Acute Liver Injury After Long-Term Herbal “Liver Cleansing” and “Sleep Aid” Supplement Use

Koenig, Gavin; Callipari, Cameron; Smereck, Janet

doi:10.1016/j.jemermed.2021.01.004

Cited by 4 publications

(3 citation statements)

References 23 publications

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“…7 The HDS-DILI can be not only severe, leading to hepatocellular injury with jaundice, but also fatal, leading to death or liver transplantation. [31][32][33][34][35][36][37] Kesar et al 35 The prevalence of the use of potentially hepatotoxic botanical products rather than use of benign, non-hepatotoxic HDSs, such as vitamins and minerals, has not been systematically studied nor reported. The present study found that between January 2017 and March 2020, approximately 15 million US adults consumed at least 1 potentially hepatotoxic botanical product within the past 30 days, which was comparable to the number of people taking potentially hepatotoxic prescription drugs, such as simvastatin, NSAIDs, and sertraline (Figure 2).…”

Section: Discussionmentioning

confidence: 99%

Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

Likhitsup,

Chen,

Fontana

2024

JAMA Netw Open

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ImportanceUse of herbal and dietary supplements (HDSs) accounts for an increasing proportion of drug hepatotoxicity cases. Turmeric or curcumin, green tea extract, Garcinia cambogia, black cohosh, red yeast rice, and ashwagandha are the most frequently reported hepatoxic botanicals, but their prevalence and reasons for use in the general population are unknown.ObjectiveTo assess the prevalence and clinical characteristics of adult consumers of 6 potentially hepatoxic botanicals.Design, Setting, and ParticipantsThis survey study analyzed nationally representative data from the National Health and Nutrition Examination Survey (NHANES), a nationally representative, cross-sectional survey of the general US population. Prescription drug and HDS exposure data in the past 30 days were analyzed, and 2020 US Census data were used for population estimates. Data were analyzed July 1, 2023, to February 1, 2024.ExposuresAdult NHANES participants enrolled between January 2017 and March 2020.Main Outcomes and MeasuresBaseline weighted characteristics of HDS users and users of 6 potentially hepatotoxic botanical products were compared with non–HDS users. Multivariable analysis was undertaken to identify factors associated with HDS use or at-risk botanical use.ResultsAmong 9685 adults enrolled in this NHANES cohort, the mean (SE) age was 47.5 (0.5) years, and 51.8% (95% CI, 50.2%-53.4%) were female. The overall prevalence of HDS product use was 57.6% (95% CI, 55.9%-59.4%), while the prevalence of using the 6 botanicals of interest was 4.7% (95% CI, 3.9%-5.7%). Turmeric-containing botanicals were most commonly used (n = 236), followed by products containing green tea (n = 92), ashwagandha (n = 28), Garcinia cambogia (n = 20), red yeast rice (n = 20), and black cohosh (n = 19). Consumers of these 6 botanicals were significantly older (adjusted odds ratio [AOR], 2.36 [95% CI, 1.06-5.25]; P = .04 for 40-59 years of age and AOR, 3.96 [95% CI, 1.93-8.11]; P = .001 for ≥60 years of age), had a higher educational level (AOR, 4.78 [95% CI, 2.62-8.75]; P &lt; .001), and were more likely to have arthritis (AOR, 2.27 [95% CI, 1.62-3.29]; P &lt; .001) compared with non–HDS users. An estimated 15 584 599 (95% CI, 13 047 571-18 648 801) US adults used at least 1 of the 6 botanical products within the past 30 days, which was similar to the estimated number of patients prescribed potentially hepatotoxic drugs, including simvastatin (14 036 024 [95% CI, 11 202 460-17 594 452]) and nonsteroidal anti-inflammatory drugs (14 793 837 [95% CI, 13 014 623-16 671 897]). The most common reason for consuming turmeric and green tea was to improve or maintain health.Conclusions and RelevanceIn this survey study, an estimated 15.6 million US adults consumed at least 1 botanical product with liver liability within the past 30 days, comparable with the number of people who consumed nonsteroidal anti-inflammatory drugs and a commonly prescribed hypolipidemic drug. Given a lack of regulatory oversight on the manufacturing and testing of botanical products, clinicians should be aware of possible adverse events from consumption of these largely unregulated products.

