Dietary supplements are readily available everywhere, and their use is increasing day by day for various purposes. 

However, recent studies of the World Health Organization declare consumption of some dietary and herbal supplements is associated with liver dangers and can cause liver injuries. 

So, can supplements cause liver damage?

Several studies and case reports show adverse effects on the liver because of dietary supplements.

Many are published on a different database such as Research Gate  or PubMed using several terms such as “nutritional supplements or Dietary supplement,” ‘liver damages,’ ‘liver injuries or failure’; ‘hepatitis,’ or” Hepatic adverse reactions.”

Are all supplements harmful?

Investigations reported that not all supplements cause liver damage, such as vitamin supplements under recommended amount, do not induce hepatic problems. 

However, higher doses of vitamin A and Niacin can be fatal for liver health and cause hepatotoxicity.

A Uniform pattern of hepatotoxicity has still not been recognized. These supplements affect in different ways, from minor hepatic damage to severe liver failure. Supplement-induced liver injury is more severe than medication-induced liver injury. 

These patients are more likely to need liver surgeries and transplantations rather than ordinary hepatotoxicity patients.

Increasing the awareness of regular dietary supplements to users and professionals is essential to stop this problem. 

It is reported that significant liver damage is caused by the intake of Camellia sinensis, Herbalife®, and Hydroxycut stuff. 

High intake of vitamin A, steroids, and anabolic products also cause hepatic problems.

Hepatotoxicity due to bodybuilding supplements

Athletes and other people intake bodybuilding supplements containing androgenic anabolic steroids (AAS), which can be fatal for their internal organs. 

In addition, ASS with other chemicals in Herbal and Dietary Supplements (HDS) can cause the liver to get damage. 

ASS is a derivative of testosterone, but most athletes consume these supplements for their bodybuilding purposes, as they increase overall performance and have muscle-building properties. In addition, most people consume steroids without consulting their health care providers. 

Hepatotoxicity due to weight loss supplements

There are various non-bodybuilding supplements, and their frequent use can cause liver damage. 

However, some people use these types of supplements for weight loss and other healthcare benefits. 

These non-body building supplements are so-called Hydroxycut, LipoKinetics, and Oxy ELITE Pro.

Green tea extracts are obtained from unfermented Chinese trees (Camellia Sinensis). 

It contains other compounds such as catechin, which is also present in other plants like cocoa powder, berries, or other shrubs. 

These compounds have weight loss properties, but the high concentration and frequent intake are harmful.

Herbal and Dietary Supplements Mechanism and Metabolism

Hepatotoxicity is probably an unpredictable phenomenon. There is no proper research system or governmental control on the exact dose of these supplements. 

A wide range of medicines and chemicals are extracted and metabolized from the human kidney and liver. 

These chemicals are produced from the body or consumed from outside as Xenobiotics. The compound, which is produced by the liver, is a complex mixture of all various chemicals.

Xenobiotic and HDS are predominantly captivated by proximal small bowel and then undergo circulation. 

When these chemicals reach the liver, this step is referred to as the “first-pass metabolism.”

The cytochrome P450 enzyme catalyzes hepatocytes. Therefore, many chemicals of HDS experience an initial oxidation reaction in phase I metabolism. 

Then, in phase II& III metabolism, these chemicals undergo further reaction. 

As a result, these HDS become more soluble in water, and when they enter the bloodstream or into bile, they are extracted in feces.

Does FDA regulate herbal and Dietary supplements?

Many supplements, which never undergo safety testing, are not FDA approved, as Food and Administration do not stringently regulate their production. 

In addition, FDA may not take any action against herbal and dietary supplements until they get a proper pattern of liver injuries due to these drugs.

Supplement statistics 

In the United States, more the 80 000 HDS different products are available in the markets and are continuously growing. 

50% of adults are consuming at least one type of these supplements daily. Yet, according to the Drug-induced liver injury network, it can cause hepatotoxicity.

In the United States, herbal and dietary supplements are used as alternative and complementary medicines. In the US, supplement users consume $6 Billion per year. 

About one, half of the US population consumes HDS to maintain their health. Herbal and dietary supplements include herbs, plants extracts, vitamins, and minerals. 

Unfortunately, hepatotoxicity has increased threefold over the past ten years. 

Use of supplements and its surveillance system

According to Verma et al., approximately 39-40% of the population do not reveal supplement use. 

Most people use HDS to support their immune systems. For example, previous investigations show that 40% of the patients suffering from chronic liver disease use HDS. 

People who consume these supplements are at higher risk of liver problems as compared to the general population. 

It is inevitable if they develop liver toxicity, it will cause adverse consequences.

Supplements Induced Liver- injury diagnosis

The first step is the awareness of supplements that can cause liver problems. 

There is no specific therapy for chronic liver diagnosis except stop using these supplements and wait for the patient’s recovery. 

The injury to the liver can be reversed, and many people recover from it. 

There are rare cases of patients who stop regular use of supplements and do not recover or die. 

Then there are different therapies, which should follow to diagnose a patient. 

CT scans, ultrasounds, or MRI can reveal liver injuries. However, using other medicines, acetaminophen or Niacin, can boost recovery in a short time interval, according to your doctor’s advice.

Conclusion

As FDA states:

Dietary Supplements can be beneficial to your health — but taking supplements can also involve health risks. 

[source: what you need to know about dietary supplements]

To determine a supplement’s safety, it’s better to understand where they are made.

A herb and dietary supplement should be manufactured in a GMP-certified and FDA-registered facility.

In saying that, anyone can put a label that they are compliant. It’s hard to know for sure. 

Asking for certification is the only way to prove their claim. If they can’t provide the documents or can’t be bothered, perhaps you should try other supplement stores that are more customer-centric.

If there is suspicion that herbal and nutritional supplements are causing liver problems, then stop using these supplements entirely and should not be reused again because the actual cause of this injury is still unknown. 

Furthermore, if there is even slight liver injury, stop using these supplements.

Always ask your doctor or a healthcare professional’s advice before using dietary supplements.