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Dietary Supplements Blamed for Sharp Rise in Drug-Related Liver Injuries — Physician’s First Watch

Medical News |
December 23, 2013

Dietary Supplements Blamed for Sharp Rise in Drug-Related Liver Injuries

By Amy Orciari Herman

Dietary supplements, including many marketed for muscle-building and weight loss, account for a spike in drug-related liver injuries over the past decade, according to a front-page story in Sunday's New York Times. Many patients ultimately recover, but some end up requiring transplants or dying from liver failure.

Supplements accounted for nearly 20 percent of drug-related liver injuries that led to hospitalization in 2010-2012, the Times reports, up from 7 percent in 2004. The data, from the NIH's National Liver Network, showed that many of the products were bodybuilding supplements that contained steroids not listed on the label. Use of green tea extract was also frequently reported. The extract contains catechins, which are said to increase metabolism; in high doses, they can cause liver toxicity.

Of over 50,000 supplements sold in the U.S., less than 1% have been examined well enough to determine their adverse effect profile, one expert told the Times.

Reader Comments (9)

Raye Ann Sifri, RPh, Pharm D, PhD Other Healthcare Professional, Pharmacology/Pharmacy, Retail Pharmacy

It is absolutely unfathomable that "supplements" are not held to the same strict standards as any other OTC product meant to be ingested. It is not the fault of the FDA. Rather it is the result of the successful lobbying efforts of the multi-billion dollar nutritional supplement industry to keep their products from being required to meet the FDA's standards for safety and efficacy. What far reaching tragedy will have to befall our society until Congress decides that whether something is technically defined as a drug or a supplement it should at the very least be safe for human consumption.

Michael Akerman Physician, Critical Care Medicine

Scientifically, professionals know that herbal supplements have a risk benefit profile. In these type of epidemiologic work it is most important to us to know if this is a quality control issue such as cheap brands with mislabeled supplements, or is this supplement specific, etc. Historically, Many important medications started with herbal origins . Such sweeping articles are only helpful if they stimulate public caution when using any supplement, leading to public demand for better quality standards, to more accurate labeling, and lead to more research in medicinal herbs and their risk benefit ratios.

Barata, Jose Diogo Physician, Nephrology, general Hospital

very usefull information in the seletion of papers

Katherine Brennan Physician, Family Medicine/General Practice

I agree completely with DR BLAYLOCK and the other health care professionals who are frustrated and angered by this article, it is truly a hatchet job.
Also the "data" from the NIH, if one can possibly call it that since it's not specified, is conflicting - on one hand it's written that "many of them are bodybuilding supplements that contain steroids" - the inference is that it is these, principally, that caused the surge in "liver failure and ...even death". But then it's written that it is not the bodybuilding products that caused the increase in the actual transplants?
And why for only 2010-2012? Surely we would be better served by looking at the results of several studies conducted over longer periods of time. And what variables were considered?
Big Pharma is determined to continue to set the standards for care - as it is purely a money making machine with strong lobbyists in Washington, and effective commercials in print media and on TV. So that patients themselves pressure their physicians, NP's and PA's to prescribe the perennial "new miracle drug". The side effects of most of the best-selling drugs are too numerous to mention here. And the number of medications with "Black Box Warnings" are now almost the norm instead of the few!
The patient bears the physical and monetary expense of unsafe and mostly ineffective drugs that are "approved" by the same corrupt organization that allowed Nutrasweet aka Aspartame and the myriad of other artificial sweeteners on the market, the FDA.
Guess who's behind Aspartame? MONSANTO (at the time a subsidiary of Pharmacia) who bought the patent from Searle in '85, and then sold it to a private equity firm.
They can't patent Stevia which is a healthy and acceptable alternative. The same principle goes for the majority of healthy, life-enhancing supplements that consumers want both information on and access to.
But as most health care professionals either don't take the time to research alternatives to the drugs listed in the PDR etc, or as they find the patients themselves resistant to treatment that's not commercially sanctioned, or as some physicians will actually tell their patients that supplements are dangerous, it's an uphill battle. To illustrate:
I recently offered my neighbor a bottle of Twinlab brand "Stress Formula B Complex" as his bottle of Solgar brand "B Complex 50" had run out. He said "I have to ask my doctor first" which was understandable. What was not is when he came back and said "my doctor said I could not take such a high dose". The difference between the 2 is negligible, and he had no medical condition that would have contraindicated him taking either formula.
Now there's an example of ... what I'm not quite sure.
It's symptomatic of our ailing health care system.
In Europe, especially in Germany, it's considered standard practice to use what we call "supplements" as part of a patients medical regimen, and it's covered by their medical insurance. Unlike here, where many who do want to take them, can't afford to,

Ashley D. Coleman Physician, Family Medicine/General Practice

Would like to see a list of supplements that are linked to this increased risk of hepatotoxicity to be better able to have a discussion with my patients. Was this just a global assessment of all supplement users or were there particular supplements looked at during the study?

Judith Packer MD Physician, Internal Medicine, Greater Boston

Since I have both patients and family using "dietary supplements," it is necessary to see the list of supplements reviewed in this study, to evaluate its applicability to situations I encounter in my clinical work

David Goheen MD Physician, Orthopedics, retired

The reaction that the report is a 'hatchet job' seems a bit extreme. I assume that the Big Pharma concerns are not pleased that the government regulations which they must follow do not extend to 'health food' concoctions, but to defend the herbal supplement racket by so noting begs the issue of danger to the folks who are prey to whatever snake oil might be packaged and promoted by anyone at all. Of course, I also assume that some of the stuff sold as a 'dietary supplement' is at worst harmless, and perhaps even beneficial. But to let items like this to be sold with no controls whatever (other than the Invisible All-Wise Hand of the Marketplace) is asking for trouble. At least now (as far as I know), tapeworm eggs are no longer sold as a weight-loss miracle, but it seems not enough has been learned from the catastrophes of the last century regarding the safety of stuff sold as 'healthy'.

Frank Jordan Other Healthcare Professional, Unspecified
Competing Interests: I am Research Director for a nutritional supplement corporation involved for almost 15 years in sponsoring continuous U.S. Medical School basic research being smeared by inuendo in your all-inclusive headline which lacks sufficient specificity on sources and characteristics of supplements the subjecdt of your article.

Why do negative reports on pharmaceuticals contain the specific drug, while negative headlines on a dietary supplement(s) condemn an entire industry instead of the specific substances or products reviewed including their source and whether natural or synthetic? Who is the "...one expert...and what is his data source?" Could we have more detail on the causes of the other 80% of drug-related liver injuries; with acetaminophen as an example?

Russell L Blaylock Physician, Surgery, Specialized, Theoretical Neuroscience Research LLC

This is another hatchet job by the medical/pharmaceutical complex. Pharmaceuticals kill over 100,000 people a year and if we look just at liver disease the number one link is acetaminophen, even when used in recommended doses. If the medical orthodoxy would stop waging this war against the nutraceutical industry and work with those of us who know the science of these compounds, we would all be a lot better off. It is of note that targeted in this report is the one area where health is not the main concern and that is exercise enhancement and bodybuilding. Virtually every area of medicine would benefit from an integrated approach. It is the patients who are being harmed by this vicious war by orthodox medicine.

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