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Caution!
Herbs and Nutritional Supplements

What's the problem?

Televised testimonial promotions, as well as advertisements in health and nutrition magazines, aggressively promote the use of herbs and nutritional supplements – frequently without explaining potential dangers or side effects. Nutritional supplements and herbal remedies are readily available in supermarkets, pharmacies, health food stores, and offices of herbal practitioners. The fact that herbs are natural preparations from plants doesn't necessarily mean they are safe. It has been documented for centuries that some plant substances are toxic to the liver. Herbal remedies are presently unregulated by any state or federal medical or health agency, and their safety and effectiveness have not been scientifically demonstrated.  Some can cause significant liver damage.

How concerned are doctors?

Doctors are very concerned that many herbal-related liver injuries go unrecognized because very often patients do not tell their doctors about the use of herbs and diet supplements. Herbal remedies contain multiple ingredients, and the labeled and actual contents of a product may differ. This makes it impossible to identify liver attack rates for specific herbs. In a recent article, Dr. Raymond S. Koff , hepatologist and vice chair of HFI, questions the role herbal products play in undefined hepatitis and fulminate (sudden and severe) disease. In almost 50% of patients, fulminate disease cannot be related to any identified hepatitis viruses. Liver injury directly related to repeated use of herbal products ranges from mild and limited to extensive disease. Dr. Koff believes that unrecognized herbal use may be the cause of unidentified hepatitis and cirrhosis.

What herbs may be harmful?

Chaparral has been named as the source of severe hepatitis leading to a liver transplant in a 60-year-old woman. She had taken two capsules of chaparral daily for 10 months. Three weeks before being hospitalized she increased her dose to six capsules daily. This case showed signs similar to three other cases of chaparral related hepatitis although hers was more severe due to the longer period and the amount she had ingested.

In addition, a Chinese herbal product, JinBuHuan, has been implicated in clinically diagnosed hepatitis in seven patients. Other herbs known to be dangerous to the liver include: germander, comfrey, mistletoe, skullcap, margosa oil, mate tea, Gordolobo yerba tea, and pennyroral (squawmint oil). Dr. Koff stresses that "many more may not yet have been recognized."

Are all herbs harmful to the liver?

Not all herbs are a threat to the liver. Some people use Milk Thistle to help maintain liver health. To date, the most reliable, and also very preliminary, studies on people show that Milk Thistle does not cure liver disease, but that it may improve the way the liver works in patients with cirrhosis. However, there is no current evidence to indicate that milk thistle relieves hepatitis symptoms or fights the virus. Other herbs used to help improve liver function include licorice root and ginseng. To help relieve side effects of interferon therapy, some turn to ginger or St. John's Wort. However, no herbal, diet supplement, or alternative medicines have been scientifically proven to cure – or even ease – symptoms of hepatitis C. Until doctors ask patients about herbal use and have an adequate reporting system whose results are backed by adequate scientific research, the only way to reduce the risk of liver damage is to limit use of herbal products. People with hepatitis have an already compromised liver, and some herbs may be an added stress, increasing liver damage.

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