“Just because something is labelled ‘natural’ does not mean it is risk-free, and easy access does not guarantee safety. The liver does the heavy lifting, processing everything we put into our bodies. However, when it gets overloaded, the fallout can be serious,” warns pharmacist Thembeka Gule of Medipost Pharmacy.
Just because natural supplements are widely available does not mean they are harmless. Many over-the-counter medicines and natural products are marketed as safe, but some common ingredients, especially when taken in high doses, combined with other substances, or mixed with alcohol, can seriously damage the liver.
“Paracetamol toxicity is a major concern in South Africa and around the world because it is widely available and is not as strictly regulated. As a result, anyone can get paracetamol without medical intervention, which makes overdoses and misuse all too common. The danger increases when paracetamol is taken with alcohol or other medications that strain the liver, raising the risk of liver damage.
“These substances are all metabolised or detoxified by the liver and compete for the same detox pathways. When alcohol or other liver-stressing medicines overwhelm these pathways, it can lead to overdose. Since alcohol and many prescription drugs are also broken down by the liver, taking them alongside paracetamol or similar compounds can overload the system and significantly increase the chance of liver injury,” explains Gule.
Herbal and dietary supplements are not without risk
Gule points out that concentrated extracts can strain the liver, especially in large doses, all at once, or mixed with other supplements or medicines.
Take turmeric, for example, which is often praised as a natural remedy for inflammation and liver support. The turmeric extract, rich in curcumin, is valued because curcumin’s antioxidant properties can help reduce liver damage and eliminate fat from the liver. But turmeric can flip from being helpful to potentially harmful, especially when combined with black pepper extract, which boosts curcumin absorption. “Patients with pre-existing liver conditions, or any liver problems, should avoid high doses of turmeric and curcumin extract supplements and discuss any concerns with a healthcare professional,” says Gule.
Green tea extract is hugely popular in weight-loss supplements, but it is not without risks. Unlike regular brewed green tea, these extracts pack a much higher dose of EGCG (epigallocatechin gallate) and other catechins, which pose a high risk to the liver. The increased concentration of EGCG, especially when taken in high doses, can overwhelm the pathway in the liver that detoxifies these compounds, causing the accumulation of toxic by-products that harm the liver.
Ashwagandha is known for easing stress by lowering cortisol, the hormone that controls your body’s stress response. The decreased cortisol levels help calm you down, but it is essential to follow the dosing instructions on the packaging insert, which will vary according to the strength of the product in the package. Because ashwagandha is metabolised by the liver, it can increase the risk of liver failure. In rare but severe cases, this has led to acute liver failure, sometimes requiring transplantation, mainly when used with other supplements that are metabolised by the liver. “Ashwagandha is generally well-tolerated when taken for short periods. It is best to avoid long-term use unless advised by a healthcare professional. Individuals with pre-existing medical conditions are advised to consult their doctor or HCP before taking this supplement,” Gule advises.
Garcinia cambogia is popular for weight loss due to its active ingredient, hydroxycitric acid. The evidence linking hydroxycitric acid to liver damage is limited and controversial, especially when combined with other fat burners, even though there have been rare cases of liver injury reported with its long-term consumption or when taken in high doses. Garcinia cambogia should be taken with caution, especially by people with pre-existing liver conditions or those taking other supplements.
Black cohosh is often used to relieve menopausal symptoms in women, but has been linked with some rare cases of liver damage. Menopausal women taking black cohosh must do so with caution, especially if they have liver conditions or are on other medications.
Typical symptoms of supplement or medication-related liver injury include stomach pain, yellowing of the eyes or skin, tiredness, and nausea and vomiting. Early signs often missed include dark urine, loss of appetite and itchy skin.
“It is important to know that supplements and herbal remedies do not undergo the same rigorous testing and clinical trials as prescription medications.”
“It is important to know that supplements and herbal remedies do not undergo the same rigorous testing and clinical trials as prescription medications. Often, their doses and full ingredient lists are not clear, so you cannot always know if they are safe or harmful. Ask a doctor or pharmacist before you start anything new, especially if you have health problems or take other medicines,” Gule emphasises.
“In South Africa, the actual number of supplement-related liver injuries is not well known, but concern is growing. Weight-loss products carry a particularly high risk. Over-the-counter medicines with paracetamol are safe only when used as directed. Taking high doses repeatedly or mixing several products containing paracetamol can cause severe liver damage.
The liver is the body’s detox hub, so it’s exposed to almost everything you swallow. Herbal supplements are not as standardised as pharmaceuticals, which means contaminants, unknown ingredients or batch variations can increase the risk. Taking multiple ‘safe’ supplements at once can overload the liver. Conditions like diabetes, fatty liver disease, or heavy alcohol use make this even riskier.
“If detected early and the harmful product is discontinued, the liver often has a chance to heal. But severe or late-detected damage can lead to permanent harm. Individual genetics and metabolism influence how people metabolise substances, resulting in variations in reactions from person to person. That is why stricter regulations and targeted monitoring of high-risk products are so important,” concludes Gule.
