Turmeric supplements, available in concentrated capsules, powders or extracts, are derived from the root of the Curcuma longa plant and are primarily valued for their curcumin content, an active compound known for its strong antioxidant and anti-inflammatory properties.
Because curcumin is poorly absorbed by the body on its own, supplements often include black pepper extract (piperine) or use other delivery systems to reduce its breakdown in the liver and help it pass through the intestinal wall into the bloodstream.
Regulatory action to date indicates that toxicity concerns do not appear to apply to turmeric consumed in the typical diet. Rather, the expert committees consulted by regulators suggest that increased systemic exposure resulting from the enhanced bioavailability has coincided with reports of rare, and sometimes severe, liver injury in susceptible individuals.
While case reports generate a safety signal, some question whether precautionary regulatory approaches sufficiently account for other confounding risk factors that might limit a causality assessment, particularly considering that the absolute risk among users remains uncertain.
2019: Italy is the inflection point
Italy reported roughly 20 cases of hepatitis associated with turmeric-containing supplements in the Tuscany and Lombardy regions between late 2018 and mid-2019.
With multiple products and formulations implicated, the Ministry of Health launched an investigation conducted by an interdisciplinary expert group and the Italian National Institute of Health. Analyses of product samples linked to the hepatitis cases ruled out the presence of contaminants or intentionally added substances as potential causes of liver damage.
Instead, the inquiry increasingly focused on whether the turmeric extract itself was responsible for liver injury in susceptible individuals. As some products contained piperine or other formulation approaches designed to increase curcumin absorption, the discussion emphasized that the conventional toxicological reference value for curcumin could not simply be assumed to apply to a formulation that substantially changes curcumin’s bioavailability.
In response, Italy introduced specific warnings for turmeric-extract supplements, particularly for people with hepatobiliary dysfunction or biliary tract stones and recommended consulting a physician in cases of concomitant medication use.
Opens in new windowNutraIngredients coverage: Italy updates labeling rules on curcumin extract use in supplements (NutraIngredients coverage)
Around the same time, health authorities in Belgium began to receive reports of acute cholestatic hepatitis, prompting the country’s Federal Agency for Food Chain Safety (AFSCA) to issue a recall for a turmeric product on the Belgium market identified by the Italian investigation. More countries would soon follow.
2019–2022: France expands the signal, suggests lower ADI
By end of August 2021, France’s nutrivigilance system had identified over 100 adverse-event reports potentially associated with turmeric supplements. Fifteen of those involved hepatitis.
This prompted the French Agency for Food, Environmental and Occupational Health & Safety (ANSES) to issue an internal request to identify the potential risks associated with the consumption of turmeric-containing food supplements.
Opens in new windowANSES’s 2022 assessment became particularly important because it identified bioavailability enhancement as a regulatory issue. It highlighted that if a formulation dramatically increases systemic exposure, a conventional dose based on ordinary turmeric may no longer represent the same toxicological exposure.
“Curcumin has very low bioavailability, i.e. it is poorly absorbed into the bloodstream and is very rapidly eliminated by the body,” Fanny Huret, then coordinator of the expert appraisal at ANSES, explained at the time. “Manufacturers have developed various formulations to increase this bioavailability and thereby enhance the effects of curcumin.”
These would include preparations with enhanced piperine or turmeric essential oils or more elaborate forms including phytosomal complexes, micelles, colloidal nanoparticles, encapsulation in cyclodextrins rather than the turmeric rhizome powder and turmeric extracts enriched or not enriched with curcumin.
ANSES set a maximum daily intake limit of 153 mg per day for a 60 kg adult—a 15% reduction to the European Food Safety Authority’s Accepted Daily Intake (ADI) value and recommended that manufacturers provide bioavailability data and advised certain vulnerable consumers, like individuals with bile duct diseases, against use.
2020-2021: Germany raises the issue
In 2020, Germany’s Joint Expert Commission on Classification of Substances (BVL/BfArM) examined curcumin products with enhanced bioavailability in certain curcumin supplements and determined that it does not automatically reclassify them as medicinal products.
The commission did however state that a high-bioavailability curcumin product should not be assumed as safe as ordinary curcumin, because increasing absorption could substantially increase exposure to curcumin and its metabolites. As such, proof of a significant physiological or pharmacological effect must still be evaluated on a case-by-case basis.
