Supplement use has grown over the past decade, with an increasing number of people interested in wellness and holistic care. From boosting your immune system to supporting mental health, many dietary and herbal supplements claim to benefit the body and mind – but can supplement use actually damage your liver?

“The proportion of liver toxicity cases that we’re seeing due to supplements is increasing but still rare, so we shouldn’t panic,” says Dr. Robert Brown, chief of Gastroenterology and Hepatology at NewYork-Presbyterian and Weill Cornell Medicine. “Not everyone who takes a supplement is going to have a problem, but consumers should be attentive to everything that we put in their bodies to make sure that it’s safe.”

Because the liver is responsible for metabolism and detoxification, any medication or drug that’s toxic will tend to exert its toxicity in the liver first, Dr. Brown says. “It’s up to the consumer in conjunction with their doctors to monitor their supplement use and liver enzyme levels.”

Health Matters spoke with Dr. Brown about whether supplement use can harm your liver, which supplements pose more risk, and how to safely monitor your liver health with your doctor.

Can supplements damage your liver?

Dr. Brown: The liver’s job is to metabolize all the foods you eat and figure out what doesn’t belong, like bacteria and viruses. Cells in the liver metabolize medications and drugs, and immune cells help determine what is safe. The liver is the most common place where you’re going to see toxicity from medications and supplements. This could be why evolutionarily, the liver is such a large organ and able to regrow so that if it does get toxicity, it can regenerate.

Supplements are not regulated the same way as medications, so there may be ingredients included that buyers are unaware of. Everyone is susceptible to all bioactive compounds at some level, and the liver’s reaction can vary from person to person. What causes a reaction in you may not cause a reaction in me, and that has to do with genetics, with other medicines we’re taking, with the enzymes in our liver and their activity or lack thereof, and individual susceptibility to injury.

What are commonly used supplements that can be linked to liver damage?

Commonly used supplements linked to liver damage include some weight-loss formulas, as they often contain ingredients like kava, which has been linked to liver injury.

Ironically, many people also take specific supplements like turmeric for liver cleansing and liver health, but turmeric in high doses can cause liver toxicity. Many supplements have multiple ingredients, which can make it difficult to study and pinpoint possible side effects.

Examples of commonly used supplements that have been linked to potential liver damage include:

• Kava
• Turmeric
• Ashwagandha
• Black cohosh
• Red yeast rice
• Green tea extracts

What are some symptoms of liver damage?

Many people can be asymptomatic for a long time, during which time only a blood test would reveal that their liver is inflamed.

If liver damage progresses, symptoms can include:

• Itching
• Jaundice, or yellowing of the skin
• Dark urine

In severe cases, the damage can progress to liver failure, requiring a transplant.

How do you diagnose and treat liver damage?

The most common way to diagnose liver damage is through a liver function blood test, which can be used to monitor possible side effects of medications. Alanine transaminase (ALT) and aspartate transaminase (AST) tests look for these specific enzymes that may indicate toxicity or inflammation.

People often aren’t just taking one kind of supplement, so trying to figure out the offending factor can involve a process. With my patients, I recommend stopping any medication or supplement that’s known to be toxic and see if symptoms cease. Typically, the liver can repair itself without any consequence depending on how long the supplement has been used. We reassess and over time, return to a regimen we deem safe.

What do you want people to know about supplement use and liver health?

We have to work on both sides: Physicians have to be more aware of supplement use and be safely supportive of patients who want to take supplements that may help them. I also encourage people to be open with their doctor. Oftentimes, patients may not disclose supplement use because they feel it’s not important information, that supplements are harmless, or that they’re going to be judged by their doctor. But I encourage people to be honest with their physician about the supplements that they’re taking so their provider can safely monitor their liver health.

Whenever I prescribe a medication that has potential liver toxicity, I monitor a patient’s liver function after starting because most changes occur in the first three months. Unlike prescribed medication, when you buy a supplement, your physician is not in the loop, and potential drug interactions and adverse effects aren’t known.

In general, a healthy balanced diet will contain enough antioxidants to support your body, so additional antioxidant support might not be needed. And for those seeking supplements for a liver detox, the liver can heal itself, and the extra supplements may not be necessary. But many of us struggle with things like healthy eating, and may experience lifestyle changes, so it isn’t always as simple as just telling someone to eat better and exercise more. So we need to work together to find strategies and acknowledge that patients may want to explore alternative forms of medicine if they choose, and as providers, we can and should monitor them safely.