The Liver is a vital organ that plays a major role in various functions of the body. It regulates glycogen storage, decomposition of red blood cells, hormone production, and detoxification among other essential functions. No wonder then that there are a number of supplements touted to protect this vital organ! Listed under are supplements that are good and bad for your liver.
Foods/Supplements and Herbs That Have a Protective Effect on the Liver
Seafood has taurine which has been shown to have a protective effect against oxidative stress-induced liver damage and fibrosis in rats , and omega 3’s the treatment of which may have beneficial effects in regulating liver lipid metabolism, adipose tissue function and inflammation .
Omega 3-PUFA supplementation may also decrease liver fat according to one study, however, the current optimal dose is not known .
A meta-analysis study indicates that a high level of white meat or fish consumption can reduce the risk of liver cell carcinoma (HCC) significantly .
Choline that is abundant in Egg yolks helps detoxification of the liver through the processing of fats and cholesterol. Hence it might be helpful to prevent Non-Alcoholic Fatty Liver Disease (NAFLD) .
Animal Liver contains uridine and choline, which are essential for a healthy liver. Beef liver is the richest source of choline (333 mg in 100 gms of food).
Provision of intravenous choline improves hepatic steatosis associated with parenteral nutrition infusion (bypasses the digestive system and goes directly into the bloodstream) .
According to one study, when deprived of dietary choline 77% of men and 80% of postmenopausal women developed fatty liver or muscle damage. Subjects had normal organ function restored after incremental amounts of choline were added back to the diet .
Chicken has carnosine, which protects against toxin-induced liver injury in rats, due to its antioxidant, anti-inflammatory properties .
According to one cohort, white meat (like chicken) intake may reduce the risk of chronic liver disease (CLD) and liver cancer (HCC) in men and women .
Blueberries and probiotics have protective effects on acute liver injury induced by d-galactosamine and lipopolysaccharide (LPS) .
Mechanism: They reduce liver cell injury, inflammation, and pro-inflammatory cytokines and improve antioxidant activity.
Also, proanthocyanidins from blueberry leaves suppress the replication of the hepatitis C virus .
Beets contain a pigment called betalain which protects the liver from oxidative stress and chronic inflammation such as liver disease .
Extracts of beetroot (betacyanin) at a very low dose exhibited a chemopreventive effect on liver tumors in mice .
Beetroot (table beet) also has liver protecting effects during an injury in mice .
An Olive Oil rich diet decreases the accumulation of Triglycerides (TGs) in the liver and therefore might be helpful for Nonalcoholic Fatty Liver Disease (NAFLD) patients who have high TGs .
One study in patients with NAFLD demonstrated that olive oil has protective effects by improving glucose and lipid metabolism and preventing atherogenesis (a disorder of the artery wall) . This study also mentioned that the Mediterranean diet has beneficial properties on NAFLD.
In animals, extra virgin olive oil and its extracts had protective effects against oxidative damage of the liver tissue when exposed to toxins, by preventing excessive lipid peroxidation .
Biofortified Carrot (carrots with increased bioactive compounds) intake increases liver antioxidant capacity and Vitamin A status in animals .
Carrots also protect against liver injury .
Carrot consumption modifies bile acid excretion and increases antioxidant status .
Oral supplementation with β-carotene during chronic alcohol feeding in rats reduces oxidative stress, cell death, and inflammation .
A study demonstrated that a 15-week garlic supplementation could decrease body fat mass among NAFLD patients. Garlic may reduce the amount of fat in the liver and prevent or delay the progression of NAFLD [22, 23].
Several studies have shown that Garlic can protect the liver from toxic agents. Human studies have shown that garlic protects against Tylenol-induced liver toxicity .
Aged black garlic (a type of caramelized garlic) according to one study in mice demonstrated liver protective effects .
A previous preliminary study reported that the insulin sensitivity in liver cells could be improved using ginger (with gingerol as its active component for this effect) in NAFLD patients .
Ginger was effective against alcohol-induced liver toxicity in rats. Ginger consumption normalized the levels of SOD (Superoxide dismutase), catalase and glutathione (GSH) in rats .
Ginger was also effective against liver cancer in rats .
According to one study conducted by Japanese researchers, Avocados contain potent liver protectants which may reduce liver damage .
Refined avocado oil fed to rats showed a significant decrease in the blood triglycerides in the liver .
