Dirty Dozen: 12 Supplements That Can Cause Liver Failure

Update 3/16/24. Can supplements cause liver failure? When it comes to supplements, natural does not always mean safe. While there are definitely some good supplements, some may not be so good for you. This review will summarize an unfortunate trend I've noticed. Liver toxicity and liver failure caused by dietary supplements. Some people have even died. The supplements listed below are not just fringe products. Some are popular supplements you may have heard of – or taken.  They can be found in health-food stores and on the web. Because of the seriousness of poor liver health- sometimes requiring liver transplant – I recommend avoiding the following 12 supplements.  If you've had liver failure from supplements,  comment below.

Before We Get Started…

First, I want to say that I did not write this to be controversial. I wrote this so you would know what I know. I've been seeing reports of supplements causing liver failure for many years.

I also want to say most of the things you'll read about below can be purchased either by themselves or they may be a part of a multi-ingredient product. This is why it's always a good idea to look at the Supplement Facts labels of products you take. The Supplement Facts label will tell you the ingredients in the product.

For example, many multi-ingredient weight loss supplements contain the first 2 ingredients on this list.

1 Garcinia Cambogia

Garcinia cambogia is a very popular weight loss supplement, but I cannot recommend it. Over the years, several cases of liver failure have been associated with Garcinia Cambogia. In many reports, a specific garcinia supplement named Hydroxycut was mentioned.

In my original review of garcinia, I identified at least 7 case reports that involved either liver failure or those requiring a liver transplant. Here they are:

• Hydroxycut hepatotoxicity (2010)

• Hydroxycut(®) (herbal weight loss supplement) induced hepatotoxicity: a case report and review of literature (2010)

• Hepatotoxicity due to Hydroxycut: a case series

• Hepatoxicity associated with weight-loss supplements: A case for better post-marketing surveillance (2009)

• Severe hepatotoxicity due to Hydroxycut: a case report (2009)

• Hydroxycut hepatotoxicity: A case series and review of liver toxicity from herbal weight loss supplements (2008)

• Fatal liver failure following food supplements during chronic treatment with montelukast. (2007)

• Two patients with acute liver injury associated with use of the herbal weight-loss supplement Hydroxycut (2005)

Because Hydroxycut contains several ingredients, I wondered if these reports might be due to a combination of ingredients or some other ingredient. However, a report published in 2016 has directly implicated Garcinia Cambogia as a cause of liver failure. In this report, a 34-year-old man needed a liver transplant after taking a garcinia supplement. The only supplement he said he was taking was Garcinia Cambogia.

This man reported taking six 80 mg capsules per day for 5 months (480 mg total per day).  The supplement was from a reputable company (Swanson) and contained ONLY Garcinia Cambogia.

Bottom line: Garcinia Cambogia is a scam weight loss product.  Regardless of how you feel, its potential for liver injury makes it too risky for my tastes.

See the Garcinia cambogia review for more info

Video: Avoid These Supplements

Watch on my YouTube channel.

2 Green Tea

I like drinking green tea, but I would not recommend green tea supplements. Green tea (Camellia sinensis) is popular in many weight loss products. This is because it's supposed to raise metabolism, helping us burn more calories both at rest and during exercise. While I have questioned whether it really worked or not, reports linking green tea to liver failure put it on my do not fly list.

As far back as 2008, the US Pharmacopoeia linked green tea supplements to 34 cases of liver damage. Of those, green tea was deemed a possible cause in 27 cases, and a probable cause in 7 cases. These researchers noted liver problems were increased when taken on an empty stomach.

In many cases, green tea was part of multiple-ingredient dietary supplements or it was taken in addition to several other supplements. This makes pinning liver problems specifically to green tea problematic.

In one study a green tea supplement was identified as the cause of liver failure in a 16-year-old boy. The product he was taking contained several other ingredients. Additionally, he was also taking other supplements. After analyzing the other things he was taking, the doctors theorized that the liver failure was “most likely secondary to the green tea extract-containing supplement.”

Bottom line: Drinking green tea is healthy, but avoid taking green tea supplements.

3 Vitamin A

Vitamin A was the first vitamin discovered. Like all micronutrients, vitamin A is critical for health in small amounts. However, when consumed in high doses, vitamin A can be damaging.

