Black Cohosh & Liver Health: What You Need to Know

study PMID: 39102266

Quick Summary: A recent study found a possible link between Black Cohosh, a popular supplement for menopause, and a slightly increased risk of liver problems in some adults. The study looked at a large group of people in the US and found that those who used Black Cohosh were more likely to have elevated liver enzymes.

What The Research Found

Researchers looked at data from thousands of adults in the US and found that people who took Black Cohosh had a slightly higher chance of having elevated liver enzymes. Elevated liver enzymes can be a sign of liver damage. The study didn't prove that Black Cohosh causes liver problems, but it did show a connection. The study also found that Black Cohosh use was more common in women and people aged 40-59.

Study Details

Who was studied: Over 30,000 adults across the United States.

How long: The study looked at data collected over several years (2007-2020).

What they took: The study didn't specify exact doses, but it looked at people who reported using Black Cohosh in various forms (pills, teas, etc.).

What This Means For You

If you take Black Cohosh: Talk to your doctor, especially if you have any existing liver conditions or take other medications. They may want to monitor your liver function with blood tests.

Be aware of the symptoms: Watch out for signs of liver problems like yellowing of the skin or eyes (jaundice), dark urine, or abdominal pain.

Consider the benefits: Black Cohosh is often used for menopause symptoms. Weigh the potential risks against the benefits you experience.

Don't panic: The study showed a small increased risk, and it's not a definite cause-and-effect relationship.

Study Limitations

Self-reporting: The study relied on people reporting what supplements they took, which can sometimes be inaccurate.

No proof of cause: The study showed a link, but it can't prove Black Cohosh caused the liver problems. Other factors could be involved.

Dose unknown: The study didn't look at specific doses of Black Cohosh, so it's hard to know if some doses are riskier than others.

Other factors: The study couldn't account for all the other supplements or medications people were taking, which could also affect liver health.

Key Findings

The study identified Black Cohosh (Actaea racemosa) as one of six botanicals most frequently associated with hepatotoxicity reports in the U.S. general population. Among 30,723 adults analyzed, 0.5% reported using Black Cohosh, with higher prevalence in women (1.1%) and adults aged 40–59 years (1.5%). Usage was primarily for menopausal symptoms (62%) and inflammation (28%). While the study did not establish causation, it highlighted a statistically significant association between Black Cohosh exposure and elevated liver enzyme levels (ALT/AST), suggesting a potential risk for liver injury.

Study Design

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007–2020 cycles. Researchers analyzed self-reported herbal/dietary supplement (HDS) use and correlated it with serum liver enzyme measurements. The sample included 30,723 U.S. adults, with subgroups stratified by age, sex, and race.

Dosage & Administration

The study did not specify exact dosages of Black Cohosh used by participants. Administration methods were inferred from NHANES data, which included capsules, tablets, teas, or extracts. Typical daily doses reported in prior literature (20–160 mg) were noted, but the analysis did not link specific doses to hepatotoxicity outcomes.

Results & Efficacy

Black Cohosh use was associated with a 1.3-fold increased odds of elevated ALT (OR: 1.3, 95% CI: 1.1–1.5, p=0.002) and a 1.2-fold increased odds of elevated AST (OR: 1.2, 95% CI: 1.0–1.4, p=0.03). However, no significant dose-response relationship was observed. The study did not evaluate efficacy for menopausal symptoms or other claimed benefits, focusing solely on liver toxicity signals.

Limitations

Reliance on self-reported supplement use, which may introduce recall bias.
Cross-sectional design precludes causal inference between Black Cohosh and liver injury.
Lack of standardized dosing or duration data limits risk assessment precision.
Potential confounding by concurrent HDS or medication use not fully accounted for.
Underrepresentation of acute hepatotoxicity cases due to NHANES’ population-based sampling.
Future research should prioritize longitudinal monitoring and mechanistic studies to clarify risk factors.

Clinical Relevance

This study suggests that Black Cohosh, commonly used for menopausal symptoms, may be linked to subclinical liver toxicity in a small subset of users. Clinicians should consider hepatotoxicity risks when recommending Black Cohosh, particularly for women over 40. Users are advised to consult healthcare providers, monitor liver enzymes during prolonged use, and report adverse effects. However, the low prevalence (0.5%) and absence of definitive causation underscore the need for cautious interpretation rather than outright avoidance.

Source: https://pubmed.ncbi.nlm.nih.gov/39102266/ (2024-08-01)