Turmeric Side Effects: 10 Liver Cases, One Death

Quick Answer

Searches for turmeric side effects usually return a list of ten mild ones. The published case series describe essentially one serious effect, and it is the liver. The US Drug-Induced Liver Injury Network (DILIN) reviewed every adjudicated case from 2004 to 2022 and found ten cases of turmeric-associated liver injury — all enrolled since 2011, and six of them since 2017. Injury was hepatocellular in nine of the ten. Five patients were hospitalised and one died of acute liver failure. Two details make this more than a list entry. First, chemical analysis confirmed turmeric in all seven products that could be tested, and three of those also contained piperine — black pepper extract, the ingredient added specifically to raise absorption. The authors name increased combination with black pepper as a possible reason the problem is growing. Second, HLA typing found seven of the ten patients carried HLA-B*35:01, two of them homozygous, an allele frequency of 0.450 against population controls of 0.056 to 0.069 — roughly seven times more common than chance. An independent Italian series reached the same place from a different direction: in seven Tuscan cases of acute hepatitis, hepatotoxicity was associated in every case with formulations of high bioavailability and high curcumin dosage. Both series point at the same thing. The feature sold as the improvement is the feature that appears in the injuries. The proportion to keep is that ten cases across eighteen years is rare against enormous use, and none of this describes turmeric in food.

What DILIN actually found

DILIN is the network that adjudicates drug- and supplement-induced liver injury in the United States, which makes it a stricter source than a collection of individual case reports: causality in each case was assessed with a five-point expert opinion score rather than assumed.

Reviewing everything enrolled between 2004 and 2022, the investigators identified ten cases in which turmeric was the implicated product.

The clustering in recent years is the reason the paper is titled a growing problem. Turmeric supplements are not new; the injuries are.

The black pepper part

This is the detail that changes how the rest of the page should be read.

Curcumin is poorly absorbed on its own. The standard fix, repeated in every guide to taking it, is to combine it with black pepper, because piperine raises bioavailability substantially. It is presented as the trick that makes turmeric worth taking.

In DILIN’s series, the products were analysed by ultra-high-performance liquid chromatography. Turmeric was confirmed in all seven products tested, and three of them also contained piperine.

The authors’ conclusion says it directly:

Liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. Turmeric causes potentially severe liver injury that is typically hepatocellular, with a latency of 1 to 4 months and strong linkage to HLA-B*35:01.

Note what that is and is not. It is a hypothesis offered by the investigators to explain a trend, not a demonstrated mechanism, and three of seven is a small number. It is not proof that piperine causes liver injury. It is a reason to stop treating the absorption enhancer as a free upgrade.

An independent series says the same thing differently

Italian researchers analysed cases of acute hepatitis reported to the Italian Phytovigilance system, using both RUCAM and WHO-UMC causality assessment, and paired them with a systematic review.

Seven Tuscan cases were described up to September 2019. Their finding on formulation is the sentence worth carrying:

In all cases, hepatotoxicity was associated with Curcuma longa formulations with high bioavailability and high dosage of curcumin/curcuminoids.

All seven. Not the root, not the spice, not the tea — the concentrated, absorption-enhanced preparations.

Their systematic review added 23 further published cases, in which the majority of patients were concomitantly exposed to at least one other medication, and 16 showed a positive dechallenge, meaning the liver improved when the product was stopped.

Two independent regulatory datasets, two different countries, converging on the same variable: not turmeric in general, but how much curcumin is being delivered and how efficiently.

The gene, and why it matters to you specifically

HLA typing in the DILIN cases produced the most concrete number in this literature.

Seven of the ten patients carried HLA-B*35:01, two of them homozygous. That is an allele frequency of 0.450, against population controls of 0.056 to 0.069.

Roughly seven times the background rate, in a sample of ten. Small, and striking.

The practical reading is not that you should get HLA-typed before buying turmeric — nobody recommends that and no such screening pathway exists. It is that this reaction appears to be idiosyncratic and host-dependent. It does not happen to everyone at a given dose, which is exactly why millions of people take turmeric without incident and why the people it does happen to had no warning. “It has never bothered me” is not evidence that it cannot, and “it bothered my friend” is not evidence that it will bother you.

