Dietary Supplements & Liver Damage

Hepatotoxicity of Dietary Supplements Revealed

Hepatotoxicity is a word that looks and sounds like it should be printed in bile-green ink with runs and streaks. It refers to things that harm the liver, of which there are a multitude. A review of dietary supplements associated with significant hepatotoxicity was recently published that was extremely comprehensive and well written.¹

Liver injury can result from either direct damage by a drug, affecting specific enzymes, or promoting free radical damage beyond the liver’s ability to combat the molecular damage being done. The first “dietary supplements” discussed are “designer steroids,” even though the class is composed of drugs. The newest language in the Anabolic Steroid Control Act has shut the door on that loophole, mostly. Designer steroids demonstrate hepatotoxicity similar to oral anabolic-androgenic steroids (AAS). Oral AAS can cause a variety of liver disease states— most commonly damage due to bile backup or cholestasis. Bile is the greenish fluid secreted by the gallbladder to aid in fat digestion. This backup harms not only the liver, but also the kidneys, as cholestasis damages both the liver in a specific pattern, and the glomeruli of the kidneys. Consider how many bodybuilders have experienced chronic kidney damage, often attributed to high-protein diets or diuretic use. This risk is now shared by adolescents and athletes who are unaware of the potential for harm.

Green tea extract (GTE) and its main active component, epigallocatechin gallate (EGCG), are extremely common ingredients in multi-ingredient fat-loss products. GTE/EGCG has been shown to increase weight loss in dieters, and the habitual consumption of green tea as a beverage is associated with many health benefits. Undeniably, GTE/EGCG has been consumed by many people who suffered liver injury— and even death. As GTE/EGCG is rarely consumed as a solo ingredient, it is difficult to conclusively state it is the causative agent of harm. There are documented cases where it was the only supplement consumed, and liver damage was evident when the patient decided to use the product again. Also, GTE/EGCG can markedly increase free radical damage when present with other drugs, or in certain conditions such as fasting. GTE/EGCG used in multi-ingredient products by people who are hypocaloric is the ideal setting for this kind of damage to occur.

Perhaps the most notorious ingredient associated with liver injury is usnic acid, a mitochondrial uncoupler derived from lichen (moss). A rash of cases presented in a short span after taking a LipoKinetix, a dietary supplement marketed for weight loss, although other usnic acid products have been named since. Most people recovered normal liver function, but there were some cases where individuals suffered such severe acute liver failure that a liver transplant was required— a very serious and life-altering procedure. THERE WERE ALSO PEOPLE WHO DIED AMONG THE CASES REPORTED.

Only three cases of liver injury associated with conjugated linoleic acid (CLA) have been reported. One patient was not taking any other substances. The number of cases is small, but if readers experience an elevation in liver enzymes while taking CLA, it would be wise to stop and then retest the blood work. The review goes on to describe a number of hepatotoxicity cases in users of Herbalife products, various Hydroxycut formulations, OxyELITE Pro and mega-dose vitamin A products. Bacterial contamination of the dietary supplement was suggested for certain Herbalife cases, adding to the avenues for concern. Simple mention of ma huang (ephedra) and Garcinia cambogia completed the review.

The liver is a vital organ, and damage can impair quality of life and health in the long term. Sudden failure of the liver will result in death within days, unless a donor organ can be found to allow for a liver transplant. Do not underestimate the value of your liver, and watch for any supplements or drugs that appear to cause it harm.

Reference:

1. García-Cortés M, Robles-Díaz M, et al. Hepatotoxicity by Dietary Supplements: A Tabular Listing and Clinical Characteristics. Int J Mol Sci. 2016;17:(23 pp). doi: 10.3390/ijms17040537.

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