study showed an increase in turmeric-induced liver injuries in the U.S. The researchers examined data from the U.S. Drug-Induced Liver Injury Network between 2004 and 2022. Only ten cases of turmeric-related liver injuries were reported, but six of these occurred since 2017.

2. Green Tea

Green tea supplements have been marketed as weight loss and cancer-fighting agents. Consuming too much of a specific compound in green tea—epigallocatechin gallate (EGCG)—may harm the liver.

“Regular tea drinking, about 3 to 5 cups per day, does not pose the same risk, as dietary intake provides much lower levels of EGCG,” Caroline Susie, RDN, a Dallas-based registered dietitian and spokesperson for the Academy of Nutrition and Dietetics, told Verywell in an email.

3. Ashwagandha

Some people take ashwagandha for stress relief or to support overall health. There have been reports of ashwagandha-related liver injuries in the U.S.

“The precise toxic threshold is unknown, but reported cases involve high-dose extracts rather than traditional root powders,” Susie said.

While high-dose extracts may cause harm, low dietary intake of ashwagandha is generally safe, she added.

It is important to speak with a trusted healthcare provider before taking ashwaganda, especially if you have a history of liver disease. Taking ashwagandha with other supplements might cause additional harm.

4. Garcinia Cambogia

Garcinia cambogia supplements that contain hydroxycitric acid (HCA) have been touted for weight loss. These may interact with other medications and have been linked to liver damage.

“The risk is higher when combined with other weight loss supplements,” Susie said.

5. Red Yeast Rice

Red yeast rice supplements are said to help lower cholesterol. These contain a natural statin that may cause liver damage, said Nima Majlesi, DO, a medical toxicologist at Northwell Staten Island University Hospital.

People who take higher doses tend to have a greater risk, but due to a lack of regulation, you don’t always know how much you are taking, he added.

Case reports have linked red yeast rice with liver issues. A 2019 case report showed that a 64-year-old woman experienced liver inflammation six weeks after starting a red yeast rice supplement. Once she stopped taking the supplement, her liver enzymes dropped, which suggests that her liver was recovering.

6. Black Cohosh

Black cohosh is an herbal product used to manage menopause symptoms. Some reports have linked supplements labeled “black cohosh” to serious liver damage.

Taking black cohosh with other medications or supplements may cause liver injury. It is important to always speak with a trusted healthcare provider about all of the medications and supplements you take.

Should You Avoid These Six Supplements?

It is important to consider risks before taking any supplement, not just these six. Studies have also shown that supplements are frequently mislabeled, so you don’t always know exactly what you are taking.

“All supplements, you have to question. The reality is because this industry is so poorly regulated, we have no idea, actually, what’s in many of them,” Majlesi said.