Liver damage frequently occurs as a result of using medicines and their byproducts, since it is the most important organ for metabolizing medicines ( 1). Safflower oil 171 mg (linoleic acid 73%, oleic acid 13%, linoleic acid 0.3%), natural peach flavor (genetically modified) 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 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 pylori infection was conducted in later therapeutic period.Ģ02 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 lecithinĬalcium 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 Considering elevated hepatogram values, eradication therapy of H. Gastroscopy confirmed Helicobacter (H.) pylori positive chronic gastritis, but no signs of portal hypertension. There were no signs of lithiasis or biliary obstruction ( Fig. Upper abdomen ultrasound revealed normal size but diffuse hyperechoic liver. Immunologic examination (antinuclear antibodies, antimitochondrial antibodies, antibodies against smooth muscle cells, antibodies against liver or kidneys ) excluded autoimmune etiology of liver damage. The levels of serum copper, ferritin and transferrin saturation were normal. Positive anti-hepatitis A virus (HAV) antibodies pointed to HAV. Serologic tests excluded hepatitis B and C infection, as well as cytomegalovirus and Epstein-Barr virus infection or reactivation. Complete blood count, inflammation parameters, glucose, electrolytes, kidney function parameters, thyroid hormones and thyroid-stimulating hormone were also normal ( Table 2). Coagulation parameters and proteinogram were normal. Initial laboratory tests showed significantly elevated markers of hepatocellular damage ( Table 1). Icterus was noticed during physical examination, however, there was no chronic liver disease stigmata. At admission, she was hemodynamically stable and not febrile. Epidemiology and family history were negative. She denied alcohol or drug addiction, taking any medicine as acute or chronic therapy, receiving blood transfusions and/or any blood products. The patient did not have any severe illnesses or any similar problems before. Taking into consideration the growing consumption of herbal products and their potential harmfulness, we consider that more strict regulations of their production process and sale are necessary, including exact identification of active substances with a list of ingredients, toxicologic testing and obligatory side effect report.Ī 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 prior to hospital admission. After removing the Herbalife® products, liver damage resolved and there was no need to perform liver biopsy. The exact mechanism of liver damage in our patient was not determined. We excluded alcohol, viral, metabolic, autoimmune and neoplastic causes of liver lesions, as well as vascular liver disease, but we noticed a connection between the use of Herbalife® products and liver damage. This case report describes liver damage that was highly suspected to originate from Herbalife® products consumption. A growing body of references accentuate their harmful effects, in particular hepatotoxicity, which varies from minimal hepatogram changes to fulminant hepatitis requiring liver transplantation. However, as their use is not subjected to strict pre-marketing testing and regulations, their ingredients are not clearly defined and there is no quality control or proof of their effectiveness and safety. Lately there has been an increased consumption of herbal preparations, distributed as nutritional supplements, often claimed to be ‘natural’ and harmless.
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