For example, in one report, a 60-year-old man needed a liver transplant after taking high doses of vitamin A. This man was taking 500,000 IU (150 mcg) of vitamin A for 4 months, after which he cut back to 100,000 IU (3000 mcg) for the next 6 months. Obviously, this is far more than the RDA and can result in cirrhosis of the liver.

Researchers in the 1990s, who reviewed 41 cases of vitamin A liver toxicity, noted the smallest daily dose that might lead to liver cirrhosis was 25,000 IU ( 7,500 mcg) taken over the course of 6 years. Taking 100,000 IU per day for 2.5 years resulted in similar outcomes.

Bottom line: be careful with vitamin A supplements. Its potential to be liver toxic is why multivitamins often contain beta-carotene instead.

4 Niacin

Niacin, also known as vitamin B3 is well known for its ability to lower triglycerides, LDL (bad cholesterol), and raise HDL (good cholesterol). Because it's a vasodilator, it may also be found in some pre-workout and male enhancement supplements.  That said, this nutrient is assocated with hepatic problems when used in high doses.

Doctors reported on a 46-year-old man who developed liver failure after taking niacin for his high cholesterol problems. He was taking 3 grams

(3000 mg) of niacin per day. After 1 month, he started having liver problems.

Another report details liver failure in a 56-year-old male taking 500 mg to 1000 mg of niacin daily for cholesterol problems. This man eventually died. However, his emphysema likely played a role.

In another report, a 17-year-old man developed liver failure after mistakenly believing niacin supplements could mask drug test results. The amount of niacin he was taking was not mentioned. The guy was also in an alcohol treatment center.  His past problems with alcohol may have made him susceptible to the effects of niacin.

Bottom line: Monitor liver enzymes when using niacin supplements. According to the CDC, there is no evidence niacin supplements can help people pass a drug test.

Is niacin anti-aging? See that review for more insights.

5 Kava

Kava, also called “Kava Kava” or Piper methysticum is sometimes used to help people with anxiety problems. In some South Pacific regions, Kava drinks are consumed at parties. In the US, kava may be consumed as a tea or in pill form. The active ingredients in the herbal product are said to be “kavalactones,” although, as with all-natural medicines, kava has thousands of bioactive compounds.

Doctors, in 2003, described the case of a 22-year-old woman who needed a liver transplant after using Kava for 4 months. She was also taking various other medications, including the occasional use of Tylenol (also liver toxin). She was taking 240 mg of kava per day. While the transplant was successful, 6 months later, the woman died from a fungal infection. Might her death be related to the anti-rejection drugs she took after the transplant to suppress her immune system? It's speculation.

That same year, a 56-year-old woman died from liver failure after taking kava supplements prescribed by her naturopathic doctor. She was taking Kava for 3 months prior to having symptoms of liver problems. While a donor's liver was found, she died during the transplant.

In another report, researchers highlighted 36 cases of kava-induced liver toxicity, of which 8 people needed a liver transplant. Three of those receiving transplants later died.

Bottom line: Kava is banned in countries such as the UK and France. Kava is available in the US and on various online websites. Fortunately, it's not often used in multi-ingredient products. Always check to make sure.

6 Conjugated Linoleic Acid

Conjugated linoleic acid (CLA) is a popular weight loss supplement, although its proven effectiveness is conflicting.

In one report, a 46-year-old woman in Portugal was admitted to the hospital with signs of hepatic failure. The woman showed no signs of any other medical issues which would cause this problem. She admitted to taking CLA supplements for 2 weeks before going to the hospital. After she stopped taking CLA, her liver returned to normal. This is said to be the first case of CLA-induced liver failure ever reported.

Unfortunately, the next case did not end as well.

In 2012, doctors reported the case of a 63-year-old woman who needed a liver transplant. She had been taking CLA supplements for one month and waited for 3 more weeks before going to the hospital. She took no other supplements and was not a drinker or had any other habits that would put her at risk of liver problems.

After studying the issue, the doctors could find “no other cause of hepatotoxicity” (liver failure) – other than CLA.

Bottom line: CLA appears to have less evidence than other supplements listed here.  Given the number of people who have used this supplement, I think the risk is low, but because of the potential for liver transplantation, CLA cannot be recommended.

7 Germander

Germander, also known as Teucrium or Teucrium polium or Teucrium chamaedrys can be found in some detox teas and weight-loss teas, as well as capsules. It's a plant people use for many reasons in addition to weight loss such as digestion problems and arthritis.  Germander has been banned in France since the 1990s after several cases of hepatitis came to light after people started using it for weight loss.

In the study linked to, 7 people developed liver problems 3 to 18 weeks after using Germander. The liver issues cleared up after stopping the supplement. Three of the people eventually went back to using Germander, after which their liver issues returned.  There has been at least 1 death from liver failure stemming from germander use.

Bottom line: fortunately, I don't see germander in many supplements. I'm glad most supplement companies avoid it.

8 Usnic Acid

Like germander above, usnic acid is rather obscure as a supplement, but it seems popular in some bodybuilder circles as a possible weight loss aid. It might also be marketed as a natural antibiotic or detox agent.

Usnic acid comes from an organism called a lichen. Lichens, in turn, are composed of both a fungus and a bacteria. Commercially, usnic acid is used as a preservative in various creams and even toothpaste.

Other names for usnic acid include Usnea, sodium usniate and Usnea Barbata.

The first case of hepatotoxicity can be traced to a 28-year-old woman in 2004. She was taking usnic acid for weight loss. Unfortunately, this woman required a liver transplant. She was taking 500 mg per day of usnic acid.

Doctors in 2006 described the case of two people – a husband and wife – who developed liver problems after taking usnic acid supplements. The wife needed an emergency liver transplant. Both of these people were taking a multi-ingredient supplement called UCP-1 (which does not appear to be available anymore). UCP stands for uncoupling protein.

UPC is a slick name for a supplement because usnic acid is supposed uncouple (break down) the process how we make energy. This appears to cause liver cell death.

For the record, there is no evidence usnic acid burns fat or helps people lose weight.

Bottom line: thankfully, I don't see usnic acid in most supplements. Always check the Supplement Facts label to make sure.

9 Aegeline

This compound – which comes from the bael tree common to India and other parts of the world – may be found in some weight loss supplements. Other names for Ageline include:

• N-[2-hydroxy-2(4-methoxyphenyl) ethyl]-3-phenyl-2-propenamide
• bael
• golden apple
• Japanese bitter orange

Aegeline has been the focus of several cases of hepatitis, liver injury and reports of liver transplants.  In 2013, the FDA reported on 97 persons with acute non-viral hepatitis who were taking an aegeline-containing supplement called OxyElite Pro. Of those, 47 people were hospitalized. At least 3 of those received a liver transplant, and 1 death was reported. OxyElite Pro no longer contains aegeline, but it may contain Garcinia Cambogia.

Bottom Line: Until more is known, avoid supplements containing aegeline.

10 Black Cohosh

Black cohosh (Cimicifuga racemosa) is a popular herbal supplement for women having menopause symptoms. It can be purchased by itself or it may be part of a supplement containing several ingredients.

To date, there are at least 3 cases of black cohosh implicated in liver failure.

In 2013, a 60-year-old woman needed a liver transplant after taking black cohosh for 6 weeks for menopause issues. Before this, researchers identified 4 other cases where a liver transplant was needed after black cohosh supplementation.

The exact process by which black cohosh promotes liver problems is unknown. It's thought the mechanism of action may be related to the immune system. This reaction is to be individualized. In other words, not everyone taking black cohosh would be expected to have alerted liver enzymes or develop liver damage. Still, identifying who is at risk prior to use is not known.

Bottom line: While reports are rare, if you use black cohosh supplements, get your liver enzymes regularly checked by your doctor.

11 Comfrey

Bottom line: While comfrey can be encountered in various forms such as tea, cream, or supplement, its presence in products appears limited. Notably, within the US market, the utilization of comfrey by supplement companies seems sparse. It's advisable to scrutinize the Supplement Facts label for verification.

12 Chinese Skullcap

In a 2010 report, physicians documented two instances of liver injury following the consumption of a skullcap supplement aimed at alleviating arthritis symptoms (Move Free Advanced). Subsequent to discontinuation of the supplement, liver function improved in both cases. Notably, Move Free Advanced comprises various ingredients, among which Chinese skullcap is included. The medical experts attributed the Chinese skullcap as the primary suspect for the liver issues.

