Popular antioxidant supplements can lead to liver damage and other toxic effects. Here's how to use them correctly.

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Diet supplements like vitamins and herbal extracts may be natural, but that doesn't make them safe.
Medical experts say that their patients often experience liver damage and other side effects when they take too many supplements.
All dietary supplements can be risky because they're unregulated, but highly concentrated antioxidants and powerful bodybuilding products can be particularly harmful, according to a liver expert.
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Natural wellness supplements may not be as healthy as they appear.
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In large doses or combined over time, they are a common cause of liver damage and even serious illness.
Experts warn that patients have taken risky amounts of these types of supplements, especially high-concentration doses of antioxidants.
Many people use supplements made from well-known plants and herbs and assume that when they are natural they are safe even in concentrated doses, as Dr. Rebecca Shatsky, an oncologist at the University of California at San Diego, recently set it out on a Twitter thread.
Even people who consider themselves healthy and informed about wellness, such as athletes, yogis, or vegans, can make this mistake, Shatsky said.
However, intensive treatments with pills, powders, and the like can lead to liver damage or even organ failure that requires a transplant.
"You can name almost any supplement and find a case study," said Dr. Victor Navarro, hepatologist (liver specialist) at Einstein Healthcare Network, told Insider.
To avoid the risk, staying away from certain brands or products isn't enough, he said. Due to the industry's lack of transparency and legal scrutiny, unlabelled ingredients can lead to the most harmless dietary supplements.
And even things we know to be healthy, like antioxidants, can quickly become harmful when combined in large enough doses.
Diet supplements aren't regulated, so knowing what you're really getting is difficult
The main risk with dietary supplements, including vitamin products, is that they are not regulated by a government agency like the FDA that would ensure safety and quality.
Read more: Vitamins and dietary supplements do not protect you from the coronavirus despite immune-boosting claims
This also means that there is no one to enforce precise labeling. Supplements may contain ingredients that are not listed or doses that differ from what is stated on the package.
"It comes down to 'buyers, be careful' because the government doesn't say," said Navarro.
Avoid concentrated extracts, which can lead to massive doses
Even if a product is accurately labeled and of high quality, it is not free of risk. Dietary supplements are often based on natural ingredients or plant compounds such as polyphenols and antioxidants. While these are considered healthy, nutritional supplements routinely contain extracts that can be 50 times more potent than what you'd find in food.
If you're taking more than one supplement, these compounds can add up quickly. And such high doses can have serious side effects like liver damage and an even higher risk of chronic illness.
"Some people naturally interpret nature as perfectly safe, but even natural substances in massive doses can be harmful," Navarro said.
Avoid big promises of weight loss or muscle gain
Navarro said two main categories of high risk supplements are those marketed for bodybuilding or to aid in muscle building or fat loss. Although these are not perceived as "natural", they can be mistakenly considered safe because they are so easily available in grocery stores and online.
Some formulas that promise to boost energy, increase strength, or crush you may contain amphetamines and anabolic steroids, according to Navarro. These can cause liver damage, tumors, and other health problems.
Some, but not all, of these are illegal, but they can still find their way into products, according to warnings from the FDA.
Even if the product doesn't contain a banned substance, the best scenario is that these marketing claims are overstated and you are just wasting your money, added Navarro.
"There is very little scientific evidence that [the products] can make these claims, and virtually no claims like this are based on evidence," he said.
Read more: People who take multivitamins say they feel healthier, but it could just be a placebo effect, according to one study
To make your workouts safer, stick to brands you trust and brands that have been third-party tested for purity and label accuracy.
Then you will know which ingredients are helpful and which ones to avoid. Caffeine, creatine, and beta-alanine are among the most popular exercise supplements. Extensive research shows their safety and effectiveness. But even these can cause serious side effects if used in excess. For example, an overdose of caffeine can be fatal.
If you are ready to use them, do so in moderation and stick to the recommended dose.
If in doubt, ask your doctor
While many people use nutritional supplements to improve their lives in some way or even treat health ailments, according to Navarro, it is best to avoid it unless you first see a doctor.
"If you don't need it, don't take it," said Navarro. "A normal, healthy person doesn't need vitamin supplements. It's not that your body is lacking green tea."
That doesn't mean you have to cut everything out, including even green herbal tea or spices like turmeric. In the small doses typically found in a tea infusion or in a culinary context, these are likely perfectly safe.
"There are situations where people get their hands on this, extract the essence, and put that [concentrated dose] into a patient that you start to see the problem," said Navarro. "I don't think they should ever be used like that."
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