6 Popular Supplements That Can Damage Your Liver

Research finds herbal pills marketed for menopause symptoms, joint pain and heart health may do more harm than good

Jessica Migala, AARP

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En español

Published April 03, 2025

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AARP Staff

If you’re like nearly 80 percent of older adults, chances are, you took a supplement today. Maybe it’s an insurance policy if your diet doesn’t cut it. Maybe it’s because you have joint pain and you want to ease the ache. Whatever your reason, the overarching goal is probably not to damage the liver. Unfortunately, the reality is that many popular supplements can do just that — and little else — causing repercussions as severe as liver failure.

While there are several categories of supplements, including multivitamins, single-nutrients (such as omega-3s, vitamin D or calcium), and herbals (also called botanicals), it’s the herbal supplements that pose the biggest risk for liver damage. About 5 percent of U.S. adults — that’s 15.6 million people — took potentially liver-damaging botanical supplements within the last month, according to a study published in 2024 in JAMA Network Open, with middle-aged and older adults being some of the most likely groups to do so.

In the study, six specific botanicals were singled out because data from the Drug-Induced Liver Injury Network identified them as the ones that are most likely to be associated with liver toxicity. These six supplements include:

Ashwagandha
Black cohosh
Garcinia cambogia
Green tea extract
Red yeast rice
Turmeric/curcumin

Researchers found that older individuals were more likely than younger populations to take these botanicals – and it’s not difficult to understand why. Turmeric/curcumin is often promoted to ease joint pain from arthritis, which affects roughly half of adults 65 and older, and black cohosh is marketed for menopause symptoms. Red yeast rice is taken to lower cholesterol levels and improve heart health, two leading health concerns among older adults.

While the six supplements above may be the ones most often implicated in liver injury, according to this study, far more fit in this category. About 1,000 medications and herbals are associated with liver damage, research suggests.

How supplements can harm the liver

A hardy organ, the liver is the body’s clearing house. “Pretty much anything you ingest has the potential to be toxic to the liver,” says Don Rockey, M.D., a professor of medicine at the Medical University of South Carolina and an American Liver Foundation volunteer expert. “Everything you consume goes into the [gastrointestinal] tract, is absorbed, and the first place it goes is the liver,” he explains.

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Hepatocytes — the main type of cells in the liver — detoxify your body, but they can be damaged. Two common substances that are toxic to liver cells include alcohol and high doses of acetaminophen.

Botanicals also fit into this category, even though they are often considered safe because they are natural. “Natural compounds still need to be processed by the liver, and, in some cases, can cause very severe liver injury and damage,” says Arun Jesudian, M.D., a transplant hepatologist at Weill Cornell Medicine and NewYork-Presbyterian in New York City.

Age can contribute to the problem. Age-related changes in the liver make the organ less resilient to stress and less effective at metabolizing substances, resulting in potentially more damage.

Liver damage can be acute or build up over time with repeated use, the latter being what typically happens with botanicals. “Some substances, including supplements, can cause liver injury in unpredictable ways, and it’s not always dependent on how much you’re taking,” Jesudian says. Damage can range from inflammation in the liver to liver failure requiring emergency liver transplant, he says.

It’s not just the main ingredient in a supplement that can cause damage. Supplements can be toxic to the liver (hepatotoxic) because they are contaminated with things not listed on the label, such as medications, molds and heavy metals. That’s a huge concern: Earlier research published in Hepatology Communications analyzing 272 dietary supplements found that 51 percent were mislabeled, meaning their contents did not match their labels. That makes it more difficult to understand exactly what is causing liver toxicity.

All of that is made more complex by how supplements are handled in the U.S.

Dietary supplements are not regulated by the U.S. Food & Drug Administration (FDA) the way prescription and over-the-counter medications are. According to the FDA, supplement manufacturers and distributors are responsible for ensuring that what’s in the bottle is safe and accurately labeled. If there is evidence that it’s not, the FDA can step in to issue warnings and take other actions against a mislabeled or potentially dangerous supplement. But this happens after it’s on the market — not before.

Tips for staying safe with supplements

If you’re going to take a supplement, there are some steps you can take to help keep you safe.

1. Research. Doing some research is a key first step—just be sure you’re using a trusted source. According to the Centers for Disease Control and Prevention (CDC), older adults often use social media as a source of health information, and unfortunately, information found there is often misguided or incorrect. One resource to check out when researching supplements is the LiverTox database from the National Institute of Diabetes and Digestive and Kidney Diseases. The website provides information on medications and supplements and their effects on the liver. But your research shouldn’t stop there, which brings us to step number two…

2. Talk to your provider. This is, by far, the most important thing you can do. “Discuss a supplement that you’re thinking of taking with your doctor before you start taking it, particularly if you have any type of liver condition,” Jesudian says. If you are already taking a supplement, bring the bottle into your provider’s office to show them, and ask what they think, if it’s safe, and if it offers added value for your health. “If there is no benefit, there is no sense in adding risk,” Rockey says. The authors of the 2024 JAMA Network Open study note that “the vast majority of at-risk botanical users” took the supplements without consulting a health care provider.

3. Be careful with herbals. Rockey tells patients that supplements like vitamins or minerals (or multivitamins) are generally safe, though you should still purchase these from reputable brands. “When you start buying herbals, especially online and taking them in high concentrations, you have to be careful,” he says. That’s especially true when a product contains multiple botanical ingredients, making it tough to know exactly what you’re getting in the mix or how they will affect you.

4. Look for third-party testing. Research suggests there are 80,000 herbal and dietary supplements on the market. With concerns about contamination and mislabeling, choose a product with independent, third-party testing from organizations like the NSF or USP. The certification helps ensure that what’s on the label matches what’s in the bottle and that there are no additional hidden ingredients in the formula.

5. Skip liver supplements entirely. Some herbal supplements are marketed for liver health or liver detox. “There is no evidence that any supplement is ‘good’ for your liver. The best thing for your liver is a healthy diet and lifestyle,” Rockey says. At the very least, these are a waste of money, he adds.

6. Get regular blood work. If you’re getting blood work to assess your health, make sure that it includes a liver function test. If this test shows elevated liver enzymes and there is a concern for liver damage due to a supplement you’re taking, you should stop taking that supplement, says Alisa Likhitsup, M.D., a clinical assistant professor of medicine at the University of Michigan Health and lead author of the JAMA Network Open study.

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