Too good to be true? Potential adverse effects/cautions and drug-herb interactions

Structures of some flavanoids and their potential toxicities.
Figure source: Galati et al. (2004)

Thus far, no adverse effects of raw Amla consumption or consumption of products with Amla as an ingredient have been reported. Even cross drug-herb interactions have not yet been identified. As mentioned earlier, this may be so because experiments investigating Amla are not long enough to establish any side effects. Another explanation could be that it is always administered in moderate doses; the effect of high doses is unknown.

I had to dig a little deeper to discover potential adverse effects of a family of compounds present in Amla. It has been suggested that flavanoids, depending on their structure (for example with or without a hydroxyl group) may induce or inhibit activity of cytochromes, enzymes that are responsible for metabolizing xenobiotics (drugs). In turn, this influences the pharmacokinetics of drugs, either by increasing their presence in the cell, making it toxic, or by increasing the drugs' absence, thereby reducing their therapeutic benefits. A warning has been issued to investigate flavanoid content in herbal and food supplements particularly with use of other drugs. Flavanoids have also been associated with liver failure and anemia (Galati et al., 2004). Please see attached figure for more risks.