Abstract
Dietary supplements (DS) are extensively consumed worldwide despite unproven efficacy. The true incidence of DS-induced liver injury (DSILI) is unknown but is probably under-diagnosed due to the general belief of safety of these products. Reported cases of herbals and DS-induced liver injury are increasing worldwide. The aim of this manuscript is to report a tabular listing with a description of DS associated with hepatotoxicity as well as review the phenotype and severity of DSILI. Natural remedies related to hepatotoxicity can be divided into herbal product-induced liver injury and DS-induced liver injury. In this article, we describe different DS associated with liver injury, some of them manufactured DS containing several ingredients (Herbalife™ products, Hydroxycut™, LipoKinetix™, UCP-1 and OxyELITE™) while others have a single ingredient (green tea extract, linoleic acid, usnic acid, 1,3-Dimethylamylamine, vitamin A, Garcinia cambogia and ma huang). Additional DS containing some of the aforementioned ingredients implicated in liver injury are also covered. We have also included illicit androgenic anabolic steroids for bodybuilding in this work, as they are frequently sold under the denomination of DS despite being conventional drugs.
Highlights
Herbals and dietary supplements (HDS) are used to maintain or improve health
Herbal products marketed in the form of food supplements should comply with Directive 2002/46/EC on food supplements and Regulation (EC) No 1924/2006 on nutrition and health claims made on foods of the European Food Safety Authority (EFSA)
Different Dietary supplements (DS) were identified as being linked to hepatotoxicity, green tea extracts, linoleic acid, usnic acid, vitamin A, garcinia cambogia, ma huang, 1,3-DMAA and multi-ingredient products such as Herbalife products, Hydroxycut, LipoKinetix, Oxy ELITE Pro and UCP-1 and anabolic steroids illicitly sold as DS for bodybuilding
Summary
Herbals and dietary supplements (HDS) are used to maintain or improve health. Regulation of herbal products may vary between different countries. In the United States (US), the Dietary Supplement Health and Education Act (DSHEA) of 1994 remains the foundation for current regulation of herbal products that are all classified as DS or botanicals [3]. Stickel et al classified HDS related to hepatotoxicity into two different groups: herbal-induced liver injury and dietary supplement induced liver injury (DSILI) [15]. This author considers DS if consumed as an aid to improve nutritional status, to lose weight or to treat constipation [15]. All citations in these reports were searched for other yet unidentified case reports, including cases with sufficient information published in other languages
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