Supplements now rank as the fifth-leading cause of death from liver disease.

Dietary and herbal supplements sit on pharmacy shelves and in medicine cabinets with an image of gentleness that prescription drugs rarely enjoy, sold as natural alternatives that promise relief from joint pain, sluggish energy, or stubborn weight without the side-effect warnings that come stapled to a prescription bottle. That reputation has increasingly collided with a body of clinical evidence showing that some of the most popular botanicals on the market can quietly damage the liver, an organ with limited outward warning signs when something goes wrong.

Recent research and reporting on liver injury registries have placed herbal and dietary supplements among the leading identifiable causes of liver disease-related death, a ranking that has alarmed hepatologists who track drug-induced liver injury cases nationwide. The shift reflects both rising supplement use and improved data collection tracking which products send people to transplant lists or emergency rooms.

A Registry Built to Catch a Growing Problem

Much of the evidence behind this trend comes from the Drug-Induced Liver Injury Network, a federally supported registry that has enrolled liver injury cases tied to medications and supplements since 2004. Researchers examining cases logged in that network found that roughly 19% involved herbal or dietary supplements rather than conventional pharmaceuticals, according to a review of liver injury cases summarized in the National Library of Medicine’s PMC archive. Other analyses cited in that review put the share of acute liver injury linked to herbal and dietary supplements as high as 20%, underscoring how a category of products regulated far more loosely than prescription drugs has become a measurable driver of serious liver disease.

That looser regulatory framework is part of the story. Supplements sold in the United States do not require the kind of pre-market safety testing pharmaceutical companies must complete before a drug reaches consumers, and manufacturers are not required to prove a product is safe before putting it on shelves. Liver injury tied to a specific supplement often only becomes apparent after enough cases accumulate in registries like the Drug-Induced Liver Injury Network for a pattern to emerge.

The Products Showing Up Most Often

Certain botanicals appear disproportionately in the case data researchers have compiled. An AARP review of supplements linked to liver damage highlighted turmeric, often taken to ease joint pain from arthritis, a condition affecting roughly half of adults age 65 and older, as one of the products most frequently implicated in registry data despite its reputation as a gentle, food-derived remedy. Green tea extract and kratom, an herbal product marketed for pain relief and mood effects, also rank among the botanicals most often tied to documented liver injury cases.

What makes these particular products notable is less their individual toxicity profile and more their popularity. Turmeric ranks among the most widely used dietary supplements in the country, and its case count in liver injury registries reflects sheer volume of use as much as any inherent danger at typical doses. Recent reporting from NBC News on the trend noted that drug-induced liver injuries tied to supplements have been rising even as supplement sales have grown, a pattern hepatologists say tracks the broader boom in over-the-counter wellness products marketed directly to consumers online and in stores.

Why the Liver Is a Silent Target

Liver damage from supplements rarely announces itself early. The organ can absorb significant injury before a person notices symptoms such as fatigue, abdominal discomfort, or the yellowing of skin and eyes associated with jaundice, meaning many people taking a supplement linked to liver toxicity have no reason to suspect a problem until blood tests or a medical event reveal the damage. That delayed presentation is part of why researchers rely on registries tracking confirmed cases rather than self-reported symptoms to estimate how often supplement-related liver injury occurs.

Older adults face particular exposure to this risk given how commonly they use supplements marketed for joint pain, heart health, and cognitive support, often stacking multiple products at once without medical supervision. Combining several supplements, or combining a supplement with a prescription medication metabolized through the liver, can compound the strain on an organ already processing more chemical load than it would from either product alone.

A Market That Has Outgrown Its Oversight

The dietary supplement industry in the United States has expanded into a business generating tens of billions of dollars in annual sales, spanning everything from single-ingredient vitamins to complex herbal blends marketed for joint health, weight loss, energy, and immune support. That growth has outpaced the regulatory framework governing it, since supplements are treated under federal law more like specialized foods than like drugs, meaning the Food and Drug Administration generally does not review a product’s safety or effectiveness before it reaches store shelves the way it would review a new pharmaceutical.

Enforcement in this space tends to be reactive rather than preventive. Regulators typically step in after a pattern of harm becomes visible, often years after a product first entered the market and built a loyal customer base, rather than catching a risky formulation before it circulates widely. That lag between when a supplement’s liver risk first begins accumulating in the data and when consumers hear about it is part of why registry-based research, like the work cataloged through the Drug-Induced Liver Injury Network, has become such an important tool for identifying problem products.

What the Ranking Signals for Consumers

Describing herbal and dietary supplements as a fifth-leading cause of liver disease-related death does not mean every bottle on a store shelf carries meaningful risk; the vast majority of supplement use does not result in documented liver injury. The ranking instead reflects how a relatively small number of frequently used, loosely regulated botanicals have accumulated enough confirmed harm cases in national registries to place them alongside far more established causes of liver disease, a list traditionally dominated by viral hepatitis, alcohol use, and metabolic conditions.

Physicians who treat liver disease increasingly recommend that patients disclose every supplement they take during routine appointments, the same way they would disclose prescription medications, given how often liver injury cases trace back to a product a patient did not think to mention because it came from a health food store rather than a pharmacy. For products like turmeric and green tea extract, whose reputations were built on being natural and therefore assumed safe, that disclosure gap may be exactly what has allowed liver injury cases to accumulate largely out of sight for years before registry data made the trend visible.

Morning Overview produced this article with AI assistance and reviewed it against the cited sources.

More from Morning Overview