One of the biggest misconceptions when it comes to supplements is thinking natural equals safe. That's just not true. While there are definitely some good supplements, there are many things that can be dangerous – even though they are natural. In this review, I want to highlight an unfortunate trend I've noticed. Liver toxicity and liver failure caused by dietary supplements. Some people have even died. The supplements I'm referring to are not just fringe products. Some of the culprits are popular supplements you may have heard of – or taken. Many 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, let me know by leaving a comment below.
Before We Get Started…
The first thing I want say is 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 liver failure caused by supplements for many years. Unless you are looking for it, you might not be aware this is happening.
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 its 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 thing on this list…
Garcinia cambogia, is a very popular weight loss supplement but I cannot recommend . Over the years there have been several cases of liver failure associated with garcinia cambogia. In many of the reports, a specific garcina-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 liver transplant. Here they are:
- Hydroxycut hepatotoxicity (2010)
- Hydroxycut(®) (herbal weight loss supplement) induced hepatotoxicity: a case report and review of literature (2010)
- Hepatoxicity associated with weight-loss supplements: A case for better post-marketing surveillance (2009)
- Hydroxycut hepatotoxicity: A case series and review of liver toxicity from herbal weight loss supplements (2008)
- Two patients with acute liver injury associated with use of the herbal weight-loss supplement hydroxycut (2005)
Because Hydroxycut contains several ingredients, I, at first, wondered these reports might be due to a combination of several ingredients or some other ingredient. However, 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 garcina 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: I believe garcina cambogia is a scam weight loss product. I believe its more hype than proof. Regardless of how you feel about its weight loss properties, its potential for liver injury makes it too risky for my tastes.
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, case 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 of the 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 to say the last.
At least one study has pointed to green tea to liver failure in the case of a 16 year old boy. The product he was taking contained several other ingredients and 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: while I like to put green tea in my smoothies, when it comes to dietary supplements, I would steer clear of them.
Vitamin A was the first vitamin discovered (that's why its called “A”). Like all of the micro-nutrients, vitamin A is critical for being healthy but too much might not be so. When taken in excess, vitamin A can be very damaging to the liver.
Doctors in 2006 reported on a 60 year old man who needed a liver transplant after taking high doses of vitamin A. This man was taking 500,000 IU of vitamin A for 4 months after which he cut back to 100,000 IU for the next 6 months. Obviously this is far more than the RDA and can result in cirrhosis of the liver. One of the other side effects of super high doses of vitamin A is hair loss.
Researchers in the 1990s, looking at 41 cases of vitamin A liver toxicity, noted the smallest daily dose that might lead to liver cirrhosis was 25,000 IU taken over the course of 6 years. Taking 100,000 IU per day for 2.5 years resulted in similar outcomes.
Those who think toxicity is unlikely, should remember that vitamin A is highly regarded as an “eye-health nutrient.” Given that eye problems become more apartment with aging and because the US population is growing older, I can see how some seniors might seek out this nutrient. Vitamin A is readily available in every health food store in the US.
Bottom line: be careful with vitamin A supplements. Its potential to be liver toxic is why most multivitamins contain beta-carotene instead of vitamin A.
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 vasodialator, it may also be found in some pre-workout and male enhancement supplements. That said, niacin can be a double edged sword due to it's liver enzyme raising effects. Over the years, there have been reports of niacin-induced liver failure too.
Doctors in 1987 reported on a 46 year old man who developed liver failure after taking niacin for his high cholesterol problems. He was taking 3 grams of niacin per day. After 1 month, he started having liver problems.
Another report, from 1991, details liver failure in a 56 year old male who was taking 500-1000 mg of niacin per day for cholesterol problems. This man eventually died, but his emphysema likely played a role in this.
In 2014, a 17 year old male developed liver failure after taking niacin supplements in an attempt to mask drug test results. The amount of niacin he was taking was not mentioned. The person in this report was also in an alcohol treatment center so obviously, it's possible his past problems with alcohol may have made him susceptible to the effects of niacin.
Bottom line: niacin is an important vitamin but people should not self medicate to lower cholesterol. It should be used in conjunction with a doctor who can monitor liver enzymes. 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.
Kava, also called “Kava Kava” or Piper methysticum is sometimes used for 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 like all natural medicines, there are thousands of compounds that might have effects.
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 occasional use of Tylenol (a known liver toxin). She was taking 240 mg of kava per day. While the transplant was successful, 6 months later, the women died from a fungal infection. Might her death be related to the anti-rejction drugs she took after transplant to suppress her immune system? It's speculation on my part.
That same year, a 56 year old women died from liver failure after taking kava supplements prescribed by her natropathic doctor. She was taking Kava for 3 months prior to having symptoms of liver problems. While a donor liver was found, she unfortunately died during the transplant.
Researchers in 2003 highlighted 36 cases of kava-induced liver toxicity, of which 8 people needed a liver transplant. Three of those getting transplants later died.
Bottom line: Don't use kava supplements. It's sale is banned in countries such as the UK and France. Kava is available in the US and at various online websites. Fortunately, its not often used in multi-ingredient products. Always check to make sure.
Conjugated Linoleic Acid
Conjugated linoleic acid (CLA) is a popular weight loss supplement with conflicting evidence if it works or not.
