A dramatic rise in cases of drug-induced liver injury (DILI) linked to herbal and dietary supplements in the United States is prompting renewed scrutiny of the global supplement industry—a warning that Thai consumers should heed as these products grow in popularity at home. Recent research referenced by NBC News highlights an eightfold increase in supplement-related liver transplants in the U.S. over the past 25 years, with experts cautioning that “natural” does not always equal safe (NBC News).
The significance of this news is twofold: it challenges common perceptions that herbal and dietary supplements are harmless, and it highlights potential health risks from products that are gaining traction in Thailand’s expanding wellness market. As many Thais seek to improve their health with supplements—from turmeric capsules touted for liver health to herbal blends for vitality—understanding the real risks is crucial.
The liver performs over 500 essential functions, including toxin filtration. While drug-induced liver injury from commonly used paracetamol (acetaminophen) is well known, supplements present a newer and often overlooked threat. According to a 2022 journal study in Liver Transplantation, the increase in DILI requiring transplantation is particularly associated with herbal and “multi-ingredient nutritional supplements,” making it difficult for researchers to pinpoint the exact culprits.
A 2017 review published in Hepatology found that 20% of liver toxicity cases across the U.S. were tied to dietary and herbal supplements—many containing numerous plant extracts, vitamins, and minute amounts of pharmaceuticals (Hepatology). Popular ingredients associated with toxic hepatitis in the U.S., according to research published in JAMA Network Open, include turmeric (curcumin), green tea extract, ashwagandha, Garcinia cambogia, red yeast rice, and black cohosh (JAMA Network Open). The challenge is compounded by the fact that these products are typically self-prescribed: nearly four in five U.S. supplement users act without medical consultation, a pattern echoed in Thailand’s own health culture.
Experts caution against uncritical trust in “natural” products. A leading U.S. hepatologist, quoted in the NBC report, observes: “Patients often assume supplements are safe because they’re natural, but high doses of concentrated plant extracts or combinations with agents like black pepper can overwhelm the liver.” For example, curcumin—turmeric’s active component—is often marketed for its anti-inflammatory and liver-supporting properties, but in clinical case descriptions, high supplemental doses (often enhanced with black pepper extract for absorption) have directly triggered severe liver damage.
The regulatory environment exacerbates risks. In the United States, the Food and Drug Administration (FDA) cannot screen or test supplements for safety before they are sold. Only after adverse effects are reported can the agency intervene, leaving consumers with limited protection (FDA statement). In Thailand, the Food and Drug Administration has issued warnings about unapproved herbal blends, steroids, or hazardous substances in “health” products sold online, but policing the supplement market remains a constant challenge (Thai FDA).
Within Thai society, herbal remedies hold deep cultural value—from chrysanthemum tea to bitter gourd and turmeric-based drinks—and are often seen as safer alternatives to Western pharmaceuticals. Yet as the U.S. case demonstrates, concentrated or processed supplements do not carry the same risk profile as traditional, food-based remedies. “Everything can be toxic at a certain amount,” warns a senior vice president of the Council for Responsible Nutrition (CRN), a dietary supplement industry group.
A real-life case from the U.S., described in the NBC article, illustrates these dangers. An otherwise healthy man began to experience liver failure after adding a highly concentrated turmeric supplement to his routine, believing it would promote liver health. Only after blood tests and hospitalization did doctors trace the issue to combined high-dose turmeric and black pepper extracts—demonstrating how easily even informed individuals can overlook supplement-related risks.
Liver damage linked to supplements remains rare, but the absolute number of cases is rising as more adults take supplements routinely. According to the Council for Responsible Nutrition, three out of four U.S. adults now use supplements, up from 58% a decade earlier. The situation is increasingly relevant to Thailand, where urban consumers especially are exposed to aggressive marketing for herbal diets, detox teas, immune boosters, and weight-loss blends.
Regulators and experts recommend a cautious, informed approach. The U.S. FDA maintains a database of recalls and safety alerts, but it is often reactive. In Thailand, where imported or locally manufactured supplements may not adhere to international safety or quality standards, consumers are advised to consult qualified healthcare providers before starting any supplement regime, especially if they are also taking prescription drugs. Combining certain supplements with medicines—such as ginkgo biloba, warfarin, aspirin, or high-dose vitamin E—can heighten the risk of dangerous interactions, including excessive bleeding or internal organ damage (LiverTox Database).
Individual risk varies not only by dose and ingredient but also by genetics. Research led by the University of Michigan points to genetic factors that may predispose some people to DILI from supplements, adding an unpredictable layer to risk assessment. “That means there’s a biological basis for why one person in a thousand may have a severe reaction,” noted a U.S. leading researcher.
Importantly, most instances of supplement-induced liver damage are reversible if the supplement is stopped early. In the U.S. case highlighted above, the individual’s liver returned to normal within weeks of discontinuing all supplements. But for others unaware of the risk or reluctant to seek medical help, the outcome can be far more severe, including hospitalization or death. Each year, at least 44,000 Americans experience liver damage related to supplements or medications, resulting in an estimated 2,700 deaths—statistics likely undercounted due to underreporting and vague early symptoms.
The complexity of the supplement landscape is further heightened by misleading marketing. In both the U.S. and Thailand, illegal health claims remain rampant online. Thai FDA officials have repeatedly warned that supplements cannot legally claim to cure, prevent, or mitigate diseases. Yet a casual glance at Thai-language e-commerce or social media reveals a flood of products touting unsubstantiated promises—from cancer prevention to viral immunity.
Dietitians argue that for most people, a balanced Thai diet—rich in vegetables, fruits, rice, fish, and moderate amounts of meat—eliminates the need for supplementation except in cases of specific medically identified deficiencies, such as iron, B12, or calcium. For those considering supplements, monitoring daily doses and keeping informed of established “upper limits” is key. The U.S. Office of Dietary Supplements offers such guidelines, though herbal extracts lack standardized dosing—a major point of uncertainty (NIH ODS Upper Intake Levels).
From a historical perspective, Thai communities have used herbal medicines for generations, but always in the context of holistic traditional care and personal advice from herbalists or community elders. The modern trend toward self-medicating with concentrated capsules, powders, or imported remedies represents a significant cultural shift—and risk.
Looking ahead, global experts predict that the popularity of supplements will only increase, fueled by an aging population seeking longevity and the wellness industry’s aggressive marketing. Without more robust pre-market testing, clearer labeling, and education, incidents of drug-induced liver injury are expected to rise further—not only in the U.S. but also in markets like Thailand, where regulatory frameworks are still catching up with digital-age commerce.
So what practical steps can Thai consumers take? First, always seek medical guidance before taking any new supplement, especially if living with chronic disease, taking prescription medications, or planning to use high-concentration herbal products. Check products for official Thai FDA registration numbers. Avoid impulse purchases from social media influencers, cross-border e-commerce sites, or unverified street vendors. For those genuinely interested in herbal health, opt for traditional Thai dietary wisdom—using whole plants, teas, and foods rather than extracts or high-dose pills. If experiencing symptoms such as nausea, jaundice (yellowing), dark urine, or severe fatigue, consult a healthcare professional immediately and bring all supplement packaging to the appointment.
In summary, the latest U.S.-based research serves as a global cautionary tale. As the supplement industry booms, accidental injuries and even deaths may follow unless consumers, manufacturers, and regulators respond with greater vigilance. In Thailand, blending traditional herbal knowledge with modern scientific caution is the surest path to safe, effective health practices.
For more information, visit the U.S. LiverTox database or contact the Thai FDA’s consumer helpline. Stay discerning. When it comes to supplements, more is not always better.