Meanwhile, a safety assessment conducted by Germany’s Federal Institute for Risk Assessment (BfR) determined that reports provided initial indications of liver-damaging effects, particularly for turmeric preparations with improved bioavailability.
Like the BVL/BfArM expert committee, it concluded that total curcumin intake should not exceed the ADI of 3 mg/kg of bodyweight per day established by the European Food Safety Authority (EFSA), as long-term (even slight) exceedance raises the possibility of adverse health effects, particularly among sensitive individuals. It also underscored the importance of product-specific evaluation.
“Exceeding the ADI is generally considered undesirable from a toxicological standpoint, even for products with enhanced bioavailability; however, the BfR takes the view that, for such products, a case-by-case assessment is required to determine whether the established ADI ensures a sufficient level of protection or whether the ADI should be lowered due to significantly increased bioavailability,” the BfR report stated. “This depends on the specific product composition, manufacturing conditions and technological formulation.”
2022: Italy prohibits health claims, issues warning
With additional reports of hepatoxicity observed, the Italian Ministry of Health concluded that the previous warning introduced should be expanded, which it did through the publication of a July 28, 2022 decree amending Annex 1 of the 2018 botanical decree.
Starting Dec. 31, 2022, it required all product labels of affected supplements to read: “IMPORTANT WARNING In the event of altered liver function, biliary system or gallstones, the use of the product is not recommended. Do not use during pregnancy and breastfeeding. Do not use for extended periods without consulting a doctor. If you are taking any medications, you should consult your doctor.”
Alongside the warning, Italy prohibited general antioxidant and digestive health claims for turmeric supplements due to insufficient scientific evidence.
Opens in new window2023: Australia takes the strongest explicit safety action
Australia’s Therapeutic Goods Administration issued its formal safety advisory in August 2023, warning consumers and health professionals that herbal supplements containing concentrated turmeric or curcumin can cause rare cases of liver injury.
This followed reports of 18 cases of liver problems, nine sufficiently suggestive of liver injury, four where turmeric/curcumin extracts were reported as the only plausible contributor, two severe cases and one fatal case.
TGA concluded that there is a rare risk of liver injury, potentially higher with high doses or enhanced-bioavailability products. It also specifically advised people with existing or previous liver problems to avoid these products. At the time, the Australian Register of Therapeutic Goods included more than 600 curcumin-containing products.
“People with existing or previous liver problems may be more likely to develop this rare adverse event,” the authority stated. “However, there is not enough information at this time to conclusively identify which medicines are higher risk.”
Meanwhile, the Complementary Medicines Australia trade group responded that correlation does not imply causation, noting that the fatality mentioned referred to an 82-year-old male who was also taking Naproxen and that the 18 cases of hepatobiliary adverse events took place over a 21-year period.
“Turmeric is a very commonly consumed product in foods and medicines, representing extremely rare reports,” the trade group stated. “Factors such as individual sensitivities, lifestyle influences or concurrent medication usage might have contributed to the case.”
It called for a more balanced perspective on the rarity of these incidents given that idiosyncratic drug-induced liver injury (DILI) is estimated to occur in 1 in 10,000 to 1 in 100,000 people who take medication.
Opens in new window2024: UK COT provides the most sophisticated toxicological assessment
The UK Committee on Toxicity (COT)—the independent scientific committee that advises the Food Standards Agency (FSA)—concluded in December 2024 that there was reasonable evidence that high-dose turmeric and curcumin supplements can exceed safe intake levels. It characterized the liver toxicity effect as potentially idiosyncratic, meaning that susceptibility may vary substantially between individuals.
COT, which referenced cases in Italy and France (but none specific to the UK), also highlighted a potentially important problem with relying on the conventional acceptable daily intake (ADI) for curcumin since enhanced-bioavailability formulations can change pharmacokinetics. Therefore, a dose that looks acceptable on a milligram-per-day basis may not have the same safety profile.
“[S]ubstantial exceedances of the ADI represents a potential health risk to humans, especially if other medicines are being taken concomitantly and for individuals with altered hepato-biliary function,” the committee concluded, which reviewed turmeric, as well as its naturally occurring metabolites.
UK COT also specifically reviewed lead contamination in turmeric supplements, concluding that lead contamination was unlikely to explain the reported hepatotoxicity incidents.
