Liver Failure Often Due to Supplements

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

By Neil Osterweil WebMD Medical News Reviewed By Michael Smith, MD advertisement

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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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Tuesday, 5 November, 2002, 13:09 GMT

Traditional medicine takes on the world

By Venkitesh Ramakrishnan

BBC reporter in Cochin

Delegates to the world's first conference on traditional medicine are leaving the southern Indian city of Cochin pledging to raise the global profile of "ayurvedic" remedies.

More than 2,000 Indian and foreign delegates spent four days discussing the relevance of the 5,000-year-old tradition of herbal and "alternative" medication in the modern world.

Prominent practitioners and academics from India and elsewhere spoke about the benefits of natural, non-chemical and non-invasive traditional medical practices.

Ayurveda uses herbs and spices like basil, turmeric, garlic, ginger and aloe vera, as well as yoga exercises, to treat physical and psychological problems.

Opened by India's Health Minister, Shatrughan Sinha, the congress talked about "the threat posed by the WTO patent regime" to traditional medicine.

Mystical art

More than 300 research papers were presented at the congress, at which some 100 speakers took the podium over four days.

Most presentations focused on adapting and standardising ancient traditional medication to the complex needs of modern societies.

A highlight of the congress was "Daiva Vipasaya Yagnam" - a ritual that relieves tension without using any drugs.

A special session on yogic exercises and "tantra" - ancient and mystical writings - also drew much attention.

But many of the Indian and overseas delegates came to the congress to learn more about India's traditional medicine.

Attractions

The organisers of the congress believe they are on to something big.

The market in traditional medicine is large, as the World Health Organisation (WHO) estimates.

In addition, officials like DN Tewari, chairman of the ayurveda task force in India's Planning Commission, say ayurveda's attractions are growing by the day.

"The world as a whole is switching over from chemical drugs to natural drugs," he told the BBC, "because they are non-narcotic, they have no side-effects and are easily available.

"The world is interested in simpler and gentler therapies - especially for ageing, the problem of obesity, diabetes, neurological disorders, cardiac diseases and digestive problems."

Big business

However, commercial concerns were a major drive behind the congress.

Although ayurveda is an Indian tradition, Delhi exports ayurvedic drugs worth under 5.5 billion rupees (about $120m) a year.

By comparison, China's ayurvedic exports are worth $5.56bn a year.

Dr SK Sharma, an adviser to the Indian Government, says Delhi has set an export target of $1.08bn by 2008.

Dr Sharma said with 15,000 plant species, India was well placed to increase its share of the $75bn global market in medicinal plants, which is growing by at least 7% a year.

Officials attending the congress said Delhi was setting up a task force of 10 industries to work out ways of expanding its revenues from this ancient tradition.

-- Anonymous, November 05, 2002