Herbal Supplement Dangers: Liver Toxicity, Contamination, and Health Risks

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• Global Liver Disease Burden
• Supplement Quality Control Issues
• Hidden Contaminants in Supplements
• False Sense of Safety
• Proven Treatment Standards
• Patient Education and Safety

Global Liver Disease Burden

Chronic liver disease affects an estimated one billion people worldwide. As Dr. Sanjiv Chopra, MD, explains, this includes hundreds of millions with Hepatitis B and C, alongside a burgeoning epidemic of Non-Alcoholic Fatty Liver Disease (NAFLD) linked to type 2 diabetes and obesity. Dr. Chopra also highlights hemochromatosis, the most common genetic disorder, which causes iron overload and can lead to cirrhosis and liver cancer.

Supplement Quality Control Issues

Patients often turn to herbal supplements and "detox" aids found online, hoping to empower their own liver health. A critical danger, as noted by Dr. Sanjiv Chopra, MD, is the complete lack of quality control in this industry. Studies show the concentration of an alleged active ingredient in a single supplement can vary wildly, from as little as 7% to over 90%. This means a patient has no reliable way of knowing what dose they are actually consuming.

Hidden Contaminants in Supplements

Beyond inconsistent potency, herbal supplements are frequently contaminated with undeclared and dangerous substances. Dr. Sanjiv Chopra, MD, points to the alarming presence of corticosteroids like prednisone in some products. While these steroids may temporarily make a patient feel better and even lower liver enzymes, they can cause severe harm. For a patient with Hepatitis B, prednisone can cause the virus to multiply rapidly, increasing viral levels tenfold and worsening liver damage seen on biopsy.

Other common contaminants include heavy metals, pesticides, and prescription drugs, all of which can cause direct organ toxicity.

False Sense of Safety

Many patients operate under the dangerous misconception that "natural" means safe. Dr. Chopra recounts patients spending hundreds of dollars monthly on supplements, arguing that natural compounds couldn't hurt their liver. He counters this by reminding them that earthquakes and tsunamis are also natural and can pack a devastating wallop. This false sense of security can lead to severe liver toxicity, kidney injury, pulmonary hypertension, and even rare fatalities.

Dr. Sanjiv Chopra, MD, uses a powerful analogy: taking an unproven supplement is like covering a growing hole in a wall with a beautiful painting. The surface looks better, but the damage behind it is getting worse.

Proven Treatment Standards

Genuine medical treatments for liver disease are held to rigorous scientific standards. As Dr. Sanjiv Chopra, MD, explains to Dr. Anton Titov, MD, effective treatment requires a triple response: biochemical (normalized liver enzymes), virologic (undetectable virus), and histological (improved liver biopsy). Herbal supplements must be held to this same standard, not merely a "whitewash" effect of slightly improved enzymes that masks underlying disease progression.

Patient Education and Safety

The paramount message from Dr. Sanjiv Chopra, MD, is one of caution and education. Patients must be aware that dietary supplements are not evaluated for safety and efficacy by the FDA like prescription medications. The interview with Dr. Anton Titov, MD, underscores the importance of consulting a healthcare professional before taking any supplement, especially for the billion individuals already managing chronic liver disease. Safety should always come before unsubstantiated claims found online.

Full Transcript

Dr. Anton Titov, MD: You are a Professor of Medicine at Harvard Medical School and a renowned expert in liver diseases. You see people with chronic liver conditions and also with acute liver failure. The only treatment in acute liver failure is liver transplantation. It has to be done as soon as possible, or patients will die. A billion people around the world have chronic liver disease. Many of them take dietary supplements. You have previously commented that many people think that dietary supplements are safe and could be effective, but in reality, some dangers are always lurking. Dr. Sanjiv Chopra, MD, could you comment on the herbal supplements and their potential dangers for the liver and other organs?

Dr. Sanjiv Chopra, MD: That's a great question! You are absolutely right. In aggregate, if we add up the people who have chronic Hepatitis B virus infection, that is about 400 million people in the world. Chronic Hepatitis C virus infection afflicts about 170 to 200 million people in the world. Then there are many other liver disorders.

Right now we are dealing with the burgeoning epidemic of Type 2 Diabetes and obesity. There is a liver condition called Non-Alcoholic Fatty Liver Disease. That condition, just in the United States, is estimated to afflict 40 to 70 million Americans. Hemochromatosis is the most common genetic disorder known to man. There is extra iron deposited from the gut into the liver and other organs. It can lead to cirrhosis and liver cancer.

Then there are many other disorders of the liver. If you add all of those up, an astounding 1 billion people in the world have chronic liver disease. That can lead to cirrhosis, the need for liver transplantation, and the risk of developing primary cancer of the liver.

Patients are always eager to try to empower themselves to do something about their liver. They will often go to the internet and Google stuff. Then they'll see claims made about herbal medications or supplements or other "aids" to "detoxify the liver". Sometimes they find even very odd things like coffee enemas to "detoxify the liver" or to take herbal medications. They take certain supplements.

My big concern about these is that there is no quality control. Studies have shown that the "active" ingredient in an herbal medication can vary between 7% and 90%. First of all, you may not even be getting the "active" ingredient at the right dose. Secondly, often these herbal supplements are contaminated. It is not unusual to find corticosteroids. This will make the person feel better, improve the appetite, and it may even lower the liver enzymes.

Somebody has chronic Hepatitis B; they take prednisone, they feel better, the liver enzymes come down. You think it is doing a good job. But in reality, the Hepatitis B virus multiplies rapidly and its levels can go up 10-fold. If you do a liver biopsy, you see worsening damage.

We can fool ourselves into thinking that these herbal products are safe and that they are effective. In reality, they haven't been rigorously studied. I tell patients it is like having a hole in the wall. We cover it with a beautiful picture of Monet. Now we say, "Good, it looks better!" But meanwhile, behind the painting, the hole is getting bigger and getting worse.

I have patients who were taking multiple supplements and spending $300 or $400 a month out of pocket to buy these supplements. When I discussed it with them, I said, "It is not safe; it may be hurting you!" The usual refrain was: "But these are natural compounds; why would it hurt my liver?"

Dr. Anton Titov, MD: I would have to point out to them that earthquake, lightning, tsunami—it is all part of nature. Nature can pack a wallop! Nature can cause great damage.

Dr. Sanjiv Chopra, MD: Please be safe. There are patients who die. Fortunately, it is rare, but they die from severe liver toxicity. Patients die from kidney injury; they die from pulmonary hypertension and heart disease from herbal products that are supposedly "safe".

It is also very important that a lot of efficacy claims and "miraculous treatments" are also not necessarily substantiated. That's very important for people to truly realize.

Absolutely! When we were treating Hepatitis C, we want to see a biochemical response, so we want to see the liver enzymes normalized. We want to see a histological response; we want to show that the liver biopsy improves. We want to see a virologic response; we want to see that the virus disappears, is undetectable.

When we have claims with herbal products, we have to hold it to the same standard, not a whitewash effect of "having the liver enzymes improve a little bit". What happened to the viral level?

Dr. Anton Titov, MD: What were their biopsies before and after?

Dr. Sanjiv Chopra, MD: We have to document that there was histological improvement. We have to hold it to the same standard.