Of course, too much of a good thing can be bad – but how much is too much? And what about things we think are completely natural? “Just because something is labeled ‘natural’ doesn’t mean it’s risk-free, and easy access doesn’t guarantee safety,” explains pharmacist Thembeka Gule of Medipost Pharmacy, a South African courier pharmacy. “The liver does the heavy lifting of processing everything we put into our bodies. However, when it becomes overloaded, the consequences can be serious.” Here’s what you should know about over-the-counter medications and supplement overdoses—and how to avoid them.
Are cases of liver damage caused by dietary supplements increasing?
“In South Africa, the actual number of liver injuries caused by dietary supplements is not precisely known, but concern is growing,” says Gule. In the United States, a 2024 report found that 15.6 million people were taking potentially harmful “natural” supplements. And it’s not just herbs. “Weight loss products pose a particularly high risk,” says Gule. The number is increasing: otherwise healthy people end up in the hospital because they take too many nutritional supplements. It is called drug-induced liver injury (DILI), and although local statistics are not documented, anecdotal reports and studies from similar regions suggest an increase in cases in recent years.
A small Australian study pointed to an increase in serious liver damage associated with herbal and dietary supplements intended to promote muscle growth or weight loss, some of which were so severe that a liver transplant was required. This trend reflects concerns in South Africa due to the widespread use of herbal and natural supplements. The serious liver damage is often associated with dietary supplements that are marketed as natural remedies or weight loss aids. Many users are unaware of their hepatotoxic risks and fail to consult medical professionals before use.
Why Your Favorite Painkiller Is the Biggest Threat
This painkiller is not naturally non-toxic. “Paracetamol toxicity is a major concern in South Africa and around the world because it is widely used and not as tightly regulated,” explains Gule. “Therefore, anyone can receive paracetamol without medical intervention, which makes overdoses and abuse all too common. The danger increases when paracetamol is taken with alcohol or other medications that stress the liver, increasing the risk of liver damage.”
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7 Supplements That Can Overload Your Liver
The liver performs over 500 vital functions, including filtering harmful substances from the blood. It is the body’s detoxification center and is therefore exposed to almost everything you swallow. While some people metabolize toxins more slowly, excessive amounts of certain medications can overwhelm even a healthy liver. Additionally, herbal supplements are not as standardized as pharmaceuticals, meaning impurities, unknown ingredients, or batch variations can increase risk. Taking multiple “safe” supplements at the same time can overload the liver. Illnesses such as diabetes, fatty liver disease or heavy alcohol consumption make this even more risky. Here are some supplement overdoses to watch out for:
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1. Turmeric
Turmeric is often praised and commonly used in curries, golden milk, and DIY flu preventatives. It can become toxic if consumed in excess. Curcumin, the antioxidant that gives turmeric its healthy glow, is anti-inflammatory and may support the liver. But turmeric can go from helpful to potentially harmful, especially when combined with black pepper extract, which increases curcumin absorption. “Patients with pre-existing liver disease or liver problems should avoid high doses of turmeric and curcumin extract supplements and discuss any concerns with a doctor,” says Gule.
These extracts are commonly used in weight loss supplements and are far more potent than their predecessor, pure green tea. They contain high levels of EGCG (epigallocatechin gallate) and other catechins that 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, leading to the accumulation of toxic byproducts that damage the liver.
3. Ashwagandha
Commonly found in superfoods and nootropic powders, this herb is known for its cortisol-lowering properties and many other health benefits. But it’s important not to overdo it. Because ashwagandha is metabolized in the liver, it may increase the risk of liver failure. In rare but serious cases, this has resulted in acute liver failure, sometimes requiring a transplant, especially when used concurrently with other nutritional supplements that are metabolized by the liver. “Ashwagandha is generally well tolerated when taken for short periods of time. It is best to avoid long-term use unless recommended by a doctor,” says Gule.
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4. Garcinia Cambogia
Another weight loss supplement ingredient with a cult-like following, GC’s active ingredient, hydroxycitric acid, suppresses appetite. But too much can become toxic, although clinical studies and case reports are limited compared to other supplements. Rare cases of liver damage have been reported with long-term consumption or ingestion of high doses. Garcinia Cambogia should be taken with caution, warns Gule.
5. Red yeast rice
Red yeast rice contains a naturally occurring statin called monacolin K, which may help lower blood cholesterol levels. However, it is often taken without consulting a doctor, which can result in inconsistent dosage and increase the risk of liver damage.
6. Black cohosh
Black cohosh is often used to relieve menopausal symptoms in women, but in some rare cases it has been linked to liver damage. Menopausal women who take black cohosh should do so with caution, especially if they have liver disease or are taking other medications.
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7.. Caffeine
Consuming excessive amounts of caffeine can have toxic effects on the central nervous and cardiovascular systems. It can arise from high consumption of caffeinated drinks, dietary supplements or powders. Overdoses are not very common, but have become more common due to easy access to caffeine supplements and energy drinks. The safe daily caffeine intake for most healthy adults is generally considered to be up to 400 mg (about 4 cups of brewed coffee).
Warning signs
- Stomach pain
- Yellowing of the eyes/skin (jaundice)
- fatigue
- Nausea and vomiting
- Early signs that are often overlooked include dark urine, loss of appetite, and itchy skin
“If the liver is recognized early and the harmful product is stopped, it often has a chance to heal,” explains Gule. “But severe damage or damage detected late can lead to permanent damage.” Individual genetics and metabolism influence the way people metabolize substances, resulting in different responses from person to person. That’s why stricter regulations and targeted monitoring of high-risk products are so important,” concluded Gule.
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