Six common natural products potentially harmful to the liver

Vitamins, minerals and other supplements made from plants purporting some medical benefit are very popular. According to a Léger survey conducted in the spring of 2021, commissioned by the company Popeye’s Supplements, 70% of Quebecers regularly consume at least one dietary supplement, which they often buy in pharmacies, and 63% of them say that it “contributes to good health in general.” However, these products are not without risks.“The safety and efficacy of dietary and herbal supplements are not well established due to the lack of regulatory requirements from the FDA [the U.S. federal Food and Drug Administration] in terms of human pharmacokinetics or prospective clinical trials,” wrote researchers from the University of Michigan who published a study in JAMA Network Open. The study found about 5% of American adults are exposed to six potentially hepatotoxic herbal remedies, typically used with a view to improving health or to treat minor complications.Previous studies have identified turmeric, ashwagandha (commonly known as Indian ginseng), green tea extract, Garcinia cambogia (or Malabar tamarind), red yeast rice, and black cohosh (also known as black cohosh, cimifuga, or St. Christopher's wort) as the natural products most often implicated in the serious and even fatal effects of liver damage. So the scientists wanted to know how many Americans were consuming any of these six supplements.According to the Drug Induced Liver Injury Network—a multicentre observational program that collects data on patients suffering hepatotoxic effects attributed to various drugs, dietary supplements and herbal remedies—rates of liver injury from botanicals increased from 7% in 2004 to 20% in 2014 in the U.S. That year, 23,000 emergency department visits and 2,154 hospitalizations were associated with the use of herbs and dietary supplements.Participants numbered 9,500 adults, with an average age of 47.5, who has taken part in the National Health and Nutrition Examination Survey (NHANES) between 2017 and 2020. Participants’ medical data included use of prescription medications and herbal supplements.A majority of them (58%) reported using herbal supplements at least once in the past 30 days. These users were more likely to be older, female, white and have a higher education level and socioeconomic background than nonusers.About 4.7% of participants reported using at least one of the six potentially hepatotoxic herbs selected by the researchers in the past 30 days. Applied to the entire U.S. population, this percentage corresponds to about 15.6 million adults.Clinical recommendationsAmong turmeric users, 26.8% used it to improve joint health or arthritis, while 27.2% of green tea extract users indicated they were trying to improve their energy levels. More than 70% of Garcinia cambogia users said they were trying to lose weight, while 84.2% of black cohosh users said they were taking it to treat hot flashes. Heart health was the most common reason given by red yeast rice users (90%).The majority of participants reported using hepatotoxic herbal remedies without any recommendation from their healthcare providers. "In light of the lack of regulatory oversight over the manufacturing and testing of these botanical products, it is recommended that clinicians obtain a thorough history of drug, herbal and supplement use when evaluating patients with unexplained symptoms or liver test abnormalities," the researchers concluded.This article was translated from its original French and was first published on our sister site Profession Santé.

Six common natural products potentially harmful to the liver

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