Turmeric is touted to have anti-inflammatory, antimicrobial and anti-cancer properties that act in opposition to a number of circumstances, together with arthritis, respiratory infections and diabetes. Scientific trials haven’t produced rigorous proof to help these broad claims, but turmeric stays one of many top-selling natural dietary supplements in the US.With many individuals taking turmeric in concentrated complement kind, a troubling pattern has emerged. Lately, turmeric has been implicated in a rising variety of circumstances of acute liver harm, a few of which have led to liver transplant and even demise.“Turmeric-induced liver harm is taken into account uncommon — one in 10,000 and even 100,000 individuals who take it’d get sick — however now, tens of millions of persons are taking turmeric,” mentioned Jay Hoofnagle, director of the Liver Illness Analysis Department within the Division of Digestive Illnesses and Vitamin on the Nationwide Institutes of Well being (NIH). “Based mostly on what we’re seeing in our knowledge, it’s probably the most widespread causes of dietary complement liver harm.”Dietary supplements have extra curcuminModern preparations of the turmeric plant, which has been utilized in conventional drugs and as a spice in meals for hundreds of years, mixed with a genetic susceptibility in sure sufferers, is most probably the reason for liver harm, specialists mentioned.Dietary supplements include high-dose purified extracts of curcumin, the principle energetic ingredient of turmeric that solely makes up between 1 and seven % of the basis. Many additionally include components reminiscent of black pepper to advertise absorption of curcumin, a substance that’s usually poorly absorbed by the digestive tract.For instance, a examine that gave human topics 2 grams of curcumin might barely detect it in blood samples. However after including black pepper, the fraction of curcumin that reached the bloodstream shot up by 2,000 %.“Individuals at present are taking 100 instances extra curcumin than what was utilized in conventional drugs,” Hoofnagle mentioned. “I am going to Costco and see these massive bottles of turmeric with black pepper, a gram per serving, and I believe, ‘Oh my goodness.’ ”Hoofnagle supervises the Drug-Induced Liver Damage Community (DILIN), an NIH-sponsored initiative that collects and analyzes circumstances of extreme liver harm attributable to medicine and various medicines. In 2022, the DILIN reported 10 circumstances of liver harm related to turmeric dietary supplements. The most typical signs have been jaundice, nausea and belly ache. Of the ten circumstances, 5 sufferers have been hospitalized, and one affected person died of acute liver failure.The researchers concluded that liver harm due to turmeric seems to be rising in the US, and the growing recognition of turmeric during the last 5 years appears to reflect the rise in reported circumstances collected by the DILIN.Circumstances have additionally been reported elsewhere on the earth. A 2020 examine described seven circumstances of acute noninfectious hepatitis that occurred in Italy, all linked to turmeric dietary supplements. In August 2023, the Australian authorities revealed a security advisory warning shoppers and health-care professionals that turmeric dietary supplements might trigger liver harm in uncommon circumstances. The advisory got here after the Division of Well being and Aged Care acquired 18 reviews of turmeric-associated liver issues, together with one which had a deadly end result.“Individuals suppose that turmeric is of course occurring and over-the-counter, so it have to be innocent, which isn’t true,” mentioned Ken Liu, a transplant hepatologist on the Australian Nationwide Liver Transplant Unit. “As a clinician, I’ve observed increasingly individuals admitted to the hospital for having liver harm from natural and dietary dietary supplements and needing liver transplants for this.”Fadi Alghzawi, a resident doctor at MedStar Union Memorial Hospital in Baltimore, has additionally observed an uptick in turmeric-related circumstances. He not too long ago noticed a 66-year-old African American lady who was admitted to the emergency division with jaundice, nausea, decreased urge for food and darkish urine. Testing revealed starkly elevated bilirubin ranges within the blood — 29 mg/dL when 0.2 to 1.1 mg/dL is taken into account regular — indicating potential liver dysfunction.After ruling out all different causes and confirming with a liver biopsy, turmeric was discovered to be the perpetrator. Six months earlier, the affected person began taking half a teaspoon of floor turmeric as an natural treatment from a retailer. Though she discontinued the turmeric upon admission to the hospital, it was too late.“Normally when individuals cease taking turmeric or any natural complement that’s inflicting harm, it’s best to see enchancment,” Alghzawi mentioned. “Nevertheless, on this case, irreversible harm occurred to the liver, and inside seven days of admission, she handed away.”Drug-induced liver harm, which will be categorized as both direct or idiosyncratic, is probably the most frequent explanation for acute liver failure in most Western nations. Direct harm is predictable, dose-dependent, and attributable to brokers which are intrinsically poisonous to the liver, reminiscent of acetaminophen. Idiosyncratic harm, however, is way trickier to diagnose and deal with. It solely impacts inclined people, and the accountable brokers have little to no intrinsic toxicity.“Idiosyncratic harm means you are taking a medicine, after which based mostly in your gender, age or immune standing, it might all of the sudden trigger a liver harm,” Alghzawi mentioned. “You can’t predict it, and it’s not dose-dependent.”For instance, girls are extra vulnerable to drug-induced liver harm than males due to variations in hormonal standing, physique composition, metabolism and different elements. African American sufferers could also be vulnerable to extra extreme liver harm and worse illness outcomes, reminiscent of liver transplant or demise, after drug-related liver harm than White sufferers.Genetics can also be a part of the story, since sure genes encode for enzymes concerned in drug processing. After a drug is ingested, it will get absorbed by the gastrointestinal tract and brought up by the bloodstream. The primary place it goes is the liver, whose job it’s to take away toxins and metabolize medicine utilizing particular enzymes. The examine by the DILIN discovered that 7 of the ten sufferers carried a genetic variant, present in solely 10 % of the U.S. normal inhabitants, that will have elevated their susceptibility to turmeric-associated liver harm.“These liver enzymes are dictated by genetics, so the way you metabolize one thing is perhaps barely completely different to how I metabolize one thing,” Liu mentioned. “You may metabolize curcumin as a totally inert, innocent metabolite, whereas I would metabolize it as one thing that’s poisonous and inflammatory to the liver.”Each health-care suppliers and shoppers ought to concentrate on the potential dangers earlier than taking turmeric as a complement. Alghzawi even thinks that taking turmeric as a complement needs to be prevented altogether, since its purported advantages don’t outweigh the dangers. Different specialists consider in a extra measured strategy.“Whereas it is probably not essential to keep away from turmeric dietary supplements altogether, it’s important for sufferers to tell their docs of their use in order that monitoring will be finished, if wanted,” mentioned Angeline Liu, a gastroenterologist with Kaiser Permanente in southern California. “Likewise, it’s important for physicians to take an entire historical past when talking with sufferers, which incorporates routinely asking sufferers if they’re taking any drugs or dietary supplements that may be bought over-the-counter.”Do you will have a query about wholesome consuming? E-mail EatingLab@washpost.com and we might reply your query in a future column.