What dietary supplements can induce hepatic failure?

From the Guidelines

Supplements that can potentially induce liver failure include high-dose vitamin A, green tea extract, kava, comfrey, chaparral, germander, pennyroyal, and certain weight loss or bodybuilding supplements containing ingredients like usnic acid or anabolic steroids. The liver is vulnerable to damage from these substances due to its role in metabolizing them, and damage can occur through direct toxicity, immune-mediated reactions, or idiosyncratic responses that vary between individuals 1. Some key points to consider when taking supplements to minimize the risk of liver damage include:

• Purchasing from reputable manufacturers
• Following dosage instructions carefully
• Avoiding combining multiple supplements without medical guidance
• Discontinuing use if symptoms like jaundice, abdominal pain, fatigue, or dark urine occur, which may indicate liver damage It's also important to note that risk factors for liver damage from supplements include taking higher than recommended doses, pre-existing liver disease, alcohol consumption, and genetic variations in liver enzymes 1. In terms of specific supplements, high-dose vitamin A (>10,000 IU daily) has been associated with liver damage, as have certain herbal supplements like kava and comfrey 1. Additionally, weight loss or bodybuilding supplements containing ingredients like usnic acid or anabolic steroids can also pose a risk of liver damage 1. Overall, it's crucial to approach supplement use with caution and to prioritize liver health by being mindful of potential risks and taking steps to minimize them.

From the Research

Supplements that Could Induce Liver Failure

The following supplements have been reported to cause liver injury, ranging from asymptomatic elevations of serum liver enzymes to hepatic failure and death:

• Herbalife and Hydroxycut products 2
• Tea extracts from Camellia sinensis 2
• Products containing usnic acid 2
• High contents of vitamin A 2
• Anabolic steroids 2
• Kava (Piper methysticum) 3

Mechanisms of Liver Injury

The exact mechanisms of liver injury caused by these supplements are not fully understood, but factors such as:

• Overdosage 3
• Botanical characteristics of the plant 3
• Harvesting, storage, and production process 3
• Idiosyncratic reactions 3
• Adulterants and contaminants 3 may contribute to the development of hepatotoxic substances.

Importance of Awareness and Regulation

Measures to reduce the risk of liver injury from supplements include:

• Tighter regulation of their production and distribution 2
• Increased awareness of users and professionals of the potential risks 2, 3
• Diagnosing and notifying cases of supplement-induced liver damage to increase knowledge and prevent or treat similar cases quickly 3, 4