A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine

Contrary to popular belief, it is evident that, apart from adverse events caused by contamination and adulteration, certain commonly used herbal components have inherent hepatotoxicity. This narrative review updates our current understanding and increasing publications on the liver toxicity potential of commonly used herbs in traditional Indian systems of medicine (Ayush), such as:

• Tinospora cordifolia (Willd.) Hook.f. & Thomson (Giloy/Guduchi),
• Withania somnifera (L.) Dunal (Ashwagandha),
• Curcuma longa L. (Turmeric),
• Psoralea corylifolia L. (Bakuchi/Babchi).

The review also highlights the importance of the upcoming liver toxicity profiles associated with other traditional herbs used as dietary supplements, such as:

• Centella asiatica (L.) Urb.,
• Garcinia cambogia Desr.,
• Cassia angustifolia Vahl (Indian senna),
• Morinda citrofolia L. (Noni fruit).

Fortunately, most reported liver injuries due to these herbs are self-limiting, but can lead to progressive liver dysfunction, leading to acute liver failure or acute chronic liver failure with a high mortality rate. The review also aims to provide adequate knowledge regarding herbalism in traditional practices, pertinent for medical doctors to diagnose, treat, and prevent avoidable liver disease burdens within communities, and improve public health and education.

The authors concluded that Turmeric, Ashwagandha, and Giloy are herbs with a high risk of hepatobiliary toxicity that are consistently reported in the medical literature. Furthermore, beyond the scope of this review, various other herbal and dietary supplements that are part of both traditional and nontraditional over-the-counter use have been reported to have severe hepatotoxic potential.

Efforts must be made to educate the public as well as practitioners of so-called alternative medicine (SCAM) to remain vigilant of avoidable disease burdens within the community by practicing critical thinking towards evidence-based health-seeking behavior and following rationale and logic driven by empirical evidence in the context of preventive and therapeutic management, respectively.

I could not agree more!