Herbal assault: liver toxicity of herbal and dietary supplements

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The worldwide market for herbal and dietary supplements is booming.  But the health benefits of such products are largely unsubstantiated by scientific data, and they are increasingly associated with harmful side-effects, including liver toxicity.

The number of people who use herbal and dietary supplements is not entirely clear, but the popularity of these products is undeniable. Surveys suggest that roughly 20% of Europeans and half of all Americans use these products. In one national survey, more than three-quarters of patients with, and survivors of, cancer in the USA reported using dietary supplements; boosting the immune system and helping to prevent cancer were among the most cited reasons for use. In the USA alone, sales of supplements were nearly US$37 billion in 2014, up from only $7 billion in 1994. In Australia, spending on complementary medicines increased by more than 100% between 1996 and 2004.

The lure of herbal and dietary supplements is not difficult to understand. They promise seemingly boundless health benefits—among them improved health, weight loss, decreased stress, increased energy, and relief from depression—and they are freely available for purchase, relatively inexpensive, and do not require a prescription. Indeed, the widespread absence of regulation of these products—which are widely considered food additives rather than medicines—means that hard data and clinical trials are not required to support claims of general health benefits.

The natural origin of many of these products also gives many people a false sense of security regarding safety. Indeed, the assumption that herbal supplements are innocuous might explain why many patients do not disclose their use to their physicians, meaning that related side-effects are frequently misattributed. Even when patients disclose supplement use to their doctors, they often do not know exactly what they are taking—few of these products contain single ingredients and many are proprietary mixtures sold under commercial names. Even more worryingly is the finding that these products can be spiked with pharmaceuticals not disclosed on labels, or contain toxic substances like arsenic and DDT, as reported in a review from Australia.

Read complete article here: http://www.thelancet.com/journals/langas/article/PIIS2468-1253(18)30011-6/fulltext