Liver Injury From Ayurvedic Herbs and Products: What the Reports Show
What case series and reviews report about liver injury linked to ashwagandha, giloy (guduchi), turmeric supplements and multi-herb Ayurvedic products, how rare it seems, and warning signs.
Content last updated . This page has not been medically reviewed.
Urgent first
Yellow skin or eyes (jaundice), dark urine, severe itching, ongoing nausea or unusual tiredness after starting any herbal product need prompt medical attention. Stop the product and see a clinician; bring the label. NCCIH gives the same advice for turmeric products: if you notice fatigue, nausea, poor appetite, dark urine or jaundice, stop and talk to your health care provider. [1] For a suspected poisoning in the US call 911 or Poison Help at 1-800-222-1222.What this page covers
Herb-induced liver injury is a rare, usually unpredictable reaction. This page reports what case series and reviews found for several herbs used in Ayurveda. These are reports of harm in individual people, so they cannot tell you how common it is. Evidence labels: evidence of harm (rare, case reports and series) and insufficient evidence for how often it occurs. Some Ayurvedic herbs also have good safety records in studies; this page is only about the harm signal. For product contamination see Ayurvedic heavy metals and product quality.A 2020 review of Indian Ayurvedic herbs says recent observational studies have confirmed the liver-toxic potential of Ayurvedic medicines, and describes several routes: direct effects, herb-herb and herb-drug interactions, adulteration with prescription medicines, and contamination from poor manufacturing. [2] A 2024 review adds that certain commonly used herbs have inherent liver toxicity, naming giloy, ashwagandha, turmeric and bakuchi, and that most reported injuries are self-limiting but some progress to liver failure. [3]
Herb by herb
| Herb | What was reported | Outcome in the reports |
|---|---|---|
| Ashwagandha (Withania somnifera) | A 2026 scoping review found 25 patients in 13 publications, commonly with jaundice and itching [4]. A case series of five patients from Iceland and the US DILIN network found jaundice after 2 to 12 weeks of use [5] | Most recovered after stopping, usually over weeks to months; one liver transplant and three deaths among people with existing cirrhosis were reported [4]. In the five-patient series, liver tests normalized within 1 to 5 months in four [5] |
| Giloy or guduchi (Tinospora cordifolia) | A multicenter Indian study of 43 patients with a median of 46 days from first use to symptoms [6] | Probable liver injury in 67.4%; the authors link giloy to acute hepatitis with autoimmune features, able to unmask underlying autoimmune hepatitis [6] |
| Turmeric or curcumin supplements | A systematic review of case reports and Italian reports tied hepatitis to high-bioavailability, high-dose curcumin formulations [7]. A clinicopathological series of 11 cases [8] | Liver tests normalized in all 11 after the supplement was stopped [8] |
| Multi-herb formulas | Three people seen at a Southern California hospital had acute liver injury with jaundice after 90 to 120 days of products including a giloy-only kwath (decoction) and formulas containing 52 or 10 plant extracts [9] | All three made a full recovery; the authors note causality is complex in mixtures [9] |
What the sources say about each
- Ashwagandha. NCCIH says that although rare, a number of cases link liver injury to ashwagandha supplements. [10] The scoping review concludes that people with advanced chronic liver disease should be counseled to avoid it. [4]
- Giloy. It was promoted in India as an immunity booster during COVID-19. [11] The Indian study and a US case review both describe liver injury with autoimmune features or an apparently immune-mediated pattern. [6] [11]
- Turmeric. NCCIH says highly bioavailable curcumin formulations may harm the liver. [1] Turmeric as a food spice is a different matter, and these reports concern concentrated supplements.
How strong is the evidence?
