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Some of the most commonly used and useful herbs can cause toxic side effects, especially liver damage, when used in the wrong way. Here are five herbs that are especially problematic if not used appropriately.

Herbal medicine, for the most part, is gentle medicine. Sometimes, however, using the wrong herb in the wrong way can have unanticipated toxic effects, especially for the liver. Here are five herbs to use with care, especially if you already have liver disease.

1. Green Tea

Green tea is not an herb you would expect to find associated with liver disease. After all, more than one study has found that occasional to moderate use of green tea actually improves liver function as measured by ALT and AST levels (enzymes that measure the death of liver cells). There have been studies that have found that drinking green tea and/or taking green tea extract slow down the process of fat deposits in fatty liver and reduce the risk of liver cancer. However, there is one situation in which the antioxidant function of epigallocatechin gallate (EGCG) in green tea extract is potentially harmful:

Taking green tea extract while fasting may induce liver injury.

Sometimes a large dose of an antioxidant becomes a pro-oxidant, a compound that does the exact thing that it is intended to prevent. That may be what happens when people take green tea extract when fasting. There have been, as of April 2016, 27 cases of liver injury linked to green tea extracts, this in millions of users. However, it is extremely simple to avoid the problem. Take green tea extract with meals.

2. Herbalife

Herbalife is a company that produces a variety of astonishingly popular herbal products. Although sales have declined significantly in recent years, gross sales of Herbalife products were over $5 billion in 2013, and the company has over 3.2 million distributors in at least 95 countries and potentially over 10 million customers.

Over a period of about 10 years there were dozens of reports of liver toxicity after using Herbalife products, one in Argentina, two in Venezuela, five in the United States, 12 in Switzerland, 12 in Israel, and 20 in Spain. There were several cases of acute liver injury that required a liver transplant. There were many cases of liver damage resulting in cirrhosis with long-term reduction in liver function. Because nearly all of the consumers who suffered liver damage were taking multiple Herbalife products, but they did not all take the same products, it was impossible to determine which component of any of the formulas, if the problem was a single herb, was accountable for liver injury.

Predictably, regulatory officials in multiple countries placed Herbalife products under intense scrutiny. No single causative agent was ever found. When eight of the Herbalife users who had developed liver problems accidentally used one or more products again, only one developed new symptoms of liver toxicity. Six of the eight, however, "may" have had been exposed to a toxin in Herbalife. They simply took so many other medications and supplements that it was impossible to determine the source of their new liver problems.

It's highly unlikely that Herbalife would cause you liver damage. Just limit your risk by adding one new supplement at a time, say, every other month. That way you and your doctor will be in a better position to know what is causing you problems should symptoms of liver damage appear.

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