Popular Herbal Supplements Can Harm Your Liver, Is Ashwagandha One Of Them?

herbal Supplements: A Double-Edged Sword for Health and Liver Safety

For thousands of years, herbs have been utilized for their medicinal properties, hailed as natural remedies for a wide array of ailments. In recent years, however, the popularity of herbal supplements has surged dramatically, thanks in large part to social media platforms like TikTok, where users promote these products as miracle cures for various health issues. Supplements like ashwagandha, green tea extract, turmeric, and curcumin have become household names for their supposed health benefits, ranging from stress relief to boosting immunity and promoting weight loss.

However, despite their natural origins, herbal supplements are not inherently safe. New research has shown that a growing number of Americans are consuming herbal supplements that could potentially harm their livers. A study conducted by researchers at the University of Michigan estimates that about 15.6 million U.S. adults, or 5% of the population, have taken herbal supplements in the past 30 days that may be hepatotoxic, meaning they pose a risk to liver health.

This article explores the complexities of herbal supplements, their potential health risks, and what medical professionals and consumers should be aware of before diving into the world of natural remedies.

The herbal Supplement Boom: Driven by Social Media
The global herbal supplement industry has exploded in popularity, especially with the rise of health influencers on platforms like TikTok. Many social media users promote herbal supplements as natural, healthier alternatives to pharmaceutical drugs. Supplements like ashwagandha, turmeric, green tea extract, and Garcinia cambogia are often touted for their benefits, which range from reducing stress and inflammation to boosting metabolism and aiding in weight loss.

For instance, turmeric and its active compound, curcumin, have been promoted for their anti-inflammatory properties, while green tea extract is marketed for its antioxidant benefits and potential to aid in weight loss. Ashwagandha, an adaptogenic herb, is believed to help manage stress and improve mental clarity. While these claims may have some scientific backing, the reality is more complicated, particularly when it comes to safety.

One of the key issues with herbal supplements is the perception that “natural” equates to “safe.” However, just because a product is derived from plants doesn’t mean it lacks potential risks. Unlike pharmaceutical drugs, which undergo rigorous testing for safety and efficacy, herbal supplements are not subject to the same stringent regulations before being marketed. This lack of oversight can lead to harmful side effects, especially when taken in high doses or alongside other medications.

The Hidden Risks of herbal Supplements: Hepatotoxicity
In a study published in JAMA Network Open, researchers at the University of Michigan examined the use of six potentially hepatotoxic (liver-damaging) herbal supplements: ashwagandha, black cohosh, Garcinia cambogia, green tea extract, red yeast rice, and turmeric or curcumin. The findings are alarming—approximately 15.6 million U.S. adults have taken at least one of these supplements in the last month, with the risk of liver injury being a significant concern.

Hepatotoxicity refers to the potential of a substance to cause damage to the liver. The liver plays a crucial role in detoxifying harmful substances in the body, and when it is overwhelmed, the result can be inflammation, cell death, or even liver failure. While certain medications are known to cause liver damage, this study shines a spotlight on the fact that herbal supplements, often perceived as safe, can also pose a significant risk to liver health.

Dr. Alisa Likhitsup, a clinical assistant professor in the Department of Internal Medicine at the University of Michigan and the lead author of the study, explained: “Potentially hepatotoxic botanical products contain plant-based ingredients that have been implicated in liver damage. How these products cause liver damage is not yet fully understood, but it is likely due to metabolism that occurs in the liver after the products are consumed.”

One concerning observation from the study was that a significant portion of individuals who experienced liver damage from dietary supplements required emergency liver transplants. This finding highlights the seriousness of hepatotoxicity related to herbal supplements and the need for greater awareness among both healthcare providers and consumers.

