CC: Room 153/155
As the use of alternative and complementary medicines, such as herbal remedies and dietary supplements, continues to increase worldwide, current and emerging research is shedding important light on the health risks associated with their use. Recent studies, for example, have demonstrated a direct association between certain supplements and liver disease. That will be the topic of Friday’s Hepatotoxicity Special Interest Group Program, “Herbal and Dietary Supplement Induced Liver Injury: Defining the Future” beginning at 2:00 pm in Room 153/155, Moscone North/South.
“The number of so-called dietary supplements and herbal remedies on the market is increasing and many of them are unknown substances or they’re mixtures of substances where the ingester has no idea what’s in them,” said Adrian Reuben, MBBS, FRCP, FACG, FAASLD, Professor Emeritus at the Medical University of South Carolina. Dr. Reuben will serve as co-chair of the program with Victor J. Navarro, MD, FAASLD, medical Chairman of the Department of Digestive Disease and Transplantation at Einstein Healthcare Network in Philadelphia.
Dr. Reuben noted that an increasing proportion of liver injury is being ascribed to these substances in national reports of severe liver injury and even liver failure.
“In some parts of the world, toxicity from such remedies is actually proportionally greater in number than it is from what we consider classical drugs and medications. In many parts of the Far East, for example, people are very prone to taking these sorts of substances, which actually are recognized by the healthcare system,” he said.
Friday’s program will include a multidisciplinary panel, who will discuss the chemistry and toxicity of various alternative/complementary “medicines” and the challenges faced by diagnosticians and researchers in establishing causation for hepatotoxicity due to herbal and dietary supplements. A good portion of the discussion, Dr. Reuben said, will focus on lessons learned from a recent toxicity outbreak, which included cases of severe acute hepatitis and liver failure, attributed to the use of a multi-ingredient supplement marketed under the brand OxyELITE Pro, which was subsequently banned by the FDA in 2013.
“One of the biggest problems, of course, is that herbal remedies are often considered as foods that are not required by the FDA to declare their contents, so most of these supplements that people take are not regulated at all,” Dr. Reuben said. “When a manufacturer of these supplements says that a certain substance is the active principal ingredient in their product, the reality is that the said ingredient may be there in high amounts, or it may not even be present at all, because there is no regulation of the quality control of these substances, let alone whether they are toxic or not. Such products may also contain toxic impurities unrelated to the proposed active principals.”
Dr. Reuben said the OxyELITE Pro example provides a model for clinicians and researchers, as well as the world’s drug regulatory agencies, to take steps to more effectively scrutinize, and ultimately more strictly regulate, herbal remedies and dietary supplements. In the meantime, he said, it is incumbent on physicians to talk to their patients about the potential risks in taking these supplements.
“Although patients may sometimes be dissatisfied with the availability of traditional treatments and cures for whatever ails them, and they take these substances thinking they’re going to be better than classical medicine, I think it behooves every physician, especially in primary care, to remind patients to avoid these complementary medicines, or at least to discuss them with their personal physicians before starting to take them ” Dr. Reuben said. “When it comes to liver disease, the message is simple — whenever you see someone with liver injury, before attributing it to viral hepatitis or alcohol, for example, you should consider alternative medicine as a potential cause and question your patient in such a way that they are not dissuaded from being honest because they’re embarrassed or they want to cover up the fact that they’re using some sort of supplement.”