“Herbal teas and supplements can definitively lead to liver injury and even liver failure — we call this herb-induced liver injury,” says Tatyana Kushner, MD, a hepatologist and an assistant professor in the division of liver diseases at the Icahn School of Medicine at Mount Sinai in New York City. “Depending on the herb, the impact can be acute — and self-resolve — or can develop into chronic liver disease and liver failure, which would necessitate a liver transplant,” Dr. Kushner says. You don’t want to mess with your liver. As the Johns Hopkins School of Medicine notes, the liver is responsible for breaking down medications, and producing bile, which carries away waste and is crucial for digestion. Yet many people do: Herb-induced liver injury, which is a form of liver disease, is a growing problem. “I have noticed a rise in herb-related injuries in my practice,” says Kushner. One possible reason for the uptick is more awareness of the phenomenon and better methods of tracking cases, Kushner says. The numbers may also be going up because herbal supplements are gaining popularity among the general public. According to a review published in June 2018 in the journal Toxics, use of herbal supplements, natural medicines, and “natural products” has been on the rise in the past few decades. People turn to these products, the NIH News in Health notes, to make sure they’re getting enough nutrients or to improve their health — but they’re often not necessary. RELATED: 9 Questions You Should Be Able to Answer About Your Liver Here’s what you need to know about these herbal products so you can keep your liver safe and working optimally.
Herbal Products and Liver Toxins
One of the major roles of the liver is to act as a filter for toxins, says Dina Halegoua–De Marzio, MD, an assistant professor of gastroenterology and the director of the fatty liver center at Thomas Jefferson University in Philadelphia. “It does this through a complex metabolic process by taking the medications we ingest and breaking them down into nontoxic components and then flushing them out of the body,” she explains. Medications and supplements can damage the liver while it’s doing its work. Certain substances can form toxic metabolites that can damage liver cells, and as a result, the liver can become so damaged that it can’t function, Dr. Halegoua–De Marzio says. According to the Mayo Clinic, this damage, which causes scarring — called cirrhosis — can lead to liver failure and can even be life-threatening. According to the Harvard T.H. Chan School of Public Health, herbal supplements are largely unregulated in the United States. Therefore, it’s unknown how pure the substances may be — and what effects they may have on the liver, Halegoua–De Marzio says. RELATED: 7 Popular Supplements With Hidden Dangers
Why Use of Herbal Remedies May Be on the Rise — and Whether They’re Helpful
Green tea extract in particular is receiving a lot of buzz these days. As the Cleveland Clinic notes, proponents claim it provides an all-natural energy boost and aids weight loss, and yet research on these proposed benefits is lacking. Furthermore, the U.S. Food and Drug Administration (FDA) has not approved green tea extract for any specific medical condition, nor does it regulate the product for safety and efficacy, according to LiverTox, a publication produced by the NIDDK. If you love green tea, rest easy: Drinking green tea generally isn’t risky, Halegoua–De Marzio says. It’s the high doses of green tea extract usually found in weight-loss supplements that have the potential to do damage. Instead of turning to extracts and similar herbal remedies, the Cleveland Clinic advises making lifestyle changes to avoid the risk of complications. Green tea extract specifically can be especially threatening to the liver — LiverTox reported in November 2020 that ingesting large amounts of green tea extract has been implicated in acute liver injury, liver failure, the need for a liver transplant, and even death. Still, that isn’t stopping Americans from gravitating to natural remedies. According to the National Institutes of Health’s National Center for Complementary and Integrative Medicine, “natural” doesn’t necessarily make a product safer or better, but there is still a personal preference for natural products, in part because of the belief, the agency says, that nature is pure and superior to human manufacture. The NIH cautions, though, that natural remedies, like kava for anxiety, for example, can come with serious side effects and safety concerns, including severe liver damage. A review published in November 2018 in Complementary Therapies in Clinical Practice showed that the risks are especially high with long-term and poor-quality formulations. This makes ensuring you’re using a high-quality product okayed by your healthcare team all the more important. RELATED: A Complete Guide to Cirrhosis, or Liver Damage
7 Tips to Keep Your Liver Healthy
Because of the potential risks, it’s important to take precautions if you decide to use an herbal product. Keep these tips in mind.
1. Ask Your Doctor About an Herbal Product of Interest Before Taking It
“People should talk about herbal remedies with their doctor prior to starting, particularly if they are not familiar with the ingredients of the herbal remedy,” says Kushner. And if you’re already using something? It’s crucial to give your doctor a full list of what you’re taking, including herbal teas or supplements. Knowing what you’re taking will help your doctor recognize side effects. If your primary care doctor or specialist can’t provide the answers you’re seeking, seek a second opinion from an integrative medicine board-certified doctor or trained specialist.
