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Could Supplements Be Harming Your Liver?

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Close-up of a woman's hand holding a vitamin capsule

Many people turn to herbal and dietary supplements to boost health, fill in nutrient gaps in their diet or enhance energy or athletic performance.

“More and more people are taking supplements, and more products are coming on the market every day,” says Jacob Wolf, ND, LAc, Dipl. OM, a naturopathic doctor and acupuncturist with expertise in dietary supplements and herbal medicine at University Hospitals Connor Whole Health. People may assume supplements are safe, but along with any benefits they may offer, supplements come with health risks, including possible harm to the liver.

How Risky Are Supplements for Your Liver?

The liver helps the body in hundreds of ways, including clearing toxins from the blood, removing old red blood cells, making bile to help with digestion, metabolizing carbohydrates, proteins and fats and storing glycogen for the body to use later.

Considering how many people take herbal or dietary supplements (more than half of U.S. adults) and the amount of supplements on the market (over 90,000), liver damage from supplements is not very common, says Wolf. But as supplements grow in popularity, supplement-related liver injury is increasing proportionally. About 20 percent of liver damage results from taking supplements.

The Most High-Risk Supplements

The makers of supplements don’t need to prove to the Food and Drug Administration (FDA) that they’re safe or effective, or even that they necessarily contain the ingredients listed on the label. Studies have found mislabeling to be a significant problem with supplements. “Supplements are not regulated like prescription medications,” he says. “And many supplements are very low quality.”

The supplements that pose the highest risk to the liver are usually those made by companies with poor quality control, says Wolf. A high-quality supplement producer will do rigorous evaluations to make sure their product contains the right amounts of the right ingredients and that it doesn’t contain harmful levels of heavy metals, pesticides or other substances or contaminants.

Supplements most commonly associated with liver damage are:

  • Bodybuilding supplements, including anabolic steroids
  • Herbal supplements, such as green tea extract and turmeric (if in a high dose or highly bioavailable form), kratom, black cohosh, and Chinese, Korean and/or Ayurvedic multi-herb supplements produced with poor quality control
  • Certain vitamins and minerals, like niacin and multivitamins formulated with added herbs

“Bodybuilding supplements are consistently the biggest offenders,” says Wolf. “Products like these that combine two or more ingredients are potentially riskier because there’s a greater chance of contamination or adulteration of the ingredients.” There is also an increased risk of interactions between the herbs in the supplement and other supplements or medications a person might be taking, he says.

How Supplements Can Harm the Liver

Supplement-related damage to the liver can vary, depending on the supplement, strength and person. “The onset can occur within days or up to years after starting or continuously using a supplement,” says Wolf.

The role the liver plays in filtering and eliminating substances from the body makes it vulnerable to harm from supplements. “Certain medications, foods and herbs can change the way the liver processes substances and cause it to detoxify substances faster or slower, which can result in harm,” he explains. “Some nutrients are also directly toxic to the liver, or they can become toxic while the liver is working to process them.”

Signs of Liver Damage

Symptoms can vary, based on the severity of the liver injury. If mild, you might not notice any symptoms. The first signs could be elevated levels of AST, ALT, bilirubin and alkaline phosphatase in lab results from routine blood tests, says Wolf.

Additional symptoms may include:

  • Fatigue
  • Pain in the upper right stomach area
  • Swollen belly
  • Nausea
  • Vomiting
  • Itchy skin
  • Jaundice or yellowing of the skin or eyeballs (a sign of more advanced damage)

Who May Be at Increased Risk?

If you already have liver disease, it potentially puts you at greater risk of liver damage from supplements. Other factors that could raise your risk include:

  • Heavy alcohol use
  • Taking multiple medications
  • Taking medications known to be harmful to the liver (such as stavudine, erlotinib, lenalidomide, thalidomide, chlorpromazine, metronidazole, prochlorperazine and isoniazid)
  • Overuse of amoxicillin-clavulanate (a combination of the antibiotic amoxicillin and clavulanic acid used to treat bacterial infections) or acetaminophen (Tylenol)
  • Age
  • Genetic makeup
  • Certain diseases and viruses (like hepatitis or Epstein-Barr)

Should You Take Supplements?

For most adults, a well-balanced diet of lean proteins, whole grains, fruits and vegetables should provide the daily recommended amounts of vitamins and nutrients. If you’re not able to eat a healthy diet regularly or your lab levels show you’re low in certain vitamins or nutrients, supplements may help. You may also be interested in taking supplements for other reasons, like improving your health, building muscle, boosting immunity or as a preventive measure against certain symptoms or conditions.

“During my initial visit with a patient, I always review all supplements they’re using and evaluate them for quality, purity and dose,” says Wolf. “Many patients self-prescribe products that are not necessary.” In such cases, he advises discontinuing those supplements. “If supplements are needed, I’ll prescribe an exact brand, dose and frequency, and make a recommendation for how long they should be taking it,” he says. If necessary, follow-up testing can be done to help ensure safety and optimize dosages.

Many people do not consult with their doctor before starting supplements, but Wolf strongly recommends discussing it with your healthcare provider first. They can help you understand whether the supplement is necessary to help you meet your goals.

Either way, Wolf says, it’s best to purchase supplements directly from the manufacturer, if possible, or from well-known suppliers. “I do not recommend buying from Amazon due to quality control concerns,” he says. When choosing supplements, you can also look for a seal of quality on the supplement label from organizations like ConsumerLab.com, NSF International or U.S. Pharmacopeia (USP). The seal doesn’t necessarily mean the product is effective, just that it’s been evaluated for quality production.

Related Links

It’s important to talk to your doctor about the benefits and risks of all dietary supplements before adding them to your regimen. At University Hospitals, our primary care providers, clinical dietitians, and integrative health experts can recommend which supplements are most likely to benefit your overall health.

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