Australia’s Drug Regulator Issues Warning on Common Household Spice Following Reports of Liver Injury

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Australia’s Therapeutic Goods Administration (TGA) has revealed a rare yet potentially fatal link between the consumption of turmeric and liver injury.

In an Aug. 15 statement, the TGA said it received 18 reports of liver problems that were experienced by consumers who took products containing turmeric and its product curcumin. Of the 18 reports, nine had liver injuries, two had severe symptoms, and one had a “fatal outcome.”

“In four cases, there were no other ingredients likely to have contributed to the liver injury,” the TGA said.

While the risk of liver injury from taking turmeric and curcumin is rare, the TGA has advised consumers and health professionals to be cautious of the herb, particularly when taking it in medicinal doses such as in medicines and supplements.

The TGA said that the “rare adverse event” is more likely to be experienced by people with existing or pre-existing liver problems.

“The risk may be higher for products with enhanced absorption or bioavailability and/or higher doses,” the TGA said.

Despite the warning, the TGA confirmed that the risk of liver injury did not appear when taken in typical dietary amounts, such as in food.

Over 600 Medicines in Australia Contain the Spice

Over 600 medicines listed in the Australian Register of Therapeutic Goods contain the Curcuma species, or curcumin, which can be isolated from turmeric and is used as an active ingredient in medicines.

However, the TGA said it does not have enough information to conclusively identify which medicines are at higher risk.

“The TGA will continue to monitor this issue and is currently considering further regulatory action, including consultation on a label warning. We will publish the outcome of this consultation, including the details of any new labelling requirements, in late 2023,” the regulator said.

Consumers are advised to be wary of the risks of developing liver injury in rare cases, to take note of early warning signs, and to stop taking the medicine or herbal supplement should any symptoms show. The TGA has identified eight symptoms for consumers and health professionals to be wary of yellowing of the skin or eyes, dark urine, nausea, vomiting, unusual tiredness, weakness, stomach or abdominal pain, and loss of appetite.

Meanwhile, doctors have been advised to be wary of the risk and, when treating patients with symptoms of liver injury, consider whether a complementary medicine is involved.

“Use of medicines or herbal supplements containing the above Curcuma species and/or curcumin should be avoided in patients with existing or previous liver pathologies,” the TGA said.

The same risks apply to related ingredients from the Curcuma species, such as Curcuma aromatica, Curcuma zanthorrhiza, and Curcuma zedoaria.

“In addition to these cases, there have been several Australian and overseas case reports in the scientific literature, and multiple cases reported to regulators in other countries,” the regulator said.

Adverse Reactions from Curcumin Reported in France and Italy

In 2022, the French Agency for Food, Environmental, and Occupational Health and Safety (ANSES) reported cases of hepatitis in France and Italy involving supplements containing turmeric and curcumin.

The agency said that while curcumin has “very low bioavailability,” meaning that it is poorly absorbed into the bloodstream and is very rapidly eliminated by the body, manufacturers have developed formulations to increase this bioavailability in order to increase the uptake.

The European Food Safety Authority (EFSA) and ANSES have recommended an acceptable daily intake of 180 mg of curcumin per day for a 60 kg adult as the safe level of consumption.

“To prevent all dietary intakes, including those from food supplements, from exceeding the ADI, ANSES determined that the daily intake in food supplement form should remain below 153 mg for a 60 kg adult,” the agency said.

But There Are Reported Health Benefits With Tumeric

In spite of the above, there are 70,000 research reports on turmeric.

For instance, a 2017 study in the journal Foods found that curcumin in turmeric has anti-inflammatory and antioxidant effects.

In addition, a 2019 study published in the journal Nutrients showed that curcumin has immunomodulatory effects that can help prevent cancer. Both curcuminoids and related turmeric products have been sanctioned as safe by the U.S. Food and Drug Administration (FDA).

Meanwhile, from 2021 to 2022, many academic journals published research results on curcumin’s treatment for COVID-19. In clinical studies, it has been found that curcumin can effectively improve symptoms such as fever, cough, dyspnea, and muscle soreness in confirmed mild and severe patients after treatment with it.

In a 2013 study, U.S. researchers found that curcumin targeted cancer stem cells and found no cause for concern when used as an adjunct to traditional cancer treatments. However, the National Cancer Institute (NCI) said that there is inadequate evidence to recommend curcumin-containing products for the treatment of cancer.

Curcuma longa (turmeric) is a plant that has been used as a food spice for over 4,000 years as well as for medicinal purposes in traditional Indian (Ayurvedic) and Chinese medicines.