Many people take supplements to improve their health, boost energy, or reduce inflammation. Because these products are sold over the counter and are often labeled as “natural,” it’s easy to assume they’re harmless. But experts say that’s not always the case.
Doctors are increasingly seeing cases of liver injury linked to certain supplements. While these products don’t cause problems for everyone, some have been connected to inflammation, liver damage, and, in rare cases, even liver failure. Experts stress that dosage, product quality, and individual risk factors all play a role.
Here are four supplements that deserve extra caution.
1. Green Tea Extract
Green tea is widely praised for its antioxidants and potential health benefits. However, concentrated green tea extract supplements are a different story.
The extract contains high levels of compounds called catechins, particularly EGCG. Research has found that in some people, high doses can trigger inflammation and injury to liver cells. The risk appears to be greater with concentrated supplements than with drinking green tea itself.
Experts say that just because something comes from a plant doesn’t automatically make it safe. The liver has to process everything we consume, including herbal supplements, and highly concentrated extracts can sometimes overwhelm it.
2. High-Dose Vitamin A
Vitamin A is essential for healthy vision, immunity, and normal cell function. But taking too much can become dangerous.
According to registered dietitian Amanda Peterson, vitamin A is fat-soluble, which means the body stores excess amounts instead of flushing them out. Over time, those extra stores can become toxic and cause inflammation and scarring in the liver.
Gastroenterologist Dr. Jay Luthar says the upper safe limit for adults is 3,000 micrograms RAE, or 10,000 IU, per day from all sources combined.
Long-term overuse can lead to serious complications, including fatty deposits in the liver, fibrosis, and cirrhosis. In some cases, the damage may be irreversible.
The good news is that many people already get enough vitamin A from their diets. Eggs, dairy products, and orange and yellow vegetables are all rich sources. Peterson notes that many people run into trouble because they take supplements without knowing whether they actually need them.
3. Turmeric Extract with Black Pepper
Turmeric has become one of the most popular supplements in recent years because of its reputation as a natural anti-inflammatory.
But supplement forms of turmeric don’t behave the same way as the spice sprinkled into food.
Registered dietitian Jill McNutt says turmeric extract combined with black pepper is currently one of the better-documented supplement-related liver concerns. The active ingredient in black pepper, called piperine, slows the liver’s ability to break down curcumin, turmeric’s main active compound.
While piperine helps the body absorb curcumin more effectively, it can also raise curcumin levels to potentially harmful amounts. Researchers have linked some of these enhanced turmeric supplements to cases of liver injury.
Using turmeric in cooking is generally considered safe, but concentrated supplements may carry different risks.
4. Ashwagandha
Ashwagandha has exploded in popularity as a supplement for stress, anxiety, and sleep support. Yet reports of liver problems associated with the herb have also been increasing.
Some people who developed liver injury after taking ashwagandha experienced symptoms such as fatigue, nausea, itching, dark urine, and yellowing of the skin and eyes.
Researchers still don’t fully understand why certain individuals develop reactions while others don’t. However, experts believe genetics, immune responses, and product quality may all contribute to the risk.
The Bottom Line
These supplements aren’t necessarily dangerous for everyone, and many people use them without any issues. But doctors say they should be treated with the same level of caution as medications.
Before starting a supplement, confirm that you actually need it, choose products that have been independently tested, and tell your healthcare provider what you’re taking. “Natural” doesn’t always mean risk-free, and when it comes to your liver, a little extra caution can go a long way.
7 Other Supplements and Medications That Can Be Hard on Your Liver
Your liver works around the clock to filter toxins, process medications, and break down nutrients. Because nearly everything you swallow passes through this vital organ, some supplements and medications can put extra stress on it. While most are safe when used correctly, taking high doses, combining multiple products, or using them for long periods can increase the risk of liver damage.
Here are some other products that experts say deserve careful use.
1. Kava
Kava is a plant-based supplement often marketed to help reduce anxiety and promote relaxation. Although some people find it helpful, it has also been linked to serious cases of liver injury.
Researchers have reported rare instances of hepatitis, liver failure, and even the need for liver transplants among people using kava supplements. Scientists are still studying why this happens, but product quality, dosage, and individual differences may all play a role.
2. Black Cohosh
Black cohosh is commonly used to relieve menopausal symptoms such as hot flashes. While many people tolerate it well, there have been reports of liver inflammation and liver failure associated with its use.
Although a direct cause-and-effect relationship hasn’t been proven in every case, many doctors recommend avoiding black cohosh if you already have liver disease or develop symptoms such as jaundice, dark urine, or persistent fatigue while taking it.
3. Anabolic Steroids
Some bodybuilders and athletes use anabolic steroids or supplements that secretly contain steroid-like compounds to build muscle faster. These products can be especially harmful to the liver.
Long-term steroid use has been linked to liver tumors, liver cysts filled with blood, and a condition called cholestasis, where bile cannot flow properly from the liver. Many “muscle-building” supplements have also been found to contain undeclared ingredients that increase these risks.
4. Acetaminophen (Tylenol)
Acetaminophen is one of the most widely used pain relievers in the world, but it is also one of the leading causes of acute liver failure when taken in excessive amounts.
Most healthy adults can use acetaminophen safely when following the recommended dosage. Problems typically occur when people accidentally exceed the daily limit by taking multiple cold, flu, or pain medications that all contain acetaminophen.
Drinking alcohol while taking high doses can further increase the risk of liver injury.
5. High-Dose Niacin
Niacin, also known as vitamin B3, is sometimes taken in large doses to improve cholesterol levels or as part of workout supplements.
While normal dietary amounts are safe, high-dose niacin supplements have been linked to liver inflammation and, in rare cases, liver failure. Sustained-release forms appear to carry a higher risk than immediate-release versions.
6. Certain Prescription Antibiotics
Most antibiotics are safe, but a small number can occasionally cause liver problems in susceptible individuals.
One example is amoxicillin-clavulanate, which is among the most common prescription medications associated with drug-induced liver injury. The reaction is uncommon and usually resolves after the medication is stopped, but symptoms such as yellowing of the skin, itching, or severe fatigue should never be ignored.
7. High-Dose Vitamin D and Multiple Supplements Together
Vitamin D itself is not usually toxic to the liver, but taking excessive amounts of supplements without medical supervision can create other health problems. More importantly, combining numerous herbal products and vitamins increases the amount of work your liver must do to process them.
Experts say many people don’t tell their healthcare providers about the supplements they take, making it harder to identify the cause of liver problems if they develop.
Protecting Your Liver
Most supplements and medications are safe when used responsibly. The greatest risks usually come from taking more than recommended, purchasing products from unreliable manufacturers, or combining several supplements without professional guidance.
If you notice symptoms such as yellowing of the skin or eyes, dark urine, severe fatigue, abdominal pain, nausea, or unexplained itching after starting a new supplement or medication, stop using it and contact a healthcare provider promptly.
Your liver is remarkably resilient, but it isn’t indestructible. Reading labels carefully, sticking to recommended doses, and discussing supplements with your doctor or pharmacist can go a long way toward keeping this essential organ healthy.
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