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Just Because It’s Natural Doesn’t Mean It’s Safe

It’s natural, so it can’t hurt me, right? Wrong! In people with healthy livers, the rate of liver damage rose from 7% of drug-induced liver injuries in 2004 to 20% in 2014, and livers process almost all medicines and supplements (which the liver sees as medicine). Drug-induced liver injuries (DILIs) occur in greater numbers with women, but the reason isn’t known. Two of the big environmental factors are viral hepatitis and alcohol consumption. Liver transplant registries show that 5% of liver transplants are as a result of herbal-induced idiosyncratic DILI. Idiosyncratic means it is unique to a person and not related to higher doses.1

Remember hemlock is natural as well: Cautions with herbals

The CDC recommends that persons diagnosed with hepatitis C should refrain from supplements or herbals until consulting a doctor. Supplements and vitamins do not have to show safety and efficacy. I’m not here to argue for FDA approval (Perhaps another time). I am here to help you protect your liver. Bodybuilding and weight-loss supplements account for about half, but also supplements for depression, sexual performance, and digestive upset.

Green tea extract

Because of concern about liver damage, both France and Spain have removed green tea extract (not brewed tea) from bodybuilding and other supplements.

Vitamin A

Higher doses of vitamin A may be dangerous because they are fat soluble and not efficiently excreted from the body. Many supplements have vitamin A, so read the labels to prevent added intake.

Kava kava

Some women take an herb called kava kava for menopause symptoms or to help them relax. However, studies show that it can interfere with liver function and that can lead to hepatitis and liver failure. Some countries have banned or restricted the herb, but it’s still available in the U.S. Since 1999, several cases of liver toxicity (including liver failure) in both Europe and the US after taking kava have prompted the FDA to mandate a warning label on kava products. Safety is under continuing surveillance.

Red yeast rice

Red yeast rice is used for lowering cholesterol. Annals of Internal Medicine research showed that “Red yeast rice, like any HMG-CoA inhibitor (lipid lowering drug), can cause hepatitis”.2 This is with healthy livers, so imagine the damage in a liver with hepatitis C. According to Mayo Clinic, red yeast rice can also increase bleeding in patients taking blood thinning agents including newer agents.3 Patients with hepatitis C may already have issues with clotting since the liver is the source for coagulation.


Yohimbe is used for “fat-burning” and penile erection. However, side effects include increased manifestations of mental illnesses such as bipolar and anxiety conditions. Effects of yohimbe may be increased by the liver because of slower removal from the body.

Consider asking your doctor

Other herbals and supplements have been touted as “sold by doctors”, “made in America”, “ten day results”… None of that is relevant to your liver. Consider checking with your healthcare provider or pharmacist before taking any supplements or herbals.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Chen, M. et. al., Drug-induced liver injury: Interactions between drug properties and host factors. J Hepatol. 2015 Aug;63(2):503-14. doi: 10.1016/j.jhep.2015.04.016. Epub 2015 Apr 22.
  2. Roselle H, Ekatan A, Tzeng J, Sapienza M, Kocher J. Symptomatic Hepatitis Associated with the Use of Herbal Red Yeast Rice. Ann Intern Med. 2008;149:516–517. doi: 10.7326/0003-4819-149-7-200810070-00021
  3. Red rice yeast. Mayo Clinic. Available at: