Turmeric Induced Liver Injury: A Report of Two Cases

Luber, Raphael P.; Rentsch, Clarissa; Lontos, Steve; Pope, Jeffrey D.; Aung, Ar Kar; Schneider, Hans G.; Kemp, William; Roberts, Stuart K.; Majeed, Ammar

doi:10.1155/2019/6741213

Cited by 40 publications

(31 citation statements)

References 24 publications

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“…RUCAM 28,29 was used in the majority of the included papers to estimate causality between the observed AEs and CL assumption. Seven cases 23,33,37,41,43,44 38 were judged as highly probably/probably and one case 22 was judged as possibly related to CL. Only Lukefahr and colleagues 23 used another algorithm to evaluate their case—simplified criteria for the diagnosis of autoimmune hepatitis 45 —with a result of a “probable” causal relationship between the event of autoimmune hepatitis and CL.…”

Section: Resultsmentioning

confidence: 99%

“…In this context, and considering that available DS usually contain several ingredients, the active substance specifically responsible for liver damage could be difficult to identify 25 . Furthermore, while clinical studies may assess pure curcumin compounds, the products available to patients in community pharmacies, nutritional food stores and online shops contain varying concentrations of curcumin plus numerous additives, potentially accounting for differing real‐life risk profiles 22 . Thus, it would be important to know where certain products were purchased.…”

Section: Discussionmentioning

confidence: 99%

“…In recent years, some reports of AEs related to the use of CL‐containing DS have been published, 22,23 raising the issue of CL safety, in particular with reference to herb‐induced liver injury (HILI). Recently, several cases of acute non‐infectious cholestatic hepatitis cases, associated with the consumption of CL‐containing DS, have been reported in Italy 24 …”

Section: Introductionmentioning

confidence: 99%

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Acute liver injury following turmeric use in Tuscany: An analysis of the Italian Phytovigilance database and systematic review of case reports

Lombardi

Crescioli

Maggini

et al. 2020

Brit J Clinical Pharma

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Aims Several cases of acute non‐infectious cholestatic hepatitis recently appeared in Italy following consumption of Curcuma longa‐containing dietary supplements. The aim of this research was to describe the Tuscan (Italy) cases of acute hepatitis and to compare them with similar cases of hepatotoxicity published in the literature by performing a systematic review. Methods Records of Tuscan cases of acute hepatitis were obtained from the Italian Phytovigilance system. Each spontaneous report was analysed in order to collect all relevant clinical information of patients and information concerning the Curcuma longa‐containing dietary supplement. Moreover, both the RUCAM and WHO‐UMC systems were used to evaluate the causal relationship between the use of dietary supplement and acute hepatitis. A systematic literature review was performed in MEDLINE and Embase and all case‐reports and case‐series published in English were included. Results Seven cases of acute hepatitis occurring in Tuscany up to September 2019 are described. In all cases, hepatotoxicity was associated with Curcuma longa formulations with high bioavailability and high dosage of curcumin/curcuminoids. The causal relationship was also supported by the positive dechallenge observed in most cases. In the 23 cases identified through the systematic review, the majority of patients were concomitantly exposed to at least one other medication and 16 of them experienced a positive dechallenge. Conclusions Within the frame of poorly controlled and regulated products, such as dietary supplements, the evaluation of Italian cases of Curcuma longa‐induced acute hepatitis and the systematic review of literature confirmed the association between Curcuma longa and liver injury.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Acute liver injury following turmeric use in Tuscany: An analysis of the Italian Phytovigilance database and systematic review of case reports

Lombardi

Crescioli

Maggini

et al. 2020

Brit J Clinical Pharma

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“…Supplements with turmeric and curcumin are generally believed to be safe, although some cases of liver damage have been reported. It is unclear whether these cases occurred because of contamination of curcumin products or the products themselves [ 36 ].…”

Section: Herbal and Dietary Productsmentioning

confidence: 99%

Food and Nutrition in the Pathogenesis of Liver Damage

et al. 2021

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The liver is an important organ and plays a key role in the regulation of metabolism and in the secretion, storage, and detoxification of endogenous and exogenous substances. The impact of food and nutrition on the pathophysiological mechanisms of liver injury represents a great controversy. Several environmental factors including food and micronutrients are involved in the pathogenesis of liver damage. Conversely, some xenobiotics and micronutrients have been recognized to have a protective effect in several liver diseases. This paper offers an overview of the current knowledge on the role of xenobiotics and micronutrients in liver damage.

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“…29,30 For the detection of synthetic 1, the determination of 14 C concentrations has proven useful as the synthesis of 1 uses petroleumbased starting materials, which are devoid of 14 C. 18 Contrarily, an equilibrium exists between 14 C intake via photosynthesis and its decay in living plants. Therefore, natural 1 and other natural turmeric compounds contain measurable amounts of 14…”

Section: Introductionmentioning

confidence: 99%

The Untargeted Capability of NMR Recognizes Adulterated Natural Products

Kim¹,

Bisson²,

Friesen³

et al. 2020

Preprint

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Curcuma longa (turmeric) has a long ethnomedical background for common ailments, and Dietary Supplements (DS) labelled as “Curcumin” (CDS) are a highly visible portion of today’s selfmedication market. Due to cost pressure, these CDS products are affected by economically motivated adulteration with synthetic curcumin and are associated with unexpected toxicological issues due to “residual” impurities. Using a combination of targeted and untargeted (phyto)chemical analysis, this study investigated the botanical integrity of two commercial “turmeric” CDS with vitamin and other additives that were associated with reported clinical cases of hepatotoxicity. Analyzing multi-solvent extracts of the CDS by 100% quantitative 1H NMR (qHNMR), alone and in combination with countercurrent separation (CCS), provided chemical fingerprints that allowed both the targeted identification and quantification of declared components and the untargeted recognition of adulteration. While confirming the presence of curcumin as a major constituent, the universal detection capability of NMR identified significant residual impurities. While the loss free nature of CCS captured a wide polarity range of declared and unwanted chemical components and increased dynamic range, (q)HNMR determined their mass proportions and chemical constitutions. The results demonstrate that NMR can recognize undeclared constituents even if they represent a relatively minor gap in the mass balance of a DS product. The chemical information associated with the missing 4.8% and 7.4% (m/m) in the two commercial samples, exhibiting an otherwise adequate curcumin content of 95.2% and 92.6%, pointed to a product integrity issue and adulteration with undeclared synthetic curcumin. Impurities from synthesis are most plausibly the cause of the observed adverse clinical effects. The study exemplifies how the simultaneously targeted and untargeted analytical principle of 100% qHNMR method, performed with entry-level instrumentation (400 MHz), can enhance the safety of DS by identifying adulterated, non-natural “natural” products<br>

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Turmeric Induced Liver Injury: A Report of Two Cases

Cited by 40 publications

References 24 publications

Acute liver injury following turmeric use in Tuscany: An analysis of the Italian Phytovigilance database and systematic review of case reports

Acute liver injury following turmeric use in Tuscany: An analysis of the Italian Phytovigilance database and systematic review of case reports

Food and Nutrition in the Pathogenesis of Liver Damage

The Untargeted Capability of NMR Recognizes Adulterated Natural Products

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