7 Supplements Linked to Liver Injury: What the Evidence Shows

Seven familiar supplement ingredients or product categories have published reports of liver injury. Some cases resolved after the product was stopped. Others involved liver failure, transplantation or death. That does not make every product dangerous, and it does not mean every reported case definitively proves which ingredient was responsible. It means that a familiar botanical name is not, by itself, evidence of liver safety. [1–13]

The key distinction is between what was reported, how confidently it can be attributed, and what is known about the actual product. That distinction is especially important for multi-ingredient formulas, poorly identified herbs and concentrated extracts.

Important: This article is general education, not medical advice or a diagnosis. Symptoms of suspected liver injury need prompt medical evaluation. Do not deliberately take a supplement again to see whether symptoms recur.

At a glance: seven safety signals

These are case-based signals, not a ranking of how likely each supplement is to harm an individual. Reporting and denominator limitations mean a trustworthy head-to-head incidence comparison cannot be calculated from this table.

1. Ashwagandha

What it is: Withania somnifera, marketed for stress, sleep and general wellness.

A five-patient case series from Iceland and the US Drug-Induced Liver Injury Network described jaundice appearing 2–12 weeks after patients started ashwagandha-containing supplements. Itching, fatigue and abdominal symptoms were common. Liver injury was cholestatic or mixed; four patients had documented normalization of liver tests within one to five months, while one was lost to follow-up. In available tested products, the researchers confirmed ashwagandha, though other supplements were used by some patients. [1]

A May 2026 scoping review synthesized the expanding published case literature, including reports of severe outcomes in susceptible patients. It should not be interpreted as an incidence study: it assembled reported cases rather than tracking all people taking ashwagandha. [2]

What matters: The reassuring safety results of short-term wellness trials do not rule out rare, serious reactions. People with advanced chronic liver disease or cirrhosis should be particularly cautious. [2,3]

For benefits and other safety considerations, see our ashwagandha evidence review.

2. Turmeric and curcumin supplements

What they are: Concentrated products derived from Curcuma longa, often marketed for joints or inflammation.

The US Drug-Induced Liver Injury Network published 10 adjudicated turmeric-associated cases. Five patients were hospitalized and one died from acute liver failure. Turmeric was chemically confirmed in all seven available products tested; three also contained piperine, which can increase curcumin exposure. [4]

Enhanced-bioavailability formulations figure prominently in case reports. However, NIH LiverTox also describes cases linked to ground turmeric powder and turmeric-containing teas. It would therefore be inaccurate to say the risk exists only with black-pepper-enhanced extracts. [5]

What matters: Ordinary culinary use of turmeric does not imply the same exposure as daily concentrated supplementation. A familiar kitchen-spice name does not settle the safety question for a high-dose capsule.

3. Black cohosh

What it is: Products sold as black cohosh (Actaea racemosa), typically for menopause symptoms.

NIH LiverTox identifies more than 50 cases of clinically apparent liver injury associated with products labeled black cohosh. Reported outcomes range from reversible hepatitis to acute liver failure, transplantation and death. [6]

The word labeled matters. Chemical analyses have found that some commercial products contained other Actaea species rather than authentic black cohosh. Meanwhile, controlled trials of authenticated preparations did not demonstrate the same clear liver-injury pattern. [6]

What matters: This is a real safety signal involving marketed products, but identifying the exact causative botanical is more difficult than the product name suggests. Be wary of any claim that every published case definitively proves the toxicity of authentic A. racemosa.

4. Concentrated green tea extract

What it is: Capsule or tablet extracts often standardized for catechins such as epigallocatechin gallate (EGCG).

A US Pharmacopeia safety review examined published reports of liver injury associated with green tea extracts and found sufficient concern to support a cautionary label statement in its Powdered Decaffeinated Green Tea Extract monograph. Research reviewed by USP found that taking bolus doses while fasting can substantially increase EGCG exposure. [7]

That labeling requirement applies to products claiming compliance with the relevant USP standard; it is not an assertion that all green tea supplements must carry identical wording. The evidence does not establish a single exposure threshold that eliminates the risk for every person. [7]

What matters: Drinking brewed green tea and swallowing concentrated catechin capsules are not interchangeable exposures. Do not assume that a botanical beverage's reputation establishes extract safety.

5. Gotu kola

What it is: Centella asiatica, marketed for cognition, circulation and skin health.

