Podcast: Can Supplements Harm Your Liver

Dr. Brown: The weight loss supplements I worry about a lot. Kratom I worry about a lot. Turmeric and ashwagandha – because they’re used so frequently and often at such a high dose – we see problems.

Courtney: Welcome to Health Matters, your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

Biotin, ashwagandha, green tea extract – standing in the supplement aisle can be dizzying. More than half of U.S. adults regularly take vitamins and supplements. But are they helping our health or actually hurting us?

On this week’s episode, Dr. Robert Brown, Chief of Gastroenterology and Hepatology at NewYork-Presbyterian and Weill Cornell Medicine, discusses the benefits and risks of supplements, including their impact on the health of our liver. 

Dr. Brown shares tips for using supplements safely, which ones to avoid, and guidelines for anyone considering adding them to their health routine. 

Courtney: Dr. Brown, thank you so much for joining us today.

Dr. Brown: Oh, it’s great to be back. Thank you, Courtney.

Courtney: And so today we want to talk about dietary supplements and their impacts on our health, in particular, the liver. To get us started, can you tell us broadly what is the liver’s job in our bodies?

Dr. Brown: Well, the liver’s got a lot of jobs in our body, and uh, that’s probably why it’s our largest internal organ. And for the most part, it works along silently and without complaining. It synthesizes, uh, a lot of our major proteins. It plays a major role in our lipids and cholesterol, both storing it and making cholesterol. It also stores sugar and is responsible for a lot of the responses to insulin, for example. In addition, uh, it is the port of entry for everything that comes in through your gut. So when you eat things or viruses that may find their way into the gut, they go into our blood and they go into a special vein called the portal vein. And that vein goes right into the liver. And the liver’s job is to figure out what it needs as a organism, and what we don’t need. And it takes the things that we don’t need, whether those be viruses, bacteria, toxins, and it tries to wall them away or get rid of them, so they don’t hurt the rest of our body. So it’s both our builder and also our protector.

Courtney: And I was thinking it sounds like the bouncer too.

Dr. Brown: Yeah. Yeah. The guy, the guy in the big suit who’s standing with his arms crossed at the entry of the velvet rope saying “You get in and you stay out here on the curb in the cold.”

Courtney: How do supplements impact the liver if they’re trying to get in?

Dr. Brown: Supplements come in a wide variety, and they range from helpful, non-toxic, and obviously some which are potentially toxic. And the important thing to remember is the vast majority are not toxic. But everything that we put in our body has the potential to cause adverse reactions, and the liver is central in some of those adverse reactions because as I said, is both the port of first entry and also it’s charged with detoxifying or metabolizing bioactive molecules, whether those be proteins or a supplement. So many of the supplements we take, just like many drugs and medication toxic reactions, will occur in the liver because the liver is detoxifying them, and, as a result, ends up being the victim of any toxicity that’s there.

Courtney: I’d love to talk about popular supplements on your radar. What are the ones patients ask you about the most?

Dr. Brown: Well, I divide them sort of into groups, you know, we have the weight loss supplements, which tend to be stimulants. We have the sort of hair and skin supplements, biotin would be in that category. And then you have the sort of antioxidants which people are taking usually because they believe they need to detoxify themselves. And so if you think about the weight loss supplements are the ones where we’ve seen the most adverse reactions, because they’re stimulants, we see that the most. For many of them, yes they’re safe, but there is always a potential for an adverse reaction, which is why the most important thing is to be able to share what you’re taking with your doctor, right? Every time you go to the physician, they ask you what medications are you taking? And you tell them all the prescription medications. Almost nobody tells them the supplements that they’re taking. And there is a potential for either – one, us not monitoring something that is potentially toxic. Two, there can often be interactions between those and your health. So for example, biotin can affect the measurement of your thyroid function. So if you’re hypothyroid, and you’re taking thyroid medication, you don’t tell your physician you’re taking biotin, you don’t stop it before your blood test, you may end up with the wrong adjustment of your medication because there isn’t knowledge.

When a patient comes to me and says they’re taking X, Y, or Z supplements, what I do for them is the same thing I do for any element of their health. That’s no different than a patient who comes to me and tells me that they’re smoking. I’m not gonna kick them out of my practice but I may monitor them differently. I think what our job as physicians is, is to be knowledgeable about supplements, and then interact with our patients in a way that is informative and nonjudgmental.

Courtney: I appreciate that beause it sounds like it’s about honest communication, building trust. ‘Cause I can picture that if someone comes in and they take these 10 supplements they’re excited about, and you say, absolutely not throw them all away, that maybe isn’t gonna be the best interaction. But if you seek to understand, talk it through, potential concerns, that sounds like that’s a different interaction.

Dr. Brown: Yeah, I hope so. And what I usually say, if they are taking 10 supplements, I’m like, oh, I think that’s probably good. This one is plus or minus. And then I think when people come to me taking what they call liver detoxes, I try to stress to them that it would likely be better if instead of taking a liver detox, maybe we should do some things to make their liver healthier so they don’t need a detox.

Courtney: Right.

Dr. Brown: So if they’re taking an antioxidant, say CoQ10, I tend to view that benign. May not help, but isn’t likely to hurt. Whereas if they’re doing high dose turmeric, they’re gonna need to be monitored at least by their liver blood test to make sure they’re not doing harm.

Courtney: Well on this note, could you explain what is a liver detox, and why do people feel like they need one?

Dr. Brown: I would say the vast majority of people who take a liver detox actually don’t need one. The liver is really good at taking care of itself. And so for most people, you know, the people who have, you know, a couple drinks on the weekend, and who then say, oh, I need to detox. All they need to do is take the week off.

