Heart attacks and liver disease remain prominent concerns for public health in the United States, claiming hundreds of thousands of lives each year. Mount Sinai cardiologists Dr. Evan Levine has raised concerns about several common supplements and their associated risk of heart attack and liver failure. While some of these are perfectly safe and healthy in food form, in supplements they pose quite a threat.
Niacin (Vitamin B3)
Niacin is an essential vitamin that plays an important role in numerous bodily functions. It is crucial for cellular metabolism, which helps the body turn food into energy that it can use. In addition, it is necessary for the health of our nervous system, digestive system, and skin. It is found naturally in red meat, fish, brown rice, nuts, seeds, legumes, and bananas. Niacin is used in supplement form often to help manage high cholesterol and for arthritis relief. However, when taken in high doses, Dr. Levine says that it can lead to liver damage, a condition known as hepatotoxicity. Recent research has also raised concerns over its effects on the cardiovascular system. This research suggests that high levels of niacin in the body may be associated with an increased risk of heart attack and stroke. If your doctor has prescribed you a niacin supplement and you are concerned about its potential effects on your health, speak with them about alternatives.
Green Tea Extract
Green tea is widely celebrated for its health benefits. Just because something is healthy in certain doses, however, doesn't mean that it is as healthy or more so in concentrated forms. Green tea extract, a highly concentrated form of green tea, has in some cases been linked to liver injury, including rare but severe cases of acute liver failure. The mechanism behind this is believed to be the high concentration of catechins. These can become toxic to the liver in large amounts. The risk of liver damage is not associated with drinking green tea, but instead with the use of highly concentrated supplements.
Xylitol and Erythritol
With so many people trying to satisfy their sweet cravings without eating too much sugar, sugar alcohols have been quite popular. You will often find them in place of sugar in many low-sugar, sugar-free, or keto-friendly products. Recent research, however, highlighted a potential link between higher levels of xylitol and erythritol in the blood and an increased risk of cardiovascular events such as heart attacks and strokes. The studies suggest that these sweeteners may promote blood clot formation by increasing the reactivity of platelets, however the findings were contraversial. While more research is needed to fully understand the long-term effects, these findings raise concerns, especially for individuals who are already at high risk for heart disease.
Gel Supplements Containing Phthalates
Many supplement manufacturers use gels when making their products, as in gel form they are easier to shape the way you want and make them easier for people to swallow. The issue is that they often contain phthalates, chemicals used to make plastics more flexible. They are often found in the gelatin-based casings of supplements, either as intentional additives or as contaminants. They are known endocrine disrupting substances, meaning they can interfere with the body's hormonal systems. Studies have linked chronic exposure to phthalates to a variety of health issues. These include liver toxicity and cardiovascular problems such as high blood pressure and atherosclerosis. The concern is that these chemicals can leach out of the gel casing and into the body, accumulating over time and contributing to long-term health risks.
However, it’s important to understand that the actual risk depends on several factors, including the type of phthalate used, the amount present, how frequently the supplement is taken, and the individual's vulnerability-such as pregnancy or pre-existing health conditions. Regulatory agencies like the FDA and EMA have set limits on phthalate levels in pharmaceuticals and monitor their use, especially in products used long-term or by sensitive populations.
Occasional use of supplements with trace amounts of phthalates is unlikely to pose a significant health threat for most people, as shown in a 2019 study in Regulatory Toxicology and Pharmacology, which assessed phthalate exposure from medications and found levels generally below thresholds of concern.
But regular or high-dose exposure may warrant more caution. A 2018 review in the British Journal of Clinical Pharmacology found that prenatal phthalate exposure, sometimes from phthalate-containing medications, was linked to adverse outcomes, including preterm birth, low birth weight, and pregnancy-related complications.
