How common is liver injury from supplements?
Uncommon for any single person, but a growing share of the cases liver specialists see. The U.S. Drug-Induced Liver Injury Network enrolled people with suspected drug-caused liver injury at eight referral centers from 2004 to 2013. In its 2014 report in Hepatology, 130 of 839 cases, or 15.5%, were judged to be caused by herbal and dietary supplements, and the supplement share rose from 7% to 20% over the study period.
The pattern split in two. Bodybuilding supplements caused prolonged jaundice in young men, with a median of 91 days, but no deaths or transplants. Other supplements caused injury mainly in middle-aged women and were more likely than medicines to end in death or transplant, 13% against 3%.
Which supplements are most often involved?
Three categories come up again and again.
| Supplement type | What the evidence shows |
|---|---|
| Green tea extract | Liver injury is uncommon but reported, mainly with extract tablets or capsules |
| Bodybuilding products with steroids or steroid-like ingredients | Serious liver injury in young men, often with high liver enzymes |
| Highly absorbable turmeric or curcumin | Liver damage reported with bioavailable formulations |
Green tea extract. The National Center for Complementary and Integrative Health says liver injury, though uncommon, has been reported mostly with green tea extracts in tablet or capsule form. People with a specific immune-related gene variant, carried by 5% to 15% of Americans, appear especially susceptible.
Bodybuilding products. An FDA review of adverse event reports from mid-2009 to 2016 found 35 cases of serious liver injury in men aged 20 to 48 who used products labeled or suspected to contain steroids or steroid-like substances. Most involved elevated liver enzymes.
Turmeric and curcumin. NCCIH’s turmeric page warns that highly bioavailable curcumin formulations, made to boost absorption, may harm the liver, and that liver damage has been reported with them.
A supplement label is not a safety review. As the FDA explains, the companies that make and sell supplements are responsible for evaluating their safety and labeling before marketing.
Which blood tests catch liver injury?
Standard liver tests do. MedlinePlus lists ALT, AST, alkaline phosphatase, GGT, bilirubin, albumin and total protein among the usual liver function tests. ALT and AST rise when liver cells are injured, and bilirubin climbs when the liver cannot clear it, which is what turns skin and eyes yellow.
One caution for men who lift: heavy training can raise AST and ALT for days without any liver problem, so mention your last hard session. Our answer on working out before a blood test explains the timing, and our ALT and AST liver enzymes page covers the ranges.
What symptoms mean you should stop and call?
NCCIH advises stopping turmeric or curcumin products and talking with your provider if you notice fatigue, nausea, poor appetite, dark urine or jaundice. The same advice fits any supplement. MedlinePlus adds abdominal swelling or pain, light-colored stool and itching to the list of liver warning signs.
Some signs cannot wait. Yellow skin or eyes with confusion, severe abdominal pain, vomiting blood or extreme drowsiness need emergency care: call 911 or go to the nearest emergency room.
Related question: is a supplement safe if it is sold as natural?
Not automatically. Natural ingredients can still injure the liver, as green tea extract and turmeric show, and the bodybuilding cases above involved products labeled or suspected to contain steroid-like substances. Our answer on whether testosterone boosters work looks at one popular category, and our article on SARMs and FDA warnings covers another.
How Ultimate Male checks your liver
Bring every supplement you take to the first visit, including powders and pre-workouts. The liver and kidney function panel checks the standard liver markers in one same-day draw, and the comprehensive panel includes the same through its metabolic panel.
A PA-C or MD reads the numbers with your supplement list and training in mind, so a lifter’s muscle-driven AST is not confused with liver injury, and a true liver signal gets a clear next step. If something looks wrong, the provider explains which product is the likely culprit and when to recheck. Explore the full range of preventative blood testing.
