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Dietary supplements, including green tea extract (particularly when standardized to have a high catechin concentration) and kava, black cohosh, high-dose curcumin, and some Chinese herbal preparations, are implicated in hepatocellular injury, cholestasis, or fulminant hepatic failure in both single case reports and small clinical series

Further evidence comes from germ-free mice, which display extremely low propionate levels (70 times lower) in the portal vein compared to control mice, strongly indicating that the majority of propionate is derived from the microbiome (Wang et al., 2024)

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