Another study showed that avocado oil improves mitochondrial ETC (Electron transport Chain) function by reducing the deleterious effects of oxidative stress in the liver of diabetic rats .
A number of experimental studies have mentioned that Coffee (Coffea arabica) has protective effects on the liver, could be used to prevent chronic liver diseases (from steatosis to fibrosis) and also liver cancer. Moderate daily unsweetened coffee can be used as adjuvant therapy for such patients [32, 33, 34].
In a large prospective study of participants with advanced Hepatitis C-related liver disease, regular consumption of coffee was associated with lower rates of disease progression .
Coffee consumption was also inversely related to the severity of steatohepatitis in patients with NAFLD (Nonalcoholic fatty liver disease) .
In one study coffee consumption was associated with an improvement in liver enzymes ALT, AST, and GGTP, especially in individuals with a risk for liver disease.
Also, coffee intake of more than 2 cups per day in patients with pre-existing liver disease have a lower incidence of cirrhosis, fibrosis, and even cancer as well as lower mortality rates .
A meta-analysis has shown that Green Tea (Camellia sinensis) intake reduces the risk of liver disease .
Individuals who consumed more than 10 cups of green tea/day showed a remarkable reduction in relative risk for liver cancers .
According to a randomized clinical study, NAFLD patients given Green tea extract (GTE) (500 mg GTE tablet per day) showed a significant decrease in ALT and AST levels after a 12 week period. It could be concluded that GTE can be considered as an absolute treatment to improve serum levels of liver enzymes in NAFLD patients .
Green tea (epigallocatechin-3-gallate (EGCG)) has a potential inhibitory effect on the proliferation of liver stellate cells which are closely related to the progression of liver fibrosis in chronic liver diseases .
Seed coat of Cocoa (Theobroma cacao) seed is used for liver ailments. Consuming a liquid meal along with dark chocolate (85% cocoa) can improve liver function after cirrhosis, but there is insufficient evidence for this (R).
In Ayurvedic medicine, Turmeric (Curcuma longa) is a well-documented treatment for liver disorders . Curcumin the most important and active component in turmeric may help prevent liver inflammation and damage according to lab studies.
Curcumin reduces liver injury induced by alcohol, thioacetamide, iron overdose, cholestasis, and acute chronic, subchronic and chronic carbon tetrachloride intoxication, and also reverses CCl4 cirrhosis to some extent .
A recent report has shown that curcumin decreases PGC-1α and significantly suppresses HBV (Hepatitis B virus) gene expression .
Curcumin also inhibits the replication of Hepatitis C virus possibly by suppressing the PI3K/Akt-SREBP-1 pathway .
Treatment with dietary curcumin in animal models reduced fatty liver, necrosis, and inflammation .
Curcumin also ameliorates the effects of liver injury induced by several drugs such as paracetamol , chloroquine , methotrexate , erythromycin estolate , isoniazid, rifampicin, and pyrazinamide  in various animal models. The antioxidant ability of curcumin is shown to be the main protective mechanism against drug-induced liver damage.
In a case report, a 40-year-old female consumed a single dose of 150mg fluconazole oral tablet for vaginitis, which later resulted in liver toxicity (Fluconazole related hepatotoxicity-FRH).
Artichoke leaf extract (at 1.5 gr/kg per day) reduced the ALT and AST levels significantly and hence could be a beneficial treatment for FRH .
A randomized clinical trial in patients with Nonalcoholic steatohepatitis (NASH), showed that artichoke had liver protective and hypolipidemic effects. Possibly due to the presence of constituents like flavonoids and caffeoylquinic acid .
Extracts of Artichoke (Cynara scolymus) are commonly found in liver detoxification supplements. Artichoke may also act on the liver to lower cholesterol levels .
Asparagus roots and shoots have a stimulating effect on both the liver and kidney and increase the flow of liquids from the body. Extracts from A. officinalis had a protective effect on liver cells from toxic substances .
Asparagus treatment in hypercholesterolemic rats increased the levels of liver enzymes like catalase, superoxide dismutase (SOD), glutathione reductase and glutathione peroxidase .
Alcoholic extract of Asparagus (A. racemosus) has been shown to significantly reduce the enhanced levels of alanine transaminase (ALT), aspartate transaminase, and alkaline phosphate in CCl4 induced liver damage in rats .
