Herbalife® Associated Severe Hepatotoxicity in a Previously Healthy Woman

Abstract

Lately there has been an increased consumption of herbal preparations, distributed as nutritional supplements, often claimed to be 'natural' and harmless. However, as their use is not subjected to strict pre-marketing testing and regulations, their ingredients are not clearly defined and there is no quality control or proof of their effectiveness and safety. A growing body of references accentuate their harmful effects, in particular hepatotoxicity, which varies from minimal hepatogram changes to fulminant hepatitis requiring liver transplantation. This case report describes liver damage that was highly suspected to originate from Herbalife® products consumption. We excluded alcohol, viral, metabolic, autoimmune and neoplastic causes of liver lesions, as well as vascular liver disease, but we noticed a connection between the use of Herbalife® products and liver damage. The exact mechanism of liver damage in our patient was not determined. After removing the Herbalife® products, liver damage resolved and there was no need to perform liver biopsy. Taking into consideration the growing consumption of herbal products and their potential harmfulness, we consider that more strict regulations of their production process and sale are necessary, including exact identification of active substances with a list of ingredients, toxicologic testing and obligatory side effect report.

Diagnóstico de un caso de hepatotoxicidad por fármacos y suplementos herbales en un hospital de Pasto, Colombia

“…Así mismo, el uso de los suplementos dietéticos y herbales ha aumentado con un consecuente impacto como causa de daño hepático (12) . Por ejemplo, los productos Herbalife® se asocian con diversos grados de daño hepático, desde mínimos cambios hasta hepatitis fulminante que requiere trasplante (13) . Los suplementos herbales y dietéticos engloban muchos ingredientes como vitaminas, minerales, proteínas, hierbas y otros productos botánicos (13,14) .…”

“…Aunque estas sustancias parecen ser naturales y seguras, existe controversia sobre su seguridad por la escasa evidencia disponible sobre su eficacia y toxicidad (14) . La hepatotoxicidad secundaria a productos herbales se origina con mayor frecuencia por una reacción idiosincrática que por daño tóxico (13) .…”

“…En concreto, los productos Herbalife® contienen como agentes sospechosos de hepatotoxicidad el extracto de té verde, ginkgo y palma enana americana (12) . Todavía más, el mecanismo predominante de daño hepático por estos es el hepatocelular, seguido del mixto, entre otros (12,13,16) . En cuanto a la gravedad del daño hepático por suplementos herbales, esta varía de leve a grave e incluso con casos de cirrosis e insuficiencia hepática que requieren trasplante hepático (13) .…”

A Case of Acute Tubulointerstitial Nephritis Following the Use of Chenopodium album L

“…[2] In recent years, the increasing interest in herbal remedies, uncontrolled usage of herbal products, and the disregard for recommendations from healthcare professionals prior to use have exacerbated the negative effects associated with these products. [3] An estimated one-third of adults in developed countries and over 80% of the population in many low-and middle-income countries use herbal and traditional medicines to enhance health or treat common illnesses. Herbal medicines can lead to kidney damage due to toxicity, contamination, misidenti cation, mislabeling, and adverse plant-drug interactions.…”

Pharmacovigilance in Serbia: a Ten-Year Pharmacoepidemiologic Analysis

“…analysis, understanding and prevention of adverse drug reactions (ADRs) is one of the most important professional activities in all healthcare professions, and has great clinical, as well as public health significance globally. The activities of ADR monitoring and reporting, or pharmacovigilance, do not refer only to medicines but also to vaccines, blood and blood products, biological therapy, herbal medicines and supplements, as well as medical devices [2][3][4] . Nowadays, pharmacovigilance is an essential activity in the regulatory system of drugs of any country, which enables early detection of unexpected, delayed or severe adverse reactions to all preparations and agents used in preventive and clinical medicine.…”