These Popular Herbal Supplements Have Been Linked to Liver Injury

Herbal and dietary supplements are often marketed as “natural,” but natural does not automatically mean risk-free. A number of widely used botanical products have been associated with drug-induced liver injury, although serious reactions remain uncommon and often affect only susceptible individuals.

Experts from the American Association for the Study of Liver Diseases (AASLD) and the U.S. National Institutes of Health’s LiverTox programme recognise herbal and dietary supplements as potential causes of liver injury. Establishing that a particular supplement caused an injury can be difficult because products may contain multiple ingredients, vary in concentration, or occasionally be contaminated or inaccurately labelled.

Turmeric / Curcumin

Turmeric has a long history of culinary use, but concentrated turmeric and curcumin supplements have increasingly been linked to clinically apparent acute liver injury. Reports have particularly involved some formulations designed to increase curcumin absorption, including products combined with piperine (black pepper extract). This risk should not be confused with ordinary culinary use of turmeric.

Green Tea Extract

Green tea as a beverage is widely consumed, but concentrated green tea extracts used in supplements have been associated with liver injury in susceptible people. The risk relates mainly to concentrated extracts rather than normal consumption of brewed green tea.

Ashwagandha

Ashwagandha is commonly promoted for stress, sleep and general wellness. Case reports and clinical reviews have linked supplements containing ashwagandha to liver injury, typically developing after several weeks of use. Most reported patients improve after the product is stopped, but medical evaluation is important.

Black Cohosh

Black cohosh is frequently used for menopausal symptoms. Products labelled as black cohosh have been linked to cases ranging from elevated liver enzymes to severe hepatitis and, rarely, acute liver failure. Researchers note that mislabelling or other ingredients may account for some cases.

Garcinia Cambogia

Garcinia cambogia is commonly found in products marketed for weight management. It has been implicated in cases of acute liver injury, sometimes as part of multi-ingredient supplements, making the precise cause difficult to determine.

Kava

Kava products are used for relaxation and anxiety. Kava has a documented history of association with clinically apparent liver injury, including rare severe cases. Product preparation, dose and individual susceptibility may influence risk.

Red Yeast Rice

Red yeast rice is promoted for cholesterol management. Some preparations naturally contain monacolin K, which is chemically identical to the prescription statin lovastatin. Rare liver injuries have been reported, and the amount of active compound can vary substantially between products.

Warning Signs of Possible Liver Injury

Symptoms can vary and some people initially have no obvious symptoms. Seek medical advice if symptoms develop after starting a supplement, particularly:

•    Yellowing of the skin or eyes (jaundice)
•    Dark urine or unusually pale stools
•    Persistent nausea or vomiting
•    Loss of appetite
•    Unusual or severe fatigue
•    Pain or discomfort in the upper-right abdomen
•    Generalised itching

Who Should Be Especially Careful?

People with existing liver disease, those taking prescription medicines, older adults, pregnant or breastfeeding people, and anyone using several supplements at once should discuss supplement use with a qualified healthcare professional. Interactions between supplements and medicines can also create additional risks.

How to Reduce the Risk

•    Tell your doctor or pharmacist about every supplement you take.
•    Avoid assuming that a higher dose will provide greater benefit.
•    Be cautious with multi-ingredient products whose exact contents or amounts are unclear.
•    Use reputable products and check labels carefully.
•    Stop using a suspected supplement and seek medical advice if symptoms of liver injury develop.
•    Do not restart a supplement suspected of causing liver injury unless specifically advised by a healthcare professional.

The Risk Needs Context

These associations do not mean that everyone who takes these supplements will develop liver damage. Many reported reactions are rare and idiosyncratic. Risk also differs according to dose, formulation, product quality, other medicines and individual susceptibility. However, because severe liver injury can occur, unexplained symptoms after starting a new supplement should not be ignored.

Medical note: This article is for general information only and is not medical advice. Do not stop prescribed medicines because of this article. Anyone with jaundice, severe abdominal symptoms, confusion, persistent vomiting or other concerning symptoms should seek prompt medical care.

Sources: American Association for the Study of Liver Diseases (AASLD) guidance on drug, herbal and dietary supplement-induced liver injury; NIH/NIDDK LiverTox database. Updated references accessed August 2026.