Approximately 15.6 million U.S. adults may be using botanicals with known liver toxicity, a number comparable to those taking hepatotoxic prescription medications like nonsteroidal anti-inflammatory drugs (NSAIDs) and statins, according to a recent study.

In the study, published in JAMA Network Open, investigators assessed the prevalence and clinical characteristics of U.S. adults consuming six botanicals with known hepatotoxic potential. An analysis of data from 9,685 participants in the National Health and Nutrition Examination Survey revealed that 4.7% of U.S. adults reported using at least one of these botanicals—turmeric, green tea, ashwagandha, Garcinia cambogia, red yeast rice, and black cohosh—within the past 30 days.

The study observed that 57.6% of U.S. adults had used at least one herbal or dietary supplement (HDS) in the previous 30 days. HDS users tended to be older, with an average age of 51.9 years, and were predominantly female (57.7%) and non-Hispanic White (67.6%) compared with nonusers. Notably, participants using these botanicals were more likely to be older (adjusted odds ratio [OR] = 3.96 for ≥ 60 years), to have higher levels of education (adjusted OR = 4.78 for some college education or higher), and to have arthritis (adjusted OR = 2.27) than nonusers. 

The number of adults in the United States using these botanicals was comparable to the 14.8 million who used NSAIDs and the 14 million who took simvastatin. The primary reasons for consuming turmeric and green tea were to enhance or preserve overall health and to address joint health or arthritis, while 70% of those using Garcinia cambogia reported weight loss as their main motivation for use.

Given the lack of regulatory oversight, the study highlighted the importance of clinicians being vigilant about the potential hepatotoxic risks associated with these botanicals.

Full disclosures can be found in the published study.