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The number of patients admitted to hospital with severe liver damage caused by herbal and dietary supplements claiming to promote muscle growth or weight loss is on the rise, with some people being so badly injured that they required treatment. liver transplant.
A study led by Dr Emily Nash of the Royal Prince Alfred Hospital looked at the hospital records of 184 adults admitted to the AW Morrow Gastroenterology and Liver Center with drug-induced liver injury between 2009 and 2020. She and her co-authors found cases of liver damage related to herbal and dietary supplements increased from two in 11 patients (15%) in 2009-2011 to 10 out of 19 patients (47%) in 2018-2020.
Liver damage from an overdose of paracetamol, a drug widely used to treat fever and pain, and antibiotics, is common, and the authors found 115 patients with paracetamol-induced liver damage during the period of ‘study. Of the 69 cases of liver damage not due to paracetamol, 19 cases involved antibiotics, 15 herbal and dietary supplements, and the rest were anti-tuberculosis or anti-cancer drugs.
Transplant-free survival was also worse for liver damage unrelated to paracetamol, the study, published Monday in the Medical Journal of Australia, found. A co-author of the article, Dr Ken Liu, a hepatologist specializing in transplants, said he felt compelled to conduct the study because he was noticing more patients with liver damage caused by drugs that are usually not not associated with liver damage.
“I was starting to see injuries in patients admitted with liver damage after using bodybuilding supplements for men or weight loss supplements for women,” he said. “I just decided that I had better do a study on this to see if my hunch that more of these substances were causing these injuries was true.”
Liu and his colleagues said more regulatory oversight is needed for supplements and other alternative and natural therapies. They also noticed that almost half of the patients with severe liver damage induced by the supplements were of non-European ethnicity. Liu said more culturally appropriate community education about the risks of supplements is needed.
Dr Ken Harvey, a public health physician and chairman of Friends of Science in Medicine, said it was important to note that Liu’s study only looked at the most severe cases of liver damage induced by supplements and that the actual rate of damage was probably much higher.
“The study only examines severe cases admitted to a specialized liver unit; they cannot be extrapolated to the overall incidence of liver damage associated with complementary medicine in Australia, ”said Harvey.
In 2018, the drug regulator, the Therapeutic Goods Administration (TGA), introduced the determination of therapeutic products (eligible indications). Manufacturers of complementary medicines could no longer build their own list of benefits associated with their products, called “indications”, but had to choose from a list approved by the TGA.
“However, the natural and complementary therapy industry was allowed to create the list,” Harvey said. “This allowed 86% of the 1,021 eligible indications to be supported by ‘traditional’ rather than ‘scientific’ evidence. This effectively removed the need for complementary medicines to have a scientific evidence base. Not surprisingly, the number of drugs listed claiming traditional use and containing herbal ingredients has increased. “
There is no pre-market assessment by the TGA, Harvey said, and limited post-market surveillance shows a high level of regulatory non-compliance.
“In addition, as the authors of the MJA article point out, herbal and dietary supplements purchased online overseas escape any Australian regulatory oversight,” Harvey said.
“A low risk product doesn’t mean there is no risk. The TGA should conduct more post-market surveillance on the listed products, especially traditional Chinese and Ayurvedic medicines which have been associated with adverse events, contamination and adulteration. They should also make their findings known.
The Royal Australian College of General Practitioners, Choice, Friends of Science in Medicine and others have called for an educational statement on packaging and promotional material for drugs making traditional claims, for example saying “This product is based on traditional beliefs and not on modern scientific data. evidence”.
“The industry and the TGA opposed it,” Harvey said. “But it’s still necessary.”
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