Turmeric supplements have been linked to a small but growing number of cases of liver damage, leading some experts to urge people to use the herbal remedy with caution.

New research, taken from a study recently published in the American Journal of Medicine as well as a presentation at the American College of Gastroenterology Annual Scientific Meeting – describes 15 different case studies of drug-induced liver damage linked to turmeric supplements.

“Physicians in general have so many patients taking this natural supplement that is believed to be very safe,” said Zachary Marwil, MD, gastroenterologist and hepatologist at Northwell Health Endoscopy Center in Long Island. Health. “But there have been reported cases, more recently it seems – it’s still quite rare – of patients who develop […] what we call drug-induced liver injury.

Here’s what to know about turmeric-related liver damage and what to consider if you’re currently taking the supplement, or before you start using it, to do so in the safest way possible.

Turmeric, which contains the active ingredient curcumin, which has anti-inflammatory and antioxidant properties, is considered “generally safe” by the United States Food and Drug Administration (FDA) when taken at recommended levels (up to ‘to 60 mg).

The supplement is marketed as helping with a wide range of health issues, including arthritis, respiratory infections, depression, allergies, and liver disease, and it continues to gain popularity in the United States.

In 2020, turmeric was the fourth best-selling herbal supplement in the country. Turmeric drinks are also expected to gain popularity in the coming years.

This popularity may help explain the increased incidence of turmeric-related liver damage as identified by researchers – and they are curious to know if the supplement has always caused liver damage at some level, or if there is something different in today’s turmeric. supplements.

” Is it [was] is still going to cause a low level of liver damage, and just because more people are using it, we’re seeing it more? mused Robert Fontana, MD, professor of internal medicine at the University of Michigan Health. “Or is it something about new products or formulations?”

Ten of 15 recently reported cases of drug-induced liver injury from turmeric were detailed in a clinical research study published in October 2022. The study reviewed data from over 2,000 suspected cases of drug-induced liver injury enrolled in the US Drug-Induced Liver Injury Network (DILIN).

Of the cases with high confidence for drug-induced liver injury, 345 were attributed to an herbal or dietary supplement; 10 of these cases were turmeric-related and occurred during or after 2011, with the majority occurring since 2017. Most cases were mild to moderate; one person died.

The researchers found that the turmeric-induced liver damage in the study typically occurred in middle-aged women using the supplement for arthritis, pain relief, or general health. Symptoms generally appeared within 84 days of first use.

Data presented at the American College of Gastroenterology meeting showed similar results. Five different teams of researchers presented five different case studies in which turmeric was linked to drug-induced liver damage.

All of the patients presented were between the ages of 49 and 64 and had symptoms similar to the 10 previous cases of liver injury, including fatigue, nausea and jaundice.

According to Dr. Marwil, whose team presented one of the case studies at the meeting, the link between turmeric and liver damage was not immediately clear.

“After stopping all the drugs, [the patient] had improved,” Dr. Marwil said. But as soon as she resumed her turmeric diet, the jaundice and hepatitis returned. “It was only then that we were able to realize [the cause],” he said.

Patients, like doctors, probably don’t immediately suspect that turmeric supplements are the cause of what ails them, or don’t see their supplement routine as relevant.

“Patients don’t often tell you what they’re taking,” said Dr. Fontana, who was one of the authors of the clinical research study. “They assume something over-the-counter can’t be toxic, because, ‘Why would they sell it to me at the grocery store?'”

If so, it’s possible that cases of turmeric-related liver damage are much more common than those reported so far, Dr. Fontana added.

Importantly, those who have experienced liver damage after taking turmeric do not appear to abuse the supplements.

“It didn’t seem like they were taking too much [or] they were overdosing,” Dr. Marwil said. “It felt like some sort of perfect storm of some type of hypersensitivity with the fact that now [with] these supplements, you get more into your body than you probably were before in previous iterations of the supplement.

In the clinical research study, three of the seven turmeric products obtained from people with liver damage also contained piperine or black pepper.

The researchers noted that when added to turmeric, black pepper can “significantly increase” the supplement’s systemic bioavailability, or a substance’s ability to be absorbed and utilized by the body. It could also increase the likelihood of liver damage, the researchers said.

“Now you have more of this drug, for lack of a better term, circulating in your bloodstream, passing through your liver,” Dr. Marwil said, referring to the addition of piperine to turmeric supplements. “Because these drugs – based on their engineering, it seems – have become more bioavailable, more of the drug is now exposed to the liver, therefore you get these cases.”

Researchers are also studying a specific gene called HLA-B*35:01which was discovered when patients in the clinical research study underwent human leukocyte antigen (HLA) sequencing.

Previously, HLA-B*35:01 had been implicated in liver damage associated with green tea, garcinia cambogiaand multicolored polygon. Seven of the 10 patients transported HLA-B*35:01but the differences between the patients were minor and the cases were too few to draw conclusions about a link between the gene and turmeric-associated liver damage.

“We have a clue now. And then we have to understand, why is the HLA-B*35:01 people are more prone to this reaction? reflects Dr. Fontana. “And then in this way we can understand maybe, [among] these people, who are really sensitive.

Although the new research points out that liver damage from turmeric supplementation appears to be increasing in the United States, experts say more research is needed before sweeping recommendations on supplement use are made.

“There are probably several million people taking this [supplement]said Dr. Fontana. “We want to alert them. But we don’t want to scare people off, that it’s going to lead to a recall and that sort of thing. Because the incidence here is still quite low.

That said, it is still important for patients and doctors to be aware of the warning signs of drug-induced liver injury so that people can seek care and treatment as soon as possible.

Symptoms such as abdominal pain, nausea, and jaundice are common with drug-induced liver injury and can be associated with turmeric supplements, even if a person has been taking them for a while at the recommended dosage.

People with a history of liver disease or with a history of drug or supplement sensitivity should avoid turmeric supplements just to be on the safe side, Dr. Marwil says.

Dr. Fontana also explained that he hopes to spread the word so that people who may experience negative side effects from taking turmeric or their doctors can report the case to the Drug-Induced Liver Injury Network and, in turn, donate researchers a clearer picture. of who might be at risk in the future.

“Most people recover, but boy, if we could build this so that no one gets liver damage, as a doctor, we would want to,” Dr. Fontana said. “That’s how medical advances happen slowly but surely, using human genetics to try to improve efficiency and reduce risk.”