Herbal supplements, energy drinks linked to liver failure

SAN DIEGO, California, USA – Severe liver damage, and even failure, has been associated with the consumption of weight loss supplements, an herbal supplement and an energy drink, according to four separate case reports presented at the American College of Gastroenterology’s 78th Annual Scientific Meeting in San Diego, CA. Use of herbal and dietary supplements is widespread for a variety of health problems. Because many patients do not disclose supplement use to their physicians, important drug side effects can be missed.

Case Report 1 SlimQuick? associated hepatotoxicity resulting in fulminant liver failure

There have been many reports of toxicity associated with dietary supplement use over the years, some with severe and even fatal outcomes. Lead investigator Dina Halegoua-De Marzio, M.D., reported a rare case of fulminant liver failure associated with the ingestion of SlimQuick?, a weight loss supplement containing green tea extract.

A 52-year old female patient was admitted to the emergency room after one week of vomiting and progressive jaundice. The patient reported she had ingested SlimQuick? for two days, while fasting three weeks prior to intake. Past medical and family histories of the patient were normal. According to Dr. Halegoua-De Marzio, the patient’s physical examination showed normal mental status, icteric sclera, mild abdominal distension and lower extremity edema. Her liver biopsy was consistent with confluent hepatic necrosis with collapse. The steroid prednisone was started but discontinued after two days, as liver function worsened and mental status deteriorated. After being evaluated and listed for liver transplant, the patient underwent transplantation two days later.

“There is a lack of knowledge about the status of Food and Drug Administration regulation of dietary supplements,” said Dr. Halegoua-De Marzio. “Currently, dietary supplements are not required to have safety or efficacy studies before they are marketed to the public, and they remain popular among consumers despite reports of hepatotoxicity. This case report is an example of how even minimal use of these unregulated dietary supplements can lead to fulminant liver failure requiring liver transplant. It is important that patients talk with their doctors before starting any new dietary supplements.”

Dr. Halegoua-De Marzio believes this is the first reported case of fulminant liver failure due to the consumption of SlimQuick?. The main ingredient in SlimQuick? is green tea extract, a common ingredient in several dietary supplements, some of which have been withdrawn from the market due to safety concerns.

Case Report 2 Black cohosh-induced hepatotoxicity leading to early cirrhosis

Lead investigator Khadija Haroon Chaudrey, M.D., presented a rare case of black cohosh-induced hepatotoxicity leading to early cirrhosis. A 44-year-old female had developed jaundice for one month,

and initial lab work revealed elevated liver function tests (LFTs). The patient had no history of alcohol intake, IV drug use, unprotected sex, recent travel outside the United States, NSAID ingestion or blood transfusions. After unsuccessful outpatient improvement on steroids, she was referred to inpatient evaluation because of gradual progression of her symptoms, marked scleral icterus and jaundiced skin.

The patient then reported she had started taking black cohosh about one month prior, to help with her menstrual symptoms. “Her ultrasound abdomen showed nodular contour of liver consistent with cirrhosis,” said Dr. ChaAir Jordan XXXI Low