A recent wave of research has spotlighted a troubling trend: as more people embrace herbal and dietary supplements for perceived health benefits, cases of severe liver injury and even liver failure connected to these products are climbing at an alarming rate. This trend comes as health experts caution that supplements, frequently advertised as safe and “natural,” can in fact carry significant health risks—particularly to the liver, the body’s vital organ for filtering toxins.
The surge in supplement usage comes against a backdrop of growing health-consciousness worldwide, including in Thailand, where wellness culture has seen an uptick in fitness routines, organic diets, and the consumption of widely available vitamins and herbal remedies. Many brands promise enhanced longevity, weight loss, or improved immunity. Yet experts say these very products could undermine the health they are meant to support—a fact that has become increasingly apparent in new studies from the United States and is likely to have global implications, including here in Southeast Asia.
The liver acts as the body’s chemical processing plant, breaking down medications, alcohol, and various substances—including compounds found in dietary supplements. When overwhelmed by excessive or toxic loads, the liver can develop “drug-induced liver injury,” also referred to as toxic hepatitis. According to the Mayo Clinic, this condition results in liver inflammation that may be reversible if caught early but carries the risk of progressing to cirrhosis or fatal liver failure if not addressed (Mayo Clinic). While decades-old warnings have focused on risks from well-known substances like alcohol or paracetamol (marketed as Tylenol in the United States), the latest risk factor is the rising popularity of supplements.
A 2024 survey from the Council for Responsible Nutrition revealed that as many as three out of four U.S. adults now take some form of supplement, whether herbal or dietary, with nearly four in five stating a preference for supplements over prescription or over-the-counter medicines (StraightArrow News). This represents a marked increase from previous years; the U.S. Centers for Disease Control and Prevention previously reported that between 2017 and 2018, only 58% of adults had used a supplement in the previous month.
More alarmingly, a 2022 study in the peer-reviewed journal “Liver Transplantation” found that the proportion of patients awaiting a liver transplant because of supplement-related liver failure soared from just 2.9% in 1995 to a staggering 24.1% in 2020. “We are seeing a substantial increase in acute liver failure cases linked to supplements,” noted the study’s lead researchers (NBC News).
Pinpointing the precise ingredients responsible for these injuries is challenging, as many supplements contain proprietary blends or multiple active compounds. However, a 2023 study led by the University of Michigan specifically identified six ingredients commonly associated with cases of toxic hepatitis: turmeric, green tea extract, ashwagandha, garcinia cambogia, red yeast rice, and black cohosh (Michigan Medicine Health Lab). These ingredients are present in products consumed by roughly 15 million Americans—and are also widely available and increasingly popular in Thailand, often found in over-the-counter herbal formulas targeting joint pain, weight loss, and menopausal symptoms.
Medical experts, including those at the American Association for the Study of Liver Diseases, estimate that about 20% of liver toxicity cases in the U.S. are now attributable to dietary or herbal supplements, rather than traditional pharmaceuticals or alcohol (pharmacist.com).
What is driving the increase? There is broad consensus among researchers: the lack of rigorous regulation on supplements is a key factor. In many countries, including Thailand and the United States, supplements are not held to the same standards for safety and efficacy as medications. Manufacturers are not always required to prove that their products are free from contaminants, contain the correct dosages, or avoid potentially dangerous drug interactions. This regulatory gap creates significant uncertainty for consumers. As underscored by a leading hepatology consultant at a major Bangkok hospital, “Most patients assume ‘natural’ means safe, but that’s not the case—liver injury is often silent until it becomes severe.”
In Thailand, the herbal supplement market is robust and growing, fueled by both traditional beliefs in natural medicine and aggressive marketing campaigns. From Bangkok’s pharmacies to the herbal stalls of Chiang Mai’s famous markets, products containing turmeric, green tea, and ashwagandha sit alongside centuries-old remedies. This cultural context enhances the acceptance of supplementation as part of holistic well-being, but it also heightens the population’s exposure to potential harm—often without adequate consumer education or regulatory controls.
Thailand’s Food and Drug Administration (FDA) has issued warnings about specific products following spikes in patient reports, but the vast majority of supplements remain unchecked. According to a regulatory affairs specialist at the FDA, who spoke on condition of anonymity, “The challenge is the market’s sheer scale and constant flow of new products. We urge people to seek medical advice before starting any supplement—especially if they have underlying liver conditions or are taking other medications.”
The health consequences linked to supplement-induced liver injury often begin subtly. Early symptoms include fatigue, jaundice (yellowing of the skin or eyes), loss of appetite, and abdominal pain. If unrecognized and untreated, the injury can progress to irreversible scarring (cirrhosis) or, in the worst case, acute liver failure. Once liver failure sets in, a transplant may be the only hope for survival—a scenario that carries immense financial, emotional, and medical burden.
While public awareness of these risks is growing in the West, the issue remains underrecognized in Thailand, where family traditions and community practices often override warnings from modern medical professionals. This is compounded by healthcare disparities, including limited access to specialist care in rural areas and a tendency for self-medication.
Looking ahead, the global escalation in supplement-induced liver injury could have profound implications. As health-conscious trends intersect with the vast online marketplace, including cross-border trade via e-commerce platforms, Thai consumers are exposed to products with little to no oversight. If current patterns persist, hospitals in major Thai cities may see a significant uptick in patients suffering from unexplained liver inflammation, especially among middle-aged adults and elderly individuals with pre-existing health conditions.
For Thai readers searching for practical guidance, the recommendation from public health authorities is clear: do not assume safety based on a supplement’s natural origins or popularity. Always consult with a healthcare professional—preferably one with expertise in internal medicine or hepatology—before starting any new supplement, especially those containing turmeric, green tea extract, ashwagandha, garcinia cambogia, red yeast rice, or black cohosh. Additionally, report any unusual side effects promptly, and carefully scrutinize both the labeling and source of any product purchased in-person or online. Importantly, for individuals with existing liver disease, supplements should only be taken under close medical supervision.
In the spirit of preventive health, Thais are urged to balance enthusiasm for natural wellness with critical scrutiny of the products they choose—and to remember that the fundamental pillars of long-term health remain a balanced diet, routine physical activity, and regular medical checkups. As one leading hepatologist at a large teaching hospital in Bangkok put it, “There are no shortcuts. Respect your liver, and it will serve you for a lifetime.”
For more information, readers may consult the Mayo Clinic’s overview on toxic hepatitis and the U.S. FDA’s consumer advice on dietary supplements (FDA.gov). Thai readers can find additional resources and warnings from the local Thai Food and Drug Administration regarding supplement safety.