With the increased use of herbal and dietary supplements worldwide, there has also been an increase in reports of liver injury attributable to their use (1). “Herbal and dietary supplement-related liver injury now accounts for 20% of cases of hepatotoxicity in the US” with rates of hepatotoxicity from herbal and dietary supplements in Europe ranging between 13-16% of cases and Asian countries reporting even higher rates. Anabolic steroids, green tea extract and supplements with multiple ingredients are the products most commonly linked to the hepatotoxicity in the US. See: Liver Injury from Herbal and Dietary Supplements.
Dietitians may also find this open access article on the hepatotoxicity of dietary supplements to be of interest. A literature search was performed in PubMed to identify English and Spanish case reports, case series and clinical reviews published from 1984 to 2015 that described reports of liver injury associated with dietary supplement and/or herbal product use (2). Products examined included: anabolic steroids, green tea extract, linoleic acid, usnic acid, 1,3-Dimethylamylamine, vitamin A, Garcinia cambogia and ma huang as well as multi-ingredient products Herbalife™ products, Hydroxycut™, LipoKinetix™, UCP-1 and OxyELITE™. They found that the prevalence of herbal and dietary supplement-induced liver injury is increasing worldwide.
Hepatotoxicity can result in anything from mildly uncomfortable symptoms, such as nausea and vomiting to, in extreme circumstances, complete liver failure. Dietary supplements are not benign substances and their safe use requires awareness of potential side-effects.
This information reminds dietitians to be sure to delve into their clients' use of supplements, paying specific attention to the type of product used and whether people are taking the recommended amounts or using them in ways that put them at risk for adverse events. Staying abreast of the literature on efficacy of dietary supplements as well as their safety is critical. A good place to start is the PEN® System. There are more than 190 practice questions and 35 background documents identified in the search for dietary supplements.
References
- Navarro V, Khan I, Björnsson E, Seeff LB, Serrano J, Hoofnagle JH. Liver injury from herbal and dietary supplements. Hepatology. 2016 Sep 27 [Epub ahead of print]. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27677775
- García-Cortés M, Mercedes Robles-Díaz M, Aida Ortega-Alonso A, Medina-Caliz I, Andrade RJ. Hepatotoxicity by dietary supplements: a tabular listing and clinical characteristics. Int J Mol Sci. 2016;17(4):537. Abstract available from: https://www.ncbi.nlm.nih.gov/pubmed/27070596