In 2009, a 46 year old women in Portugal was admitted to the hospital with signs of liver failure. The woman showed no signs of any other medical issues which would cause this problem. She did admit to taking CLA supplements for 2 weeks before going to the the hospital. Fortunately, after she stopped taking CLA, her liver returned to normal. This is often said to be the first case of CLA-induced liver failure ever reported.
Unfortunately the next case did not end as well.
In a 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 3 more weeks before going to the hospital. She took no other supplements and was not a drinker or had any other habits which 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 damming evidence than some other supplements listed here. Given the number of people who have used this supplement, I think the risk is low but because the potential for liver transplantation, CLA cannot be recommended.
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 3-18 weeks after using germander. Liver issues cleared up after stooping the supplement. Three of the people eventually went back to using germander, after which their liver problems 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 using it.
Like germander above, usnic acid is rather obscure, as supplements go, but 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 a preservative in various creams and even toothpaste.
Other names for usnic acid include Usnea, sodium usniate and Usnea Barbata.
The first case of heptatoxicity 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 seem 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.
This compound – which comes from a tree common to India and other parts of the world – may be found in some weight loss supplements. Other names for aegeline include:
- N-[2-hydroxy-2(4-methoxyphenyl) ethyl]-3-phenyl-2-propenamide
- 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 ageline-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 does contain garcinia cambogia. See the garcina section above.
Bottom Line: Until more is known, avoid supplements containing aegline.
Black cohosh (scientific name, Cimifuga racemosa) is a very popular herbal supplement with 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. Prior to this, researchers have identified 4 other cases of where a liver transplant was needed after black cohosh supplementation.
The exact process by which black cohosh appears to promote liver problems is not known. 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: If your going to use black cohosh supplements, make sure you regularly get your liver enzymes checked by your doctor.
While some regard this for its anti-inflammation properties, it's unlikely most in the US will see comfrey (Symphytum officinale) in supplements due to the FDA advising companies against using it. The FDA has stated that compounds in comfrey (called pyrrolizidine alkaloids) are thought to be toxic to the liver and may cause cancer.
Bottom line: while comfrey may be found as a tea, cream or supplement, I have not seen many products containing this ingredient. I'm not aware of any supplement in the US using this in their products. Always look at the Supplement Facts label to double check.
Chinese skullcap (Scutellaria baicalensis ) is sometimes used in arthritis supplements. Recently, reports have hinted skullcap may be toxic to the liver.
In one report doctors in 2010 reported two cases of liver damage after taking a skullcap supplement for arthritis (Move Free Advanced). In both cases, liver problems got better after the people stopped taking the supplement. Move Free Advanced contains a combination of ingredients including Chinese skullcap. These doctors stated Chinese skullcap was the “most likely cause” of the liver problems.
Later, in 2012, doctors implicated skullcap in the liver injury of a 78 year old women 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.
As her osteoarthritis started hurting again, the 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. Many labels I saw made reference to something called “Uniflex.” Some product labels I saw mention skullcap as an ingredient in the Uniflex formulation.
Bottom line: case reports link Chinese skull cap to abnormal liver functioning. If you use a product containing this ingredient and its helping your arthritis, you may want to regularly have your liver enzymes checked just to be safe.
Brand Names Linked To Liver Failure
Case reports have mentioned the following supplements as being linked to liver toxicity and liver transplant. This list is not complete and limited to what I was able to locate via case reports.
Inclusion in this list is not meant to deprecate any brand. Rather, the intention is to serve as a resource of 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:
- Some of the products in this list may no longer be sold
- Some complaints may only be based on one or few reports
- Supplements often contain more than 1 ingredient
- Companies may sell a variety of supplements under a brand name
- People sometimes take multiple supplements at the same time
Also, because companies might alter the ingredients in their products, there is no guarantee products you buy today would have the same effects as mentioned in the case reports.
The website LiverTox has a searchable database of supplements and drugs which 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, it's best to go to 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 -like inability to sleep or feeling fatigued – can be a bit vague and pertain to many things. More pronounced symptoms of liver failure would include:
- yellowing of the skin or eyeballs
- abdominal bloating
- pain the upper right abdominal region
- Disorientation /confusion
Most of us are not doctors and so this is why getting medical treatment is so important. Liver problems can quickly spread to becoming life threatening.
How Can I Know My Supplements Are Safe?
There are thousands of supplements on the market. How can you tell if your supplement might be linked to liver problems? Here are a few tips. The first thing is to do an online search for your supplement and “liver damage.” For example, if you were taking supplement X, you would 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 / case 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, just ask a pharmacist or registered dietitian. They can often give you the scoop right on the spot.
I Know What You're Thinking…
After reading this, some are going to point out that Tylenol (acetaminophen) poisoning is the #1 cause of liver failure in the US – maybe the world. This is true. Compared to Tylenol, the risk of developing liver problems from dietary supplements is much smaller. I get that and I agree. Still, for the person who needs a liver transplant after taking a supplement, small risk or not, it's a significant and life changing event.
While I do think most supplements are liver-safe, always do your homework on what you take. Don't assume natural means safe and remember, not everybody writing about supplements on the web knows what they are talking about.