- Herbs have been used for medicinal purposes for thousands of years.
- Herbal supplements have recently become very popular due in part to the social media platform like TikTok.
- Researchers at the University of Michigan report that an estimated 15.6 million U.S. adults — or 5% — have taken at least one herbal supplement in the last 30 days that might be damaging to their liver.
- Among the supplements studied are ashwagandha, green tea extract, turmeric, or curcumin.
Although people have been using plants and herbs for medicinal purposes for thousands of years, these days they are highly popular due in part to posts on social media sites like TikTokTrusted Source, where users highlight the advantages of consuming herbal supplements like green tea, ashwagandha, and turmeric.
Although herbal supplements might be regarded as "natural," they are not intrinsically safe and don't need FDATrusted Source clearance before being sold. Herbal supplements can also have negative effects on users, and some herbs can conflict with prescription drugs they already take.
Studying 6 potentially hepatotoxic botanical products
According to a recent study by researchers at the University of Michigan, 15.6 million American adults, or 5% of the population, may have taken at least one hepatotoxic, or liver-damaging, herbal supplement in the previous 30 days.
Researchers examined information from over 9,500 American individuals, with an average age of 47.5, who participated in the National Health and Nutrition Examination Survey (NHANES)Trusted Source from 2017 to 2020 in order to conduct this study. The usage of herbal supplements and prescription drugs was included in the medical data for these individuals.
Researchers concentrated on examining study participants' use of six herbal supplements that were previously thought to be possibly hepatotoxic.Reliable Source:
Researchers examined information from over 9,500 American individuals, with an average age of 47.5, who participated in the National Health and Nutrition Examination Survey (NHANES)Trusted Source from 2017 to 2020 in order to conduct this study. The usage of herbal supplements and prescription drugs was included in the medical data for these individuals.
Researchers concentrated on examining study participants' use of six herbal supplements that were previously thought to be possibly hepatotoxic.Reliable Source:
- ashwagandha
- black cohoshTrusted Source
- Garcinia cambogiaTrusted Source
- green tea extract
- red yeast rice
- turmeric or curcumin
Lead author of this study Alisa Likhitsup, MD, MPH, clinical assistant professor in the Department of Internal Medicine in the Division of Gastroenterology and Hepatology at the University of Michigan, told Medical News Today that "potentially hepatotoxic botanical products are the products that contain plant-based ingredients which have been implicated as potential causes of liver damage."
Although the exact mechanism of liver damage caused by these products is unknown, she said that it is probably because of the liver's post-consumption metabolism.
As a hepatologist in practice, I have encountered patients who used nutritional supplements and suffered liver damage; some of these patients were deadly and needed an immediate liver transplant. The rates of liver damage caused by drugs were reported by the Drug Induced Liver Injury Network due to botanical products has been on the rise from 7% in 2004-2005 to 20% in 2013-2014. Therefore, I had (an) interest to analyze the prevalence and see how many Americans were consuming these products,” Likhitsup continued.
Although the exact mechanism of liver damage caused by these products is unknown, she said that it is probably because of the liver's post-consumption metabolism.
As a hepatologist in practice, I have encountered patients who used nutritional supplements and suffered liver damage; some of these patients were deadly and needed an immediate liver transplant. The rates of liver damage caused by drugs were reported by the Drug Induced Liver Injury Network due to botanical products has been on the rise from 7% in 2004-2005 to 20% in 2013-2014. Therefore, I had (an) interest to analyze the prevalence and see how many Americans were consuming these products,” Likhitsup continued.
15.6 million adults use a potentially liver-damaging herb
At the end of the 30-day trial, Likhitsup and her colleagues discovered that almost 58% of all participants had used a nutritional supplement or herbal remedy at least once.
Five percent of individuals reported consuming at least one of the six botanicals that may be hepatotoxic within the previous thirty days. This percentage, when applied to the entire adult population in the United States, equals almost 15.6 million.
According to studies, the amount of people who are projected to be administered possibly hepatotoxic medications, such as nonsteroidal anti-inflammatory medicines (NSAIDS) and the cholesterol-lowering medication simvastatinTrusted Source, is comparable to the use of potentially hepatotoxic botanicals.
