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Yahoo
11 hours ago
- Health
- Yahoo
Measles Is Now Showing Up in Wastewater
Credit - Getty Images Measles cases in the U.S. have been rare in recent decades, thanks to a strong childhood vaccination program. But a few cases inevitably pop up each year as travelers bring the virus in from other countries and infect unvaccinated people, primarily children. Those cases are no longer blips. Now that the measles vaccination rate is dropping precipitously across the U.S.—due in part to anti-vaccine sentiments—cases are rising. So far in 2025, 14 outbreaks have been reported in 33 states, according to the U.S. Centers for Disease Control and Prevention (CDC). (By comparison, in 2024, there were just 16 outbreaks reported during the entire year.) Scientists may now have a new way to catch cases. For the first time, researchers have posted national information on where the measles virus is showing up in wastewater. Wastewater surveillance is a useful public-health tool because it provides an objective glimpse into where a given virus is causing infections—often before traditional testing methods. For viruses like measles, which infected people shed in urine, feces, or saliva, it can provide a critical heads-up for health officials. 'It gives us a finger-to-the-wind weather map of what is happening with infectious diseases,' says Dr. Marlene Wolf, assistant professor at Emory and principal investigator and co-program director of WastewaterSCAN, an academic and commercial group that includes researchers from Stanford University, Emory University, and Verily (which is Alphabet Inc.'s research organization). Here's what wastewater is revealing about measles in the U.S. WastewaterSCAN began testing sewage in the U.S. for the COVID-19 virus in 2020 and has since added other disease-causing microbes including influenza, RSV, human metapneumovirus (HMPV), norovirus, enterovirus, mpox, Candida auris, and hepatitis A. This spring, the scientists began developing a test for picking up signs of the active or "wild type" measles virus that is causing outbreaks in the U.S. The test uses samples from nearly 150 sewage sites across the country and can pick up signs of measles within 48 hours. Read More: What to Know About the New COVID-19 Variant NB.1.8.1 So far, they have detected it in three sites: one day in Hollywood, Md.; four days toward the end of May in Sacramento; and twice in mid-May in Stamford, Conn. WastewaterSCAN is only one such wastewater surveillance network in the country, though it's the first to test for measles on a national level. The CDC launched its National Wastewater Surveillance System in 2020 and includes more than 1,400 sites that cover 150 million Americans. Some state health departments—including in Texas, where the current measles outbreaks began—also test wastewater samples. WastewaterSCAN collaborates with the CDC, but the CDC does not yet test for measles in wastewater. Doctors who see patients with measles must report the case to the CDC so the agency can track it and respond to any outbreaks. But it takes time for people to develop symptoms, seek medical care, get tested, and then have their case reported if the test is positive. In addition, the first symptoms of measles are common ones like fever, runny nose, and cough—before the telltale rash appears. Plus, not everyone may get sick enough to know they have measles, so their cases may go unreported. Still others may get sick but not have access to health care and therefore never seek medical help. Read More: Measles Vaccination Rates Are Plummeting Across the U.S. Wastewater monitoring bypasses those hurdles and can theoretically catch evidence of the virus much earlier. That could be especially helpful with a highly contagious disease like measles, in which one infected person can quickly spread the virus to as many as 18 others. 'This is anonymous testing that combines everyone in a community,' says Wolfe. 'And for measles, it's likely that shedding [of the virus] into wastewater is happening before people necessarily recognize what they have.' This type of tracking for measles is too new to know yet whether it can detect cases in a region before people start testing positive, Wolfe says. But wastewater surveillance was able to pick up signs of the COVID-19 virus days or sometimes even weeks before cases began appearing in hospitals and testing labs. Over time, as more data are collected on measles, health experts can begin to look for trends and patterns, such as increases in the number of positive samples. That could help public-health departments focus resources like vaccines in areas where infections are spreading. If the number of positive samples start to decline, that information could also give them a heads up when infections are under control. Getting vaccinated is the best way to protect yourself against measles infection, and the immunization provides close to lifelong immunity. Making sure that anyone who is eligible is up to date on their measles vaccines can help them avoid infection. Contact us at letters@
