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Carty J, Navarro VJ. Dietary Supplement-Induced Hepatotoxicity: A Clinical Perspective. J Diet Suppl 2024:1-20. [PMID: 38528750 DOI: 10.1080/19390211.2024.2327546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
The consumption of dietary supplements (DS) has resulted in a significant and escalating number of cases involving liver injury. It is crucial for clinicians and consumers to be well informed about the adverse effects of such products, leading to their discontinuation and timely reporting of any harmful cases. This article delves into the clinical perspective of DS-related hepatotoxicity, highlighting key concepts such as a systematic diagnostic approach. The discussion extends to notable examples of both currently popular and potential future dietary supplements, such as garcinia cambogia, turmeric, and ashwagandha, accompanied by an overview of recent findings. Causality assessment tools play a crucial role in establishing a connection between these products and instances of liver injury, with consideration of the advantages and disadvantages associated with their use. Fostering a comprehensive understanding of regulatory standards, coupled with a solid foundation of knowledge of DS, will prove instrumental in preventing DS-related hepatotoxicity. Achieving this goal requires collaborative efforts from both consumers and clinicians.
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Affiliation(s)
- Jordan Carty
- Department of Medicine, Jefferson Einstein Medical Center, Philadelphia, PA, USA
| | - Victor J Navarro
- Department of Medicine, Jefferson Einstein Medical Center, Philadelphia, PA, USA
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Turmeric-Associated Drug-Induced Liver Injury. ACG Case Rep J 2022; 9:e00941. [PMID: 36600786 PMCID: PMC9794274 DOI: 10.14309/crj.0000000000000941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/16/2022] [Indexed: 01/06/2023] Open
Abstract
Turmeric is a common herbal supplement used for its possible anti-inflammatory and other properties. It is marketed as safe with few reports of major adverse effects directly related to oral supplementation. We report a case of turmeric supplement-induced liver injury in a 49-year-old woman admitted with elevated aspartate aminotransferase and alanine aminotransferase with no history of liver disease or alcohol use disorder. Thus, this case re-emphasizes the importance of evaluating herbal and dietary supplements as potential drug-induced liver injury causes.
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Gurley BJ, McGill MR, Koturbash I. Hepatotoxicity due to herbal dietary supplements: Past, present and the future. Food Chem Toxicol 2022; 169:113445. [PMID: 36183923 DOI: 10.1016/j.fct.2022.113445] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 11/26/2022]
Abstract
Dietary supplements (DS) constitute a widely used group of products comprising vitamin, mineral, and botanical extract formulations. DS of botanical or herbal origins (HDS) comprise nearly 30% of all DS and are presented on the market either as single plant extracts or multi-extract-containing products. Despite generally safe toxicological profiles of most products currently present on the market, rising cases of liver injury caused by HDS - mostly by multi-ingredient and adulterated products - are of particular concern. Here we discuss the most prominent historical cases of HDS-induced hepatotoxicty - from Ephedra to Hydroxycut and OxyELITE Pro-NF, as well as products with suspected hepatotoxicity that are either currently on or are entering the market. We further provide discussion on overcoming the existing challenges with HDS-linked hepatotoxicity by introduction of advanced in silico, in vitro, in vivo, and microphysiological system approaches to address the matter of safety of those products before they reach the market.
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Affiliation(s)
- Bill J Gurley
- National Center for Natural Products Research, School of Pharmacy, University of Mississippi, University, MS, USA; Center for Dietary Supplement Research, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Mitchell R McGill
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Department of Pharmacology and Toxicology, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Center for Dietary Supplement Research, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
| | - Igor Koturbash
- Department of Environmental Health Sciences, Fay W. Boozman College of Public Health, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA; Center for Dietary Supplement Research, University of Arkansas for Medical Sciences, Little Rock, AR, 72205, USA.
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Luber RP, Rentsch C, Lontos S, Pope JD, Aung AK, Schneider HG, Kemp W, Roberts SK, Majeed A. Turmeric Induced Liver Injury: A Report of Two Cases. Case Reports Hepatol 2019; 2019:6741213. [PMID: 31214366 PMCID: PMC6535872 DOI: 10.1155/2019/6741213] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 04/17/2019] [Indexed: 02/08/2023] Open
Abstract
Turmeric is a commonly used oral herbal supplement with purported anti-inflammatory and antineoplastic properties. It is promoted as safe, with limited reports of severe adverse effects directly related to oral turmeric thus far in the literature. Herein we report two cases of turmeric supplement induced severe hepatitis. These cases highlight the need for physicians to be aware of patients taking this common supplement and the potential risks that exist.
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Affiliation(s)
- Raphael P. Luber
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Gastroenterology and Liver Transplantation, The Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Clarissa Rentsch
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
- Department of Pharmacy, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Steve Lontos
- Department of Gastroenterology and Liver Transplantation, The Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, Victoria, Australia
| | - Jeffrey D. Pope
- Clinical Biochemistry Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Ar Kar Aung
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
- Department of General Medicine, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
| | - Hans G. Schneider
- Clinical Biochemistry Unit, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - William Kemp
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Stuart K. Roberts
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
| | - Ammar Majeed
- Department of Gastroenterology, The Alfred Hospital, 55 Commercial Road, Melbourne, Victoria, Australia
- Central Clinical School, Monash University, The Alfred Hospital, 99 Commercial Road, Melbourne, Victoria, Australia
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Atkin SL, Katsiki N, Derosa G, Maffioli P, Sahebkar A. Curcuminoids Lower Plasma Leptin Concentrations: A Meta-analysis. Phytother Res 2017; 31:1836-1841. [DOI: 10.1002/ptr.5905] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 07/31/2017] [Accepted: 08/02/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | - Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School; Aristotle University of Thessaloniki, Hippocration Hospital; Thessaloniki Greece
| | - Giuseppe Derosa
- Department of Internal Medicine and Therapeutics, University of Pavia and Fondazione IRCCS Policlinico S. MatteoPavia, Italy; Center for the Study of Endocrine-Metabolic Pathophysiology and Clinical Research; University of Pavia; Pavia Italy
- Molecular Medicine Laboratory; University of Pavia; Pavia Italy
| | - Pamela Maffioli
- Department of Internal Medicine and Therapeutics; University of Pavia and Fondazione IRCCS Policlinico S. Matteo; Pavia Italy
- PhD School in Experimental Medicine; University of Pavia; Pavia Italy
| | - Amirhossein Sahebkar
- Biotechnology Research Center; Mashhad University of Medical Sciences; Mashhad 9177948564 Iran
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