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Herb-induced liver injury: the signs, the risk and what to do | CION Cancer Clinics
Herb-induced liver injury is damage to the liver caused by a herbal remedy, tonic or supplement. It can cause yellow eyes, dark urine, itching and tiredness, or show up only on a blood test. The risk is highest in people who already have cirrhosis, hepatitis or liver cancer. This page explains the signs, who is most at risk, and how to talk to your doctor about what you take. At CION Cancer Clinics, our team supports patients and families through symptoms, follow-up and life during and after treatment.
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Medically reviewed by Dr. Naresh GunduConsultant Medical Oncologist · MBBS, DNB (Internal Medicine), DM (Medical Oncology, AIIMS) · last reviewed October 2026, next review due October 2027
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On this page
- What is herb-induced liver injury, and what does it feel like?
- Who is most likely to be harmed by a herbal remedy?
- How do doctors find out whether a herb caused the damage?
- What do the words on a liver injury report mean?
- Is a herbal product safe because it is natural?
- What this page cannot tell you
- Common questions about herbs and liver injury
The short answer
What is herb-induced liver injury, and what does it feel like?
Herb-induced liver injury, often shortened to HILI, is damage to the liver caused by a herbal remedy, tonic, powder or supplement. The usual signs are yellow eyes or skin, dark urine, pale stools, itching, tiredness, nausea and a dull ache under the right ribs. Some people feel nothing at all, and the injury only shows up on a liver blood test.
Why it happens even with natural products
The liver is the organ that breaks down almost everything you swallow, including plant chemicals. Some of those chemicals are harmful to liver cells in some people. Others are safe on their own but the product they come in has been mixed with something else. Natural describes where a product comes from. It does not tell you how the liver will handle it.
Who this page is for
This page is for anyone with cirrhosis, hepatitis B or C, fatty liver or liver cancer who takes, or is thinking about taking, a herbal product, and for the family member who buys it for them. It is not written to criticise anyone's choices. Many families reach for these remedies out of love. The aim is to keep the liver you have working, because liver cancer treatment depends on it.
Most people who take a herbal product never develop liver injury. The risk is much higher when the liver is already damaged.Where the risk is highest
Who is most likely to be harmed by a herbal remedy?
The same product can be harmless in one person and dangerous in another. These are the situations where your doctor will be most careful.
A liver that is already scarred
With cirrhosis there is very little spare liver left. An injury that a healthy person would recover from can tip a scarred liver into failure. This is the group the warnings matter most for, and it is explained further on why herbs harm the liver most.
Someone on cancer treatment
Targeted therapy, immunotherapy and chemotherapy are all checked against liver blood tests. A herbal product can raise those tests, interact with the medicine, or make it hard to know which one caused a problem.
Treatment may have to be paused while the doctors work out the cause.Several products at once
People often take a tonic, a powder and a capsule together, sometimes from different advisers. Each one adds to the load on the liver, and nobody may know the full list.
Products with unclear contents
Some preparations are sold loose or without a full label. A few have been found to contain heavy metals or hidden ingredients. See heavy metals in some preparations.
Not sure whether this applies to you?
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When this cannot wait
If you have liver disease and you notice new yellowing of the eyes, confusion or unusual sleepiness, vomiting blood, black stools, or a fever with a swollen belly, go to hospital today. Take every product you have been using with you. If the yellowing is mild and you feel well otherwise, still see your doctor this week and stop adding anything new until you have been seen.
If an injury is suspected
How do doctors find out whether a herb caused the damage?
A full list of everything taken
The doctor asks about every tonic, powder, tea, capsule and home remedy, how long each was taken, and when the symptoms started. This is the most useful step of all, so bring the packets or bottles.
Liver blood tests
These show how inflamed the liver is, whether bile is backing up, and how well the liver is still making proteins. Repeat tests show whether it is settling.
Ruling out other causes
Hepatitis viruses, alcohol, gallstones, other medicines and the cancer itself can all look the same on a blood test. An ultrasound or other scan, arranged through CION's diagnostic partners, usually comes next.
Stopping and watching
Most herb-induced injury improves once the product is stopped. Improvement after stopping is one of the strongest clues that the herb was to blame. A hepatologist takes over if the liver does not recover.
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On your report
What do the words on a liver injury report mean?
- ALT and AST
- Enzymes that leak out of damaged liver cells. High levels mean the liver cells are inflamed or injured.
- Bilirubin
- A yellow pigment the liver normally clears. When it builds up, the eyes and skin turn yellow. This is jaundice.
- Alkaline phosphatase
- Rises when bile is not draining properly. Some herbal injuries mainly affect bile flow rather than the liver cells.
- INR and albumin
- Measures of how well the liver is still doing its work of making clotting proteins and blood proteins. These matter more than the enzymes for judging how serious the injury is.
- Drug-induced liver injury
- The wider medical term. Herbal and dietary supplement injury is one type, and doctors assess it in the same way.
Commonly believed
Is a herbal product safe because it is natural?
"It is natural, so it cannot harm the liver."
Many plant chemicals are processed by the liver, and some can damage it. Herbal and dietary supplements are a recognised cause of liver injury in medical records worldwide.
"A liver tonic will protect my liver during treatment."