Time Magazine
12 hours ago
- Health
- Time Magazine
Measles Is Now Showing Up in Wastewater
Measles cases in the U.S. have been rare in recent decades, thanks to a strong childhood vaccination program. But a few cases inevitably pop up each year as travelers bring the virus in from other countries and infect unvaccinated people, primarily children. Those cases are no longer blips. Now that the measles vaccination rate is dropping precipitously across the U.S.—due in part to anti-vaccine sentiments—cases are rising. So far in 2025, 14 outbreaks have been reported in 33 states, according to the U.S. Centers for Disease Control and Prevention (CDC). (By comparison, in 2024, there were just 16 outbreaks reported during the entire year.) Scientists may now have a new way to catch cases. For the first time, researchers have posted national information on where the measles virus is showing up in wastewater. Wastewater surveillance is a useful public-health tool because it provides an objective glimpse into where a given virus is causing infections—often before traditional testing methods. For viruses like measles, which infected people shed in urine, feces, or saliva, it can provide a critical heads-up for health officials. 'It gives us a finger-to-the-wind weather map of what is happening with infectious diseases,' says Dr. Marlene Wolf, assistant professor at Emory and principal investigator and co-program director of WastewaterSCAN, an academic and commercial group that includes researchers from Stanford University, Emory University, and Verily (which is Alphabet Inc.'s research organization). Here's what wastewater is revealing about measles in the U.S. Adding measles to the menu of wastewater tests WastewaterSCAN began testing sewage in the U.S. for the COVID-19 virus in 2020 and has since added other disease-causing microbes including influenza, RSV, human metapneumovirus (HMPV), norovirus, enterovirus, mpox, Candida auris, and hepatitis A. This spring, the scientists began developing a test for picking up signs of the active or "wild type" measles virus that is causing outbreaks in the U.S. The test uses samples from nearly 150 sewage sites across the country and can pick up signs of measles within 48 hours. So far, they have detected it in three sites: one day in Hollywood, Md.; four days toward the end of May in Sacramento; and twice in mid-May in Stamford, Conn. WastewaterSCAN is only one such wastewater surveillance network in the country, though it's the first to test for measles on a national level. The CDC launched its National Wastewater Surveillance System in 2020 and includes more than 1,400 sites that cover 150 million Americans. Some state health departments—including in Texas, where the current measles outbreaks began—also test wastewater samples. WastewaterSCAN collaborates with the CDC, but the CDC does not yet test for measles in wastewater. Why wastewater monitoring may be especially useful for measles Doctors who see patients with measles must report the case to the CDC so the agency can track it and respond to any outbreaks. But it takes time for people to develop symptoms, seek medical care, get tested, and then have their case reported if the test is positive. In addition, the first symptoms of measles are common ones like fever, runny nose, and cough—before the telltale rash appears. Plus, not everyone may get sick enough to know they have measles, so their cases may go unreported. Still others may get sick but not have access to health care and therefore never seek medical help. Wastewater monitoring bypasses those hurdles and can theoretically catch evidence of the virus much earlier. That could be especially helpful with a highly contagious disease like measles, in which one infected person can quickly spread the virus to as many as 18 others. 'This is anonymous testing that combines everyone in a community,' says Wolfe. 'And for measles, it's likely that shedding [of the virus] into wastewater is happening before people necessarily recognize what they have.' How wastewater data can help health officials This type of tracking for measles is too new to know yet whether it can detect cases in a region before people start testing positive, Wolfe says. But wastewater surveillance was able to pick up signs of the COVID-19 virus days or sometimes even weeks before cases began appearing in hospitals and testing labs. Over time, as more data are collected on measles, health experts can begin to look for trends and patterns, such as increases in the number of positive samples. That could help public-health departments focus resources like vaccines in areas where infections are spreading. If the number of positive samples start to decline, that information could also give them a heads up when infections are under control. What to do if cases are detected near you Getting vaccinated is the best way to protect yourself against measles infection, and the immunization provides close to lifelong immunity. Making sure that anyone who is eligible is up to date on their measles vaccines can help them avoid infection.