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Section: Discussionmentioning

confidence: 99%

Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

Likhitsup,

Chen,

Fontana

2024

JAMA Netw Open

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“…Further, although the safety of turmeric and curcumin has been well established, recent reports of isolated cases of HILI have been noted. Koenig et al [39] described a 53-year-old woman who developed jaundice after a monthlong use of a combination herbal "liver-cleansing" compound and a nightly herbal "sleep aid." The "Liver Detoxifier and Regenerator" listed turmeric root as one of its many ingredients.…”

Section: Turmeric/curcuminmentioning

confidence: 99%

Herbal- and Dietary-Supplement-Induced Liver Injury: A Review of the Recent Literature

Patel-Rodrigues,

Cundra,

Alhaqqan

et al. 2024

Livers

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Herbal-induced liver injury (HILI) continues to increase in prevalence each year due to the ongoing popularity of herbal supplements and complementary and alternative medicines. A detailed literature review of case reports and clinical studies published from March 2021 to March 2023 was performed. We discuss the epidemiology and diagnosis of HILI as well as the current and proposed laws and regulations. The 2021 ACG guidelines and 2022 AASLD practice guidelines for the diagnosis and management of drug and herbal-induced liver injury are discussed. We describe updates to previously reported etiologies of HILI such as ayurveda, ashwagandha, turmeric, kratom, green tea extract, and garcinia cambogia. Newly described supplements resulting in HILI, such as tinospora cordifolia, horse chestnut, alkaline water, and more, are described. We discuss newly and previously identified hepatoprotective herbal supplements as they have been reported in the study of animal models and human liver cells. This review suggests the need for ongoing research on the causes and mechanisms of HILI to ensure its proper diagnosis, prevention, and treatment in the future. The goal of this review is to provide novice and expert readers with knowledge regarding the possible etiologies of HILI and a general overview.

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“…The table below (Table 11) is a summary of published case reports with key information retrieved to demonstrate the circumstances behind the adverse events attributed to herbal supplements [123][124][125][126][127][128][129][130][131][132][133][134][135].…”

Section: Case Reports Showcasing the Health Hazards Of Herbsmentioning

confidence: 99%

Clinical Implications of Herbal Supplements in Conventional Medical Practice: A US Perspective

Hassen¹,

Belete²,

Carrera³

et al. 2022

Cureus

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Herbal supplements are common complementary and alternative medicine (CAM) approaches with an everincreasing use trend in the last two decades among the US population. Self-medication with herbal supplements which are promoted for general well-being, weight loss, immunity, and memory boost, and mental and physical health claims are very prevalent. There is a misperception that herbal supplements are harmless as they are prepared from natural sources. Unlike conventional drugs, the US Food and Drug Administration (FDA) does not regulate herbal supplements for premarketing purity and potency. Hence, there is a growing concern for health risks due to misbranded toxic ingredients, contaminants, adulterants, and herb-drug interactions (HDI) with co-administered drugs. The spectrum of pharmacological and toxicological effects of herbal supplements includes deranged lab results, allergic reactions, genotoxicity, carcinogenicity, teratogenicity, organ damage, and even fatality contributing to sizable emergency visits and hospitalizations in the US. The use of herbal supplements should be carefully monitored in high-risk groups such as pediatric and geriatric populations, pregnant women, breastfeeding mothers, immunocompromised patients, and surgical candidates. The deleterious health effects of herbal supplements are loosely addressed in conventional medical practice in part due to the limited knowledge of practitioners. This comprehensive narrative review aims to explore the clinical implications of herbal supplements in order to fill the knowledge gaps by summarizing scientific publications. It also highlights the pivotal roles physicians can play in minimizing the health risks of herbal supplements by encouraging patients to disclose usage through a non-judgmental approach, employing HDI screening tools, and reporting adverse reactions to FDA. Formal training of physicians, a standardized pharmacovigilance system, stricter regulation of the herbal industry, and more scientific studies are keys to establishing herbal safety and efficacy in clinical practice.

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Acute Liver Injury After Long-Term Herbal “Liver Cleansing” and “Sleep Aid” Supplement Use

Cited by 4 publications

References 23 publications

Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

Estimated Exposure to 6 Potentially Hepatotoxic Botanicals in US Adults

Herbal- and Dietary-Supplement-Induced Liver Injury: A Review of the Recent Literature

Clinical Implications of Herbal Supplements in Conventional Medical Practice: A US Perspective

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