The Rising Concern Over Hepatotoxic Botanicals: What You Need to Know

The Rising Concern Over Hepatotoxic Botanicals: What You Need to Know In the United States, herbal and dietary supplements (HDS) have grown exponentially. These supplements, often marketed as natural remedies to boost health and treat various ailments, have become a staple in many households. However, a recent study published in JAMA Network Open has shed light on a lesser-known risk associated with some of these supplements—potential liver toxicity or hepatotoxicity. The Study in Focus The study titled “Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults,” conducted by Dr Alisa Likhitsup and her colleagues, analyzed data from the National Health and Nutrition Examination Survey (NHANES) to assess the prevalence of six botanicals commonly associated with liver damage. These botanicals are turmeric, green tea extract, Garcinia cambogia, black cohosh, red yeast rice, and ashwagandha. The findings were eye-opening: approximately 4.7% of US adults, or about 15.6 million people, reported using at least one of these potentially hepatotoxic botanicals in the past 30 days. The Popularity of Hepatotoxic Botanicals Among the six botanicals studied, turmeric was the most frequently used, followed by green tea extract, ashwagandha, Garcinia cambogia, red yeast rice, and black cohosh. These supplements are widely consumed for various reasons, such as improving joint health, boosting energy, aiding weight loss, and managing menopause symptoms. Despite their popularity, the study highlights a significant concern: most users of these botanicals were unaware of the potential risks associated with their consumption. The vast majority were taking these supplements without any recommendation from healthcare providers, relying instead on marketing claims and popular belief in the health benefits of these “natural” products. The Hidden Dangers Hepatotoxicity refers to liver damage caused by chemical substances. While the liver is a resilient organ, capable of regenerating itself after injury, repeated or severe damage can lead to serious conditions such as hepatitis, cirrhosis, or even liver failure. The study’s authors emphasized that the risk of liver damage from these botanicals is not negligible, particularly given the lack of regulatory oversight in the manufacturing and testing of these products. For instance, turmeric and green tea extract, while generally considered safe in dietary amounts, have been associated with liver injury in some cases when taken in concentrated forms. Garcinia cambogia, often promoted as a weight loss supplement, has been linked to acute liver failure. Black cohosh, used by women to manage menopausal symptoms, has also been implicated in cases of liver toxicity. Who Is at Risk? The study found that users of these potentially hepatotoxic botanicals tend to be older, more educated, and more likely to have chronic conditions such as arthritis. Interestingly, these users were also more likely to take prescription medications, which raises concerns about potential interactions between botanicals and drugs, further complicating liver health. Moreover, the study revealed that many individuals were consuming multiple HDS products simultaneously, which could increase the risk of adverse effects. For example, users of red yeast rice and ashwagandha were found to consume a median of four different supplements, raising questions about the cumulative impact of these products on liver health. The Regulatory Gap One of the key takeaways from the study is the glaring lack of regulatory oversight in the HDS industry. Unlike prescription medications, which undergo rigorous testing for safety and efficacy, dietary supplements are not subject to the same level of scrutiny by the Food and Drug Administration (FDA). This means that the actual contents of these products can vary significantly from what is listed on the label, and their potential effects on the liver are not always well understood. The study’s authors called for increased regulatory oversight, including mandatory safety testing of HDS products and accurate ingredient labeling. They also urged healthcare providers to take a proactive role in educating patients about the potential risks associated with these supplements, particularly those with known hepatotoxic effects. What Should Consumers Do? If you are among the millions of Americans who take herbal supplements, it is important to be aware of the potential risks. Here are a few steps you can take to protect your liver health: Consult Your Healthcare Provider: Before starting any new supplement, especially if you are taking prescription medications or have a chronic health condition, talk to your healthcare provider. They can help you assess the potential risks and benefits based on your health needs. Research the Supplement: Look for reliable information on the safety and efficacy of the supplement you are considering. Be wary of marketing claims that sound too good to be true, and seek out scientific studies or reviews from reputable sources. Watch for Signs of Liver Trouble: If you experience symptoms such as jaundice (yellowing of the skin or eyes), dark urine, fatigue, or unexplained nausea, stop taking the supplement and seek medical attention immediately. These could be signs of liver damage. Limit the Use of Multiple Supplements: Taking several supplements simultaneously can increase the risk of interactions and adverse effects. Stick to a few well-researched products that address your specific health needs. Conclusion The use of herbal and dietary supplements is widespread, and many people assume that because these products are “natural,” they are also safe. However, as the study by Dr. Likhitsup and colleagues illustrates, this is not always the case. Certain botanicals can pose a real risk to liver health, particularly when taken in concentrated forms or in combination with other supplements and medications. As consumers, it is crucial to approach these products cautiously and seek guidance from healthcare professionals. At the same time, there is a pressing need for more robust regulation and oversight of the HDS industry to ensure these products are safe and accurately labelled. Only then can consumers make truly informed decisions about their health. 1. American Medical Association. Dietary supplements: underregulated, unknown, and maybe unsafe. Accessed January 19, 2024. https://www.ama-assn.org/delivering-care/public-health/dietary-supplements-underregulated-unknown-and-maybe-unsafe 2. Mishra  S, Stierman  B, Gahche  JJ, Potischman  N.  Dietary Supplement Use Among Adults: United States, 2017–2018. NCHS Data Brief, No. 399. National Center for Health Statistics; 2021. 3. Navarro  V, Avula  B, Khan  I,