Experts spotlight liver injury from herbal dietary supplements in the U.S

Posted 19 April 2023

Experts on natural products and toxicology have provided an overview of the problem of liver damage due to herbal dietary supplement (HDS) use in the United States. They suggest two strategies they hope will improve consumer safety and drive bad actors from the marketplace. One is a path for pre-clinical assessment and the other is the establishment of a list of products.
Reference: Gurley BJ, and others. Hepatoxicity due to herbal dietary supplements: Past, present, and the future. Food and Chemical Toxicology 169:113445, 2022

Their key points include:

  • The Dietary Supplement Health and Education Act of 1994 provides an insufficient framework for regulating HDS products.
  • 20% of adult Americans regularly consume HDS products.
  • Liver toxicity is among the most frequent serious events reported through the U.S. Food and Drug Administration’s Center for Food Safety and Applied Nutrition Adverse Event Reporting System.
  • 20% of all drug-induced liver injuries in 2013, many of which required hospitalization and liver transplantation or resulted in death, were attributable to HDS, according to the Drug-Induced Liver Injury Network.
  • Most HDS-induced liver injuries (HILI) are attributable to unusual and heretofore untested combinations of exotic botanical extracts and/or purified phytochemicals, poorly researched new dietary ingredients, products intentionally adulterated with approved or unapproved drugs, or combinations of these.
  • Multi-ingredient products linked to HILI cases have included Slimquick, Hydroxycut, OxyELITE Pro, and several formulations marketed by Herbalife.
  • HILI cases have been linked to products marketed for bodybuilders and products containing cannabidiol.
  • Ingredients in HDS products, including caffeine and yohimbine extract, can interact with other ingredients, leading to liver injury.
  • Ingredients in HDS products that came on the market since 1994, such as green tea extract, Hoodia gordonii, Garcinia cambogia, or Scutelleria, are responsible for a significant proportion of HILI cases.
  • Adulterated products have contributed significantly to the HILI problem.
  • HDS products on the market with suspected potential for causing liver injuries include products containing: (a) Ashwagandha and Coleus forskohlii extract (CFE) used in Ayurvedic medicine, (b) kratom, (c) turmeric, and (d) Tinospora cordifolia, more commonly known as Giloy.

Source: Consumer Health Digest #23-14, April 2, 2023

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