Arun Sanyal, M.D., who heads the VCU Stravitz-Sanyal Institute for Liver Disease and Metabolic Health, recently highlighted a clinical trial involving 800 people that showed promising results for treating fatty liver disease with a weekly dose of semaglutide. Meanwhile, there’s a growing concern among experts about the rise in cases of drug-induced liver injury, often caused by some common medications and supplements. Statistics indicate that since the 1960s, toxic hepatitis, or hepatotoxicity, has been a significant cause of acute liver failure in Western countries.
Research published in Toxicology Reports suggests that about one in five people taking prescribed medications may experience drug-induced liver injury (DILI). Herbal products, dietary supplements, and certain medications have been identified as potential triggers. This risk is heightened for individuals with pre-existing liver conditions, nutritional deficiencies, or those who are pregnant.
The American College of Gastroenterology (ACG) explains that the liver’s main role is to break down substances like supplements and medications. For some, this process is slower, elevating the risk of liver damage. Even FDA-approved medications can sometimes cause liver injury, although such cases are rare. Symptoms to watch out for include nausea, loss of appetite, abdominal pain, itching, dark urine, and jaundice, though some people might not notice any signs.
A study in Toxicology Reports lists drugs most likely to cause liver injury, such as acetaminophen and NSAIDs used for pain and inflammation. Other medications include methotrexate for cancer treatment, corticosteroids for inflammation, and isoniazid for tuberculosis. Additionally, antibiotics like tetracyclines and anesthetics such as halothane are also on the list.
Interestingly, turmeric—a common kitchen spice—is also linked to potential liver toxicity, raising concerns about herbal and dietary supplements (HDS). Fox News’ Dr. Marc Siegel points out the issue with HDS is the lack of strict regulation on active chemical amounts, making it hard to know exactly what’s being consumed. This could explain the increasing incidence of liver toxicity in users.
Between 2004 and 2014, cases of DILI linked to herbal or dietary supplements nearly tripled, according to a 2024 study in JAMA Network Open. Among the culprits identified are turmeric, green tea, ashwagandha, Garcinia cambogia, red yeast rice, and black cohosh. An estimated 15.6 million U.S. adults have used at least one of these products recently.
“The most commonly implicated botanical products in the DILIN (Drug-Induced Liver Injury Network) include turmeric, kratom, green tea extract and Garcinia cambogia, with potentially severe and even fatal liver injury,” the study mentioned. Siegel warns that turmeric may be toxic in large doses despite its natural anti-inflammatory benefits.
Garcinia cambogia is popular for weight loss, but Siegel notes there’s no solid evidence of its efficacy, especially with the availability of new GLP-1 drugs. Red yeast rice, known for statin-like properties, lacks the strict regulation of approved medications. Siegel finds it useful for patients hesitant about statins but stresses the importance of monitoring usage.
Green tea, with its antioxidant properties, is best consumed as a beverage due to its caffeine content. Taking it as an extract could be toxic, according to Siegel. The FDA states it regulates dietary supplements differently from conventional food and drugs, requiring manufacturers to ensure product safety and proper labeling before marketing.
