Herbs and Liver Injury: Which Botanicals Have Been Linked and How to Spot Warning Signs
Which botanicals have been linked to liver injury, what NCCIH and NIH LiverTox say about each, the warning signs to act on, and why adulteration and product form matter.
Content last updated . This page has not been medically reviewed.
Safety first. Supplements can cause side effects and interact with medicines. Read mushroom safety and interactions before you use any mushroom product.
Warning signs come first. NCCIH lists fatigue, nausea, poor appetite, dark urine and jaundice as liver damage symptoms to watch for with turmeric or curcumin, and says to stop those products immediately and talk with a health care provider. [1] Jaundice means the skin and the whites of the eyes turn yellow. [2] For black cohosh, NCCIH advises consulting a provider if symptoms such as dark urine and fatigue develop. [3] If you have these signs while using any herbal product, tell a clinician or pharmacist promptly and bring the product label. A longer guide is at Liver injury warning signs from supplements and herbs.
Why herbs and the liver are discussed together
The liver processes most things we swallow. In a US survey study of national data, turmeric or curcumin, green tea extract, Garcinia cambogia, black cohosh, red yeast rice and ashwagandha were described as the most frequently reported liver-harming botanicals. [4] The same study estimated that about 15.6 million US adults had used at least one of them in the previous 30 days. [4] That is a survey estimate of use, not a count of injuries. The sources below describe injury as uncommon or rare for several of them. [5][6]Botanicals with reported liver injury
The table summarizes what NCCIH and the NIH LiverTox entries (read as PubMed records) say. "Reported" means case reports or case series, which show a link but cannot give a risk rate.| Botanical (plant part or form) | What the source says | Evidence label |
|---|---|---|
| Turmeric, Curcuma longa (rhizome; curcumin products) | NCCIH says highly bioavailable curcumin formulations may harm the liver and that liver damage has been reported. [1] LiverTox says some turmeric products have been implicated in several dozen instances of clinically apparent acute liver injury. [7] | Evidence of harm (case reports) |
| Green tea, Camellia sinensis (extract in capsules or tablets) | NCCIH says liver injury is uncommon but reported, primarily with extracts in tablet or capsule form. [5] LiverTox adds that large amounts of the drink have rarely been implicated. [8] | Evidence of harm (case reports) |
| Black cohosh, Actaea racemosa (root products) | NCCIH says cases of liver damage, some very serious, have been reported with products labeled as black cohosh, and that contaminants might be responsible but this is not proven. [3] | Evidence of harm (case reports) |
| Ashwagandha, Withania somnifera | NCCIH says it is rare but there have been a number of cases linking liver injury to ashwagandha supplements. [6] See ashwagandha side effects and liver injury reports. | Evidence of harm (rare case reports) |
| Kava, Piper methysticum (root) | NCCIH says various kava products have been linked to rare cases of liver injury, some serious or even fatal. [9] NCCIH lists possible explanations (plant variety or part, alcohol, contamination) but these are suggestions, not settled. [9] See Kava: traditional use, research and liver safety. | Evidence of harm (case reports) |
| He shou wu, Polygonum multiflorum (accepted name Reynoutria multiflora) | A hospital case series of 29 patients in Beijing found jaundice was the most common symptom. [10] | Evidence of harm (case series) |
| Chaparral, Larrea tridentata | LiverTox says extracts have been linked to several cases of clinically apparent liver injury. [11] | Evidence of harm (case reports) |
| Germander, Teucrium species | LiverTox says extracts have been linked to multiple instances of liver injury that can be severe and lead to fatality. [12] | Evidence of harm (case reports) |
| Comfrey, Symphytum officinale (taken by mouth) | LiverTox says it contains pyrrolizidine alkaloids and, when taken orally, can cause sinusoidal obstruction syndrome and severe liver injury. [13] See pyrrolizidine alkaloids. | Evidence of harm |
| Greater celandine, Chelidonium majus | LiverTox says it has been linked to several instances of clinically apparent liver injury. [14] | Evidence of harm (case reports) |
| Pennyroyal oil, Mentha pulegium | LiverTox says that taken by mouth the oil is highly toxic and has been linked to several instances of toxic liver injury and death. [15] | Evidence of harm |
| Skullcap, Scutellaria lateriflora | LiverTox says it has been linked to several instances of liver injury, but usually in combination with other botanicals. [16] | Mixed; see adulteration below |
Several other herbs are described by LiverTox as not linked to injury on their own: it says licorice has not been reported to cause clinically apparent liver injury, and ginseng has not been implicated although it may cause significant herb-drug interactions. [17][18] That is not the same as safe for everyone: licorice has other documented risks, covered in Licorice root.
