Liver Injury Due to Herbals and Dietary Supplements Is Up

If you regularly take herbals and dietary supplements, it may be time to reevaluate why you take them and what the potential cost to your health could be. New research published in Hepatology (doi: 10.1002/hep.27317), a journal of the American Association for the Study of Liver Diseases, shows that liver injury caused by herbals and dietary supplements increased from 7% to 20% in a U.S. study group over a 10-year period.

Researchers found that liver injury caused by nonbodybuilding supplements was most severe, occurring more often in middle-aged women and more frequently resulting in death or the need for transplantation than liver injury from bodybuilding supplements or conventional medications.

Nearly half of all adult Americans consume herbal and dietary supplements, with prior reports suggesting that usage is on the rise. Medical evidence shows that supplements are used more often by women, non-Hispanic whites, those over 40 and those with more advanced education. Data from the National Health and Nutrition Examination Survey III indicate that multivitamins, minerals, calcium and fish oils are the most commonly used supplements.

“While many Americans believe supplements to be safe, government regulations (Dietary Supplement Health and Education Act of 1994) require less safety evidence to market products than what is required for conventional pharmaceuticals,” explained lead author Victor Navarro, MD, from Einstein Medical Center in Philadelphia. “With less stringent oversight for herbals and dietary supplements, there is greater potential for harmful consequences, including life-threatening conditions.”

The present study, which enrolled 839 patients with liver injury from eight Drug-Induced Liver Injury Network (DILIN) referral centers in the U.S. from 2004 to 2013, examined hepatotoxicity due to either supplements or medications. Liver injury cases included 45 caused by bodybuilding supplements, 85 attributed to non-bodybuilding supplements, and 709 due to medications.

The research team determined that liver injuries from herbal and dietary supplements rose from 7% to 20% of cases during the study period. While bodybuilding supplements caused prolonged jaundice (median 91 days) in young men, no fatalities or liver transplantations occurred. Death or liver transplantation occurred more frequently from injury caused by non-bodybuilding supplements (13%) than from harm due to conventional medications (3%). Liver injury from non-bodybuilding supplements was more common in middle-aged women.

“Our study group is specific to DILIN centers and therefore we cannot conclude that liver injury due to herbals and dietary supplements in on the rise in the US. Further population-based study of liver injury
due to herbal products and dietary supplements is needed,” concluded the authors.

In the meantime, buyer beware. Also, be sure to stay within your scope of practice when clients ask about herbals and supplements.