Experts on natural products and toxicology have provided an overview of the problem of liver damage due to herbal dietary supplements (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 preventive assessment and the other is the establishment of a list of products. Their article: “Hepatoxicity (Liver injury) due to herbal dietary supplements,” was reported in the journal 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.
  • CONCLUSIONI emphasize here that liver injury is a horrible condition, potentially leading to death or the need for liver transplantation, both of which are terrible results. This should provide a strong warning to all: Stay away from all dietary “supplements,” especially those known to have herbal origins! Just because they are advertised on TV doesn’t render them innocuous; as a matter of fact, those products that are not accompanied by a list of warnings and potential side-effects, are paradoxically, the most potentially dangerous, since they have not been adequately evaluated and approved by the FDA.

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