The supplement industry is booming, and many are leaning towards herbal ones, hoping they are safe, because they are ‘natural’. But does natural mean they are safe for your health? Well, not really. People across the globe consume supplements, and a recent study found that many contain potentially harmful natural ingredients.
A study by the researchers at the University of Michigan found that millions of people consume supplements that contain potentially hepatotoxic botanical ingredients. The findings are published in the journal
JAMA.
Herbal supplements and liver damage
This study dug deeper into the breadth of consumption of herbal supplements, which were previously shown to be potentially toxic to the liver. They found that millions of Americans consume herbal supplements that are toxic to the liver.
The researchers analyzed data from the National Health and Nutrition Examination Survey conducted between 2017 and 2020. Over a 30-day period, 4.7% of surveyed U.S. adults reported taking supplements containing at least one of six botanicals of interest:
- turmeric
- green tea
- ashwagandha
- black cohosh
- garcinia cambogia
- red yeast rice
Explaining the paper
Estimated Exposure to 6 Potentially Hepatoxic Botanicals in US Adults, the lead author, Alisa Likhitsup, M.D., M.P.H., the clinical assistant professor of Medicine at U-M, said, “Our interest started when we saw cases of liver toxicity from herbal and dietary supplement use in people enrolled in the ongoing NIH-funded DILIN study.”
The number of people taking these supplements was shocking. “But it was difficult to say how many people were using these supplements and why. The major finding here is the large number of Americans taking these products with an estimated 15 million adult Americans taking them on a regular basis,” Likhitsup added.
Not all supplements are safe
While supplementation is often used to compensate for the deficiency of nutrients in the body not all are safe. Previous studies have shown that certain botanicals can potentially cause liver damage.
The lack of government regulation, insufficient attention to medical screenings, and frequent mislabeling are some other concerns related to supplements.
“In a previous study, we found that there was a great deal of mislabeling of some of these products,” Robert Fontana M.D., Michigan Medicine hepatologist, professor of medicine and the study’s senior author, said.
“We performed analytical chemistry and found about a 50% mismatch between stated ingredients on the label and what they actually contained, which is quite alarming. If you buy a supplement and it says it has a certain ingredient, it's basically a coin flip if that’s true or not,” Fontana added.
The lack of regulation in the supplement industry leads to mislabeling. And since their effects are not well understood, clinicians often will not ask patients what supplements they are taking.
“We weren't aware that so many people were taking these supplements. So, when doctors see patients in the office, they don't necessarily ask about supplement use or take into consideration their effects,” Likhitsup, a transplant hepatologist stressed.
What they found
The researchers found that most of the people take supplements containing turmeric (3.46%), followed by green tea (1.01%), ashwagandha and black cohosh (0.38%), garcinia cambogia (0.27%), and red yeast rice products (0.19%), in the studied population.
What’s more concerning is that most of the participants of the study reported that they take these botanicals without the advice of a doctor.
Most of the participants took the botanicals either to improve or maintain health. Of the turmeric users, 26.8% consumed the products specifically for supposed benefits for joint health or arthritis, while 27.2% of the green tea users were hoping to improve their energy levels.
People who took garcinia cambogia hoped it would help them lose weight.
Boom of herbal supplements
The researchers also found that there is a boom in the supplement industry, particularly among herbal products. There are more than 80,000 unique supplement products available for purchase worldwide and that supplement sales surpassed $150 billion in the United States in 2023, a figure that rivals the combined sales of prescription drugs.
Another study found a 70% increase in liver transplants due to injury caused by supplements from 2010 to 2020, compared to 1994-2009.
This study was, however, not able to establish any kind of causal relationship between consumption of the six botanicals and liver injury since it was intended to assess supplement exposure in the general US population.
Since these supplements are not well regulated, the researchers are hoping to make clinicians and patients aware of just how much is still unknown about these supplements.
“We're not trying to create an alarm. We're just trying to increase awareness that the over-the-counter supplements people are taking and buying have not been tested nor necessarily proven to be safe,” Fontana said.
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