Why product form and quality matter
- Concentrated extracts are not the same as food or tea. Green tea liver reports involve mainly extracts, and the turmeric warning concerns formulations made to be absorbed better. [5][1]
- Adulteration. Skullcap supplements have occasionally been adulterated or contaminated with germander (Teucrium canadense or Teucrium chamaedrys), which contains liver-toxic compounds, according to a study that surveyed products sold in the USA. [19] See adulteration and substitution of herbs.
- Mixtures. When a product has many ingredients it can be hard to know which one is responsible; LiverTox notes this for skullcap. [16]
Who should ask first
People with existing liver disease, people who drink alcohol regularly, and people who take medicines processed by the liver should ask a pharmacist or clinician before starting any herbal product. The sources read here do not rank these groups by risk, so no ranking is given. Do not stop a prescribed medicine on your own; ask the prescriber or pharmacist. Tell the clinician about every supplement before liver blood tests or surgery. See Liver safety and supplements, how herb-drug interactions happen and quality testing.Limits of this page
Case reports cannot show how often injury happens, and the sources read do not give an amount below which injury is unlikely. "Proper evidence not found" for a safe threshold for any herb in this table in the NCCIH and LiverTox entries searched. Nothing here says a herb treats or protects the liver; for that question see herbs for liver health and detox claims, checked.Frequently asked questions
Which herbs are most often linked to liver injury?
A US survey study named turmeric or curcumin, green tea extract, Garcinia cambogia, black cohosh, red yeast rice and ashwagandha as the most frequently reported liver-harming botanicals. [4] Kava, chaparral, germander, comfrey and others also have reports. [20][11][12]
What are the warning signs?
NCCIH lists fatigue, nausea, poor appetite, dark urine and jaundice for turmeric products. [1] Jaundice is yellowing of the skin and the whites of the eyes. [2] Tell a clinician promptly.
Is green tea as a drink a liver risk?
NCCIH says liver injury from green tea is uncommon and has been reported primarily with extracts in tablet or capsule form. [5] LiverTox says ingestion of large amounts of the drink has rarely been implicated. [8]
Could my skullcap product contain something else?
A study of skullcap dietary supplements sold in the USA describes occasional adulteration with germander, which contains liver-toxic compounds. [19] The sources read do not say how common this is today.
Does a "natural" label mean a product is safe for the liver?
No. The LiverTox and NCCIH entries above describe serious liver injury, including fatal cases, linked to products sold as herbal supplements. [20][8] See Natural does not mean safe.
References
- NCCIH (US), Turmeric. Read 2026-10-23.
- MedlinePlus (US National Library of Medicine), Jaundice. Read 2026-10-23.
- NCCIH (US), Black Cohosh. Read 2026-10-23.
- Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults, NHANES survey study, 2024 (PubMed abstract). Read 2026-10-23.
- NCCIH (US), Green Tea. Read 2026-10-23.
- NCCIH (US), Ashwagandha. Read 2026-10-23.
- NIH LiverTox, Turmeric (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Green Tea (PubMed record of the LiverTox entry). Read 2026-10-23.
- NCCIH (US), Kava. Read 2026-10-23.
- Clinicopathological features of He Shou Wu-induced liver injury, retrospective case series, Beijing, 2019 (PubMed abstract). Read 2026-10-23.
- NIH LiverTox, Chaparral (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Germander (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Comfrey (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Greater Celandine (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Pennyroyal Oil (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Skullcap (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Licorice (PubMed record of the LiverTox entry). Read 2026-10-23.
- NIH LiverTox, Ginseng (PubMed record of the LiverTox entry). Read 2026-10-23.
- A flow-injection mass spectrometry fingerprinting method for authentication and quality assessment of Scutellaria lateriflora-based dietary supplements (PubMed abstract). Read 2026-10-23.
- NIH LiverTox, Kava Kava (PubMed record of the LiverTox entry). Read 2026-10-23.