Myth: Natural means completely safe

Not true. Natural substances can have strong effects on the body, which is why they can help, and also why they can harm. In India, herbal and alternative medicines were the second most common cause of drug-induced liver injury in a national study of 1288 patients.

Choose Detailed for the fuller picture, or Scientific for mechanisms and study data.

The idea that natural products cannot cause harm is understandable, and wrong. Several important medicines were first derived from plants, including aspirin, morphine and digoxin.

What the evidence shows

A national Indian registry of 1288 people with drug-induced liver injury found that complementary and alternative medicines, including herbal products, were the second most common cause, after tuberculosis medicines.

Case reports and series have described liver injury with giloy during the pandemic and with ashwagandha supplements.

Why this happens

• The active compounds can be potent
• Products may be taken at high doses, for long periods, without supervision
• Products can be contaminated or misidentified
• Herbs can interact with prescription medicines

What we believe

Ayurvedic and botanical medicines deserve the same respect as any medicine: quality manufacturing, correct dosing, clear labelling and medical guidance.

Devarbhavi et al. (2021): among 1288 prospectively enrolled patients with DILI in India (2013 to 2018), combination anti-tuberculosis therapy accounted for 46.4 per cent and CAM for 13.9 per cent, with overall mortality of 12.3 per cent.

Mechanisms of herbal hepatotoxicity include idiosyncratic immune-mediated injury, intrinsic toxicity at high exposure, herb-drug interactions via cytochrome P450 and transporters, and adulteration with undeclared pharmaceuticals or heavy metals.