Hepatoxicity Associated with Garcinia Cambogia Used as a Weight Loss Supplement

Abstract

Introduction: Obesity is a major public health problem affecting 35% of the adult population in the United States. Garcinia cambogia (GC) extract with its active ingredient: hydroxycitric acid is widely used for weight loss. It has been shown to suppress the appetite and decrease de-novo fatty acid synthesis; however, its effects on long-term weight maintenance programs is unknown. It has also been associated with cases of fulminant liver failure requiring liver transplant. We describe a case of acute hepatitis after GC use for weight loss. Case: A 36-year-old female with no significant medical history presented with a 3-day history of lowgrade fever, nausea, vomiting and abdominal pain. She reported taking GC for four weeks for weight loss. She also complained of anorexia, malaise, fatigue, jaundice and choluria. She denied alcohol consumption and was in a monogamous heterosexual relationship. Physical exam: scleral icterus, cutaneous jaundice, and tender hepatomegaly measuring 2 cm below costal margin. Abnormal laboratory results: white blood cell count 2.73 ×103 cells/μL (4-11), platelet count 78 ×103 cells/μL (150-400), aspartate aminotransferase (AST) 5340 U/L (15-41), alanine aminotransferase (ALT) 5615 U/L (7-52), alkaline phosphatase 104 U/L (32-91), total bilirubin 7.4 mg/dl (0.3-1.0) and direct bilirubin 4.9 mg/dl (0.0-0.4). Hepatitis A, B and C and all autoimmune markers were negative. Abdominal doppler ultrasound showed, mild echotexture coarsening in the liver and small ascites. GC was discontinued upon admission, and conservative management was initiated. Upon discharge, six days later her liver function was improving with an ALT of 680 U/L, ALT 1894 U/L and total bilirubin 8.1 mg/dL. Conclusion: GC is commonly advertised anti-obesity supplement with unknown effects on long-term weight maintenance. The general public needs to be aware of the potential hepatotoxic effect of GC.Figure 1