Medscape
7 days ago
- Health
- Medscape
Juice Cleanses Likely Good for Nothing, Bad for Much
'It's a great way to get those fruits and vegetables into my diet, especially since I can't be bothered peeling or preparing them…' 'I lost weight and felt lighter…' 'I'm helping my body detox, and that's a good feeling.' Social media is rife with statements like the above about juice cleanses. It's a favorite topic as well as something patients often ask about. The perception is that by doing a juice cleanse, they're doing something healthy for themselves — yet experts agree that in most cases, they're not. But if they're having a conversation or asking about it, it offers an opportunity to provide evidence-based guidance. American Gastroenterological Association Spokesperson Fazia Mir, MD, clinical assistant professor at the University of New Mexico and a gastroenterologist with Presbyterian Healthcare Services, both in Albuquerque, New Mexico, said some of her patients ask about juice cleanses because they're interested in doing a liver detox or helping their gut inflammation. 'I tell them that, in fact, it does the opposite,' she told Medscape Medical News . 'The majority of juice cleanses impact gut health negatively. They can cause bowel habit irregularity and even precipitate inflammatory bowel disease, as the gut microbiota is disrupted due to the lack of fiber in these cleanses. And we see patients all the time whose irritable bowel syndrome worsens after they've embarked on a juice cleanse.' What the Evidence Says There's little evidence to support the use of juice cleanses for eliminating toxins from the body, according to the US National Center for Complementary and Integrative Health. Furthermore, some juices used in 'detoxes' and 'cleanses' haven't been pasteurized or treated in other ways to kill harmful bacteria, meaning they can expose individuals to toxigenic E coli, Salmonella , hepatitis A, and Cryptosporidium . In addition, some juices are made from foods high in oxalate, such as leafy green vegetables and beets. Individuals susceptible to kidney stone formation should limit their consumption of high-oxalate foods, which can present a health threat. In fact, a case report published several years ago documented acute oxalate nephropathy caused by a 'green smoothie cleanse' prepared from juicing oxalate-rich green leafy vegetables and fruits. 'Reality Check' Two recent studies highlight the negative impact of juice cleanses. In a small randomized, three-arm intervention study with 14 healthy participants published online in Nutrients , 'a 3-day exclusive juice cleanse (800-900 kcal/d) led to shifts in the oral and gut microbiome, with increases in taxa linked to inflammation, gut permeability, and even cognitive decline after juice consumption,' said principal author Melinda Ring, MD, executive director, Osher Center for Integrative Health at Northwestern University in Chicago. Participants followed one of three diets — juice only, juice plus food, or plant-based food — for 3 days. Microbiota samples (stool, saliva, and inner cheek swabs) were collected at baseline, after a pre-intervention elimination diet, immediately after the juice intervention, and 14 days after the intervention. Gene sequencing was used to analyze microbiota taxonomic composition. The juice-only group showed the most significant increase in bacteria associated with inflammation and gut permeability, as well as associated changes in the saliva and cheek microbiota — particularly in the relative abundances of proinflammatory bacterial families. These changes are potentially due to the high sugar and low fiber intake of the juice-related products, the authors suggested. Ring said the study 'offers a reality check' on juice cleanses. 'Whether a cleanse is 'healthy' depends on the individual and the intent behind it,' she told Medscape Medical News . 'A short, structured cleanse, ideally lasting no more than 1-3 days, can be safe for many people if it focuses on polyphenol-rich, low-sugar vegetables rather than fruit, retains some fiber (as in blended rather than pressed juices), and avoids extreme calorie restriction.' Pediatricians should also be aware that a high-sugar, low-fiber diet may promote the growth of pro-inflammatory taxa, first author Maria Luisa Savo Sardaro, PhD, a professor of food microbiology at San Raffaele University in Rome, Italy, told Medscape Medical News . 'Families often rely on juice boxes in lunch packs, believing they're a healthy substitute for whole fruit, and school cafeterias frequently offer sugary drinks throughout the day,' she said. 'Together, these habits may contribute to an early life increase of inflammation in children.' Change Dietary Guidelines? Although it did not address juice cleanses per se, a new review published online in Nutrition Bulletin specifically compared evidence on whole fruit and 100% fruit juice with regard to nutrient composition, impact on hunger and satiety, and association with chronic health conditions. Lead author Hemangi Mavadiya, a PhD candidate at the Joe C. Wen School of Population & Public Health, University of California Irvine, Irvine, California, said that, like the Nutrients study, the review of 83 studies found juicing does indeed remove much of the dietary fiber that has beneficial effects on the gut. In addition, processing and/or storing 100% fruit juice reduces vitamins and other antioxidant contents and