2. Beware of the Big Liver Offenders
When it comes to supplements, the simpler, the better. “If you find a bottle with a long list of italicized words in the ingredient list naming the multiple herbs that are components in the particular supplement, I would steer clear,” says Kushner. Green tea extract, anabolic steroids, and multi-ingredient nutritional supplements are among the top products that can cause liver injury, according to a review published in January 2017 in the journal Hepatology. “It is important to know that many different types of herbs can cause liver injury in an unpredictable way — for example, Herbalife and other weight loss herbal supplements have caused liver injury in many people,” says Kushner. A review published in LiverTox in April 2018 also highlights reports of acute liver injury by those taking Herbalife products, but the specific ingredients that caused the damage are still unknown. Certain herbs used in traditional Chinese medicine have also been found to pose some risks. Research published in Annals of Hepatology in 2015 identified 28 traditional Chinese medicine herbs and herbal mixtures that have been reported to cause liver injury. Meanwhile, comfrey contains several pyrrolizidine alkaloids that may cause liver injury when taken orally, according to an October 2017 report in LiverTox. Chaparral, kava, and skullcap can also damage your liver, they report. RELATED: A Detailed Guide to Activated Charcoal
3. Investigate the Ingredients List of an Herbal Remedy Before Trying It
Before buying, read the back of the bottle to see what’s actually inside the supplement. Some herbal products, such as milk thistle, for example, are known to be safe and could even play a role in treating certain liver conditions, according to the Mayo Clinic. Still, you’ll want to talk to your doctor before taking any supplement product. Also, keep an eye out for additional ingredients: Green tea extract, for example, is added to many herbal products. And you’ll want to avoid big claims on the label. In some cases, supplements don’t list the ingredients at all but make claims that they will flush your liver. According to Johns Hopkins Medicine, liver cleanse supplements aren’t recommended — not only is there no evidence showing they actually work, but they can actually cause damage to the liver, they say.
4. Check the LiverTox Website for Background Information on Remedies
Run by the NIDDK, the LiverTox website contains valuable information on hundreds of drugs that have been found to damage the liver, including herbal products. If you’re looking to buy a new supplement (or if you already have a supplement in your medicine cabinet), check its ingredients on this regularly updated site to see if it can damage your liver. You’ll also, of course, want to run it by your doctor before you start continue on a supplement. RELATED: What You Need to Know Before Trying a Detox Cleanse
5. Turn to Independent Labs That Certify Quality Supplements
As mentioned, the FDA doesn’t regulate herbal remedies. That means labels may mislead consumers like you. For example, black cohosh is often taken for menopause symptoms like hot flashes and night sweats, notes the National Institutes of Health. But products labeled as black cohosh have been linked to more than 50 cases of liver injury, according to LiverTox, and some cases have been so severe that they resulted in liver transplants and even death. In several of those cases, though, scientists found herbs from the Chinese actaea species in the supplement rather than black cohosh, and this mislabeling may have been the culprit, LiverTox notes. In addition, herbal supplements can contain mystery pharmaceutical ingredients. For example, a study published in October 2018 in JAMA Network Open found unapproved pharmaceutical ingredients in a whopping 776 dietary supplements, which were often marketed as weight loss, sexual enhancement, or muscle-building products. If your healthcare team green-lights taking a certain supplement, work with them to choose a brand that has been tested by an individual lab, such as ConsumerLab, NSF International, or U.S. Pharmacopeia, Harvard Health Publishing notes. These companies independently certify supplements for dosage accuracy and safety.
6. Work With Your Doctor to Identify Potential Drug Contraindications
Another reason to report any supplements you’re taking to your doctor: They could be working against your prescription medications. For example, anyone taking the newer hepatitis C medications would be wise to avoid St. John’s wort, because past research showed this herbal remedy may worsen liver function in people on hepatitis C medications, and could even result in hospitalization. And according to a review published July 2017 in American Family Physician, almost 25 percent of U.S. adults say they are taking a prescription medication while also taking a dietary supplement. The authors recommend that people on any pharmacological therapy avoid St. John’s wort. Also, if you already have a liver issue, taking potentially risky supplements could make matters much worse. “Generally speaking, if you have a liver disease that is advanced — be it from hepatitis C or other causes — a superimposed liver injury from herbs can lead to significant worsening,” says Kushner. So as a reminder: “People should talk about herbal remedies with their doctor prior to starting, particularly if they are not familiar with the components of the herbal remedy,” she says. If you are managing a liver condition or are concerned about risks specific to the liver, consult a hepatologist. RELATED: 5 Complementary and Alternative Therapies for Hepatitis C
7. Limit the Number of Herbal Products You Take
Beyond toxicity, talk to your healthcare team to avoid potential interactions between any herbal products or supplements with each other. In general, though, less or none may be more. Not to mention, supplements aren’t a substitute for a healthy diet or lifestyle, nor are they a replacement for a treatment plan your healthcare team has recommended, as Harvard Health Publishing points out. Instead, you might consider these remedies as a possible complement to more conventional approaches. So rather than taking a supplement you’re not sure about, talk with your doctor or integrative medicine trained provider, learn all you can about it, and improve your health by making other lifestyle changes, like exercising and sleeping more, and eating healthier. Additional reporting by Marie Suszynski.