Turmeric sales on the rise
According to the American Botanical Council’s 2024 Herb Market Report, turmeric was the top-selling herbal supplement ingredient in U.S. natural retail stores in seven of the last 11 years, with sales totaling $37.1 million in 2024. In the mainstream channel, turmeric sales increased nearly nine-fold, from $15.7 million in 2015 to nearly $141.8 million in 2024—a surge the council suggests creates a favorable situation for adulteration, which it reviewed in a paper published late last year in the journal Pharmaceutical Biology.
2025: Health Canada calls for label warnings
In late 2025, Health Canada issued a safety review calling for mandatory cautionary label on turmeric- or curcuminoid-containing supplements. It found 12 Canadian cases of liver injury reported in Health Canada’s adverse reaction database, which spans more than 60 years, as well as more than 60 international case reports.
“All 12 cases had insufficient clinical information and/or the presence of confounders (other factors that may have contributed to the occurrence of hepatotoxicity), such as underlying medical conditions and use of other medications and NHPs that are known to affect the liver, which limited further assessment,” the review decision stated. “However, a link to the use of the product could not be ruled out.”
As a result of this potential rare risk of hepatoxicity, license holders are now required to update the risk information on the affected product labels to include information about the warning signs and symptoms of hepatotoxicity, including yellowing of the eyes or skin, dark urine, nausea, vomiting and stomach pain; advise consumers to stop using these products and consult a healthcare professional if symptoms occur; and advise consumers to consult a healthcare professional before use if they have a liver disorder or are taking medications.
Health Canada has authorized more than 3,000 natural health products containing turmeric or curcuminoids for oral use—with different formulations and ingredient combinations and marketed for purposes including relieving joint pain and inflammation, providing antioxidants, aiding digestion and supporting liver health. Most are not authorized for people under the age of 18 or recommended for those with gallbladder or bile-duct disorders.
Opens in new window2026: South Korea re-evaluating
South Korea’s Ministry of Drug and Food Safety (MFDS) announced that it was re-evaluating turmeric extract along with eight other ingredients including hyaluronic acid, Rhodiola rosea extract, Lactobacillus gasseri BNR17, mastic gum, boswellia extract, Spanish liquorice extract, green coffee bean extract and lemon balm powder.
The ministry focused on ingredients that had been on the market for over 10 years, along with those for which emerging research has raised concerns about safety or effectiveness. Turmeric, in particular, was flagged, as were green coffee bean and lemon balm extracts.
“Three types were selected in consideration of social issues such as controversies over functionality and safety,” the MFDS shared in a press release.The Healthy Functional Foods Review Committee is expected to release the findings by the end of the year.
Opens in new window2026: United States Pharmacopeia recommends cautionary label
Prompted by reports of potential hepatoxicity associations and increased regulatory concerns, in December 2025, the United States Pharmacopeia (USP) Dietary Supplements Admission Evaluation & Labeling Expert Committee (DSAEL EC) conducted its own safety evaluation of turmeric and curcuminoids monographs. The private, non-profit scientific organization sets official public quality standards for medicines, dietary supplements and food ingredients.
Instead of summarizing the expansive number of individual clinical trials related to curcumin and turmeric due, the committee considered systematic-, safety-, umbrella reviews and meta-analyses, identifying over 30 liver injury case reports in the literature. It determined that clinical studies conducted with turmeric or curcumin have reported no serious adverse effects (up to 12 g/day) with only mild GI symptoms noted at higher doses and acknowledged that liver and kidney functions have been mostly unaffected in these studies.
Citing the cautionary labeling implemented over concerns potential hepatotoxicity by multiple authorities, USP recommended adding the following cautionary label to the monographs:
“Liver problems have been reported very rarely in people taking supplements containing turmeric or curcumin. Consult your health care practitioner before using this product if you have a history of liver problems. Stop using this product if you develop symptoms such as abdominal pain, dark urine, or jaundice (yellowing of the skin or eyes), and seek medical advice.”
Following a presentation of the research review supporting the decision at the 2026 USP dietary Supplements Stakeholder Forum, an FDA official raised the question whether drug interactions or supplements adulterated with poor quality synthetic curcuminoids from petroleum, or with lead chromate and pesticides, might have contributed to reports of hepatoxicity.