Background: Herbal preparations, nutraceuticals, and concentrated food extracts are increasingly consumed by patients who perceive them as natural and therefore safe. However, many of these substances significantly influence drug metabolism—most notably through cytochrome P450 and P-glycoprotein inhibition—and may contribute to drug-induced liver injury (DILI). With rising multimorbidity and polypharmacy, interactions between prescribed therapy and food-derived products represent an under-recognised challenge in general practice. We describe a 65-year-old patient followed for ulcerative colitis in stable remission. During a routine specialist check-up, progressively rising hepatic and cholestatic markers were identified. Peak laboratory values were markedly abnormal: total bilirubin 39.08 µmol/L (ref. 4.00–22.00), conjugated bilirubin 15.16 µmol/L (ref. 0.00–5.00), AST 2.07 µkat/L (ref. 0.22–0.59), ALT 2.74 µkat/L (ref. 0.15–0.95), GGT 13.88 µkat/L (ref. 0.00–1.13), and ALP 3.25 µkat/L (ref. 0.67–1.99). Abnormalities were confirmed on repeat testing. Liver ultrasound showed no obstructive pathology. A detailed medication and dietary history revealed long-term use of atorvastatin, propafenone, and esomeprazole. Crucially, the patient had recently begun consuming approximately 0.5 L per day of a highly concentrated pomegranate extract. Pomegranate compounds are known inhibitors of CYP3A4 and P-glycoprotein, providing a plausible mechanism of cumulative hepatotoxicity in the context of chronic pharmacotherapy. The clinical picture and temporal association were consistent with an acute mixed hepatocellular–cholestatic DILI. Discontinuation of the extract and adjustment of therapy led to gradual biochemical improvement.This case links a clearly documented DILI episode to a common scenario in general practice: a polymorbid older patient on long-term cardiometabolic medication who adds a “natural” concentrated food product.This work offers a concise overview of clinically relevant food–drug interactions with emphasis on hepatotoxic and CYP-mediated mechanisms. Instead of exhaustive pharmacology, it highlights combinations most relevant for general practitioners, including statins, antiarrhythmics, warfarin, immunosuppressants, and herbal or nutraceutical productsComplex metabolic concepts (CYP3A4, P-gp, vitamin K, potassium balance, tyramine) are translated into practical red-flag examples applicable in routine counselling and medication review.This case underscores the underestimated risk of interactions between commonly prescribed medications and concentrated food extracts.Routine inquiry about supplements and nutraceuticals should be a standard part of primary care assessment, particularly in polymorbid patients on long-term therapy.