No tonic has been shown to protect the liver during cancer treatment. What reliably protects it is avoiding alcohol, keeping hepatitis B controlled, eating enough protein and checking every new medicine with your team.
"If my doctor finds out, they will stop treating me."
Your doctor needs to know so they can read your blood tests correctly. Nobody will refuse to treat you. Read how to tell your oncologist without being judged.
"I have taken it for years, so it must be safe for me."
A liver that coped a few years ago may not cope now, once cirrhosis or cancer has developed. Batches of loose products can also differ from one purchase to the next.
Being straight with you
What this page cannot tell you
It cannot tell you whether a particular product caused your symptoms or your raised blood test. That needs a doctor who knows your liver, your cancer, your other medicines and exactly what you have taken. Even then the answer is sometimes uncertain, because there is no single test that proves a herb was the cause.
It cannot tell you which products are safe
We do not name any herbal product as safe or effective for the liver. The evidence is thin for most of them, and contents vary between makers. If you want to keep taking something, discuss it with your oncologist and a hepatologist before you continue. You can also keep it on your single medicine list.
Who this does not apply to
If your liver is healthy and you take a well-labelled product for a short time, your risk is low. This page is mainly for people whose liver is already damaged, or who are on cancer treatment. That is where a small injury can have large consequences.
Call the helpline if you are unsure. A doctor's team will look at what you are taking without judging you.Questions we are asked
Common questions about herbs and liver injury
What are the first signs of herb-induced liver injury?
Often tiredness, nausea, loss of appetite and a vague ache under the right ribs, followed by dark urine and yellow eyes. Itching and pale stools are common when bile flow is affected. Some people have no symptoms, and the injury is found only on a routine liver blood test.
How soon after starting a product can it happen?
It varies widely. Some injuries appear within a few weeks of starting. Others appear after months of steady use, or soon after the dose or brand was changed. Because of this, doctors ask about everything taken over a long stretch, not only in the last few days.
Does the liver recover after stopping the herb?
In most people, yes, once the product is stopped. Recovery is slower and less certain when the liver was already scarred by cirrhosis. A small number of people develop liver failure, which is why new jaundice in someone with liver disease needs hospital care the same day.
Should I stop all my herbal products right now?
If you have new jaundice or feel unwell, stop adding anything and see a doctor promptly. Otherwise, make a list of everything you take and bring it to your next appointment. Your doctor will tell you what to pause and what can continue, and why.
Can herbs interact with liver cancer medicines?
Yes. Some change how the liver breaks down targeted therapy or other medicines, and some add to the same side effects. Read interactions between herbs and cancer medicines, and tell your team before you start anything new.
Is there a test that proves a herb caused the damage?
No single test does. Doctors put together the timing, the pattern of blood results, the improvement after stopping, and the absence of other causes. Sometimes the product itself can be tested, but this is rarely available, so the judgement is usually clinical.
My family insists I keep taking the tonic. What do I do?
Bring a family member to your appointment and let the doctor explain the risk to everyone together. Families usually want the same thing you do, which is for the treatment to work. Hearing it from the doctor often settles the disagreement without anyone feeling blamed.
Who at CION should I tell about what I am taking?
Tell your medical oncologist and the nurse who checks your blood tests, and keep the list in your file. If you are not sure whether something counts, call the helpline and describe it. Someone will tell you whether it needs to be raised before your next treatment.
Your Specialists
Meet CION's liver cancer specialists. Bring your scan reports and liver blood tests.
Our medical and surgical oncologists plan liver cancer care together, weighing the tumour and how well your liver works before choosing surgery, a liver-directed procedure or medicines.
Medical Oncologist
Dr. C. Raghavendra Reddy
MBBS(Gold Medal), DNB(General Medicine), DM(Medical Oncology)(Gold Medal)
Medical Oncologist
Dr. Bharati Devi Gorantla
MBBS, MD(General Medicine), DM(Medical Oncology)(Adyar,Chennai), ECMO, MRCP SCE(UK)
Medical Oncologist
Dr. Owais Mohammed
MBBS, MD (General Medicine), DrNB (Medical Oncology), ECMO, MRCP SCE (Medical Oncology) (UK)
Medical Oncologist
Medical Oncologist
Surgical Oncologist
Dr. Muralidhar Muddusetty
MBBS (AIIMS), MS (Surgery) (AIIMS), DNB (Surgical Oncology), MRCS (Edinburgh)
Surgical Oncologist
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Sources
- MedlinePlus — Herbal Medicine
- NCCIH — Using Dietary Supplements Wisely
- National Cancer Institute — Complementary and Alternative Medicine (CAM)
- NIDDK — Cirrhosis - NIDDK
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Why the liver is the organ most harmed by herbal remediesWhy a scarred liver has so little room for injuryHow to tell your oncologist without being judgedWhat to say, and what to bring, at your next visitInteractions between herbs and cancer medicinesIf you are on targeted therapy or immunotherapyLiver 'detox' and 'liver cleansing'What detox products actually do to a damaged liver
Talk to us
Worried a tonic or supplement is affecting your liver?
Tell us what you are taking and what your blood tests show, and a doctor's team will look at it without judging you. We can help you work out what to raise before your next treatment. One helpline serves every CION centre.