Liver Injury from Herbs and “Dietary Supplements”: Highlights of a Literature Review from 2015 to 2017

Abstract

To present highlights of recent liver injury from herbs and “dietary supplements,” based on a literature review from 2015 to 2017. Challenging are quality issues of herb and dietary supplements (HDS) products, influenced by the circadian clock system in plants that controls many important metabolic pathways including photosynthesis and molecular processes of gene expression. Important also is plant stress, caused by pathogen attacks, heavy UV radiation, draft, soil contamination by salts or heavy metals, involving oxidative stress through generation of free radicals including reactive oxygen species (ROS), damaging the plant’s integrity. Finally, expectations are high if physicians publish case reports of HDS liver injury using the Roussel Uclaf Causality Assessment Method (RUCAM), but intentional overscoring of causality gradings must be resisted. In critical situations, reevaluation of original case data was a good approach clarifying divergencies. Plant stress impairs the quality of herbs, requiring better understanding of plant physiology, and clinical liver injury cases need better causality assessment using RUCAM.