Safety Alert

Herbal Supplements and Liver Damage: A Growing Concern

Mar 24, 2026 · Updated Apr 25, 2026 · 6 min readBy the SupplementScore Editorial Team · Reviewed against our evidence methodology

Drug-induced liver injury (DILI) from herbal and dietary supplements has become a serious and growing clinical problem. The U.S. Drug-Induced Liver Injury Network (DILIN) reported that between 2004 and 2013 the share of enrolled liver-injury cases attributed to herbal and dietary supplements rose from about 7% to about 20% — roughly a tripling over a decade (Navarro et al. 2017, Hepatology). More recent DILIN data suggest the share has remained near or above that range, and supplements now sit alongside antibiotics as one of the largest single drug-class causes of severe DILI in U.S. transplant referrals.

The Most Implicated Supplements

Green tea extract (EGCG): One of the most-reported single botanical causes of DILI in Western countries, with cases linked to high EGCG doses (often 700+ mg/day from concentrated extracts in weight-loss products). The European Food Safety Authority concluded in 2018 that EGCG doses of 800 mg/day or more from supplements are associated with hepatotoxicity, and Health Canada has required liver-warning labels on green tea extract supplements since 2017.

Kava (Piper methysticum): Associated with severe hepatotoxicity, including fulminant liver failure requiring transplant. The FDA issued a Consumer Advisory in 2002, and Germany, the United Kingdom, France and other jurisdictions have placed restrictions on kava supplements at various points.

Black cohosh: Used for menopausal symptoms; associated with dozens of hepatotoxicity reports worldwide, including some transplant cases. EMA assessments and Australia's Therapeutic Goods Administration require liver-warning labels on black cohosh products.

Bodybuilding supplements: Anabolic-androgenic steroid analogs, SARMs, and undeclared compounds are a leading cause of DILI in young men in DILIN; cholestatic injury is the typical pattern.

Warning Signs

Early hepatotoxicity symptoms include fatigue, nausea, dark urine, right-upper-quadrant discomfort, and jaundice (yellowing of the skin or whites of the eyes). Stop any new supplement immediately if these appear and seek medical evaluation. Liver injury can progress even after the supplement is stopped — early recognition is critical.

Sources

  1. Navarro VJ, Khan I, Björnsson E, Seeff LB, Serrano J, Hoofnagle JH. "Liver injury from herbal and dietary supplements." Hepatology, 2017;65(1):363–373. PMID: 27677775. DOI: 10.1002/hep.28813.
  2. Navarro VJ, Barnhart H, Bonkovsky HL, Davern T, Fontana RJ, Grant L, Reddy KR, Seeff LB, Serrano J, Sherker AH, Stolz A, Talwalkar J, Vega M, Vuppalanchi R. "Liver injury from herbals and dietary supplements in the U.S. Drug-Induced Liver Injury Network." Hepatology, 2014;60(4):1399–1408. PMID: 25043597. DOI: 10.1002/hep.27317.
  3. European Food Safety Authority Panel on Food Additives and Nutrient Sources added to Food. "Scientific opinion on the safety of green tea catechins." EFSA Journal, 2018;16(4):5239. DOI: 10.2903/j.efsa.2018.5239.
  4. Hoofnagle JH, Bonkovsky HL, Phillips EJ, Li YJ, Ahmad J, Barnhart H, Durazo F, Fontana RJ, Gu J, Khan I, Kleiner DE, Koh C, Rockey DC, Seeff LB, Serrano J, Stolz A, Tillmann HL, Vuppalanchi R, Navarro VJ; Drug-Induced Liver Injury Network. "HLA-B*35:01 and Green Tea-Induced Liver Injury." Hepatology, 2021;73(6):2484–2493. PMID: 32892374. DOI: 10.1002/hep.31538.
  5. U.S. Food and Drug Administration. "Consumer Advisory: Kava-Containing Dietary Supplements May Be Associated With Severe Liver Injury." 2002. fda.gov.
  6. Teschke R, Schwarzenboeck A, Hennermann KH. "Kava hepatotoxicity: a clinical survey and critical analysis of 26 suspected cases." European Journal of Gastroenterology & Hepatology, 2008;20(12):1182–1193. PMID: 19279474. DOI: 10.1097/MEG.0b013e3283036768.
  7. European Medicines Agency, Committee on Herbal Medicinal Products. "Assessment report on Cimicifuga racemosa (L.) Nutt., rhizoma." EMA/HMPC/600717/2017. ema.europa.eu.
  8. Health Canada. "Green tea extract-containing natural health products and the risk of liver injury." 2017 risk-communication update. recalls-rappels.canada.ca.
  9. Robles-Diaz M, Gonzalez-Jimenez A, Medina-Caliz I, Stephens C, García-Cortes M, García-Muñoz B, Ortega-Alonso A, Blanco-Reina E, Gonzalez-Grande R, Jimenez-Perez M, Rendón P, Navarro JM, Gines P, Prieto M, Garcia-Eliz M, Bessone F, Brahm JR, Paraná R, Lucena MI, Andrade RJ; Spanish DILI Registry. "Distinct phenotype of hepatotoxicity associated with illicit use of anabolic androgenic steroids." Alimentary Pharmacology & Therapeutics, 2015;41(1):116–125. PMID: 25394890. DOI: 10.1111/apt.13023.

Reviewed against 9 peer-reviewed and regulatory sources (safety category).

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