All of the evidence above is observational reports and reviews of them. There are no randomized trials designed to find liver injury, and the reports cannot give a rate. In several reports people also took other products (four of five in the ashwagandha series took additional supplements [5]), so assigning blame to one herb is difficult; one case series on multi-herb products calls for a catalog of Ayurvedic ingredients that cause liver damage, similar to LiverTox. [9] A liver-injury reference database was not available to us when this page was written, so we relied on the case series and reviews cited here.Who should take extra care
People with existing liver disease, those who take medicines that can affect the liver, people with autoimmune conditions, and anyone pregnant or breastfeeding. The NHS says not to take herbal medicines if you have kidney or liver problems. [12] NCCIH does not recommend ashwagandha for people with autoimmune or thyroid disorders. [10] See liver safety and supplements.What to do
- Tell your clinician about every herbal product when you have abnormal liver tests. A histology series on turmeric concluded a full history of supplements is needed when investigating liver injury. [8]
- Do not stop prescribed medicines because of this page. [13]
- Do not start several herbal products at once; it makes any reaction hard to trace.
- Report reactions: reporting a problem with an Ayurvedic product.
Related pages
Frequently asked questions
Is ashwagandha liver-safe?
Usually it is tolerated, but liver injury has been reported, rarely. NCCIH says there have been a number of cases. [10] Most people in a scoping review recovered after stopping. [4]
Is giloy (guduchi) safe for the liver?
Reports from India describe liver injury, including acute hepatitis with autoimmune features, in 43 patients in one study. [6] That does not tell us how common it is among all users.
Can turmeric tea or curry harm the liver?
The reports concern supplements, particularly high-bioavailability forms. [1] [7] We did not find a source setting a limit for turmeric as a food.
How long after starting does liver injury appear?
In the ashwagandha series it appeared after 2 to 12 weeks of use. [5] In the giloy study the median was 46 days. [6]
Should I get my liver checked before using these herbs?
That is a question for your clinician, especially if you already have liver disease or take other medicines.
References
- NCCIH, Turmeric (liver). Read 2026-10-22.
- Philips et al., Comprehensive review of hepatotoxicity associated with traditional Indian Ayurvedic herbs, World J Hepatol 2020. Read 2026-10-22.
- Philips and Theruvath, A comprehensive review on the hepatotoxicity of herbs used in the Indian (Ayush) systems of alternative medicine, Medicine (Baltimore) 2024. Read 2026-10-22.
- McIntyre et al., Ashwagandha-Associated Liver Injury: A Scoping Review, Cureus 2026. Read 2026-10-22.
- Bjornsson et al., Ashwagandha-induced liver injury: a case series from Iceland and the US Drug-Induced Liver Injury Network, Liver Int 2020. Read 2026-10-22.
- Kulkarni et al., Tinospora Cordifolia (Giloy)-Induced Liver Injury During the COVID-19 Pandemic, Multicenter Nationwide Study From India, Hepatol Commun 2022. Read 2026-10-22.
- Lombardi et al., Acute liver injury following turmeric use in Tuscany, Br J Clin Pharmacol 2021. Read 2026-10-22.
- Papke et al., Turmeric supplement-associated hepatitis: a clinicopathological series of 11 cases, Histopathology 2025. Read 2026-10-22.
- Karousatos et al., Case series and review of Ayurvedic medication induced liver injury, BMC Complement Med Ther 2021. Read 2026-10-22.
- NCCIH, Ashwagandha. Read 2026-10-22.
- Nnamani et al., Tinospora cordifolia (Guduchi/Giloy)-Induced Liver Injury: A Case Review, Cureus 2023. Read 2026-10-22.
- NHS, Herbal medicines and complementary therapies (who should not use them). Read 2026-10-22.
- NHS, Herbal medicines and complementary therapies (checking safety). Read 2026-10-22.
Education, not medical advice. This page is for general information. It does not diagnose or treat any condition and is not a substitute for care from a qualified health professional. Natural does not automatically mean safe. Ask a clinician or pharmacist before changing your care, especially if you take medication, are pregnant or breastfeeding, or have a health condition.