45-year-old woman damages liver from herbal brew

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Herbal supplements are widely used as a natural alternative to prescribed medicines. Their heavily purported health claims make them alluring to global consumers searching for a quick fix to boost their health. Due to the categorisation of the remedies as supplements, however, they’re exempt from regulation on other medicines sold in pharmaceutical settings.

Earlier this year, doctors published the case report of an unnamed 45-year-old woman with liver injury in the Cureus Journal of Medical Science.

The patient, who was receiving treatment for hypothyroidism at the time of her presentation, reported severe epigastric pain and nausea.

She denied any alcohol or drug use, recent travel and history of blood transfusions prior to her symptoms.

One note-worthy admission was that she had started drinking a herbal tea three days before experiencing symptoms, in a bid to boost her immunity.

“Further examination revealed that the patient had recently begun using a herbal tea and that symptoms had completely resolved after discontinuation,” noted the authors.

According to the report, the tea contained 23 ingredients, including reishi mushroom, aloe, vera, and Siberian ginseng.

All three ingredients have been linked to cases of liver injury in past research.

Twelve case reports have been published since 2005 indicating a risk of liver injury in connection to aloe vera.

Research dating back to 2004, has identified several cases of liver injury in patients taking reishi mushroom formulations.

Finally, research published in the British Journal of Clinical Pharmacology in 2020, suggested that ginseng may inhibit various cytochromes, which are involved in the metabolism of drugs.

The problem with these remedies appears to be that they form toxic metabolites that damage live cells when ingested.

As a result, the liver can become so badly damaged that it ceases to function, which causes liver failure in some cases.

The authors concluded their report with the statement: “A diagnosis of herbal supplement-induced liver injury requires an effective inquiry into any herbs or supplements a patient may be taking, patients may be hesitant to provide this information.

“It is imperative for clinicians to familiarise themselves with herbal supplements to better inquire about their use with patients and educate them on potential side effects.”

The patient was using a herbal tea with known hepatotoxic ingredients and had definitive improvement after cessation of use.

“This […] shows the value of further inquiry into supplement use once common causes of acute liver injury are ruled out,” added the authors.

As a rule of thumb, WebMD suggests practising caution when using supplements that contain the following ingredients:

  • Aloe vera
  • Black cohosh
  • Cascara
  • Chaparral
  • Comfrey
  • Ephedra
  • Kava.

Patients using other medications should always speak to a healthcare provider before starting a new dietary regimen that includes vitamins and supplements.

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