Can turmeric supplements damage your liver?

Over the past decades, turmeric has become increasingly popular in the West.

Turmeric and curcumin — the active ingredient in turmeric — are big business. In 2021, the curcumin market was valued at more than $73 million.

It’s projected to exceed $155 million by 2029. And one of the most common uses of curcumin is in supplements.

At ZOE, we’re not in the business of scaremongering, so we’ll get right to the point.

If you like adding turmeric to your curries and lattes, don’t worry, there are no health concerns at all. In fact, adding spices to your food can support good health.

The recent news is about supplements. Specifically, ones that contain a compound called piperine. However, the risks are still minimal. 

Right, let’s start at the beginning.

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Turmeric and curcumin

Manufacturers make turmeric, the delicious spice, by powdering the dried rootstalk of turmeric plants. 

While humans have prized it for its health benefits for centuries, there’s no strong evidence that this spice can help treat any medical conditions.

This is partly because curcumin doesn’t dissolve readily in water, and your gut doesn’t easily absorb it. So, most curcumin comes out in your poop.

Any curcumin that does get absorbed is broken down quickly.

But when you pair curcumin with piperine — a compound in black pepper — its bioavailability increases by up to 2,000%. That’s why many curcumin or turmeric supplements also contain piperine.

OK, so why are we talking about turmeric and liver health today?

Turmeric and liver health

In the last few years, scientists have published several case studies linking turmeric supplements to liver injury.

Most recently, the Drug‐Induced Liver Injury Network (DILIN) helped fund a scientific investigation into 10 cases.

To identify these, the researchers took data from the DILIN, including 2,392 cases of drug-induced liver injury. Almost 1 in 5 cases were due to herbal and dietary supplements, and 3% were attributed to turmeric.

Five of the patients needed hospital treatment, and one person died of liver failure.

There have been other medical reports linking turmeric supplements to liver injuries. For instance, a review from 2020 describes seven cases of hepatitis (liver inflammation) linked to curcumin supplements in Tuscany between December 2018 and July 2019. 

The authors of that paper also identified another 23 similar case studies from around the globe.

What’s going on?

A great deal of research has shown that turmeric and curcumin aren’t toxic to humans. However, this might be because curcumin is so poorly absorbed. 

However, millions of people take turmeric supplements every day without problems, so there must be more behind the liver damage.

In short, scientists don’t know yet. The authors of the Tuscany paper theorize that drug interactions might be part of the answer.

Others wonder whether a genetic component might make some people more susceptible to injury than others.

Previous studies have shown that this variant is also associated with liver injury from other compounds, including green tea.

Still, identifying who is most at risk of liver injury from curcumin will take more research. And because this is such a rare issue, the details will be challenging to pin down.

Guideline changes

Following a series of curcumin-related liver injuries in Italy, the Italian Ministry of Health took action in 2019.

They made this message mandatory on supplements containing turmeric: “In the event of alterations in liver function, biliary, or calculosis of the biliary tract, the use of this product is not recommended.”

In August 2023, following 18 reports of similar liver injuries in Australia, the country's Department of Health and Aged Care published a safety advisory stating: 

“Consumers and health professionals are advised that medicines and herbal supplements containing the herb Curcuma longa (turmeric) and/or curcumin may cause liver injury in rare cases.” 

Aren’t there more pressing concerns?

There certainly are greater risks to liver health than turmeric supplements — alcohol is an obvious frontrunner. The difference is that no one is promoting alcohol as a cure-all.

The authors of the Tuscany paper describe some of the many lab and animal studies on turmeric.

This research suggests that curcumin may have antioxidant, anticancer, anti-inflammatory, antimicrobial, and antiviral properties, as well as the potential to help lower blood sugar and heal wounds.

But the authors also observe that human studies haven’t shown clear benefits so far, which is why doctors don’t prescribe turmeric. 

Plus, curcumin can affect many types of molecules, including proteins, enzymes, DNA, and RNA, making its possible health effects difficult to predict.

What should you do?

We’ll end this article as we started it: You don’t need to worry about adding turmeric to meals or drinks.

Scientists have shown that it’s safe, and people worldwide consume this spice freely without issues.

However, there’s no strong evidence that turmeric can benefit your health. So, you might consider swapping your supplement for a piece of fruit or vegetable — we know that eating more plants does support your health.