CRN argues that botanical use research confirms products’ safety, not risk to liver health

07 Aug 2024 --- The Council for Responsible Nutrition (CRN) has responded to a survey on the prevalence of six “potentially hepatotoxic” botanicals in the US, stating that the study’s findings do not “expose any new risk of liver injury or that should alarm consumers of these supplements.” In the survey, 4.7% of US adults reported exposure to turmeric, green tea, ashwagandha, Garcinia cambogia, red yeast rice and black cohosh products. 

For the study in JAMA Network Open, researchers used nationally representative data from 9,685 adults enrolled in a cohort of the National Health and Nutrition Examination Survey (NHANES). They extrapolated the reported use to a nationwide estimate of 15.6 million adults consuming at least one “botanical product with liver liability” within the past 30 days. 

“This analysis of existing NHANES survey data doesn’t appreciate that the overall risk these ingredients pose is exceedingly low. Revealing that more than 15 million US citizens use at least one of these herbal supplements, compared to their actual reported risks, only strengthens the case for their safety,” comments Steve Mister, president and CEO of CRN. 

Meanwhile, the authors caution that “clinicians should be aware of possible adverse events from consumption of these largely unregulated products,” claiming a lack of regulatory oversight on production and testing. 

No causal relationship 
Users of the six botanicals of interest were similar to overall consumers of herbal and dietary supplements — of older age, more women and non-Hispanic White individuals with a higher income and higher level of education. As they were older, supplement users were more likely to have hypertension, diabetes, coronary heart disease, stroke, arthritis, thyroid disorder, cancer and liver conditions. 

At the same time, consumers of these six botanicals were significantly older, had a higher educational level and were more likely to have arthritis than participants who did not use supplements. 

However, the study’s authors concede that it was not designed to identify any causal relationship between botanical consumption and the development of liver injury over time. They highlight that the survey’s sample size was inadequate to detect hepatotoxic or other adverse effects since these arise in less than 1% of exposed individuals. 

Turmeric (Curcuma longa) was the most commonly used botanical, to improve or maintain health.CRN comments that the study does not add any new scientific findings regarding their potential for hepatotoxicity. The organization underscores that news coverage sounding the alarm based on the publication does not fully appreciate its limitations. 

According to the council, liver injury from botanicals may occur in rare cases, such as individuals with specific genetic predispositions or pre-existing conditions. However, CRN details that “the vast majority of the population taking these botanical supplements uses them as directed without issue.”

Growing interest 
The study notes that the six botanical products are used “as frequently” as common hypolipidemic drugs (lowering the concentration of lipoproteins that transport cholesterol and triglycerides), nonsteroidal anti-inflammatory drugs and antidepressants.

However, CRN states that the high prevalence of botanical use reflects a growing interest in these supplements to improve or maintain health. The organization says this reinforces the need for healthcare providers to have open and informed dialogues with patients about including supplements in a healthcare regimen. 

“What consumers and healthcare practitioners should take away from this study is that there is great — and growing — interest in using herbal supplements to promote health and wellness. Practitioners should encourage candid and open-minded conversations with their patients about supplement usage,” says Mister. 

“Alarmist headlines that mislead doctors and panic consumers shut down those conversations and do a disservice to the millions of people who trust and use these products safely every day.”

Supplement use 
The overall prevalence of herbal and dietary supplements in the study sample was 57.6%, and 4.7%, or 350 participants, used one of the six botanicals investigated. 

Among the 9,685 adults, turmeric was the most commonly used botanical (236 cases), followed by products containing green tea (92), ashwagandha (28), Garcinia cambogia (20), red yeast rice (20) and black cohosh (19). 

The most common reasons reported for using these products were to improve or maintain health, prevent health problems or boost immunity. 26.8% of users also used turmeric for joint health, and 27.2% of green tea users tried to improve their energy levels. 

Garcinia cambogia was mainly used for weight management, and these users also had the highest median body mass index and diabetes rates. Black cohosh was primarily used to manage hot flashes, and most of these consumers were women. In contrast, red yeast rice was used for heart health by people who tended to be older and had the second highest incidence of diabetes. 

CRN encourages consumers to use botanical products as directed and consult with their healthcare providers, especially if combined with prescription medications. The organization highlights the importance of recognizing these products’ long history of safe use, even though consumers should be aware of potential risks. 

By Jolanda van Hal