Popular herbal supplements used in America linked to liver damage

Supplements: Recent research from the University of Michigan has uncovered a concerning trend: millions of Americans are consuming herbal supplements that could potentially harm their livers, often without realizing the risks involved. This study sheds light on the widespread use of Supplements like turmeric and green tea, which, despite their popularity, may pose significant health risks, especially when taken without medical supervision. The study also highlights the pressing issues of mislabeling, lack of regulation, and insufficient medical oversight in the booming supplement market.


Popular herbal supplements used in America linked to liver damage

The Alarming Prevalence of Hepatotoxic Supplements
The University of Michigan's research team conducted an extensive analysis using data from the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2020. The study revealed that over a 30-day period, 4.7% of adults surveyed had taken herbal and dietary supplements containing at least one botanical ingredient known to be potentially hepatotoxic. The botanicals in question included turmeric, green tea, ashwagandha, black cohosh, garcinia cambogia, and red yeast rice. The study estimates that approximately 15 million American adults are regularly consuming these supplements.
 
"Our interest in this study was piqued by the cases of liver toxicity from herbal and dietary supplements observed in participants enrolled in the ongoing NIH-funded Drug-Induced Liver Injury Network (DILIN) study," said Dr Alisa Likhitsup, clinical assistant professor of Medicine at the University of Michigan and the study's lead author. "However, it was challenging to determine how widespread the use of these supplements was and the reasons behind their use. The significant finding here is the sheer number of Americans consuming these products regularly."
 
The Challenges of Regulating Herbal Supplements
One of the study's most concerning findings is the lack of regulation in the supplement industry, which contributes to the widespread use of potentially harmful products. Unlike prescription drugs, which are subject to rigorous testing and regulation by the U.S. Food and Drug Administration (FDA), herbal supplements are not required to undergo the same level of scrutiny. This regulatory gap allows for frequent mislabeling and the distribution of products with unverified or misleading ingredient lists.
 
"In a previous study, we discovered that there was a significant amount of mislabeling in some of these products," said Dr Robert Fontana, a Michigan Medicine hepatologist and the study's senior author. "When we performed analytical chemistry on these supplements, we found a 50% mismatch between the ingredients listed on the label and the actual contents. This is alarming because consumers are essentially flipping a coin when they buy a supplement, not knowing whether the label accurately reflects what's inside."
 
The study also highlighted the f act that many clinicians do not routinely ask patients about their supplement use, leading to a lack of awareness about the potential risks associated with these products. Dr Likhitsup noted, "We weren't aware that so many people were taking these supplements, and as a result, doctors often don't consider their effects when evaluating patients."
 
Why Are People Taking These Supplements?
The study found that the most commonly consumed botanical was turmeric, with 3.46% of the population reporting its use, followed by green tea (1.01%), ashwagandha and black cohosh (0.38%), garcinia cambogia (0.27%), and red yeast rice products (0.19%). Interestingly, most users reported taking these supplements on their own, without the advice of a healthcare provider.
 
The reasons for using these supplements varied. Among turmeric users, 26.8% took the product for its purported benefits for joint health or arthritis, while 27.2% of green tea users were hoping to boost their energy levels. The majority of garcinia cambogia users believed it would help them lose weight.
 
This surge in supplement use is part of a broader trend in the growing herbal and dietary supplements industry. With more than 80,000 unique supplement products available worldwide, sales in the United States alone surpassed $150 billion in 2023, rivaling the combined sales of prescription drugs.
 
However, the safety of these products remains a significant concern. Another study cited by the researchers found a 70% increase in liver transplants due to injury caused by supplements from 2010 to 2020, compared to the period from 1994 to 2009. While the University of Michigan study did not establish a direct causal relationship between the consumption of these botanicals and liver injury, the researchers emphasize the need for greater awareness among both clinicians and patients about the potential risks.
 
The Hidden Dangers of Common Botanicals
The study's findings underscore the hidden dangers of common botanicals that are often marketed as natural and safe. Despite their widespread use, these products can have serious health consequences, particularly when taken in large amounts or over extended periods.
 
For instance, turmeric, which is often touted for its anti-inflammatory and antioxidant properties, has been linked to cases of liver toxicity. Similarly, green tea extract, another popular supplement, has been associated with liver damage when consumed in high doses. Garcinia cambogia, a weight loss supplement, has also been implicated in liver injury, as has black cohosh, which is commonly used to treat menopausal symptoms.
 
The study found that users of these potentially hepatotoxic botanicals were generally older, more educated, and more likely to have arthritis compared to non-users. This demographic tends to be more health-conscious, which may explain their higher use of supplements. However, this also means they are at greater risk of adverse effects, particularly if they are taking these supplements in combination with other medications.
 
The Need for Greater Regulation and Awareness
Given the lack of regulatory oversight in the supplement industry, the researchers call for increased awareness among both healthcare providers and the general public. "We're not trying to create alarm," said Dr Fontana. "We just want to increase awareness that the over-the-counter supplements people are taking and buying have not been tested or proven to be safe."
 
The researchers also recommend that clinicians routinely ask patients about their supplement use, particularly when evaluating cases of unexplained symptoms or liver abnormalities. With the growing popularity of botanical products, there is an urgent need for more rigorous testing and regulation to ensure the safety of these products.
 
The study's findings highlight a critical gap in the current regulatory framework and underscore the need for stricter oversight of the supplement industry. As millions of Americans continue to consume these products, often without proper medical advice, the potential for harm remains high.
 
Conclusion
The University of Michigan study serves as a wake-up call for both consumers and healthcare providers. While herbal supplements may seem harmless, their potential for liver damage cannot be overlooked. With millions of Americans at risk, there is an urgent need for increased regulation and awareness to protect public health. As the supplement market continues to grow, so too must our understanding of the risks associated with these products.
 
For those interested in more detailed findings, the research has been published in the peer-reviewed journal: JAMA Network Open
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2821951
 
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