transforms intrinsic sugars in the whole fruit into free sugars, which have little nutritional benefit. Furthermore, fruit consumed in solid form provides greater satiety due to delayed gastric emptying and related physiological reactions, and 'the synergistic effects of polyphenols and fiber in whole fruit benefit the gut microbiome by acting as prebiotics and producing short-chain fatty acids that reduce inflammation,' the authors wrote. The review also showed that consuming high amounts of fruit juice is associated with increased risks for certain types of cancer, while results were mixed for type 2 diabetes and hypertension. As a result of their findings, the authors recommended that the next version of the next set of Dietary Guidelines for Americans, coming out at the end of 2025, be updated to better reflect the amount of whole fruit and 100% fruit juice adults and children should consume. Current guidelines recommend that at least half of the daily recommended fruit intake of two cups a day should come from whole fruits, potentially allowing the other half to be fulfilled by 100% fruit juice. Tips for Patients What are clinicians telling their patients regarding juice cleanses? 'When used as a bridge to more sustainable, whole-food, high-fiber eating habits, a brief cleanse might serve as a motivational tool,' Ring said. 'However, clinicians should counsel patients that detoxification is a natural, ongoing function of the liver and kidneys, not something that requires commercial juice products.' Patients should also be told that juice cleanses may temporarily disrupt the body's microbial balance, likely due to their high sugar and low fiber content and may not support long-term gut health. 'Cleanses may offer a psychological 'reset,' but without adequate fiber and protein, they could undermine microbial diversity and resilience, especially if repeated or prolonged.' Patients who love juicing can consider blending instead, to keep the fiber intact, or pairing juices with whole foods to balance the impact on the microbiome, she suggested. Mavadiya advises patients read food labels, which can help distinguish between fruit juice and fruit drinks, since the latter 'is loaded with added sugars,' and it's easy to confuse the two. 'Ultimately, the healthiest path forward is not a periodic cleanse, but a consistent, nutrient-dense, fiber-rich diet that supports gut and systemic health over the long term,' Ring concluded. Furthermore, clinicians should assess for underlying conditions such as diabetes, eating disorders, or frailty, which may make juice cleanses inadvisable. No conflicts of interest were declared.
Yahoo
28-05-2025
- Business
- Yahoo
Drug-induced liver injuries rise in the U.S. as supplements grow in popularity: What to know
It started with nausea and loss of appetite. Robert Grafton, of Turnersville, New Jersey, tried to convince himself he was just coming down with something one weekend in mid-March. Then came the itching and dark urine. Grafton, a former interventional radiology technologist whose wife is a nurse, recognized the hallmarks of liver failure. The otherwise healthy 54-year-old had a gut feeling that his herbal and dietary supplements were the culprit. 'I stopped taking everything, thank goodness,' Grafton said. 'If I hadn't known, if I was not in the medical field, I might have thought, 'Oh, I think I'm getting sick. I need to take some more of these supplements to help me feel better.'' When his symptoms had only worsened by midweek, Grafton visited his primary care physician. The doctor, he said, suspected hepatitis A, a liver infection that can be caused by consuming food or drink contaminated with the hepatitis A virus. Grafton's laboratory test results showed otherwise. 'My liver enzymes were super elevated, my bilirubin was really high — all the signs of liver failure,' Grafton said. 'I pretty much broke down, my wife as well. I was, at that point, thinking it was liver cancer, pancreatic cancer or something.' That Friday, less than a week after his symptoms had begun, Grafton was admitted to Thomas Jefferson University Hospital in Philadelphia, where he received a diagnosis. 'It turns out I had something called a drug-induced liver injury, which came from my supplements.' The liver is responsible for more than 500 functions in the human body, including filtering harmful substances from the blood. Some people's livers metabolize toxins more slowly than others, but too much of certain drugs can overwhelm even the healthiest liver. When taken in excess, acetaminophen, for example, the active ingredient in Tylenol, is among the most common causes of drug-induced liver injury, also called toxic hepatitis. Pharmaceutical products aren't solely the cause. Herbal and dietary supplements are causing liver damage with mounting prevalence. From 1995 through 2020, supplement-related liver failure requiring U.S. patients to be waitlisted for transplants increased eightfold, according to a 2022 study in the journal Liver Transplantation. In addition, a 2017 review in the journal Hepatology found that 20% of liver toxicity cases nationwide are tied to herbal and dietary supplements. Because 'multi-ingredient nutritional supplements' caused the majority of those cases, the authors said, it's hard to pinpoint which component(s) may be to blame. Whereas dietary supplements typically contain nutrients such as vitamins, minerals and amino acids from a range of sources such as fish oil, herbal supplements are a subset of dietary supplements composed of plant-based ingredients. Liver damage linked to supplements is rare. How rare is unclear. What is known is why cases are on the rise: More Americans are taking supplements. As many as 3 in 4 adults 18 and older take them, according to a 2024 survey by the Council for Responsible Nutrition, a trade group representing the dietary supplement and functional food industry. Almost 4 in 5 users said they prefer supplements to prescription or over-the-counter medications. By comparison, the 2017–2018 National Health and Nutrition Examination Survey showed that 58% of adults 20 and older had used a dietary supplement in the past 30 days. 