{"id":503,"date":"2014-12-12T09:00:05","date_gmt":"2014-12-12T09:00:05","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=503"},"modified":"2017-08-21T12:04:03","modified_gmt":"2017-08-21T12:04:03","slug":"primary-care-corner-with-geoffrey-modest-md-herbaldietary-supplemnts-and-liver-injury","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2014\/12\/12\/primary-care-corner-with-geoffrey-modest-md-herbaldietary-supplemnts-and-liver-injury\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Herbal\/dietary supplements and liver injury"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong><\/p>\n

There was a rather disturbing article in the journal Hepatology showing increasing hepatoxicity from herbals and dietary supplements (HDS) (see\u00a0DOI:\u00a010.1002\/hep.27317<\/strong>). The report is from the Drug-Induced Livery Injury Network (DILIN, supported by National Institute of Diabetes and Digestive and Kidney Diseases), reporting on the findings in 8 US referral centers (including centers in California, Connecticut, Indiana, Michigan, Minnesota, North Carolina, Pennsylvania, taxes), assessing consecutive patients from 2004-2013 with hepatoxocity from either medications or HDS, a total of\u00a0839 patients. attribution of cause of hepatotoxicity was from expert opinion, including biochemical evidence of hepatic injury with assessment for\u00a0viral or autoimmune hepatitis, checking serum ceruloplasmin, iron studies, and a-1 antitrypsin, and reviewing biopsy if available.<\/p>\n

\"OLYMPUS<\/a>Findings:<\/p>\n

–130 patients (15.5%) with liver injury from HDS, 709 from medications<\/p>\n

–The incidence of HDS hepatotoxicity\u00a0increased from 7% to 20%<\/strong> over the 10-year\u00a0observation period<\/p>\n

–Of the HDS\u00a0cases, 45 were from bodybuilding HDS and 85 from non-bodybuilding<\/p>\n

–Bodybuilding HDS cases were exclusively in\u00a0men (median age 31)\u00a0and were\u00a0milder: prolonged jaundice (median 91 days), but no fatalities or liver transplants.<\/p>\n

–Non-bodybuilding HDS cases mostly in middle-aged women (median age 47, 65% women), and more frequently led to death or liver transplantation as compared to medication-induced hepatotoxicity\u00a0(13% vs 3%)<\/p>\n

So, this seems to be a very real problem, even though this is not a rigorous population-based study. more than 1\/2 the US population consumes HDS. Although overall the consumption is highest in non-Hispanic white women >40yo and with higher levels of education, my experience is that use of these supplements is very common in our multicultural poor inner-city community. I see a lot of young men taking\u00a0testosterone and other body-building HDS, and many people who buy TV-advertised (and quite expensive) supplements\u00a0(ie, I don’t think this is only\u00a0a white middle-class issue). \u00a0There are even data that taking multivitamins are not helpful in general population. The Physicians Health Study II of 14,641 men >50yo and followed 11.2 years\u00a0found no benefit of multivitamins on major cardiovascular events or total mortality, even if they had baseline\u00a0history of coronary artery disease\u00a0(see\u00a0JAMA. 2012;308(17):1751-1760<\/strong>) and another study of 1700 people, 82% men, taking multivitamins after an MI and followed 55 months similarly found no benefit (see\u00a0Ann Intern Med. 2013;159:797-804<\/strong>) \u00a0all of this confirms the oft-repeated concept\u00a0(by me, at least) that we should be eating well and exercising, not looking to micro- or macro-nutrient additions to improve health (ie, there is no easy fix….).<\/p>\n","protected":false},"excerpt":{"rendered":"

Herbal\/dietary supplements and liver injury […]<\/p>\n

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