Walnuts (Juglans regia) contain high levels of l-arginine, an amino acid, glutathione, and omega-3 fatty acids, also help detoxify the liver of disease-causing ammonia. Walnuts also help oxygenate the blood, and extracts from their hulls are often used in liver-cleansing formulas .
In one study dietary lipids from walnut oil inhibited lipid accumulation in the liver and also modulated the liver gene expression in fatty acid influx or lipoprotein assembly. Thus walnut oil modulates liver steatosis in obese rats .
Oral administration of a polyphenol-rich extract from walnuts in mice significantly reduced liver weight and liver and serum triglycerides (TG) .
A randomized controlled trial in patients with Nonalcoholic Fatty Liver disease (NAFLD), treatment with water extract of licorice root showed a significant decrease in the elevated enzyme levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) .
Water extract of licorice showed protective effects on the liver against CCl4-induced acute liver toxicity in rats. There was a dose-dependent increase in the enzyme levels as well as an increase in the total protein and albumin levels .
It may also interact negatively with medications being metabolized by the organ. For these reasons, the National Institutes of Health (NIH) warn against using licorice if you have liver or kidney disease.
Fruits like Apples, Plums, Grapefruit, Oranges, and lemons are helpful in cleansing the Liver.
One study in children with NAFLD (pediatric non-alcoholic fatty liver disease) treatment with DHA could modulate liver progenitor cell activation, liver cell survival .
One study suggests that fish oil given either parenterally or enterally may be a potential treatment for patients with PNALD (Parenteral Nutrition Associated Liver Disease) .
DHA substantially reduced liver injury induced by Valproic Acid. DHA manipulated cellular machinery to curb liver oxidative stress and inflammation .
Dietary DHA also has a protective effect in necroinflammatory liver injury in animals .
Milk thistle may help improve liver health in people with HIV and hepatitis C .
One randomized double-blind clinical study in children with Acute lymphoblastic leukemia and grade 2 or higher liver toxicity showed that milk thistle reduced the levels of AST and ALT significantly.
A significantly larger number of children in the milk thistle group developed a >50% reduction in the total bilirubin compared to the placebo .
In a randomized controlled study when patients with alcoholic liver and or hepatitis B or C, diseases were treated with milk thistle, there was a >50% decrease in mortality rate compared to the placebo .
Milk thistle (Silybum marianum) is used in Traditional Chinese medicine to clear toxic material from the liver and promote bile flow .
In animals, Milk thistle (Silymarin) reduces liver injury caused by acetaminophen, carbon tetrachloride, radiation, iron overload, phenylhydrazine, alcohol, cold ischemia and Amanita phalloides .
A case report mentions that milk thistle (silybin) may offer protection against pharmaceutical drug phenytoin-induced liver toxicity .
Quercetin reduces liver oxidative damage, ductular proliferation, and fibrosis in biliary obstructed rats. These effects suggest that it might be a useful agent to preserve liver function in patients with biliary obstruction .
Quercetin exhibited a potential protective effect on t-HBP caused injury in liver cells through the induction of MT (Metallothioneins, which protect the liver against acute metal toxicity) .
Mechanism: Induction of Metallothioneins expression is through the activation of MAPK and P13K pathways and enhancing Nrf2 DNA binding activity.
In Ayurvedic medicine, Boswellia is regarded as a hepatoprotective (protects the liver) agent .
Boswellia serrata extract at lower doses (87.5 mg) had liver protective effects than at higher doses (175 mg) in animal models with chemically induced liver damage .
In one study rats given Boswellia extract had an increased liver functioning with an increase in the dosage .
Articum lappa Linne could reduce the liver damage caused by chronic alcohol consumption potentiated by carbon tetrachloride (CCl4) in rats .
Articum can prevent most of the liver tissue damage caused by acetaminophen overdose in rats .
The inhibitory effects on carrageenan-induced paw edema and CCl4 induced liver toxicity could be due to the scavenging ability of A. lappa .
Articum root extract had a protective effect on the liver against cadmium toxicity in rats .
The liver protective ability of Articum is attributed to its antioxidant property, which decreases the oxidative stress in liver cells.
Melatonin protects the liver from methotrexate-induced oxidative injury in rats. It increased the MDA (Malondialdehyde) levels, MPO (Myeloperoxidase) activity and increased Glutathione levels in the blood, liver, and kidney .
