Can Turmeric Cause Elevated Liver Enzymes?
Yes, turmeric supplements can cause elevated liver enzymes and drug-induced liver injury, though this appears to be uncommon and primarily associated with over-the-counter supplement formulations rather than culinary use.
Evidence for Turmeric-Induced Hepatotoxicity
The most compelling evidence comes from a recent 2025 clinicopathological series documenting 11 cases of turmeric supplement-associated hepatitis, where 91% of patients showed predominant transaminase abnormalities 1. These cases demonstrated:
- Acute hepatitis patterns in 73% of biopsies, including both pan-lobular and zone 3-predominant inflammation 1
- Asymptomatic presentation in 55% of patients discovered only through abnormal liver function tests 1
- Complete normalization of liver enzymes after discontinuation of turmeric supplements in all cases 1
Additional case reports from 2023 and 2022 document similar presentations, including a 55-year-old woman with progressive jaundice and elevated bilirubin who recovered after stopping turmeric supplementation 2, and a 49-year-old woman with elevated AST and ALT without prior liver disease 3.
Mechanism and Risk Factors
The hepatotoxicity appears related to supplement formulations rather than turmeric itself, particularly those containing piperine (black pepper extract) added to enhance bioavailability 2. This is a critical distinction because:
- Culinary turmeric use has not been associated with liver injury 1
- Over-the-counter supplements may contain concentrated extracts with additives 2, 3
- The lack of FDA quality control requirements for dietary supplements means variable product composition 4
Contradictory Evidence
A 2021 prospective clinical trial of 12 healthy subjects taking 500 mg standardized turmeric extract (95% curcuminoids) twice daily for 90 days showed no significant alterations in liver function parameters including AST, ALT, ALP, bilirubin, GGT, or LDH 5.
Furthermore, a 2021 randomized controlled trial in 64 NAFLD patients demonstrated that turmeric supplementation (2 g/day for 8 weeks) actually reduced liver enzymes significantly: AST decreased from 26.81 to 21.19 (P=0.044), ALT from 39.56 to 30.51 (P=0.043), and GGT from 33.81 to 25.62 (P=0.046) 6.
Clinical Implications and Recommendations
When evaluating elevated liver enzymes, clinicians must obtain a complete medication review including all herbal and dietary supplements 7, 8. This is emphasized in current guidelines as essential for diagnosing drug-induced liver injury 7, 8.
Key diagnostic considerations:
- Turmeric-induced liver injury typically presents with hepatocellular pattern (elevated transaminases) rather than cholestatic pattern 1
- RUCAM (Roussel Uclaf Causality Assessment Method) analysis can help establish causality, though histological analysis may provide additional diagnostic value 1
- Temporal relationship between supplement initiation and enzyme elevation is critical 2, 3, 1
Management approach:
- Immediate discontinuation of turmeric supplements if suspected as the cause 2, 3, 1
- Monitor liver enzymes every 2-4 weeks until normalization 7
- Consider liver biopsy only if enzymes remain persistently elevated >3× upper limit of normal after discontinuation 7
- Steroid therapy may be considered in severe cases, though most cases resolve with discontinuation alone 1
Important Caveats
The absolute risk of turmeric-induced liver injury appears low, as turmeric is widely consumed with relatively few reported cases 5, 6. However, the increasing popularity of concentrated supplement formulations may be increasing the incidence of this adverse effect 2, 1.
Do not confuse turmeric's potential hepatotoxicity with CBD-related liver injury, which is a separate concern with cannabinoid products showing dose-related transaminase elevations, particularly at doses >300 mg/day 4.
When turmeric supplements are discontinued, complete recovery is expected within 2 months in most documented cases 2, 1, making the prognosis excellent with appropriate recognition and management.