Which herbal Supplements Pose a Risk to Liver Health?
The study focused on six herbal supplements that have been identified in previous research as having potentially hepatotoxic effects:

• Ashwagandha: This adaptogen is often taken to reduce stress and improve mental clarity, but there have been reports of liver toxicity in some users.
• Black cohosh: Used primarily for managing symptoms of menopause, black cohosh has been associated with cases of severe liver injury.
• Garcinia cambogia: Often marketed as a weight loss supplement, this fruit extract has been linked to hepatotoxicity and has caused liver failure in some users.
• Green tea extract: While green tea is generally considered safe, concentrated extracts taken in high doses have been implicated in cases of liver damage.
• Red yeast rice: Used to lower cholesterol, this supplement contains compounds similar to prescription statins, which can be toxic to the liver in certain doses.
• Turmeric/curcumin: Known for its anti-inflammatory properties, turmeric supplements may be hepatotoxic when taken in high doses or combined with other supplements.

Among the six supplements, turmeric and green tea extract were the most commonly consumed by study participants, followed by ashwagandha, Garcinia cambogia, red yeast rice, and black cohosh.

Why Are herbal Supplements So Popular?
The popularity of herbal supplements is often fueled by a combination of factors, including social media influence, marketing strategies, and a general preference for natural remedies over pharmaceutical drugs. Many people turn to herbal supplements for health improvement, disease prevention, and immunity-boosting benefits. In the case of turmeric, users often report taking the supplement to relieve arthritis symptoms, while green tea extract is favored for improving energy levels.

However, many consumers are unaware of the potential risks involved in taking these supplements, especially in high doses or over long periods of time. According to the study, the majority of individuals using hepatotoxic botanicals did so without recommendations from healthcare providers, highlighting a dangerous lack of medical supervision.

Lack of Regulation: A Major Concern
One of the most significant concerns with herbal supplements is the lack of regulation by the U.S. Food and Drug Administration (FDA). Unlike pharmaceutical drugs, herbal supplements do not require FDA approval before being marketed to the public. This means that the safety and efficacy of these products are not guaranteed, and many supplements may contain mislabeled or adulterated ingredients.

Research suggests that more than 50% of dietary supplements are mislabeled, and in some cases, the actual ingredients can be harmful to health. This lack of oversight also means that consumers may be taking supplements that contain dangerous ingredients without realizing it.

Rosario Ligresti, MD, FASGE, chief of Gastroenterology at Hackensack University Medical Center, emphasized the risks of herbal supplements: “Because supplements are supposedly made from natural ingredients, people have a false sense of security. They may believe that because the ingredients are natural, they must be safe. However, it’s important to remember that natural does not always equal safe.”

What Medical Professionals Should Consider
Given the risks associated with herbal supplements, healthcare providers must take a proactive approach in discussing these products with their patients. Many individuals who use herbal supplements do not inform their doctors, which can complicate treatment, particularly when supplements interact with prescription medications.

When evaluating patients with unexplained symptoms or abnormal liver function tests, clinicians should always inquire about the use of herbal supplements. As Dr. Likhitsup pointed out, “We hope our results will increase awareness among patients and providers about these potentially liver-toxic ingredients being consumed regularly among Americans.”

What Consumers Should Know Before Taking herbal Supplements
For consumers considering herbal supplements, it is crucial to consult with healthcare professionals, such as physicians, registered dietitians, or pharmacists, before starting any new product. Additionally, taking a "food-first" approach—incorporating ingredients like turmeric or green tea in culinary form rather than as supplements—can be a safer alternative.

Monique Richard, MS, RDN, LDN, a registered dietitian nutritionist, stressed the importance of working with qualified healthcare providers: “Unfortunately, for a number of reasons, from influencers to clever marketing, the market is ripe with products touted to ‘cure,’ ‘solve an ill,’ or ‘enhance a stated outcome.’ Before purchasing promises in a bottle, turn to your trusted nutrition and healthcare professionals.”

herbal Supplements—A Cautionary Tale
herbal supplements, while often perceived as safe due to their natural origins, can pose significant health risks, particularly to the liver. The findings from the University of Michigan study underscore the importance of greater regulation and awareness when it comes to the use of these products.

As herbal supplements continue to gain popularity, it is essential for both consumers and healthcare providers to approach them with caution. While these products can offer health benefits, they must be used responsibly and under medical supervision to avoid potentially life-threatening complications.