By Hayden Stutz, Student Pharmacist and Karen L. Kier, Pharmacist
On behalf of ONU Healthwise Pharmacy 

To sow a seed of doubt means to cause someone to have doubts, worries, or concerns.  The sower of the seed conveys that someone is planting information into your head, creating doubt. A recent study may be planting a seed!

Within the United States, there is an increase in the use of dietary/herbal supplements. A study in JAMA Network Open evaluated dietary and herbal supplement use in the United States. They conducted a survey with 9685 participants. Of those who participated, 57.6% have taken an herbal supplement in the past 30 days. The researchers identified 4.7% were taking one of the six potentially dangerous herbals known to cause liver damage. 

Companies producing dietary/herbal supplements do not have the same rules as prescription drug manufacturers. This is because supplements are considered food, not drugs, and are not intended to prevent or treat diseases. Since these are under food, the FDA categorizes them as generally safe while the companies’ manufacturing them are not required to verify the ingredients in the products. 

Some of these may not follow good manufacturing quality standards and they can contain unclaimed (not on the label) ingredients. They can even contain undeclared prescription drugs within the supplement itself. There are over 80,000 supplements on the market in the United States and it is difficult for the FDA to inspect all of them for quality and for accurate labels.

While marketed to be helpful, sometimes supplements can cause harm. This study identified six herbal supplements with the potential to injure the liver. The six supplements of concern are curcumin (active ingredient in turmeric), green tea extract, ashwagandha, Garcina cambogia, black cohosh, and red yeast rice.

These six herbal supplements make up more than 20% of liver injury cases caused by supplements. Liver injuries from supplements can be severe or even deadly. Signs and symptoms of liver damage include nausea, lack of appetite, tired feeling, dark yellow urine, itching skin, and yellowing of the eyes or skin.  In the United States, this liver damage is tracked by the Drug Induced Liver Injury Network (DILIN). In addition to these 6 supplements, the DILIN warns about the use of kratom and potential liver damage. 

Curcumin (turmeric) is relatively safe in lower doses, but can cause liver damage when combined with black pepper (piperine) and other medications both prescription and over the counter drugs. The risk is even higher in individuals with a known genetic risk for liver disease. The greatest concern is with supplements labeled as highly purified forms of curcumin.  

Green tea extract is a highly concentrated form of green tea containing the compound epigallocatechin-3-gallate (EGCG). High doses of supplements with an EGCG component have caused significant liver damage.  Green tea beverages and products are considered safe if they do not contain EGCG. Green tea extract can be found in products promoted for weight loss and improving energy.  

Ashwagandha is broken down into an active ingredient called withanone.  The withanone causes liver damage.  This ingredient can be found in supplements promoting relief from stress, anxiety, and loss of sleep.  

Garcina cambogia is promoted for weight loss and breaks down into the active ingredient of hydroxycitric acid (HCA).  Many of the supplements advertised for weight loss contain multiple ingredients such as green tea extract with HCA and caffeine.  It is important to read the labels. 

Red yeast rice contains monacolin K, which is structurally similar to prescription statin medications such as lovastatin.  The FDA warns consumers not to buy red yeast rice products because many of them contain unlabeled prescription cholesterol drugs rather than the active red yeast rice.  

Black cohosh is promoted to relieve hot flashes due to menopause despite clinical studies showing a lack of benefit.  A problem with black cohosh and liver damage is many of these products have more than 1 ingredient making it more difficult to know which one is the cause. 

All of these are good reasons why you need to tell your healthcare providers about the prescription medications you take and any over the counter medications or dietary/herbal supplements.

Plant the seed in your providers’ minds so they know how to give advice and help you!

If you are interested in starting a new dietary or herbal supplement, you should always talk with your pharmacist or healthcare provider.