And then for the ones that are really have a liver disease, I don’t think a detox is enough to reverse whatever is damaging their liver. Rather than detoxing the liver, let’s UN-tox the liver and remove those things that were doing damage.

Courtney: What are some ways we can take care of our liver?

Dr. Brown: It starts with: eat a healthy diet. Because the liver is so central in processing nutrients, putting in good healthy nutrients is the first step towards liver health. And what is that? It’s foods that you see in nature. Less processed. I know people like to take protein bars and stuff, and maybe they’re fine, but to me, you know, it’s not as good as something that looks like a carrot. A bag of pistachios – that has plenty of protein, and it’s natural. And so I think the less processed our foods, the closer they are to their parent organism, the better. And then, you know, alcohol is probably the largest toxin to our liver. That alcohol should always be consumed in moderation under the safe limits, which is generally viewed as one drink per day for women, two drinks per day for men, and try not to exceed that on a regular basis.

And then the one thing that I would say is coffee seems to be good for the liver. It’s probably the oils in the coffee bean have some beneficial effect. And then, if you’re at a healthy weight, and you exercise and you’re not becoming insulin resistant or pre-diabetic, those are all the good things for the liver, and I don’t think it needs much else.

Courtney: I am still just so excited about what you said about coffee. That’s really great news. I thought you were gonna say, drink as much water as you want. And you said coffee.

Dr. Brown: We don’t wanna be dehydrated, so you gotta have your coffee in one hand and your water in the other. Cause drinking a lot of water is also healthy. I probably am good on the coffee side of the equation. I probably could do a little better on the water side.

Courtney: Are there any supplements, in particular, that might cause you a little concern if someone comes into the office and says they’re taking them?

Dr. Brown: Yeah, I think there are certainly are supplements that are more concerning. Green tea extract, black cohosh, which is commonly taken. Even things like red yeast rice, which people take to lower their cholesterol, has been associated with liver toxicity.

The weight loss supplements I worry about a lot. Kratom I worry about a lot. And then probably less toxic, but more frequently used is the turmeric and ashwagandha. I think they’re not as worrisome as some of the others, but because they’re used so frequently and often at such a high dose, we see problems.

Courtney: I’m wondering what kinds of studies or investigations have been done into supplement ingredients? Can we trust what’s on the bottle?

Dr. Brown: Oftentimes what the claims are, are related to individual ingredients and not the whole, because very few of them actually do a clinical trial where they take a hundred people and put them on supplement X, and a hundred people, and they don’t give them supplement X, and then they measure something at the end. But in general what I would say is – if you could read the ingredients, and it doesn’t say it has a million percent of the recommended amount of something, you’re probably okay. If the ingredients aren’t complete, says it has a proprietary blend, then you’re putting something in your body you don’t even know what it is. And I can’t imagine if I walked up to you on the street, Courtney, and said, “here’s a pill just take it trust me,” – you would do that. And if you would, we got some lessons for you. So if you don’t know what’s in it, my advice to you is don’t take it. And so the, the, the issue is that many are fine, and some are not fine, which is why I always say when it comes to supplements, it is buyer beware.

Courtney: Buyer beware. 

Dr. Brown: And, and as I said, you know, I don’t want people to be in a panic about this. But just like if you take a hundred different prescription medications, there can be interactions between those. When people start taking, you know, a hundred different supplements, or 20 different supplements, they can interact as well. And so, just as you probably wouldn’t take 20 different medications at the same time unless you really needed them, to me, this is another call for moderation.

Courtney: And what are the impacts of liver toxicity on the different functions of the liver that you described?

Dr. Brown: Yes, if you have a real high toxic reaction, you can turn jaundiced or yellow. You can get sick, you can end up in the hospital. But for many people who are taking things that are toxic to the liver, all they’re doing is having low level inflammation in their liver. And the liver is working away, regenerating, doing all the things it’s supposed to do. But with longstanding inflammation, you can also get what we call fibrosis, and fibrosis is scarring, and it probably represents the liver’s attempt to wall away the things that are making it inflamed. And then, over time, it’s that fibrosis or scarring that leads to the problems with liver disease. So cirrhosis, which we all know of as a, you know, bad liver, is just from long standing, progressive scarring that gets the liver to a point where it stops working well.

Courtney: Can the liver recover from damage?

Dr. Brown: Yes, at almost any point. If we remove the inciting event, whether that be a medication, or whether that be the effects of alcohol. When we remove that thing that’s damaging the liver, the liver will both regenerate and remodel. And even the scarring over time can go away, but we just have to recognize it at an early enough stage to intervene before the liver gets too sick. And so, you know, the liver is a great organ ’cause it’s robust and because kind of hope springs eternal. As long as we catch it in time, the liver will actually fix itself without needing to be detoxed.

Courtney: It really is an amazing organ.

Dr. Brown: It’s as someone who only does one organ, uh, uh, you gotta choose one that’s, um, that’s cool enough to keep you interested for 50 years.

Courtney: Thank you so much, Dr. Brown. As always, it is such a pleasure having you. I really appreciate everything you’ve shared about liver, supplements, and how we can take care of ourselves. Thank you.

Dr. Brown: Well, thank you, Courtney. This has been really fun and I hope we do it again sometime soon.

Our many thanks to Dr. Robert Brown. I’m Courtney Allison. Health Matters is a production of NewYork-Presbyterian. The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Brown’s work with patients, check out the show notes. NewYork-Presbyterian is here to help you stay amazing at every stage of your life. To get the latest episodes of Health Matters, be sure to follow and subscribe on Apple Podcasts, Spotify, or wherever you get podcasts.