Melatonin protects liver cells against oxidative molecular damage and metabolic dysfunction. It achieves this protection via the diverse free radical scavenging mechanisms .
Melatonin (MT) exhibits potent antioxidant properties that may create favorable conditions for the recovery of liver function following ischemia-reperfusion injury in rats .
Melatonin also exerts a protective effect against fatty liver in rats induced by a high-fat diet .
In one study melatonin, injections at pharmacologic doses were effective in reducing liver damage in rats with BDL (Bile Duct Ligation)-induced liver fibrosis. This protective action could be related to its antioxidant, anti-inflammatory and anti-fibrotic activities .
Uridine supplementation normalized or reduced all the abnormalities of zalcitabine induced microvesicular steatohepatitis in mice. It reduced mitochondrial liver toxicity without any side effects .
Uridine co-administration was effective in preventing tamoxifen-induced liver lipid droplet accumulation. This ability of uridine appeared to depend on the pyrimidine salvage pathway, which promotes the biosynthesis of membrane phospholipids .
Uridine also prevents galactosamine-induced liver cell necrosis in rats .
A double-blind clinical study in patients with Nonalcoholic fatty liver change showed that grape seed extract was more protective and improved liver function when compared to Vitamin C .
Grape seed extract (Vitis vinifera) protects rat liver and inhibits Methotrexate-induced oxidative stress. When used with MTX (Methotrexate) it significantly decreased MDA (Malondialdehyde) levels and increased the activity of SOD (superoxide dismutase) and CAT (Catalase) .
Grape seed extract may be a promising therapeutic option in radiation-induced oxidative stress in rat liver [102, 103]. It also protects the liver from oxidative damage following bile duct ligation in rats .
Grape seed and skin extract (GSSE) could be used as a safe preventive agent against fat and doxorubicin-induced liver toxicity .
In mouse models of chemically induced hepatotoxicity, andrographolide and neo andrographolide (Andrographis paniculata) reduced levels of lipid peroxidation, glutathione depletion, and enzymatic leakage, possibly through antioxidant effects .
Andrographis could effectively prevent liver injury induced by CCl4 in mice .
A choleretic effect was seen in rats and guinea pigs with paracetamol-induced liver damage .
According to one study, the standardized extract of A. paniculata with the right composition of diterpenic labdanes is likely to have good potential for the development of a liver protective medication. Though it might not provide an immediate remedy, but it can be considered as a comprehensive therapy for liver inflammation .
Extracts of Rosemary (Rosmarinus officinalis) relaxes smooth muscles and has a liver protective effect .
Rosmarinic acid was able to inhibit proliferation and induce apoptosis hepatic stellate cells (HSCs), which are activated during liver injury and thus contributed to the reversal of liver fibrosis [111, 112].
Rosmarinic acid (RA) could reduce fibrosis grade, ameliorating biochemical indicator and histopathological morphology, reducing liver TGF-beta 1 and CTGF expression in CCl4-induced liver fibrosis .
Some clinical studies suggest improvement in liver function in both Alcoholic liver disease (ALD) and hepatitis C following zinc supplementation and one study suggested improved fibrosis markers in hepatitis C patients .
A prospective study in patients with C-viral chronic hepatitis (CH) and liver cirrhosis (LC), supplementation of zinc in these patients clearly lowered the incidence of hepatocellular carcinoma (HCC) and improved the long-term outcome in CH and LC patients .
In one study it was found that zinc deficiency is profound and should be assumed to be present in every patient with end-stage liver disease awaiting transplant, and during the waiting period, oral supplementation with zinc should be provided .
Zinc has beneficial effects against arsenic-induced liver toxicity in rats. Administration of zinc caused signs of improvement in liver histoarchitecture, increased the levels of GSH (Glutathione) and decreased LPO (Lipid peroxide) levels .
Zinc supplementation might play an important role in the prevention of hepatic encephalopathy by activating glutamine synthetase in patients with decompensated liver cirrhosis .
Zinc supplementation offers protection in experimental animal models of acute and chronic liver injury and also could protect against other liver diseases as well .
Water decoction of Sweetheart (Desmodium adscendens) showed a protective effect in rats against liver damage induced by D-galactosamine and ethanol. This effect is in part due to the presence of D-pinitol .
A patent has been taken on the use of Desmodium, especially D. adscendens in the treatment of viral and chemically induced hepatitis .
