Liver Failure Often Due to Supplements

Diet Aids, Herbal Supplements May Play A Role In Organ Failure

By Neil Osterweil
WebMD Health News

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Nov. 4, 2002 (Boston) -- You could lose a lot more than a few pounds with some over-the-counter diet aids and herbal supplements: You could lose your liver or even your life, researchers from the Oregon Health Sciences University suggest.

They studied 20 patients who were scheduled for liver transplants due to sudden onset of liver failure. The only possible explanation for organ failure in 11 of the 20 was that they had used either a weight-loss supplement with or without the herb kava, or common herbal supplements that are known or believed be toxic to the liver, report David R. Stolpman, MD, and colleagues at the American Association for the Study of Liver Diseases meeting.

This devastating disease is described as a "true medical emergency." Sudden liver failure is usually caused by an injury to the liver from a viral infection, or when a person eats or drinks a substance that is poisonous to the liver. The injury results in a rapid, massive destruction of liver cells, causing jaundice (yellowing of the skin and whites of the eyes), blood clotting problems, and changes in mental status, which may include confusion or coma. The condition, which is uncommon but not rare, can also lead to failure of other organs.

In the Oregon study, six of the patients who took supplements died from the liver failure, three required liver transplants, and only one recovered without transplantation.

"This is an observation that we made at our institution when we noted that so many patients with [severe] failure seemed to have no explanation [for the disease] other than herbs or supplements," study researcher David Stolpman, MD, tells WebMD. He is a fellow in gastroenterology at OHSU.

The researchers reviewed data on the 20 patients who had been treated for sudden liver failure at their institution over a period of 22 months, and looked for evidence of all possible causes, including viral infections, autoimmune diseases, or other conditions that could damage the liver.

They found that in 11 of the 20 patients, the use of over-the-counter weight loss supplements, a bodybuilding supplement, or herbs used for energy or relaxation were the only possible explanations they could find for the liver damage. The supplements contained either unlabeled ingredients, or herbs that previously have been linked to liver problems, including kava, chaparral, dandelion root, skullcap, and ephedra, also known as ma huang.

In March, the FDA issued a consumer advisory warning that kava-containing supplements may be associated with severe liver injury.

"I think that a lot of problems with these agents are that many are imported from foreign countries, where they don't have the same regulations for drug development, so there may be adulteration, or maybe these agents by themselves are directly related to causing toxicity as well," Abdul Nadir, MD, medical director of the Liver Disease Center at Good Samaritan Medical Center in Phoenix, Arizona, tells WebMD.

Nadir, who was not involved in the study, says that he has seen several cases of liver failure associated with the use of ephedra and cascada sagrada bark, which is widely used as a natural laxative. He says that the liver damage from a toxic substance can occur within a few weeks or up to six months after exposure.

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