Turmeric supplements have become increasingly popular after small studies suggested their active ingredient may ease some inflammatory conditions Science Photo Library/Alamy
Turmeric supplements and teas have been linked with five new cases of liver injuries that caused people’s skin to turn yellow. All cases recovered with treatment.
Turmeric is a yellow spice from the Curcuma longa plant. It has become a popular supplement as it contains a compound called curcumin, which has slightly eased inflammatory conditions such as arthritis and hay fever in small studies.
As of May 2021, more than a dozen cases of turmeric-related liver injuries had recently been reported to the US National Institute of Diabetes and Digestive and Kidney Diseases. Five new incidences were presented at the annual scientific meeting of the American College of Gastroenterology in North Carolina this week.
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One case, presented by Angeline Luong at the Kaiser Permanente Los Angeles Medical Center in California, is a 49-year-old woman with no underlying health issues who developed nausea and vomiting after taking a daily turmeric supplement, the dose recommended on the packaging, for three months.
Her symptoms resolved when she temporarily stopped taking the supplement but returned when she resumed the regimen. She also developed yellowing to her skin and the whites of her eyes. Blood tests and a liver biopsy later revealed she had a severe liver injury.
The woman’s skin and eyes turned yellow because her liver was unable to perform its normal function of processing bilirubin, a yellow substance made during the natural breakdown of red blood cells, leading to jaundice, says Luong.
The woman recovered after she was given steroids and N-acetylcysteine, a medicine normally used to treat paracetamol (acetaminophen) overdoses. She was discharged after three weeks in hospital.
Similar cases were presented by researchers based in New York, Florida and New Jersey, with the affected all taking the recommended dose on the supplement packaging.
In addition, Prisca Pungwe at Baylor College of Medicine Texas described how a 62-year-old woman developed nausea, abdominal pain and yellow eyes after drinking a turmeric tea for three weeks, with tests confirming she had a liver injury. The woman recovered with treatment.
The vast majority of people who take turmeric supplements – the fourth top-selling herbal supplement in the US – don’t develop liver injuries, but certain genetics can make people more susceptible, says Ken Liu at Royal Prince Alfred Hospital in Sydney, Australia.
“When you take a herbal supplement, it gets digested and absorbed into your bloodstream, then enters the liver to be metabolised before going to the rest of your body,” he says. “That metabolism is done by enzymes in the liver that are genetically different from one person to the next, so some people process it into something that is inert and harmless, while others process it into something toxic.”
Supplements are riskier than eating turmeric in food because they often contain additives to increase curcumin’s absorption, says Luong. For example, adding black pepper to supplements and teas can increase curcumin absorption 30-fold. Turmeric and black pepper are often used together in cooking, but this is within complex mixtures of other ingredients that limit their absorption.
As herbal and dietary supplements become more popular, Liu says he is seeing more people with liver injuries, some requiring liver transplants. Similar trends have been reported in the US and Europe.
It can take a long time to realise a herbal supplement is the cause of liver problems because individuals don’t always mention their supplement use when a doctor asks if they are taking any medicines, says Liu.
Cases of liver injuries caused by non-turmeric herbal supplements were also presented at the meeting. For example, Connor Wayman at the University of Nevada described how a 19-year-old man developed severely itchy skin, jaundice and dark brown urine after taking supplements containing the plant ashwagandha.
Khushboo Bhatia at Mount Auburn Hospital in Massachusetts presented how a 55-year-old woman developed itchiness, dark urine and a loss of appetite after consuming a herbal tea containing skullcap root, gardenia fruit and rhubarb root. Both cases had liver injuries that resolved after they stopped taking the products.
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