Later, in 2012,  doctors implicated skullcap in the liver injury of a 78-year-old woman who was taking Move Free Advanced for arthritis pain.

Doctors in 2013 reported symptoms consistent with liver damage in a 62-year-old woman taking Move Free Advanced arthritis supplement. Her symptoms improved when she stopped taking the supplement. However, as her osteoarthritis pain began to flair up again, she re-started taking Move Free Advanced. Two weeks later, she again started having liver problems.

Move Free may or may not list skullcap as an ingredient. Some labels refer to something called “Uniflex.” Some product labels I saw mention skullcap as an ingredient in the Uniflex formulation.

Bottom line: Studies have associated Chinese Skull Cap with irregular liver function. If you're utilizing a product featuring this ingredient to manage arthritis and experiencing relief, it's advisable to regularly monitor your liver enzymes for safety precautions.

Supplement Brand Names Linked To Liver Failure

Case reports have mentioned the following brands of supplements as being linked to liver toxicity and liver transplant. This list is not complete and is limited to what I was able to locate via case reports.

Inclusion in this list is not meant to deprecate any brand. Rather, it is intended to serve as a resource for those doing their own research. Links to supporting research are also provided.

• Hydroxycut (iovate health sciences)
• OxyElite Pro (USP Labs)
• Lipokinetx, Syntrax Innovations
• UCP-1 (BDC Nutrition)
• Green Tea Fat Burner (Applied Nutrition)
• Swanson Premium Brand Garcinia Cambogia 5:1 Extract
• SlimQuick (Wellnx Life Sciences USA)
• Herbalife (Herbalife)
• Somalyz and Lipolyz (Species Nutrition)
• Exolise (ArkoPharma-France)
• Rockstar energy drink (Rockstar Inc)
• Move Free (Schiff)
• Move Free Advanced (Schiff)
• Kava 1800 Plus (Eagle Pharmaceuticals)

The shortcomings of this list include:

1. Some of the products in this list may no longer be sold.
2. Some complaints may only be based on one or a few reports.
3. Supplements often contain more than 1 ingredient.
4. Companies may sell a variety of supplements under a brand name.
5. People sometimes take multiple supplements at the same time.

Additionally, because companies might alter the ingredients in their products, there is no guarantee that the products you buy today will have the same effects as those mentioned in the case reports.

The website LiverTox has a searchable database of supplements and drugs that can be toxic to the liver.

Liver Failure Symptoms

Here is a summary of the symptoms of liver failure. If you think you have any of these symptoms, it's best to consult your doctor and/or to the hospital.

Pain in your upper right abdomen region	yellowing of skin or eyes (jaundice)	General feelings of discomfort that you may not be able to identify
Abdominal swelling	Fatigue	Confusion / disorientation
Feeling nautilus or vomiting	Cant sleep	Loss of appetite

Granted, some of these symptoms can be a bit vague and may pertain to many things. More pronounced symptoms of liver failure would include:

• yellowing of the skin or eyeballs.
• abdominal bloating.
• pain in the upper right abdominal region.
• Disorientation /confusion.

Most of us are not doctors, so getting medical treatment is so important. Liver problems can quickly spread to become life-threatening.

How Can I Know My  Supplements Are Safe?

To gauge whether your supplement could be associated with liver issues, consider these guidelines. Start by conducting an online search pairing your supplement with “liver damage.” For instance, if you were using supplement X, you'd search for:

• Supplement X liver damage
• Supplement X liver failure

A search like that may turn up others who are discussing your supplement.

If you want to locate clinical studies/reports on this issue,  add “pubmed” to your search terms. For example:

• Supplement X liver damage pubmed
• Supplement X liver failure pubmed

If you really want to know, consult your physician, pharmacist or dietitian.

You can also search the LiverTox website as well.

I Know What You're Thinking…

Some are going to point out that Tylenol (acetaminophen) is the #1 cause of liver failure in the US – maybe the world. This is true. Compared to Tylenol, the risk of developing liver failure from dietary supplements is much smaller.  Still, for the person who needs a liver transplant after taking a supplement, a small risk or not, it's a significant and life-changing event. 

While I do think most supplements are safe for the liver, always do your homework on what you take. Investigate the supplement AND the company that makes it. Don't assume natural means safe. And remember, not everybody writing about supplements knows what they are talking about.

What Do You Think?