'I think people assume these things are safe,' said Dr. Dina Halegoua-De Marzio, a Jefferson Health hepatologist who treated Grafton. 'The No. 1 reason we see people taking these are for good health or to supplement their health, and so I don't think that they realize that there is a real risk here.' Grafton was one such consumer. The father of five became more health-conscious when he hit 50, going to the gym and starting a supplement regimen that included fenugreek, DHEA, ashwagandha, L-carnitine and nitric oxide. He continued that cocktail, with few changes, for years without incident. About a month before he got sick, Grafton added turmeric pills to the mix, with the goal of reducing inflammation. Then Grafton saw the social media promo he said helped set his health crisis in motion. Ironically, he bought an advertised turmeric-based liquid supplement in part because it claims to support long-term liver health. Similar products are widely available. 'The whole push with that is that you're getting a super-high, concentrated dose of turmeric and dandelion root and milk thistle, which I have always known from my medical past is good for liver health,' Grafton said. 'It all sounded good. … I thought I did enough digging.' He fell ill within a week of adding the liquid supplement to his routine. Even though Grafton stopped the turmeric pills the day he started the turmeric drink, Halegoua-De Marzio said, turmeric overload most likely caused his liver injury. Not only was the drink ultra-concentrated; the pills contained 2,250 mg of curcumin, a substance that comes from the root of the turmeric plant. The pills also include black pepper extract, which Halegoua-De Marzio warned increases absorption twentyfold. 'When you cook with turmeric, that could be really safe. But some of the supplements now are 2,000 mg plus, which is a very high dose of turmeric,' she said. Coupled with black pepper, 'the liver now has to break down that supplement and it can't. It could make it really sick.' The supplement spectrum includes everything from powders that claim to promote muscle growth to gummies that promise to reduce stress. When it comes to herbal supplements, natural doesn't necessarily mean better or safer, Halegoua-De Marzio said. 'That's what I hear from patients all the time — 'Oh, I want something natural' — this fear of prescription medicines being unsafe,' she said, adding that while prescriptions bear their own risks, they've gone through rigorous clinical trials. Supplements aren't subjected to the same premarket testing. Among herbal ingredients tied to toxic hepatitis, turmeric is the most commonly consumed in the U.S., according to a study published last year in the journal JAMA Network Open. Following that are green tea extract, ashwagandha, Garcinia cambogia, red yeast rice and black cohosh. About 15.6 million Americans take supplements containing at least one of these six botanicals, the study found. Most reported doing so on their own, not under a doctor's advice. Prescription medications are tightly regulated and therefore more easily quantified; it's difficult to determine how many people consume supplements whose ingredients can cause liver damage. A goal of the JAMA Network Open research was to capture this magnitude — at least where herbal supplements are concerned — said co-author Dr. Robert Fontana, a professor of internal medicine at the University of Michigan Medical School. 'It's important for other doctors to know, for the general public to know,' Fontana said. 'The denominator of use is going up.' Fontana and Halegoua-De Marzio are part of the Drug-Induced Liver Injury Network, a research group backed by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. More than 1,800 patients have been enrolled since the program's 2004 inception, with 19% of cases tied to supplements. Previous research has estimated that the U.S. sees 44,000 cases of liver damage linked to medications and supplements annually, including 2,700 deaths. The actual incidence is likely higher, Fontana said. Liver failure symptoms can be vague, so some people may be unaware they have the condition. People who sought natural remedies in the form of supplements may be wary of seeing a doctor. Others, Fontana said, may be embarrassed about inadvertently harming themselves; botanical users in his 2024 research were older, wealthier and more educated than nonusers. 'When you're the patient, you're like, 'Why did this happen to me?'' Fontana said. ''What do you mean, this stuff isn't safe?'' For Joanne Slavin, a registered dietitian and professor in the department of food science and nutrition at the University of Minnesota, consumer education on the risks and rewards of supplements is critical. 