Milk osteopontin could be a simple nutritional strategy to prevent liver toxicity which is mainly due to its stomach protective, anti-inflammatory, and anti-steatotic actions. It also diminished ethanol-mediated liver injury .
Osteopontin acts as a protector during inflammatory liver injury. In one study it was shown that it promotes the survival of liver cells during DEN (diethylnitrosamine)-induced liver injury (inhibits the activation of Nf-kb, and increase the production of TNF-αin macrophages and IL-6) .
Glycine containing diet accelerates the process of recovery from alcohol-induced liver injury and may lead to its clinical application in alcoholic hepatitis .
Glycine also diminishes liver and kidney injury caused by liver and kidney toxicants and drugs .
Glycine and Uridine prevent D-galactosamine liver toxicity in rats .
In a study done on rats, the alcoholic extract of Holy Basil (Ocimum sanctum) had liver protective effects. It also had synergistic liver protection effects in conjunction with Silymarin .
Tulasi extract had protective effects against oxidative stress induced by p-hydroxybenzoic acid in mice liver .
In hypercholesterolemic animals treatment with Dill tablet or Dill extract reduced the levels of ALT (Alanine transaminase) and AST (Aspartate transaminase), which are the sensitive markers for liver injury .
Wormwood (Artemisia absinthium) had preventive and curative effects on acetaminophen and CCl4-induced liver damage in animal models .
Alcohol soluble part of the hot-water extract from Artemisia (A. iwayomogi) inhibited fibrosis and lipid peroxidation in rats with liver fibrosis induced by CCl4 in rats .
Oriental wormwood (A. capillaris) as “Yin Chen Hao” in Traditional Chinese medicine has been found to have liver protective effects both in lab studies and in animal models .
Chamomile (Matricaria chamomilla) flower extracts showed effective prevention of fatty liver formation and hepatic inflammation in obese mice, indicating liver protective effects of this extract .
Chamomile was also protective to liver against CCl4 induced toxicity in animal models .
Chamomile treated diabetic rats showed a decrease in Aspartate transaminase (AST) and Alanine transaminase (ALT) levels, hence chamomile was liver protective in STZ-induced diabetic rats .
Chamomile also had a protective effect against paracetamol-induced liver injury in rats .
Astragalus had anti-tumor effects against hepatocellular carcinoma cells, it significantly inhibited the growth of H22 cells .
Astragalus (total flavonoids of Astragalus) have a potential protecting effect against the paracetamol-induced liver damage in mice .
Flavonoids extracted from semen Astragali (SA) are useful in preventing rat liver fibrosis induced by dimethylnitrosamine (DMN) .
A. membranaceus has a protective effect on BCG/LPS (Bacillus Calmette-Guérin and lipopolysaccharide) induced liver injury in mice .
One study recommends that dietary intake of plant mixture of celery, chicory, and barley at 15% (5% of each) concentrations can be beneficial to patients suffering from hypercholesterolemia and liver diseases .
In a randomized double-blind multicentered study G. lucidum extract “Ganopoly” was administered to patients with chronic hepatitis B, results showed that this extract was effective against HBV and was well tolerated in these patients .
Reishi mushroom (Ganoderma lucidum) significantly decreased blood ALT (Alanine aminotransferase) and AST (Aspartate aminotransferase) levels in mice livers injured with α-amanitin .
Extracts of Reishi mushroom had a protective effect on the liver against damage caused by benzopyrene in rats .
G. lucidum extracts also had protective effects on the liver fibrosis in rats caused by thioacetamide .
Polysaccharides extracted from G. lucidum were found to improve the symptoms of cirrhosis induced by biliary ligation in rats .
In a randomized double-blind placebo-controlled clinical trial in patients with acute viral hepatitis, a polyherbal formulation containing Stonebreaker or Chanca Piedra (Phyllanthus niruri) had anti-hepatitis activity and was effective .
P. niruri has antioxidant and liver protective effects in CCl4 induced hepatotoxicity .
P. niruri also plays a protective role against liver cirrhosis induced by thioacetamide in rats .
A dry extract of P. niruri protects normal cells and induces apoptosis in human liver carcinoma cells .
In a randomized, parallel and placebo-controlled study Schisandra fruits extract and sesamin (SCH) treated subjects had an improved fatty liver with an improvement in the liver function .