Keeping the risk in proportion

A page that stopped at the paragraph above would be scaremongering, so here is the other side, stated as plainly.

Ten cases in eighteen years of a national network. Turmeric supplements are among the most widely used botanicals in the United States. Against that denominator, adjudicated severe liver injury is rare.

This is not about food. Neither series describes turmeric used as a spice. The Italian cases were high-bioavailability, high-dose supplements; the American cases were supplement products confirmed by chromatography. Curry is not the subject of this research.

Rare and serious are different axes. One patient died of acute liver failure. A rare event with a severe ceiling is worth knowing about precisely because the usual response — assuming a natural product cannot do much harm — is the thing that delays recognising it.

What to actually do with this

1. Know the latency. One to four months. Liver injury from a supplement started in January can present in April, by which time most people no longer connect the two. If you develop fatigue, nausea, dark urine, pale stools, right-upper-abdominal discomfort or yellowing of the eyes or skin, the supplement you have been taking for two months belongs in the conversation with your doctor.
2. Tell your doctor you take it. Supplements are routinely omitted from medication lists because people do not think of them as drugs. In the Italian systematic review, the majority of the published cases involved concomitant use of at least one other medication.
3. Treat “enhanced absorption” as a dose increase, not a bonus. That is what it is. Both series associate injury with the high-bioavailability, high-dose end rather than the ordinary end.
4. Stopping is informative. Sixteen of the reviewed cases showed positive dechallenge — improvement after withdrawal. That is a medical decision to make with a clinician, not a self-experiment, but it is why the first question a hepatologist asks is what you are taking.

Frequently Asked Questions

What are the serious side effects of turmeric?

In the adjudicated literature there is essentially one, and it is liver injury. The US Drug-Induced Liver Injury Network reviewed all cases enrolled between 2004 and 2022 and found ten in which turmeric was the implicated product, with injury hepatocellular in nine of the ten. Five patients were hospitalised and one died of acute liver failure. The typical latency was one to four months from starting the product. The long lists of ten mild effects that dominate search results are not describing the finding that the case series actually document.

Does black pepper make turmeric dangerous?

The evidence supports a flag, not a verdict. Piperine, from black pepper, is added to raise curcumin absorption, and in DILIN’s series three of the seven products that could be chemically analysed contained it. The authors offer increased combination with black pepper as one possible explanation for why cases appear to be rising in the United States. That is a hypothesis to explain a trend from a small sample, not a demonstrated mechanism. What it justifies is treating an absorption enhancer as an increase in effective dose rather than as a free improvement.

Is turmeric in food a problem?

Neither series describes it. The Italian cases were associated in every instance with Curcuma longa formulations of high bioavailability and high curcumin dosage, and the American cases were supplement products confirmed by chromatography. Culinary turmeric delivers a small fraction of the curcumin in a concentrated capsule and is absorbed poorly, which is the entire reason the supplement industry adds piperine. Nothing in this research is a reason to change how you cook.

How would I know if turmeric was affecting my liver?

You would not know from how the supplement feels, which is the difficulty. The signs are the general signs of liver injury: fatigue, nausea, loss of appetite, discomfort under the right ribs, dark urine, pale stools, and jaundice, meaning yellowing of the eyes or skin. The detail that matters most is timing, because the DILIN cases had a latency of one to four months, so the supplement will not feel like a recent change by the time symptoms appear. If any of these develop, tell a doctor what you are taking and ask about liver function tests. Do not attempt to diagnose this at home.

What is HLA-B*35:01 and should I get tested?

It is a human leukocyte antigen variant that turned up in seven of the ten DILIN patients, two of them homozygous, giving an allele frequency of 0.450 against population controls of 0.056 to 0.069. In plain terms it was about seven times more common in the injured patients than in the general population, which suggests the reaction is idiosyncratic and depends on the person rather than the dose alone. No, you should not seek testing: no screening programme exists for this, no guideline recommends it, and a single small case series is not a basis for one. Its practical value is understanding why this happens to a few people and not to most.