'We really only know human data when something goes wrong,' she said. The Food and Drug Administration maintains a searchable database of recalls, market withdrawals and safety alerts but can't vet supplements for safety or effectiveness before they hit store shelves. Only once they're on the market does the agency have the authority to penalize 'adulterated or misbranded' products. That's thanks to the Dietary Supplement Health and Education Act of 1994, which limited the FDA's reach. The number of supplements on sale today is almost 20 times as many as three decades ago. Consuming supplements comes with risks, the FDA warns. 'Dietary supplements may contain ingredients that can have strong effects in the body, even if the ingredients are natural or plant-derived,' the agency said in a statement to NBC News. 'Adverse events are more likely to occur if consumers take supplements in high doses, take multiple supplements or take supplements instead of or in addition to medications.' According to the Council for Responsible Nutrition (CRN), dietary supplements can't make claims concerning the prevention, diagnosis, mitigation or curing of a disease. 'Dietary supplements can't say they can cure your cold, they can't say they can prevent your Alzheimer's or your cancer,' CRN President and CEO Steve Mister said. 'If you see (such) a product out there, it is blatantly illegal.' In short, he said, supplements are intended for healthy people who are trying to stay healthy. While everyone should ideally get all nutrients through a balanced diet, Slavin said, she recognizes that dietary supplements have their place. People who don't eat red meat, for instance, may need to seek an alternate source of iron. 'A supplement is fine, sure,' she said. 'But that's on the individual basis rather than the public health basis for the whole world.' Monitoring how many vitamins or mineral supplements are taken daily is straightforward, Slavin said. The federal Office of Dietary Supplements has established daily upper limits for nutrients, from vitamin A to zinc, which vary by age and sex. Calcium, for example, has an upper limit of 2,000 mg per day for adults 51 and older — including food, drink and supplements. Herbal supplements have no such boundaries and aren't as well studied. 'Everything can be toxic at a certain amount,' said Andrea Wong, CRN senior vice president of scientific and regulatory affairs. 'It's really up to the manufacturers and the researchers who are looking at these ingredients to determine what is the beneficial amount … then also look at what would be the amount where you start seeing some evidence of toxicity.' She said it's important to let your doctor know about any supplements you're taking or starting. Some supplements may interfere with prescription medications or each other, or be unsafe for people with certain medical conditions. For example, the FDA advises against taking any combination of aspirin, vitamin E, prescription warfarin or herbal supplement ginkgo biloba — all are blood thinners and may increase risk of stroke or internal bleeding. According to Fontana, some people are even genetically susceptible to supplement-induced liver damage. 'That means there's a biological basis as to why they were the one in 1,000, one in 10,000 people who took this and got into trouble,' Fontana said of supplements. 'The same thing is true for prescription drugs; we're finding genetic associations.' The federal LiverTox database is a free tool highlighting medicines and supplements linked to liver injury. The liver is usually a forgiving organ, Fontana said. Grafton's was. His hospital stay was brief, and he said his blood work had returned to normal within weeks of ceasing supplements. Additional testing revealed no permanent damage to his liver. He said he has a new lease on life and resumed his health kick — with one notable exception. 'I don't take any supplements whatsoever.' This article was originally published on
NBC News
27-05-2025
- Health
- NBC News
Rates of liver injuries rise in the U.S. as supplements grow in popularity
It started with nausea and loss of appetite. Robert Grafton, of Turnersville, New Jersey, tried to convince himself he was just coming down with something one weekend in mid-March. Then came the itching and dark urine. Grafton, a former interventional radiology technologist whose wife is a nurse, recognized the hallmarks of liver failure. The otherwise healthy 54-year-old had a gut feeling that his herbal and dietary supplements were the culprit. 'I stopped taking everything, thank goodness,' Grafton said. 'If I hadn't known, if I was not in the medical field, I might have thought, 'Oh, I think I'm getting sick. I need to take some more of these supplements to help me feel better.'' When his symptoms had only worsened by midweek, Grafton visited his primary care physician. The doctor, he said, suspected hepatitis A, a liver infection that can be caused by consuming food or drink contaminated with the hepatitis A virus. Grafton's laboratory test results showed otherwise. 'My liver enzymes were super elevated, my bilirubin was really high — all the signs of liver failure,' Grafton said. 'I pretty much broke down, my wife as well. I was, at that point, thinking it was liver cancer, pancreatic cancer or something.' That Friday, less than a week after his symptoms had begun, Grafton was admitted to Thomas Jefferson University Hospital in Philadelphia, where he received a diagnosis. 