A study published in Frontiers in Gastroenterology has analyzed the link between certain traditional and alternative medicinal products and severe liver injury in patients.1 The research examined medicines used by individuals who developed liver damage and investigated the substances present in these products.
Researchers evaluated 386 alternative and complementary medicines consumed by patients who later presented with liver injury at a hepatology department. These products belonged to systems such as Ayurveda, Homeopathy, Siddha, Unani, and other traditional medicine practices. The study assessed the ingredients, contaminants, and clinical outcomes associated with these products.
The study reported that a number of affected patients developed acute-on-chronic liver failure (ACLF). This condition occurs when the liver suddenly deteriorates in people who already have underlying liver disease.
Among patients who developed ACLF, the study reported a mortality rate of nearly 40%. Researchers evaluated clinical data to understand the factors linked to disease progression and patient outcomes.
Dr. Cyriac Abby Philips, the first author of the study and a hepatologist popularly known as “The Liver Doc” on X (formerly Twitter), tweeted about the publication and highlighted the key findings of the research.
The analysis found that unlabeled medicinal products were strongly linked with poorer outcomes. These products were sold without clear ingredient lists, manufacturer information, or batch identification.
Patients who consumed such products had a higher risk of death. The risk increased with the number of unlabeled medicines taken. Data from the study showed a dose-response pattern, with mortality reaching 42.9% among patients who had consumed three or more unlabeled products.
Laboratory testing revealed toxic metal contamination in several of the analyzed medicines. Researchers identified mercury, lead, arsenic, and cadmium in some products, often at concentrations higher than recommended safety levels.
Among these contaminants, cadmium exposure showed a strong association with severe liver failure. The study reported that 75.9% of patients exposed to cadmium developed ACLF, compared with 22.6% of patients who were not exposed.
Researchers also detected modern pharmaceutical drugs in several traditional medicinal products. Nearly one-third of the tested products contained undeclared prescription medications.
These included steroids, antibiotics, and pain-relief drugs, some of which are known to cause liver injury. Because these substances were not listed on product labels, patients consumed them without medical guidance.
The analysis also reviewed plant components present in the medicines. Researchers reported that more than 40% of the products contained plant ingredients previously documented to have potential liver toxicity.
Among the plants detected were Tinospora cordifolia (Giloy) and Withania somnifera (Ashwagandha). The findings indicate that plant-based ingredients can also produce harmful effects under certain conditions, especially in complex or concentrated formulations.
Testing further showed that around one-third of the products contained animal-derived ingredients that were not mentioned on labels. These included substances from dairy, marine sources, or other animal extracts.
The presence of undisclosed animal ingredients may affect individuals who avoid animal products because of dietary practices, ethical choices, or religious beliefs.
Researchers also identified high levels of phytosterols, plant compounds commonly present in concentrated herbal extracts. The study found that higher concentrations of these compounds were associated with an increased occurrence of severe liver failure.
The study connects contaminants, hidden pharmaceutical ingredients, and labeling gaps with liver injury outcomes in patients who consumed certain alternative medicines. The findings highlight the importance of clear ingredient disclosure, product testing, and regulatory oversight to improve the safety of medicinal products used by the public.
1. Philips, Cyriac Abby, T. T. Oommen, A. H. Theruvath, A. Sreemohan, A. Baby, R. Ahamed, A. Tharakan, and P. Augustine. 2026. “Analysis of 386 Alternative Medicinal Products Implicated in Liver Injury Reveal Clinically Relevant Associations with Potentially Hepatotoxic Botanicals, Pharmaceutical Adulteration, Heavy Metal Contamination, and Undisclosed Animal Content.” Frontiers in Gastroenterology 5:1784785. https://doi.org/10.3389/fgstr.2026.1784785.
(Rh/SS/MSM)