A published series described three women who developed jaundice after using gotu kola products, with recurrent liver injury after re-exposure in one patient. NIH LiverTox describes gotu kola as a probable rare cause of clinically apparent liver injury. [8,9]

This evidence base is small. Chemical characterization of the implicated products was incomplete, so contamination or additional ingredients could not be decisively excluded. [9]

What matters: A small number of reports is enough to justify a safety warning, but not enough to calculate an individual's chance of injury or claim that all gotu kola formulations carry identical risks.

6. Chinese skullcap

What it is: Scutellaria baicalensis, a species distinct from American skullcap (Scutellaria lateriflora).

Severe hepatitis has been reported after exposure to formulas containing Chinese skullcap. A 2012 case involved an arthritis supplement that also contained black catechu, glucosamine and chondroitin; the liver injury recurred when the patient restarted the product. The recurrence supports causation by the product, not necessarily Chinese skullcap alone. [10]

A separate 2016 report described acute hepatitis after a Chinese skullcap-and-black-catechu preparation. Other skullcap reports have involved product identification, multi-ingredient formulas or adulteration concerns. [11,12]

What matters: Re-exposure to an implicated formula can be dangerous. In analyzing these reports, ingredient identity and the full formulation are essential, and the presence of multiple herbs limits attribution.

7. Fo-ti (He Shou Wu)

What it is: Polygonum multiflorum, also known as Shou Wu Pian or fo-ti, marketed for hair, vitality and traditional anti-aging uses.

Fo-ti is implicated in numerous reports of acute liver injury, especially from East Asia. NIH LiverTox describes a typical hepatocellular or mixed pattern, cases progressing to transplantation or death, and recurrence upon re-exposure. Some studies associate susceptibility with the HLA-B*35:01 allele, but this is not a routine screening test that predicts a person's safety. [13]

What matters: Long traditional use is not proof of safety. A previous suspected liver reaction is a strong reason not to try the same product again.

How worried should you be?

A report of severe liver injury is not the same as a known high probability of injury. For many supplements, published case reports lack the denominator—how many people used that exact product, at what dose, and for how long—that would allow an individual risk estimate.

Four questions improve the interpretation:

1. Was liver injury medically established? Liver tests, diagnosis and exclusion of competing causes are more informative than an anecdote.
2. Was the precise product verified? The label may not fully identify the botanical species or actual contents.
3. Were other ingredients or medications involved? Attribution is harder in multi-ingredient products.
4. Did symptoms improve after stopping? This can strengthen suspicion, but does not by itself prove causation. Deliberate re-exposure is unsafe.

This is why the seven entries above have different levels of causal certainty despite all appearing in published medical literature.

Warning signs: when to get help

Stop the suspected supplement and seek prompt medical assessment if you experience yellow eyes or skin, dark or tea-colored urine, pale stools, new generalized itching, persistent nausea or vomiting, marked unexplained fatigue, or pain in the upper-right abdomen. These symptoms can have many causes; the point is to evaluate them promptly, not assume the supplement is the diagnosis.

Go to emergency care immediately for severe confusion, unusual bleeding, fainting, or rapidly worsening illness—especially alongside jaundice.

Bring or photograph the original supplement packaging, including ingredients, dose, lot number and any other products or medicines you were taking. This can help clinicians identify possible causes and report adverse events.

What the labels do—and do not—establish

This article does not claim that every manufacturer omits a warning. Product labeling varies by company, formulation, market and date. Proving a specific label omission requires a dated, product-level label review.

The defensible lesson is broader: a natural-sounding label or an absent warning is not a complete account of the clinical literature. The evidence for serious but uncommon harms belongs in the consumer's decision, alongside evidence for any claimed benefits.

Editorial methods and transparency

This article is an owner-authorized, AI-assisted scientific safety synthesis, grounded in the 13 NIH monographs and peer-reviewed reports listed in its references. Sources were checked on October 11, 2026. It is not a product-label audit, a prospective incidence study or a substitute for medical care. No clinician or independent human scientific reviewer is claimed. We distinguish case reports, case series and expert safety syntheses, and note ingredient-attribution limitations wherever they matter.

Bottom line: You do not need to panic about a supplement you already use. You do need accurate information about its composition, the quality of evidence, and the symptoms that should prompt medical evaluation.