You are a Professor of Medicine at Harvard Medical School and renowned expert in liver diseases. You see people with chronic liver conditions and also with acute liver failure. The only treatment in acute liver failure is liver transplantation. It has to be done as soon as possible, or patients will die. A billion people around the world have chronic liver disease. Many of them take dietary supplements. You have previously commented that many people think that dietary supplements are safe and could be effective. But in reality some dangers are always lurking. Dr. Sanjiv Chopra, MD. Could you comment on the herbal supplements and their potential dangers for liver and other organs? Dr. Anton Titov, MD. That's a great question! You are absolutely right. In aggregate, if we add up the people who have chronic Hepatitis B virus infection, that is about 400 million people in the world. Chronic Hepatitis C virus infection afflicts about 170 to 200 million people in the world. Then there are many other liver disorders. Right now we are dealing with the burgeoning epidemic of Type 2 Diabetes and obesity. There is a liver condition called Non-Alcoholic Fatty Liver Disease. That condition just in the United States is estimated to afflict 40 to 70 million Americans. Hemochromatosis is the most common genetic disorder known to man. There is extra iron deposited from the gut into the liver and other organs. It can lead to cirrhosis and liver cancer. It is the most common genetic disorder known to man. Then there are many other disorders of the liver. If you add all of those up, an astounding 1 billion people in the world have chronic liver disease. That can lead to cirrhosis, the need for liver transplantation, the risk of developing primary cancer of the liver. Dr. Sanjiv Chopra, MD. Patients always eager to try to empower themselves to do something about their liver. They will often go to the internet and Google stuff. Then they'll see claims made about herbal medications or supplements or other "aids" "to detoxify the liver”. Sometimes they find even very odd things like coffee enemas to "detoxify the liver" or to take herbal medications. They take certain supplements. My big concern about these is that there is no quality control. Studies have shown that the "active" ingredient in a herbal medication can vary between 7% and 90%. Dr. Sanjiv Chopra, MD. First of all, you may NOT even be getting the "active" ingredient at the right dose. Secondly, often these herbal supplements are contaminated. It is not unusual to find corticosteroids. This will make the person feel better, improve the appetite, it may even lower the liver enzymes. Dr. Sanjiv Chopra, MD. Somebody has chronic Hepatitis B, they take prednisone, they feel better, the liver enzymes come down. You think it is doing a good job. But in reality the Hepatitis B virus multiplies rapidly and its levels can go up 10-fold. If you do a liver biopsy, you see worsening damage. Dr. Sanjiv Chopra, MD. We can fool ourselves into thinking that these herbal products are safe and that they are effective. In reality they haven't been rigorously studied. I tell patients it is like having a hole in the wall. We cover it with a beautiful picture of Monet. Now we say, "Good, it looks better!" But meanwhile behind the painting the hole is getting bigger and getting worse. Dr. Sanjiv Chopra, MD. I have patients who were taking multiple supplements and spending $300 or $400 a month out of pocket to buy these supplements. When I discussed it with them. I said, "It is not safe, it may be hurting you!”. The usual refrain was: "But these are natural compounds, why would it hurt my liver? Dr. Anton Titov, MD." I would have to point out to them that earthquake, lightning, tsunami. It is all part of nature. Nature can pack a wallop! Nature can cause great damage. Dr. Sanjiv Chopra, MD. Please be safe, there are patients who die. Fortunately, it is rare, but they die from severe liver toxicity. Patients die from kidney injury, they die from pulmonary hypertension and heart disease from herbal products that are supposedly "safe". That is also very important that a lot of efficacy claims and "miraculous treatments" are also not necessarily substantiated. That's very important for people to truly realize. Absolutely! when were treating Hepatitis C. When we treat Hepatitis C, we want to see a biochemical response, so we want to see the liver enzymes normalized. We want to see a histological response, we want to show that the liver biopsy improves. We want to see a virologic response, we want to see that the virus disappears, is undetectable. Dr. Sanjiv Chopra, MD. When we have claims with herbal products, we have to hold it to the same standard, not a whitewash effect of "having the liver enzymes improve a little bit". What happened to the viral level? Dr. Anton Titov, MD. What their biopsies were before and after? Dr. Anton Titov, MD. We have to document that there was histological improvement. We have to hold it to the same standard. Renowned liver diseases expert on food supplements’ many dangers to liver. Liver toxic injury from food supplements is more common than many realize, undeclared toxic and inappropriate ingredients. Heavy metals and steroids can be present in supplements. Dr. Sanjiv Chopra.