Schisandra (Schisandra chinensis) (SC) has the ability to prevent alcohol-induced fatty liver disease in rats (possibly by the activation of AMPK and PPARα signaling) .
SC reduces ER stress and prevents the development of NAFLD (Nonalcoholic Fatty Liver disease) .
A clinical study has shown that Guduchi (Tinospora cordifolia) plays an important role in the normalization of altered liver functions (ALT, AST) .
Antiretroviral therapy (ART) for the treatment of HIV-AIDS is associated with alteration in liver function tests. These were reversed and normalized by Guduchi .
A food supplement formulation comprising Dandelion root improves the function of the human liver, by supporting the body’s process of cleansing and detoxifying the liver .
Water extract of Dandelion (Taraxacum officinale) has a protective action against alcohol-induced toxicity in the liver of mice (possibly by elevating antioxidative potentials and decreasing lipid peroxidation) .
Dandelion water-alcohol extract (DWE) had protective effects against CCl4-induced liver fibrosis (by inactivating liver stellate cells and enhancing liver regenerative capacity) in mice .
Traditionally used for enlarged liver and for liver revitalizing .
Amla (Emblica Officinalis) and Chyavanaprash were found to inhibit liver toxicity produced by acute and chronic CCl4 administration in rats .
Amla possesses protective effects against chemical-induced liver carcinogenesis in animal models of study (appear to be mediated by free radical scavenging activity) .
Amla reduces N-Nitrosodiethylamine-induced apoptosis, autophagy, and inflammation in rat livers .
Amla fruit extract supplementation had significantly reduced arsenic-induced oxidative stress in the liver of mice .
Vitamin E and C were significantly more effective than Vitamin A against ethanol-mediated toxic effects during liver regeneration. Both E and C could protect against liver injury and dysfunction and reduced lipid peroxidation .
Clinical trials in small cohorts of patients have shown that treatment with Vitamin E could be proposed for Nonalcoholic Fatty Liver Disease (NAFLD) .
Vitamin E plus C treatment was effective in treating patients with fatty liver diseases in an open-labeled, prospective, randomized study .
Vitamin D deficiency is highly prevalent in patients with Chronic liver disease (CLD), and Vitamin D levels are inversely related to the severity of CLD. Hence supplementation could be a therapeutic option . Also, the prescription of Vitamin D is advised in patients with cholestasis .
In one study Kombucha tea (KT) showed liver protective and curative effects against CCl4-induced toxicity in mice .
Kombucha tea has liver protective effects against acetaminophen-induced liver injury in mice .
Lemon balm (Melissa Officinalis) extract had a protective effect on liver cells in rats with high cholesterol according to one study. This was attributed to the presence of flavonoids in this plant .
Castor oil packs
Apply continuous and frequent Castor oil packs for a healing and detoxifying action on an inflamed liver.
Checking Your Liver Function
You can request that your doctor test your liver function. Conventional doctors will look at high or low blood protein and liver enzyme levels and not mention anything. Sometimes, a lab result may be in the reference range, but not actually be in the optimal range. Reference ranges are not the same as optimal ranges. This is why even values in the ‘normal’ range can be unhealthy and indicate that certain processes in the body aren’t optimal.
Herbs and Supplements that are Toxic and Hard to the Liver or May Cause Liver Damage
Alcohol consumption is directly associated with liver disease, Alcoholic Liver Disease (ALD) may take the form of acute involvement (alcoholic hepatitis) or chronic liver disease (steatosis, steatohepatitis, fibrosis, and cirrhosis) .
In advanced countries, mortality due to liver diseases is directly proportional to alcohol consumption (30g of pure alcohol per day is regarded as a “safe dose”). Serious alcoholic hepatitis has a mortality record of up to 50% .
Steatosis characterized by fat accumulation in liver cells develops in 90% of individuals who drink more than 16g of alcohol/day  but resolves upon cessation of alcohol consumption.
Many reports have claimed that the liver toxicity of paracetamol (acetaminophen) is increased in chronic alcoholics. Individuals not only carry an increased risk of severe and fatal liver damage after acute overdosage, but similar serious liver damage may occur at “therapeutic” dose as well .
Fo-ti (Polygonum Multiflorum, PMT) has been ranked in the top five of individual herbs or used most frequently in Traditional Chinese Medicine (TCM) formulations to induce Liver toxicity .