'It turns out I had something called a drug-induced liver injury, which came from my supplements.' Rising rates of liver damage The liver is responsible for more than 500 functions in the human body, including filtering harmful substances from the blood. Some people's livers metabolize toxins more slowly than others, but too much of certain drugs can overwhelm even the healthiest liver. When taken in excess, acetaminophen, for example, the active ingredient in Tylenol, is among the most common causes of drug-induced liver injury, also called toxic hepatitis. Pharmaceutical products aren't solely the cause. Herbal and dietary supplements are causing liver damage with mounting prevalence. From 1995 through 2020, supplement-related liver failure requiring U.S. patients to be waitlisted for transplants increased eightfold, according to a 2022 study in the journal Liver Transplantation. In addition, a 2017 review in the journal Hepatology found that 20% of liver toxicity cases nationwide are tied to herbal and dietary supplements. Because 'multi-ingredient nutritional supplements' caused the majority of those cases, the authors said, it's hard to pinpoint which component(s) may be to blame. Whereas dietary supplements typically contain nutrients such as vitamins, minerals and amino acids from a range of sources such as fish oil, herbal supplements are a subset of dietary supplements composed of plant-based ingredients. Liver damage linked to supplements is rare. How rare is unclear. What is known is why cases are on the rise: More Americans are taking supplements. As many as 3 in 4 adults 18 and older take them, according to a 2024 survey by the Council for Responsible Nutrition, a trade group representing the dietary supplement and functional food industry. Almost 4 in 5 users said they prefer supplements to prescription or over-the-counter medications. By comparison, the 2017–2018 National Health and Nutrition Examination Survey showed that 58% of adults 20 and older had used a dietary supplement in the past 30 days. 'I think people assume these things are safe,' said Dr. Dina Halegoua-De Marzio, a Jefferson Health hepatologist who treated Grafton. 'The No. 1 reason we see people taking these are for good health or to supplement their health, and so I don't think that they realize that there is a real risk here.' Grafton was one such consumer. The father of five became more health-conscious when he hit 50, going to the gym and starting a supplement regimen that included fenugreek, DHEA, ashwagandha, L-carnitine and nitric oxide. He continued that cocktail, with few changes, for years without incident. About a month before he got sick, Grafton added turmeric pills to the mix, with the goal of reducing inflammation. Then Grafton saw the social media promo he said helped set his health crisis in motion. Ironically, he bought an advertised turmeric-based liquid supplement in part because it claims to support long-term liver health. Similar products are widely available. 'The whole push with that is that you're getting a super-high, concentrated dose of turmeric and dandelion root and milk thistle, which I have always known from my medical past is good for liver health,' Grafton said. 'It all sounded good … I thought I did enough digging.' He fell ill within a week of adding the liquid supplement to his routine. Despite Grafton stopping the turmeric pills the day he started the turmeric drink, Halegoua-De Marzio said, turmeric overload likely caused his liver injury. Not only was the drink ultra-concentrated, the pills contained 2,250 mg of curcumin, a substance that comes from the root of the turmeric plant. The pills also include black pepper extract, which Halegoua-De Marzio warned increases absorption twentyfold. 'When you cook with turmeric, that could be really safe. But some of the supplements now are 2,000 mg plus, which is a very high dose of turmeric,' she said. Coupled with black pepper, 'the liver now has to break down that supplement and it can't. It could make it really sick.' The supplement spectrum includes everything from powders that claim to promote muscle growth to gummies that promise to reduce stress. When it comes to herbal supplements, natural doesn't necessarily mean better or safer, Halegoua-De Marzio said. 'That's what I hear from patients all the time — 'Oh, I want something natural' — this fear of prescription medicines being unsafe,' she said, adding that while prescriptions bear their own risks, they've gone through rigorous clinical trials. Supplements aren't subjected to the same premarket testing. Among herbal ingredients tied to toxic hepatitis, turmeric is the most commonly consumed in the U.S., according to a study published last year in the journal JAMA Network Open. Following that are green tea extract, ashwagandha, Garcinia cambogia, red yeast rice and black cohosh. About 15.6 million Americans take supplements containing at least one of these six botanicals, the study found. Most reported doing so on their own, not under a doctor's advice. Prescription medications are tightly regulated and therefore more easily quantified; it's difficult to determine how many people consume supplements whose ingredients can cause liver damage. A goal of the JAMA Network Open research was to capture this magnitude — at least where herbal supplements are concerned — said co-author Dr. Robert Fontana, a professor of internal medicine at the University of Michigan Medical School. 