Mims.com, Jan 14, 2017
Drug-induced liver injury has recently been on the rise as herbal and dietary supplements gain popularity over the last decade.
Local hepatologist Dr Lim Chee Sang from Hospital Kuala Lumpur (HKL) shares his concerns on the toxicities accompanying many of these herbal prescriptions.
“It is a misconception that ‘all-natural’ herbal supplements are safe just because their source is all-natural.”
Herbal supplements linked to 20% of liver injuries
Last November, an international collaboration between researchers from the United States and Iceland reviewed data from the Drug Induced Liver Injury Network (DILIN), a large database first set up by the National Institute of Diabetes and Digestive and Kidney Diseases in 2003.
They concluded that a fifth of liver toxicity cases are currently caused by “all-natural” herbal products. While they might sound deceivingly good for health and most may be harmless, these multi-ingredient nutritional supplements do not come without associated risks.
While the DILIN tracks severe liver injuries caused by any sort of drug reported to a hospital, the researchers specifically focused on those caused by herbal and dietary supplements. They found that 20% of liver toxicity cases are currently caused by these products, most commonly by what they called multi-ingredient nutritional supplements. Anabolic steroids and green tea extract were also common sources of liver toxicity, they found.
Dr Lim also referenced a 2013 study in the US, which found a rise in liver injuries due to herbal and dietary supplements had been recorded between 2004 and 2012. He states that herbal supplements contain active ingredients which may lead to health complications which could be lethal if inappropriately consumed.
Patients need to be taught how to evaluate supplements
Lim said a sense of initiative in questioning what they are told especially in relation to products of alleged medicinal values is important for the public. Patients should cultivate the practice of speaking to their doctors before taking supplements, rather than just buying them off the counter without knowing the effects these may have on their health.
“This is especially the case for those who are pregnant, nursing, have chronic medical conditions such as diabetes, hypertension or heart disease, as well as those taking medications.”
“What is of great concern, is that most people, even in the US do not tell their doctors what supplements they take, so these figures may not even paint a complete picture,” Lim adds.
He shared that complications could arise indirectly from combining supplements which on its own could be harmless, but taking them with other medications could cause adverse drug reactions. This is especially so when consumers fail to mention the herbal supplements due to the misconception that they are solely herbs in content.
“Some supplements may interact with prescriptions and OTC medicines. For example, Coumadin (a prescription medicine), ginkgo biloba (a herbal supplement), aspirin (an OTC drug) and vitamin E (a vitamin supplement) can each thin the blood, and taking any of these products together can increase the potential for internal bleeding,” explained Lim.
Controls necessary to stem trend of unregulated alternative medicines
Without tighter regulation of the supplement industry, the fear that both patients and healthcare practitioners will be left in the dark when a case of supplement-related liver toxicity comes their way becomes very real. This is especially so amongst doctors in particular as they may misidentify cases leading to delays in treatment and possibly even mortality.
The ultimate goal in mind should be to prohibit or more closely regulate potentially injurious ingredients and thus promote public safety amongst patients. This would only be possible if doctors and pharmacists themselves are able to be that frontline provider of awareness and enforce healthy medications consumption practices in general. MIMS