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Health Supplements Can Lead to Liver Damage

Jasjit Mundh2 years ago

A study shows that using herbal or dietary supplements (HDS) can lead to an increased risk of liver damage.

About the HDS Risk

According to Medscape, HDS, which are usually used by body-builders or middle-aged women trying to lose weight, have become increasingly significant causes of liver injury over the last 10 years. A study conducted by Victor J. Navarro, MD, and colleagues at the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2013 discovered that proportion of cases linked to HDS increased from 7% to 20%.

In the study, HDS were split into two categories: bodybuilding and nonbodybuilding. The most common nonbodybuilding supplements were multivitamins, calcium, and fish oil. The study included patients either with jaundice or coagulopathy (with any elevation in alanine or aspartate aminotransferase or alkaline phosphatase) or, if there was no jaundice or coagulopathy, with alanine aminotransferase or aspartate transaminase more than 5 times the upper limit of normal. Patients with nondrug-related liver diseases were excluded.

The study concluded that liver injury caused by nonbodybuilding supplements was more severe than that associated with other causes. Use of such supplements resulted in death or the need for liver transplantation in 13 female patients who ranged in age from 27 to 73 years.

The HDS products associated with death or need for transplant included energy boosters, “herbal Viagra,” Chinese herbal mixtures, ayurvedic compounds, and various colon and other “cleanse” products.

Liver toxicity associated with bodybuilding supplements was observed primarily in young men (associated with prolonged jaundice but with no fatalities or need for liver transplant). Their final conclusion was that that numerous HDS products have been associated with liver injury, and that HDS-induced liver injury is more likely to require liver transplantation than is hepatotoxicity associated with conventional medications.

The study warned of the overgeneralization of the findings and recommended requiring manufacturers to list every identifiable ingredient in all implicated HDS products, along with toxicological analysis of those ingredients.

Description of HDS/Liver Damage Study

  • The research involved 839 people with drug-induced liver injury caused by HDS or conventional medications (excluded acetaminophen-related cases).
  • The liver injury cases included 45 attributed to bodybuilding supplements, 85 attributed to nonbodybuilding supplements, and 709 caused by medications.
    • Of the 85 patients using nonbodybuilding HDS, 3 died (13%).
      • 1 death was a result of “an endoscopic procedural complication.”
      • Nonbodybuilding supplements resulted in death or the need for liver transplantation in 13 female patients, all women (ranging from 27 to 73 years).
    • There were no deaths among the 45 users of bodybuilding supplements.
      • However, liver toxicity associated with bodybuilding supplements was observed primarily in young men, which led to prolonged jaundice (median, 91 days) but no fatalities or need for liver transplant.
    • There were 50 (3%) deaths among the 709 patients with liver injury resulting from conventional medications.
  • Patients with nondrug-related liver diseases were excluded.
  • During the 10-year study period, the proportion of cases linked to HDS increased from 7% to 20%.

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