Supplements More Likely than Medications to Lead to Death or Liver Transplantation
New research shows that liver injury caused by herbals
and dietary supplements increased from 7% to 20% in a U.S. study
group over a ten-year period. According to the study published in Hepatology,
a journal of the American Association for the Study of Liver
Diseases, liver injury caused by non-bodybuilding supplements is most
severe, occurring more often in middle-aged women and more frequently
resulting in death or the need for transplantation than liver injury
from bodybuilding supplements or conventional medications."
Nearly half of all adult Americans consume herbal
and dietary supplements with prior reports suggesting that is on the
rise. Medical evidence shows that supplements are used more often by
women, non-Hispanic whites, those over 40 years of age and those with
more advanced education. Data from the National Health and Nutrition
Examination Survey (NHANES) III indicate that multivitamins, minerals,
calcium and fish oils are the most commonly used supplements.
“While many Americans believe supplements to be
safe, government regulations (Dietary Supplement Health and Education
Act of 1994) require less safety evidence to market products than what
is required for conventional pharmaceuticals” explains lead author
Dr. Victor Navarro, from Einstein Medical Center Philadelphia. “With
less stringent oversight for herbals and dietary supplements, there is
greater potential for harmful consequences including life-threatening
conditions.”
In response to the need for research in this area,
the National Institutes of Diabetes and Digestive and Kidney Diseases
(NIDDK) supported the establishment of the Drug-Induced Liver Injury
Network (DILIN) in 2003 to track cases of liver injury caused by
medications (excluding acetaminophen (Tylenol®)), herbals, and dietary
supplements. Herbals and dietary supplements were identified as the
second most common cause of liver injury in the first DILIN report.
The present study examines hepatotoxicity due to
supplements compared to medications, enrolling 839 patients with liver
injury from 8 U.S. DILIN referral centers between 2004 and 2013.
Liver injury cases included 45 caused by bodybuilding supplements, 85
attributed to non-bodybuilding supplements, and 709 due to
medications.
The research team determined that among cases
enrolled, liver injuries from herbal and dietary supplements rose to 20%
during the study period. While bodybuilding supplements caused
prolonged jaundice (median 91 days) in young men, no fatalities or liver
transplantations occurred. Death or liver transplantation occurred
more frequently among cases of injury from non-bodybuilding
supplements, 13%, than from conventional medications, 3%. Liver injury
from non-bodybuilding supplements was more common in middle aged
women.
Dr. Navarro said, “Our study group is specific to
DILIN centers and therefore we cannot conclude that liver injury due
to herbals and dietary supplements in on the rise in the U.S. Further
population-based study of liver injury due to herbal products and
dietary supplements is needed.” The authors want to inform the public
of potential dangers of using dietary supplements and advise that
supplement producers, government agencies, healthcare providers and
consumers work together to improve safety.
Full citation: “Liver injury from
Herbals and Dietary Supplements in the US Drug Induced Liver Injury
Network.” Victor J. Navarro, Huiman Barnhart, Herbert L. Bonkovsky,
Timothy Davern, Robert J. Fontana, Lafaine Grant, K. Rajender Reddy,
Leonard B. Seeff, Jose Serrano, Averell H. Sherker, Andrew Stolz,
Jayant Talwalkar, Maricruz Vega, Raj Vuppalanchi. Hepatology; (DOI: 10.1002/hep.27317)
URL: http://doi.wiley.com/10.1002/hep.27317
Author Contact: Media wishing to speak with Dr. Navarro may contact Damien Woods with Einstein Healthcare Network at woodsdam@einstein.edu.Labels: drug-induced liver injury, hepatotoxicity, herbal supplements