Which specific ingredients in detox supplements are linked to liver injury in clinical studies?
Executive summary
Clinical reports and surveillance databases and reviews repeatedly link specific supplement ingredients to drug-induced liver injury (DILI): green tea extract, turmeric (high‑dose/curcumin), kava, black cohosh, usnic acid and certain weight‑loss formulations such as OxyELITE Pro are named in multiple sources as implicated agents (see LiverTox and reviews) [1] [2] [3]. Large case series and product analyses also flag milk thistle, dandelion and multi‑herb “liver cleanses” as common contents of marketed products—though evidence of benefit is weak and harms are documented in case reports and surveillance [4] [5] [6].
1. The surveillance picture: supplements are a growing share of DILI cases
National surveillance and network data show that supplements now account for a rising proportion of reported liver injuries, and reviews of herbals implicated in DILI list recurring offenders—green tea extract, turmeric, kava, black cohosh and usnic acid among them—making supplements a recognized and increasing cause of clinically significant liver injury [2] [1].
2. Green tea extract: a well‑documented hepatotoxin in concentrated form
Clinical studies and reviews cite green tea extract (often used in weight‑loss and “detox” products) as capable of causing hepatocellular injury akin to viral hepatitis in some patients; WebMD and LiverTox note that green tea extract has been linked to liver damage in published reports and case series [3] [1].
3. Turmeric/curcumin: commonly perceived as safe but linked to injury in some reports
Turmeric and concentrated curcumin supplements appear widely in liver‑support products yet have been implicated in case reports and surveillance databases with presentations sometimes showing autoimmune features; multiple outlets note turmeric as a repeatedly reported ingredient in injurious products [2] [4] [7].
4. Kava, black cohosh and usnic acid: established herbal culprits
Specialist reviews list kava (used for anxiety), black cohosh (for menopausal symptoms) and usnic acid (weight‑loss products) among herbal agents most frequently linked to hepatotoxicity in clinical series and regulatory alerts [2] [1].
5. Weight‑loss blends and proprietary formulations (OxyELITE Pro and similar)
Products marketed for rapid weight loss or fat burning—sometimes sold alongside “liver detox” marketing—have been tied to severe liver injury in clusters and case series; OxyELITE Pro and similar formulations are specifically cited as linked to hepatotoxic events [3] [2].
6. Milk thistle, dandelion and turmeric dominate retail liver‑supplement formulas—but safety data are mixed
A 2025 analysis of top‑selling online liver supplements found milk thistle in 19 of 20 products and turmeric and dandelion common as well; the market prevalence contrasts with limited clinical proof of efficacy and an accumulating record of adverse‑event reports that clinicians must investigate [4]. Available sources do not mention definitive randomized trials proving benefit for these over‑the‑counter formulations [4] [6].
7. Case reports: how real‑world harm emerges from complex mixtures
Individual case reports show acute liver injury after using multi‑ingredient “liver cleansing” and sleep‑aid products; in at least one published case, a combination product listing concentrated scute root and turmeric preceded biopsy‑confirmed DILI that improved after stopping the supplements and receiving steroids, illustrating how mixtures complicate causality [5].
8. Regulatory and clinical context: limited oversight, rising incidence, mixed messaging
Experts note that dietary supplements are not regulated like drugs; large numbers of products are marketed with liver‑support claims despite scarce clinical proof and documented harms—this gap explains why DILI from supplements has risen in surveillance networks and why clinicians urge caution [1] [2] [3].
9. Practical takeaway for clinicians and consumers
If you take or advise about “liver detox” products, clinicians should ask explicitly about supplement use; prioritize stopping suspect agents if liver injury appears, and be alert for known high‑risk ingredients (green tea extract, concentrated turmeric/curcumin, kava, black cohosh, usnic acid and certain weight‑loss blends) [1] [3] [2].
Limitations and open questions: the sources document associations from case reports, surveillance and product analyses rather than uniform randomized‑controlled trial causation for every ingredient; causality is often complex when multi‑ingredient products are involved and adulteration or unlisted constituents may play a role—available sources do not provide a single exhaustive clinical trial list proving causality ingredient‑by‑ingredient [1] [4] [5].