Doctors are warning of a concerning rise in acute liver failure cases linked to the increasing popularity of herbal and dietary supplements, with some individuals developing severe damage within weeks of consumption. The problem is exacerbated by the fact that many of these products are unregulated, and high-strength extracts can deliver doses far larger than those found in food.
Tilda Pattman, a retired intensive care nurse, experienced this firsthand when she began taking a combination of supplements including green tea, black seed, turmeric, ginseng, melatonin, and ashwagandha to aid her recovery from COVID-19. Within three weeks, she developed liver failure and required an emergency transplant, spending nearly a year in the hospital. Doctors determined that the supplements were the cause of her condition, as other potential causes like alcohol consumption were ruled out.
Professor Guruprasad Aithal, a consultant liver specialist at Nottingham University Hospitals NHS Trust, noted that herbal and dietary supplements account for a significant percentage of acute liver injuries caused by medicines. Unlike damage from long-term alcohol abuse or obesity, supplement-induced liver injury can progress rapidly, sometimes within weeks.
This rapid deterioration occurs because the liver, while processing concentrated plant extracts, can produce toxic by-products that damage or kill liver cells. In some individuals, supplements can also trigger an autoimmune response, where the immune system mistakenly attacks liver cells, especially in those with a specific genetic variant, HLA-B*35:01. This variant has been found in a significant majority of patients experiencing liver damage from turmeric and green tea extract supplements.
Rising Incidence and Regulatory Gaps
The incidence of supplement-related liver damage is growing globally. A study analyzing patients on U.S. transplant waiting lists showed that cases of acute liver failure caused by supplements rose more than eightfold between 2003 and 2020. Experts in the UK are also observing a similar trend.
The Food Standards Agency (FSA) in the UK has launched an investigation into reports of serious and potentially fatal liver damage linked to supplements. Products under scrutiny include concentrated green-tea extract, turmeric extracts, ashwagandha, and Garcinia cambogia, as well as multi-ingredient 'detox,' fat-burning, and bodybuilding supplements. These products are often marketed for sleep, energy, weight loss, and general wellness, yet they are regulated as food rather than medicines. This classification means they do not undergo the same rigorous testing or monitoring as pharmaceutical products, and their labels may not accurately reflect their contents. Undeclared substances, such as anabolic steroids in bodybuilding supplements, can also pose serious health risks.
Specific Ingredients of Concern
High-strength extracts of familiar substances like turmeric and green tea are of particular concern. Curcumin, the active compound in turmeric, is often combined with piperine to enhance absorption. While this increased absorption is generally safe from dietary turmeric, it can overwhelm the liver in individuals with the HLA-B35:01 gene variant. Similarly, concentrated green tea extracts contain high levels of catechins, particularly EGCG, which can become toxic to liver cells in large doses. Studies have shown that green tea extract is a frequent cause of liver damage in specialist liver centers, with a high prevalence of the HLA-B35:01 gene variant among affected patients.
Professor Aithal emphasized that genetic predisposition does not explain all cases. Concentrated extracts can directly harm the liver, and certain chemicals in fat-burning supplements can disrupt cellular mitochondria, leading to cell death. The combination of multiple ingredients in some supplements further complicates matters, as the exact strength and interaction of each component may be unclear and can vary between batches.
Experts like Stephen Ryder, a consultant hepatologist, point to a widespread belief that over-the-counter products are inherently safe due to rigorous testing, a misconception that can be amplified by social media and influencer marketing. The notion that 'natural' equates to 'safe' is also a dangerous oversimplification, as Tilda Pattman's near-fatal experience illustrates. Following her transplant, Pattman experienced kidney failure and required life support, but made a remarkable recovery, regaining her health and independence.