'It's important for other doctors to know, for the general public to know,' Fontana said. 'The denominator of use is going up.' Fontana and Halegoua-De Marzio are part of the Drug-Induced Liver Injury Network, a research group backed by the National Institute of Diabetes and Digestive and Kidney Diseases, part of the National Institutes of Health. More than 1,800 patients have been enrolled since the program's 2004 inception, with 19% of cases tied to supplements. Previous research has estimated that the U.S. sees 44,000 cases of liver damage linked to medications and supplements annually, including 2,700 deaths. The actual incidence is likely higher, Fontana said. Liver failure symptoms can be vague, so some people may be unaware they have the condition. People who sought natural remedies in the form of supplements may be wary of seeing a doctor. Others, Fontana said, may be embarrassed about inadvertently harming themselves; botanical users in his 2024 research were older, wealthier and more educated than nonusers. 'When you're the patient, you're like, 'Why did this happen to me?'' Fontana said. ''What do you mean, this stuff isn't safe?'' FDA doesn't monitor supplement safety before sale For Joanne Slavin, a registered dietician and professor in the department of food science and nutrition at the University of Minnesota, consumer education on the risks and rewards of supplements is critical. 'We really only know human data when something goes wrong,' she said. The Food and Drug Administration maintains a searchable database of recalls, market withdrawals and safety alerts but can't vet supplements for safety or effectiveness before they hit store shelves. Only once they're on the market does the agency have the authority to penalize 'adulterated or misbranded' products. That's thanks to the Dietary Supplement Health and Education Act of 1994, which limited the FDA's reach. The number of supplements on sale today is almost 20 times as many as three decades ago. Consuming supplements comes with risks, the FDA warns. 'Dietary supplements may contain ingredients that can have strong effects in the body, even if the ingredients are natural or plant-derived,' the agency said in a statement to NBC News. 'Adverse events are more likely to occur if consumers take supplements in high doses, take multiple supplements or take supplements instead of or in addition to medications.' According to the Council for Responsible Nutrition (CRN), dietary supplements can't make claims concerning the prevention, diagnosis, mitigation or curing of a disease. 'Dietary supplements can't say they can cure your cold, they can't say they can prevent your Alzheimer's or your cancer,' CRN President and CEO Steve Mister said. 'If you see (such) a product out there, it is blatantly illegal.' Dietary supplements have their place In short, he said, supplements are intended for healthy people who are trying to stay healthy. While everyone should ideally get all nutrients through a balanced diet, Slavin said, she recognizes that dietary supplements have their place. People who don't eat red meat, for instance, may need to seek an alternate source of iron. 'A supplement is fine, sure,' she said. 'But that's on the individual basis rather than the public health basis for the whole world.' Monitoring how many vitamins or mineral supplements are taken daily is straightforward, Slavin said. The federal Office of Dietary Supplements has established daily upper limits for nutrients, from vitamin A to zinc, which vary by age and sex. Calcium, for example, has an upper limit of 2,000 mg per day for adults 51 and older — including food, drink and supplements. Herbal supplements have no such boundaries and aren't as well studied. 'Everything can be toxic at a certain amount,' said Andrea Wong, CRN senior vice president of scientific and regulatory affairs. 'It's really up to the manufacturers and the researchers who are looking at these ingredients to determine what is the beneficial amount … then also look at what would be the amount where you start seeing some evidence of toxicity.' She said it's important to let your doctor know about any supplements you're taking or starting. Some supplements may interfere with prescription medications or each other, or be unsafe for people with certain medical conditions. For example, the FDA advises against taking any combination of aspirin, vitamin E, prescription warfarin or herbal supplement ginkgo biloba — all are blood thinners and may increase risk of stroke or internal bleeding. According to Fontana, some people are even genetically susceptible to supplement-induced liver damage. 'That means there's a biological basis as to why they were the one in 1,000, one in 10,000 people who took this and got into trouble,' Fontana said of supplements. 'The same thing is true for prescription drugs; we're finding genetic associations.' The federal LiverTox database is a free tool highlighting medicines and supplements linked to liver injury. The liver is usually a forgiving organ, Fontana said. Grafton's was. His hospital stay was brief, and he said his blood work had returned to normal within weeks of ceasing supplements. Additional testing revealed no permanent damage to his liver. He said he has a new lease on life and resumed his health kick — with one notable exception.