In around 25 patients according to one study, it was found that P. multiflorum could be hepatotoxic and could lead to severe drug-induced liver injury and even death .
The processed roots of PMT have displayed lower rates of toxicity as reported in animal studies .
Chronic treatment with peppermint oil resulted in some degree of liver impairment, although no other parameters of the liver function or liver morphology were impaired in animal models .
One study on the effects of peppermint oil on rat liver and cultured human hepatoma cells showed that there was an increase in the rat bile flow after an acute high dose and an increase in alkaline phosphatase after a chronic dose of peppermint oil .
There are few studies indicating liver toxicity after consumption of products made from Kava (Piper methysticum), but most of them were from patients with a history of alcohol consumption or other prescribed drugs [199, 200].
Humberston et.al reported a case of acute hepatitis associated with kava-kava ingestion in a 14-year-old girl. She recovered after a liver transplant .
High Doses of some Vitamins
Long term or high doses of Niacin (time -release preparations ) have led to liver failure or hepatotoxicity . Liver toxicity is possibly related to metabolism via amidation resulting in NAD production .
High dose of β-carotene has been demonstrated to increase alcohol-induced liver injury while lower doses have been liver protective . Therefore supplementation of beta carotene with alcohol should be made with caution.
High doses of valerian oil had toxic effects on rat liver and cultured hepatoma cells in one lab experiment .
Saw Palmetto (Serenoa repens) preparations have caused cholestatic hepatitis in some patients .
Saw Palmetto induced acute hepatitis and pancreatitis in one patient and after discontinuation of this supplement .
Acute liver damage was reported with the use of Saw palmetto in one case report .
Borage (Borago officinalis) seed oil has complex molecules called pyrrolizidine alkaloids (PA) which are toxic to the liver, (the concentration of PA’s must be lower than 200 ppt for the safe usage of this oil) .
Total alkaloid (PA) content is less than 0.001% .
Liver damage has been reported in a few individuals taking Black Cohosh (Actaea racemosa). But a meta-analysis study reported that there is no such evidence in this regard .
According to one study, two females had developed acute submassive liver necrosis following consumption of black cohosh .
In another case study, a 44-year-old female developed subacute liver injury within a month of using black cohosh to resolve her hot flashes .
In one study an oral administration of 60 mg of Red Clover (Trifolium pratense) in men caused a significant increase in liver transaminases by >30% . Possibly due to the presence of high amounts of isoflavones.
According to one study, red clover might interact with Non-steroidal anti-inflammatory drugs particularly aspirin and cause adverse reactions. These adverse events are in particular with herbal supplements that contain coumarin .
According to one study, three women (61, 52 and 49 years old) developed jaundice after taking Centella Asiatica (Gotu Kola). All the patients improved after the discontinuation of this supplement .
Gotu kola also induced liver toxicity in one child, hence care should be taken while using this supplement .
Centella asiatica has been reported to cause granulomatous hepatitis and cirrhosis .
Liver injury associated with oral administration of Aloe vera was first reported in 2005. An injury typically arises between 3 and 24 weeks of starting oral aloe vera and is rare .
According to one report, three women (aged 55, 57 and 65) suffered acute hepatitis after taking aloe preparations for months. Liver enzymes returned to normal upon discontinuation of the oral aloe preparations .
Pennyroyal (Mentha pulegium) oil is said to be highly toxic, studies have reported its toxicity to the liver possibly due to the presence of pulegone a highly toxic organic compound affecting the liver .
A reversible liver veno-occlusive disease was seen in an infant after consumption of Coltsfoot tea . Possibly due to the presence of pyrrolizidine alkaloids.
Coleus forskohlii root extract
In a study, the effect of CFE (Coleus forskohlii root extract) extract with 10% forskolin on the liver of mice was examined. CFE generates dose-dependent liver toxicity in mice, the highest concentration (5%) increased liver weights (63%) and plasma AST (Aspartate aminotransferase), ALT (alanine aminotransferase) and ALP (alkaline phosphatase) activities .
A clinical study published in 2000 in the “Public Health Nutrition” journal found that the herb Comfrey (Symphytum spp) posed a “substantial health hazard” to the liver, causing various levels of damage potentially leading to liver failure. Possible due to the presence of Pyrrolizidine alkaloids (PA).
