Doctors are concerned that many Americans are now taking herbs that could be harmful to their livers. A study published in JAMA Network Open (Aug. 2024) analyzed data from the National Health and Nutrition Examination Survey (NHANES). More than 9,000 adults answered questions about diet and supplement intake. The authors identified 6 herbal products that could have the potential to harm the liver. They issued a strong warning that captured headlines. We wish there was equal concern about OTC and prescription medications that can also cause liver damage.
Headlines Warning About Herbs and Liver Damage:
The media is very quick to report on the dangers of herbal supplements. Here are some examples:
- “6 Popular Herbal Supplements Linked to Potential Liver Risks” Medical News Today (Aug. 18, 2024)
- “Study Estimates Millions in US Risk Liver Damage From Herbal Remedies” Science Alert (Aug. 7, 2014)
- “Turmeric and Green Tea Among Health Supplements Putting People in Hospital” New Atlas (Aug. 5, 2024)
The subhead of the last article:
“More than 15 million Americans may be putting their liver health at risk, simply by trying to better their overall health. New research has revealed the extent of the damage being caused by taking popular botanical supplements including turmeric, green tea, the stress-relieving ashwagandha and weight-loss aid Garcinia cambogia.”
What Dietary Supplements Were Linked to Liver Damage?
The article published in JAMA Network Open (Aug. 2024) was titled:
“Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults”
The herbs the authors listed as “hepatoxic botanicals” were:
- Green tea extract
- Turmeric
- Garcinia cambogia
- Black cohosh
- Red yeast rice
- Ashwagandha
The authors introduce their article by stating that:
“Herbal and dietary supplements (HDSs) include a multitude of products consumed by millions of people every day to improve their general health and to treat minor ailments. Over 80,000 HDS products can be purchased without a prescription at various unregulated retail outlets or via the internet.”
That statistic comes from an article published by the AMA (American Medical Association) May 11, 2024 titled:
Dietary Supplements: Underregulated, Unknown and Maybe Unsafe”
The article goes on to quote the AMA President, Gerald E. Harmon:
“The dietary supplement marketplace is an uncertain place for consumers—so little transparency, so much confusion”
Is Anyone In Charge?
We would not disagree that there is a lot of confusion in the dietary supplement marketplace, just as there is for both OTC and prescription drugs. We have quality concerns about all such products. We have been writing about problems with house brand medications and generic prescription drugs for decades.
For example, articles by Anna Edney for Bloomberg have noted problems with OTC cold medicines that might contain cancer-causing benzene (Bloomberg Law, Aug. 12, 2024).
Another article was titled:
“Dozens of CVS Generic Drug Recalls Expose Link to Tainted Factories” (Bloomberg, June 10, 2024).
Anna Edney starts her article this way:
“One factory making CVS-branded pain and fever medications for children used contaminated water. Another made drugs for kids that were too potent. And a third made nasal sprays for babies on the same machines it used to produce pesticides.”
“There’s little incentive for large drug purchasers like pharmacies and hospitals to choose suppliers based on quality, said Kevin Schulman, a professor of medicine at Stanford University. Rather, they often choose the lowest-cost manufacturing contracts, which Schulman’s research has found leads to lower-quality medicines.”
You can listen to our interview with Anna Edney about drug quality at this link.
Liver Damage from Drugs, Herbs and Dietary Supplements:
We are as concerned about drug quality as we are about the quality of dietary supplements and herbal products.
The article in JAMA Network Open reported that nearly 5 percent of the people in the survey reported taking one of these dietary supplements, with turmeric being the most popular.
The authors go on to conclude:
“In this survey study, an estimated 15.6 million US adults consumed at least 1 botanical product with liver liability within the past 30 days, comparable with the number of people who consumed nonsteroidal anti-inflammatory drugs and a commonly prescribed hypolipidemic drug. Given a lack of regulatory oversight on the manufacturing and testing of botanical products, clinicians should be aware of possible adverse events from consumption of these largely unregulated products.”
Why Aren’t Doctors Concerned About Drugs that Cause Liver Damage?
As you just read, the authors suggest that the number of people who took herbs was comparable to the proportion of adults taking an anti-inflammatory drug or a cholesterol-lowering drug. They were referring to prescription NSAIDS! They state that:
“Approximately 14,793,837 US adults used prescription anti-inflammatory drugs…”
That does not count the tens of millions of Americans who rely upon OTC anti-inflammatory meds like ibuprofen (Advil, Motrin IB) or naproxen (Aleve). It also ignores acetaminophen (Tylenol). We suspect that tens of millions of people use an OTC drug containing acetaminophen on a regular basis. It is well known that this familiar pain reliever can cause serious liver damage. Here is a link to an article we wrote on this topic:
Acetaminophen Pain Reliever Can Cause Liver Problems
The authors of the JAMA Network Open article go on to state that:
“Simvastatin, a hypolipidemic drug used to treat and prevent cardiovascular disease similar to the use for red yeast rice, was consumed by 14,036,024 individuals.”
They did not count other statins. According to our calculations, atorvastatin is taken by 30 million people and over 50 million Americans swallow statin-type cholesterol-lowering drugs on a daily basis.
Most people do not develop liver damage from statins. But according to an article in the journal Clinics in Liver Disease (Feb. 2020):
“Up to 3% of patients on statins may develop elevated liver enzymes.”
If you do some quick calculations, that means about 1.5 million people could develop elevated liver enzymes from statins.
There are dozens of other medications that can cause hepatotoxicity. That includes antibiotics such as ciprofloxacin (Cipro) and amoxicillin-clavulanate (Augmentin), the anti-arrhythmic heart medicine amiodarone (Cordarone), the epilepsy medicine carbamazepine (Tegretol) and the antifungal agent ketoconazole (Nizoral), to name just a few.
Herbs AND Drugs Can Cause Liver Damage:
We are equally concerned about medications and herbal or dietary supplements that can cause liver damage. This is a serious adverse reaction that must never be ignored. Fortunately, it is relatively uncommon with both medications and herbs.
We would hope that people would be careful to monitor their liver function whether they are regularly taking turmeric or acetaminophen. What symptoms should get people to a doctor quickly?
- Any skin color changes, especially yellowing. That also goes for yellowing of the eyes. This could be a sign of jaundice.
- Darkish urine. This could also be a sign of bilirubin buildup due to jaundice.
- Digestive disorders such as loss of appetite, nausea, bloating or belly pain
- Itching! If your skin starts to itch or flake get a liver function test!
The American Botanical Council points out that the recent study does not illuminate the actual risk of liver injury from herbs, which is relatively low in most cases.
Final Words:
The French prize their livers. Americans take their livers for granted. We would like you to pay more attention to your liver! To protect you from liver damage we have prepared an article titled:
Do You Love Your Liver Enough?
It lists a number of medications that can cause liver toxicity. It also warns about some dangerous dietary habits that may not be good for your liver.
To read more about how drugs and herbs can affect your liver, here is a link to another article we have written.
We would like to hear from you. Have you ever experienced liver toxicity from an herb or a medication? Please share your story in the comment section below. If you think this article might interest a friend or family member, please pass it along. Who isn’t taking a acetaminophen, a statin, NSAID or acid suppressing PPI medication? Thanks for your support.
