Liver Injury Warning Signs From Supplements and Herbs

Act first. If the skin or the whites of the eyes look yellow, the NHS (UK) says this "can be a sign of something serious, such as liver disease, so you need to get urgent medical help." [1] Call a clinician the same day. Call 911 (US) if the person collapses, has a seizure, has trouble breathing or cannot be woken. [2] Do not change or stop a prescribed medicine on your own; ask the prescriber or pharmacist.

What this page covers

This page is about warning signs. It does not say which products are "safe" or "unsafe", and it cannot tell you what is causing a symptom. Liver injury has many causes, and herbs and supplements are only one of them. For the wider picture see Liver safety and supplements.

Why supplements are on the list

NIDDK (US, 2022) describes LiverTox, a public resource on liver injury from prescription and over-the-counter drugs, herbal products and dietary supplements. [3] NIDDK says most such cases are mild, but some people develop injury "so severe that it can lead to acute liver failure and, ultimately, need for liver transplantation or death." [3]

NCCIH (US) says that although it is still rare, more cases of sudden liver damage in people taking dietary supplements are being reported, and that the injury can be severe and sometimes fatal. [4]

A US network that studies this (the Drug-Induced Liver Injury Network) reported, in a study of patients enrolled from 2004 to 2013, that injury from non-bodybuilding herbal and dietary supplements was more severe than injury from bodybuilding supplements or from medicines. [5] That is a finding from patients already referred to liver centers. It does not tell us how common problems are among all users.

Warning signs

Because early signs can be mild or absent, the review adds that "it is not uncommon for patients to withhold information on supplement use," so clinicians need to be told. [7]

Which products have been named

• Kava. NCCIH says various kava products have been linked to rare cases of serious or even fatal liver injury. [9] See Kava: traditional use, research and liver safety.
• Weight-loss products. A review says several multi-ingredient weight-loss products have been reported to cause liver injury, possibly through ingredients such as green tea or Garcinia cambogia, but that "direct toxicity has not been proved." [7] See green tea extract and liver safety.
• Other herbs. Pages in the Herbs and Adaptogens libraries cover single plants: chaparral, germander and other herbs with liver reports and ashwagandha liver reports.

Absence from this list is not proof of safety. Products can also differ from their labels: NCCIH notes that what is on the label may not be what is in the product. [4]

What to do

1. Get medical advice promptly for yellow skin or eyes, or for itching, dark urine or pale stools that you cannot explain. [1]
2. Bring every product you use, including herbs, teas, powders and capsules, with the labels. Tell the clinician about all of them. [4]
3. NCCIH advises that if you have side effects from a supplement, you stop it and contact your health care provider. [4] Prescribed medicines are different: ask the prescriber or pharmacist before changing them.
4. Ask the clinician about reporting. Problems with supplements can be reported to FDA. [10] See Side effects and reporting.

MedlinePlus says that when a medicine causes cholestasis (slowed bile flow), it will often go away when that medicine is stopped. [6] That statement is about medicines in general, and only a clinician can say what applies to a person.

Limits

This page cannot be used to rule liver injury in or out. We could not read the LiverTox chapters on the NCBI site this session, so we rely on NIDDK's description of LiverTox and on published reviews. Proper evidence not found, in the sources we read, for how common supplement liver injury is in the general population.

Related: How to talk with a health professional, When to call 911, Poison Help or a clinician and Quality testing and certifications.