Too much of a good thing can be bad, sure – but just how much is too much? And what about things we think of as all-natural? “Just because something is labelled ‘natural’ does not mean it is risk-free, and easy access does not guarantee safety,” explains pharmacist Thembeka Gule of Medipost Pharmacy, a South African courier pharmacy. “The liver does the heavy lifting, processing everything we put into our bodies. However, when it gets overloaded, the fallout can be serious.” Here’s what to know about over-the-counter medicines and supplement overdoses – and how to avoid them.
Are Supplement-Induced Liver Damage Cases On The Rise?
“In South Africa, the actual number of supplement-related liver injuries is not well known, but concern is growing,” says Gule. In the U.S., a 2024 report found that 15.6 million people took potentially damaging “natural” supplements. And it’s not just herbs. “Weight-loss products carry a particularly high risk,” says Gule. It’s on the rise: otherwise-healthy people are ending up in the hospital for taking too many supplements. It’s called drug-induced liver injury (DILI) and while local statistics are not documented, anecdotal evidence and studies from similar regions indicate increasing cases over recent years.
A small Australian study highlighted a rise in severe liver injury cases associated with herbal and dietary supplements promoting muscle growth or weight loss, some severe enough to require liver transplants. This trend echoes concerns in South Africa due to the widespread use of herbal and natural supplements. The serious liver injuries are often related to supplements marketed as natural or weight-loss aids, with many users unaware of their hepatotoxic risks and failing to consult healthcare providers before use.
Why Your Go-To Painkiller Poses The Biggest Threat
This go-to pain tab isn’t inherently non-toxic. “Paracetamol toxicity is a major concern in South Africa and around the world because it is widely available and is not as strictly regulated,” explains Gule. “As a result, anyone can get paracetamol without medical intervention, which makes overdoses and misuse all too common. The danger increases when paracetamol is taken with alcohol or other medications that strain the liver, raising 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’s the body’s detox hub, so it’s exposed to almost everything you swallow. While some individuals metabolise toxins more slowly, excessive amounts of certain drugs can overload even a healthy liver. Plus, herbal supplements are not as standardised as pharmaceuticals, which means contaminants, unknown ingredients or batch variations can increase the risk. Taking multiple ‘safe’ supplements at once can overload the liver. Conditions like diabetes, fatty liver disease, or heavy alcohol use make this even riskier. Here, a few supplement overdoses to look out for:
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1. Turmeric
Often praised and widely used in curries, golden milk and DIY flu shots, turmeric, when taken in excess, can turn toxic. Curcumin, the antioxidant that gives turmeric its health glow, is anti-inflammatory and can support the liver. But turmeric can flip from being helpful to potentially harmful, especially when combined with black pepper extract, which boosts curcumin absorption. “Patients with pre-existing liver conditions, or any liver problems, should avoid high doses of turmeric and curcumin extract supplements and discuss any concerns with a healthcare professional,” says Gule.
Massively used in weight-loss supps, these extracts are far punchier than their predecessor, plain green tea. They’re high in EGCG (epigallocatechin gallate) and other catechins, which 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, causing the accumulation of toxic by-products that harm the liver.
3. Ashwagandha
This herb, commonly found in superfood and nootropic powders, is known for its cortisol-lowering properties and many other health benefits. But, it’s important to not go overboard. Because ashwagandha is metabolised by the liver, it can increase the risk of liver failure. In rare but severe cases, this has led to acute liver failure, sometimes requiring transplantation, mainly when used with other supplements that are metabolised by the liver. “Ashwagandha is generally well-tolerated when taken for short periods. It is best to avoid long-term use unless advised by a healthcare professional,” says Gule.
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4. Garcinia cambogia
Another weight-loss supplement ingredient with cult-like devotees, GC’s active ingredient, hydroxycitric acid, works by inhibiting the appetite. But too much can become toxic, even though clinical studies and case reports are limited compared to other supps. There have been rare cases of liver injury reported with its long-term consumption or when taken in 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 healthcare professional, which can lead to inconsistent dosing, raising the risk of liver damage.
6. Black cohosh
Black cohosh is often used to relieve menopausal symptoms in women, but has been linked with some rare cases of liver damage. Menopausal women taking black cohosh must do so with caution, especially if they have liver conditions or are on other medications.
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7.. Caffeine
Drinking excessive amounts of caffeine can lead to toxic effects on the central nervous and cardiovascular systems. It can occur from high intake of caffeinated beverages, supplements, or powders. Overdose is not extremely common but has become more frequent with easy access to caffeine supplements and energy drinks. Safe daily caffeine intake for most healthy adults is generally considered up to 400 mg (about 4 cups of brewed coffee).
Warning Signs
- Stomach pain
- Yellowing of the eyes/skin (jaundice)
- Tiredness
- Nausea and vomiting
- Early signs often missed include dark urine, loss of appetite and itchy skin
“If detected early and the harmful product is discontinued, the liver often has a chance to heal, explains Gule. “But severe or late-detected damage can lead to permanent harm. Individual genetics and metabolism influence how people metabolise substances, resulting in variations in reactions from person to person. That is why stricter regulations and targeted monitoring of high-risk products are so important,” concludes Gule.
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