Five percent of individuals reported consuming at least one of the six botanicals that may be hepatotoxic within the previous thirty days. This percentage, when applied to the entire adult population in the United States, equals almost 15.6 million.
According to studies, the amount of people who are projected to be administered possibly hepatotoxic medications, such as nonsteroidal anti-inflammatory medicines (NSAIDS) and the cholesterol-lowering medication simvastatinTrusted Source, is comparable to the use of potentially hepatotoxic botanicals.
“We hope our results will increase awareness among patients and providers about these potentially liver toxic ingredients being consumed regularly among Americans and the dietary supplement products available in the market are not strictly regulated,” Likhitsup said.
‘Natural’ does not always equal safe
Following review of this study, Rosario Ligresti, MD, FASGE, chief of gastroenterology at Hackensack University Medical Center in New Jersey, informed MNT that although hepatotoxic botanical products are made from plants or plant derivatives, consumers should be aware that they may be doing more harm to their bodies than good if they consume them due to a lack of regulatory oversight over their manufacturing and testing.
Ligresti went on, "Because they are completely unregulated [before going on sale], I don't find it surprising that they can present serious health risks, especially for the liver, which is supposed to be affected in some way by their inability to process and detoxify harmful substances." This may result in an accumulation of poisons in the liver, which may lead to inflammation, cell death, and in some severe cases, liver failure
Ligresti went on, "Because they are completely unregulated [before going on sale], I don't find it surprising that they can present serious health risks, especially for the liver, which is supposed to be affected in some way by their inability to process and detoxify harmful substances." This may result in an accumulation of poisons in the liver, which may lead to inflammation, cell death, and in some severe cases, liver failure
Ligresti said that every physician should be talking with their patients about the risks of these types of products and asking if they are taking any of them.
“This needs to be explained to patients along with the fact that the supplement industry is not as heavily regulated as the pharmaceutical industry. This means that companies are not required to prove the safety and effectiveness of their products before they are sold. This can lead to consumers purchasing products that are not well-studied or that may contain harmful ingredients,” he added.
Ligresti said that every physician should be talking with their patients about the risks of these types of products and asking if they are taking any of them.
MNT also discussed this study with Monique Richard, MS, RDN, LDN, owner of Nutrition-In-Sight and registered dietitian nutritionist.
Richard stated, "The study's findings are alarming and validate what I frequently see in practice, on social media, and in the healthcare industry." Unfortunately, there are many items on the market that claim to "cure," "solve an ill," or "enhance a stated outcome," but in most cases, they are not that easy to use. This is due to a variety of factors, including influencers, deceptive marketing, scare tactics, and everything in between.
"The FDA monitors supplements, but primarily in relation to the risk that supplement ingredients may provide when sold. This is far different from having a supplement 'certified by the FDA' for quality, efficacy, safety, and benefit,” she continued.
MNT also discussed this study with Monique Richard, MS, RDN, LDN, owner of Nutrition-In-Sight and registered dietitian nutritionist.
Richard stated, "The study's findings are alarming and validate what I frequently see in practice, on social media, and in the healthcare industry." Unfortunately, there are many items on the market that claim to "cure," "solve an ill," or "enhance a stated outcome," but in most cases, they are not that easy to use. This is due to a variety of factors, including influencers, deceptive marketing, scare tactics, and everything in between.
"The FDA monitors supplements, but primarily in relation to the risk that supplement ingredients may provide when sold. This is far different from having a supplement 'certified by the FDA' for quality, efficacy, safety, and benefit,” she continued.
For readers considering taking an herbal supplement, Richard said to first and foremost work with their healthcare team, including their physician, pharmacist, registered dietitian nutritionist (RDN), or other credentialed herbalist or botanist practitioners, to really understand what botanicals may be best suited for their current condition and goals.
She also advised taking a “food-first approach” instead of herbal supplements, such as adding active ingredients like turmeric or green tea in a culinary form, depending on the person’s specific needs and goals.
“Words of wisdom: Turn to your trusted nutrition and healthcare professionals before purchasing promises in a bottle that could be secretly sabotaging your health, your liver, and wallet,” Richard said.
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