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JAMA paper on botanical use and liver damage draws criticism

The investigation—carried out by researchers in the Department of Internal Medicine, Division of Gastroenterology and Hepatology, at the University of Michigan—looked back at nationally representative data from the National Health and Nutrition Examination Survey (NHANES) to determine reasons for and frequency of botanical use in the United States and extrapolated population estimates from the 2020 U.S. Census.

Among the 9,685 adults enrolled in the NHANES cohort, the researchers reported that the prevalence of use within the last 30 days was 7.5% for herbal dietary supplements (HDS) overall and 4.7% for the six botanicals classified as potentially hepatotoxic. These included turmeric or curcumin, green tea extract, Garcinia cambogia​, black cohosh, red yeast rice and ashwagandha. 

“In this survey study, an estimated 15.6 million U.S. adults consumed at least one botanical product with liver liability within the past 30 days, comparable with the number of people who consumed nonsteroidal anti-inflammatory drugs and a commonly prescribed hypolipidemic drug,” the paper concluded. “Given a lack of regulatory oversight on the manufacturing and testing of botanical products, clinicians should be aware of possible adverse events from consumption of these largely unregulated products.” 

Considering the data

The JAMA paper noted that dietary supplementation in the U.S. has increased dramatically over time, growing from 32.9% in the NHANES 1971-1974 cohort to 52% in the NHANES 2011-2012 cohort and 57.6% in the NHANES 2017-2018 cohort. 

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