A 28-year-old developed jaundice after taking Pau d’arco and skullcap for 6 months for his multiple sclerosis, progressing to liver failure .
Administration of Bitter melon (Momordica charantia) extract to mice elevated the levels of Alkaline phosphatase (ALP), but there was no significant histopathological change in the liver .
Ingestion of Clove oil in one case study resulted in coma, fits and acute liver damage .
Olive leaf extract
In South Africa Impila (Callilepis laureola) has been associated with some cases of hepatitis and renal tubular necrosis. Another case a mother who consumed Impila died of hepatocellular necrosis .
A 55-year-old woman developed acute liver failure after drinking a tea containing Senna (Cassia augustifolia). The liver-toxic effects of Senna are ascribed to its major constituents sennosides .
Compounds Present in Foods/Supplements That are Toxic to the Liver
Coumarin is a natural substance found in many plants. It is moderately toxic to the liver and kidneys with a median lethal dose (LD50) of 275 mg/kg. Though this compound is only somewhat dangerous to humans at moderate doses, it is toxic at high doses.
Coumarin is hepatotoxic in rats and mice due to its differential metabolism .
European health agencies have warned against high consumption of cassia cinnamon bark due to its high coumarin content . Coumarin is found naturally in various other edible plants like strawberries, black currant, apricots and cherries .
According to one study coumarins have an influence on the brain which can lead to mild neurological dysfunction in children after prenatal exposure to coumarins (R).
The content of Coumarin in specific food categories is regulated European regulation (EC) No 1334/2008 .
Eugenol is a pale yellow oily liquid extracted from certain essential oils like clove leaf oil (80 – 88%), nutmeg , cinnamon, sweet basil , African basil , Japanese star anise  and bay leaf . It is toxic to the liver and may cause liver damage [262, 263].
Pyrrolizidine alkaloids are produced by plants as secondary metabolites. There are more than 600 PAs and PA N-oxides identified in over 6,000 plants and more than half of them exhibit hepatotoxicity .
Herbal remedies containing PAs can induce liver damage, including hepato-sinusoidal obstruction syndrome or veno-occlusive disease .
There is currently controversy over whether the use of the PA (Pyrrolizidine alkaloids)-containing herbs for short periods of time is safe, considering the track records of the use of many of these herbs in the past versus the fact that negative effects can accumulate over time.
Fortunately, some companies, such as Herb Pharm, now make pyrrolizidine-free comfrey. This can be used safely and confidently for longer periods of time.) The herb extracts (which contain PAs) are run through an ion exchange bed that removes the PAs. The finished extract contains less than 1ppm of PAs.
Whole valerian contains liver-toxic substances called valepotriates; however, valepotriates are thought to be absent from most commercial valerian products and case reports suggest that even very high doses of valerian do not harm the liver.
Furano-diterpenoids which are toxic to the liver and may cause hepatitis and even liver damage are found in certain herbs like germander.
Herbs and Supplements to Use Only With Caution
Many natural products have the capacity to harm the liver. Furthermore, due to the generally inadequate regulation of dietary supplements that exist at the time of this writing, there are real risks that herbal products, at least, may contain liver-toxic contaminants even if the actual herbs listed on the label are safe. For this reason, we recommend that people with liver disease do not use any medicinal herbs except under the supervision of a physician. Here, we list some specific information to aid in your decision-making process.
High doses of the supplements beta-carotene  and vitamin A are thought to accelerate the progression of alcoholic liver disease in people who abuse alcohol (Nutritional supplementation at the standard daily requirement level should not cause a problem).
All forms of vitamin B3, including niacin, niacinamide (nicotinamide), and inositol hexaniacinate, may damage the liver when taken in high doses. (Again, nutritional supplementation at the standard daily requirement level should not cause a problem.)
In addition, herbs that are not toxic to the liver in themselves are sometimes adulterated with other herbs of similar appearance that are accidentally harvested in a misapprehension of their identity (for example, germander found in skullcap products). Furthermore, blue-green algae species such as spirulina may at times be contaminated with liver-toxic substances called microcystins, for which no highest safe level is known.
Some articles claim that the herb echinacea is potentially toxic to the liver, but this concern appears to have been based on a misunderstanding of its constituents. Echinacea contains substances in the pyrrolizidine alkaloid family. However, while many pyrrolizidine alkaloids are toxic to the liver, those found in echinacea are not believed to have that property.
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