The market for herbal supplements is in rude health. However, there are growing concerns related to the safety and toxicities of these medicines. "Despite popular belief that the consumption of natural products is harmless, herbs might cause injury to various organs, particularly to the liver, which is responsible for their metabolism in the form of herb-induced liver injury (HILI)," researchers wrote in a study published last year.

They sought to identify herbal products associated with HILI and describe the type of lesion associated with each product.

HILI describes an adverse reaction to herbal medicines.

Searches were run and studies were retrieved from the electronic databases Scopus, Web of Science, MEDLINE, BIREME, LILACS, Cochrane Library for Systematic Reviews, SciELO, Embase, and Opengray.eu.

In the final analysis, 446 references were included, with a total of 936 cases reported.

A range of common supplements, including green tea extract, linked to liver injury

A range of common supplements, including green tea extract, linked to liver injury© Getty Images

The researchers found 79 types of herbs or herbal compounds related to HILI.

The "most common" supplements linked to HILI in the literature were:

  • He-Shou-Wu - Green tea extract-Herbalife-Kava kava-Greater celandine-Multiple herbs-Germander
  • Hydroxy cut--skullcap-Kratom-Gynura segetum-Garcinia cambogia-Ma huang-Chaparral-Senna-Aloe vera.

Fortunately, most of these patients had complete clinical recovery (83 percent).

However, liver transplantation was necessary for 6.6 percent of these cases.