How common is this really?

Rare. Ten adjudicated cases across eighteen years of a national network, set against one of the most widely used botanical supplements in the country. This page is not arguing that turmeric supplements commonly damage livers. It is arguing that the risk is not zero, that it has a severe ceiling — one death — and that the recognisable pattern is worth carrying because a natural product is the last thing most people suspect.

Should I stop taking turmeric?

That is a decision for you and a clinician who knows your history and what else you take, and this page will not make it for you. What the evidence supports is narrower: if you take a high-dose, high-bioavailability curcumin product, you are at the end of the range that both series associate with injury; if you have existing liver disease or take other medication, the conversation is more urgent; and if you develop the symptoms above, the supplement belongs on the list of suspects rather than being assumed harmless.

Why is there no product recommendation on this page?

Because the conclusion does not support one. This is a page about an adverse effect, and the two things the evidence associates with that effect are exactly the features a product page would be selling: high dose and enhanced absorption. There is nothing here we could point you at without contradicting the research the page is built on. We have taken the same position on ashwagandha and its LiverTox grading.

Sources

1. Halegoua-DeMarzio D, Navarro V, Ahmad J, Avula B, Barnhart H, Barritt AS, Bonkovsky HL, Fontana RJ, Ghabril MS, Hoofnagle JH, Khan IA, Kleiner DE, Phillips E, Stolz A, Vuppalanchi R. Liver Injury Associated with Turmeric — A Growing Problem: Ten Cases from the Drug-Induced Liver Injury Network (DILIN). Am J Med. 2023 Feb;136(2):200–206. DOI 10.1016/j.amjmed.2022.09.026. PMID 36252717. PMCID PMC9892270. All DILIN cases adjudicated between 2004 and 2022 reviewed, causality assessed with a five-point expert opinion score, products analysed by ultra-high-performance liquid chromatography, HLA sequencing performed. Ten cases, all enrolled since 2011 and six since 2017; 8 of 10 women, median age 56 (range 35–71); hepatocellular injury in 9, mixed in 1; five hospitalised and one death from acute liver failure; turmeric confirmed in all seven products tested, three of which also contained piperine; HLA-B*35:01 carried by seven patients, two homozygous, allele frequency 0.450 against population controls of 0.056–0.069. Authors’ conclusion, verbatim: “Liver injury due to turmeric appears to be increasing in the United States, perhaps reflecting usage patterns or increased combination with black pepper. Turmeric causes potentially severe liver injury that is typically hepatocellular, with a latency of 1 to 4 months and strong linkage to HLA-B*35:01.” Checked 17 August 2026. PubMed record
2. Lombardi N, Crescioli G, Maggini V, Ippoliti I, Menniti-Ippolito F, Gallo E, Brilli V, Lanzi C, Mannaioni G, Firenzuoli F, et al. Acute liver injury following turmeric use in Tuscany: an analysis of the Italian Phytovigilance database and systematic review of case reports. Br J Clin Pharmacol. 2021 Mar;87(3):741–753. DOI 10.1111/bcp.14460. PMID 32656820. Seven Tuscan cases of acute hepatitis reported up to September 2019, causality assessed with both RUCAM and WHO-UMC. Verbatim: “In all cases, hepatotoxicity was associated with Curcuma longa formulations with high bioavailability and high dosage of curcumin/curcuminoids.” The accompanying systematic review identified 23 further published cases, in which the majority of patients were concomitantly exposed to at least one other medication and 16 experienced a positive dechallenge. Cited here as the independent series that converges on formulation strength rather than turmeric as such. Checked 17 August 2026. PubMed record
3. Proportion note, drawn from the same two sources rather than a third. The DILIN figure is ten adjudicated cases across eighteen years of a national surveillance network, and neither series describes culinary turmeric. Recorded here as a source entry because the rarity is part of the finding and omitting it would misrepresent both papers. Checked 17 August 2026.