Herbs and healthy livers

The pursuit of optimal nutrition, ‘wellness’ and slim bodies has become fertile ground for the marketing of products, diets and regimens that promise “a lifetime of good health.” Herbal and natural dietary and weight loss supplements can be alluring because they may seem safe. Three new studies, however, have documented liver toxicity among healthy people using natural herbal supplements — more than 20 cases were just among Herbalife customers in two small countries.

Few consumers hear about the reports in the medical literature of liver and other toxicities from herbal products. Dr. Leonard B. Seeff, M.D., of the National Institutes of Health, reviewed the herbal products that have been associated with liver damage in the journal Clinical Liver Disease. His concerns about the growing numbers of medical cases were similar to an earlier 2005 comprehensive review for the European Association for the Study of the Liver in the Journal of Hepatology, led by Dr. Felix Stickel, M.D.. These doctors reported that, depending on the geographic region, 21% to 65% of patients seen for liver disease have been taking herbal preparations. Most evident is that women are at greatest risk not only because they use more herbals, but because of their higher susceptibility to herbal- and pharmaceutical-induced liver damage. Because many practitioners and consumers believe herbals are safe, the doctors noted the many times patients will even continue to take them as their liver diseases worsen.

Dr. Stickel and colleagues added:

Another problem is that herbals are usually mixtures of several ingredients or plants harvested during different seasons and extracted through variable procedures, which makes the identification of both the pharmacologically active and toxic compounds difficult. Also, contamination of herbals with microorganisms, fungal toxins such as aflatoxin, with pesticides, heavy metals and synthetic drugs has been described. Interactions between herbs and chemical drugs are another source of problems associated with the intake of herbal compounds.

While liver damage appears infrequently, the consequences are serious enough for patients that these cases are getting the notice of doctors. Another article in this month’s issue of the Journal of Hepatology by researchers at Hadassah-Hebrew University Medical Center in Israel reported on 12 patients (11 women) with acute liver injury after using Herbalife products. Incredibly, after three patients recovered, they resumed taking Herbalife products and succumbed to a second bout of hepatitis.

Another article in the same issue reported on a study by doctors in Switzerland. They had become concerned after seeing several patients with severe liver damage who had been using Herbalife products and tried to determine how prevalent liver toxicity due to Herbalife products might be. They surveyed all departments of medicine at 121 Swiss public hospitals, divisions of gastroenterology/hepatology, pathology and the Swiss pharmacovigilance database and identified 10 cases of liver toxicity in otherwise healthy people not taking any other herbal products or medications from 1998-2004. Rigorous questioning proved necessary as patients consistently underreported their use of herbal products, they said. They carefully documented the cases, including obtaining liver biopsies in most. Three of the ten patients had potentially life-threatening liver failure requiring liver transplants.

“The lack of labeling of contents of these products renders causality assessment impossible,” they reported. But using the WHO criteria for Causality Assessment of Suspected Adverse Reactions and expert hepatopathologists blinded to the patient information of herbal use, they determined that two were certainly caused by the Herbalife products, seven cases were probably and one case possibly.

This is not the first time that Herbalife has been in the news and the target of governmental regulatory agencies and concerned medical professionals. As recently reported, it is one of the oldest multi-level marketing companies selling vitamin and herbal products promising better health and slimness. Herbalife has found it especially lucrative to take advantage of poor people in developing countries. MLM is a sales technique where people, working as independent distributors, buy sales kits and products which they sell and, in return, are promised they’ll make money from those sales as well as from a percentage of the sales of those who they recruit as new distributors. However, fewer than 1% of distributors ever earn much money and many are stuck with thousands of dollars of products. MLM and pyramid schemes are listed on many attorney generals' top ten lists of consumer complaints. At MLM Watch.org, you can read more about MLM, including a summary of complaints that have previously been submitted to the FTC on Herbalife products.

A few years ago, the National Council Against Health Fraud issued a position paper on MLM health product companies. It listed important precautions for consumers, as well as described the harm that’s come to people who’ve gotten mixed up in them. Dr. Stephen Barrett, M.D., NCAHF Vice President, examined more than 100 MLM companies offering health-related products and concluded “that every one of them has made false or misleading claims in their promotional materials.” He said:

The products promoted as remedies are either bogus, unproven or intended for conditions that are unsuitable for self-medication...Most supplement companies get their raw ingredients from the same bulk wholesalers and merely repackage them...During the past several years, many physicians have begun selling health-related multilevel products to patients in their offices. Doctors are typically recruited with promises that the extra income will replace income lost to managed care....During the past 20 years, more than 25 health-related MLM companies have faced regulatory actions for false advertising, operating a pyramid scheme, or both. Although such actions usually improve future behavior, they rarely provide adequate redress for victims. Moreover, the number of MLM frauds known to Federal Trade Commission vastly exceeds its capacity to prosecute them on a case-by-case basis.

The growing reports of life-threatening health risks among users of these products remind us to not to be taken in by claims of magical benefits of any dietary intervention. Beyond preventing deficiencies — which is easily achieved by virtually everyone simply when enjoying all sorts of foods — no food or supplement is supernatural. When we hear claims that optimal or personalized nutrition is science-based and can improve our heart, digestive or immune health; help us age healthfully, improve our memory or eyesight, or remove wrinkles; increase our energy and fitness; or manage weight, control our appetite or boost metabolism...we know it sounds too good to be true.