Many references accentuate the harmful effects of herbal products. Their most frequent harmful side effect is hepatotoxicity. Herbalife® products are connected to various liver damage grades, from minimal hepatogram changes to fulminant hepatitis that requires liver transplantation. In the last few years, there have been more than 50 cases of liver damage connected with Herbalife® use, some of them even life-threatening.
A 54-year-old female patient was admitted to the Department of Gastroenterology and Hepatology for icterus, abdominal pain, pale stool, tiredness, and general weakness, which occurred several days before hospital admission. The patient did not have any severe illnesses or any similar problems before. She denied alcohol or drug addiction, taking any medicine as acute or chronic therapy, receiving blood transfusions and/or any blood products. Epidemiology and family history were negative. At admission, she was hemodynamically stable and not febrile. Icterus was noticed during the physical examination. However, there were no chronic liver disease stigmata.
Initial laboratory tests showed significantly elevated markers of hepatocellular damage. Coagulation parameters and proteinogram were normal. Complete blood count, inflammation parameters, glucose, electrolytes, kidney function parameters, thyroid hormones, and thyroid-stimulating hormone were also normal. Serologic tests excluded hepatitis B and C infection, as well as cytomegalovirus and Epstein-Barr virus infection or reactivation. Positive anti-hepatitis A virus (HAV) antibodies pointed to HAV. The levels of serum copper, ferritin, and transferrin saturation were normal. Immunologic examination (antinuclear antibodies [ANA], antimitochondrial antibodies [AMHA], antibodies against smooth muscle cells [AGLM], antibodies against liver or kidneys [LKM]) excluded autoimmune etiology of liver damage. Upper abdomen ultrasound revealed normal size but diffuse hyperechoic liver. There were no signs of lithiasis or biliary obstruction. Gastroscopy confirmed Helicobacter (H.) pylori-positive chronic gastritis but no signs of portal hypertension. Eradication therapy of H. pylori infection was conducted in a later therapeutic period due to high hepatogram values.
The patient had been using the following Herbalife® products: Guarana comprese, RoseOx, Herbalifeline, Tang Kuei Plus, and Formula 4 at the recommended dosage (10 tablets per day in total), for approximately half a year before admission. During her stay at the Department of Gastroenterology and Hepatology, these products were excluded from therapy; soon after, the clinical picture regressed, and the initially high hepatogram values decreased. According to the World Health Organization criteria (WHO-UMC Criteria) for the cause and effect of liver failure and Herbalife® products, the patient’s toxic hepatitis was probably the result of taking the products mentioned above.
Table of Contents
Per serving: 202 mg calcium carbonate, 800 mg guarana seed blend, microcrystalline cellulose, hydroxypropyl cellulose, silicon dioxide, stearic acid, magnesium stearate, maltodextrin, sodium carboxy methylcellulose, dextrin, dextrose, soy lecithin.
Per serving: Calcium carbonate 140 mg, exclusive herbal blend 620 mg (dried rosemary extract – leaf, cruciferous vegetable concentrate – broccoli, cauliflower, cabbage and carrot extracts, dried turmeric extract – root, tomato concentrate – fruit, sage – leaf, cloves – flower), corn starch, croscarmellose sodium, stearic acid, hydroxypropyl cellulose, silicon dioxide, magnesium stearate, microcrystalline cellulose, ethylcellulose, hydroxypropyl methylcellulose, guar gum, propylene glycol, vegetable oil, carnauba wax.
Tang Kuei Plus
Per serving: Vitamin C as ascorbic acid 8 mg, Tang Kuei root extract 200 mg, passionflower
extract 30 mg, microcrystalline cellulose, modified food starch, stearic acid, croscarmellose sodium, magnesium stearate, silicon dioxide, sodium carbomethylcellulose, dextrin, dextrose, soy lecithin.
Per serving: Vitamin E as D-alpha tocopherol 8 IU, marine lipid complex as fish oil 758 mg, omega-3 fatty acids from fish oil 336 mg, gelatin, glycerin, soybean oil, white thyme oil, clove oil, peppermint oil, ethyl vanillin.
Per serving: Safflower oil 171 mg (linoleic acid 73%, oleic acid 13%, linoleic acid 0.3%), natural peach flavor (genetically modified).
Some of the herbal preparations connected to hepatotoxicity are Kava Kava (Piper methysticum rhizoma), Jin Bu Huan (Lypocodium serratum), Ma Huang (Ephedra spp.), Germander (Teucrium chamaedrys), Chaparral (Larrea tridentata), and pyrrolizidine alkaloids (Heliotropium, Senecio, Symphyíum and Crotalaria spp.). Considering the growing consumption of herbal products and their potential harmfulness, more strict regulations of the manufacturing process and sale of herbal products are necessary, including exact identification of active substances with the list of ingredients, toxicologic testing, and obligatory side effects report. The public, physicians, and pharmacists have to be informed about the potential risks of Herbalife® products.
Herbalife® Associated Severe Hepatotoxicity in a Previously Healthy Woman
Dragan Jurčić, Maruška Gabrić, Rosana Troskot Perić, Ana Marija Liberati Pršo, Jure Mirat, Aleksandar Včev, Ivan Alerić, Barbara Ebling
Acta Clinica Croatica, Vol. 58, No. 4, 2019:771-776.
Available online (free access): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7314303/pdf/acc-58-771.pdf