Turmeric and Black Pepper Supplements May Cause Liver Injury in Some People: Study

A study published in The American Journal of Medicine has found that turmeric supplements may be linked to several cases of liver injury.

Previous research and case studies have associated turmeric, or its active compound curcumin, with liver damage. The latest findings indicate that the incidence of liver injury related to turmeric supplementation may be on the rise.

Turmeric, derived from the roots of Curcuma longa, is a popular herbal product used to treat conditions like arthritis, respiratory infections, liver disease, and recently, COVID-19. The active component, curcumin, is believed to provide these benefits. While clinical trials have shown turmeric to be safe, rare cases of acute liver injury have been reported.

Turmeric supplements now often include piperine (black pepper) to increase curcumin's absorption. Piperine can boost curcumin's bioavailability by 20-fold, which may heighten the risk of liver injury.

For the current study, researchers assessed only high-confidence cases of liver injury related to herbal and dietary supplements, categorized as definite, highly likely, or probable. They analyzed demographic, clinical, biochemical, and histologic features. Researchers tried to obtain the specific supplements taken by patients and sent them to the National Center for Natural Products Research for ingredient verification and contamination testing. Available liver biopsies were reviewed and scored for various histological features and overall liver injury patterns.

The results showed that chemical analysis confirmed the presence of turmeric in seven cases. Additionally, piperine was found in several of the more recent cases, suggesting it might have increased the bioavailability of turmeric, leading to toxic exposure and liver injury. However, since no cases of liver injury from piperine alone have been reported, this seems less likely. It is more plausible that piperine enhanced the direct toxicity of turmeric. Other methods to increase turmeric's bioavailability, such as using lecithin and packaging it in nanoparticles, have also been used.

“This study looked at turmeric supplements and the addition of piperine, which boosts absorption. The liver acts as the body's gatekeeper, processing supplements first and working hard to break them down and detoxify them. Because of this, the liver can get strained and injured, especially if it's already dealing with issues. About 1 in 3 people now have metabolic dysfunction-associated steatotic liver disease (MASLD), which makes it harder for the liver to function properly and increases the risk of injury,” said the authors.

Reference: Dina Halegoua-DeMarzio, MD, Victor Navarro, MD, Jawad Ahmad, MD, Elizabeth Phillips, MD, Andrew Stolz, MD, Raj Vuppalanchi, MD, et al,; Liver Injury Associated with Turmeric—A Growing Problem: Ten Cases from the Drug-Induced Liver Injury Network [DILIN]; The American Journal of Medicine; DOI:https://doi.org/10.1016/j.amjmed.2022.09.026