Patients are being admitted to hospital for severe liver injuries due to herbal and dietary supplements that claim to promote weight loss or muscle growth. Some people were even required to have a liver transplant.Dr Emily Nash, Royal Prince Alfred hospital, conducted a study that examined hospital records for 184 adults who were admitted to the AW Morrow Gastroenterology and Liver Centre because of drug-induced liver damage. The study covered the period 2009 through 2020. Her co-authors discovered that liver injury cases related to herbal and nutritional supplements rose from two out 11 patients (15%) in 200911 to 10 out 19 patients (47%) in 201820.Paracetamol overdose can cause liver injury. This is a common medication used to treat fever and pain. 19 of the 69 cases with non-paracetamol-related liver injury involved antibiotics; 15 used herbal and dietary supplementation, and the remainder involved anti-tuberculosis and anti-cancer medication.The study published in Monday's Medical Journal of Australia found that transplant-free survival was even worse for non-paracetamol-related liver injury. Specialist transplant hepatologist Dr Ken Liu was also a co-author. He said that he was seeing more patients suffering from liver injury due to drugs not usually associated with liver harm.He said that he was seeing liver injuries in patients who had been admitted for liver injury due to bodybuilding or weight loss supplements in males. It was so alarming that I decided to do some research on the matter.Liu and his coworkers said that there should be more strict regulatory oversight of supplements and alternative and natural therapies. The researchers also found that almost half of patients suffering from supplement-induced severe liver damage were not of European ethnicity. Liu stated that more community education was required about the dangers of supplements to be culturally sensitive.Dr Ken Harvey is a public health physician and president of Friends of Science in Medicine. He stated that Lius study was limited to the most severe cases of supplement-induced liver damage and that the actual rate of harm could be much higher.Harvey stated that the study was limited to severe liver injuries only and cannot be used to determine the incidence of liver damage from complementary medicine in Australia.The Therapeutic Goods Administration (TGA), a drug regulator, introduced the Therapeutic Goods (Permissible Indices) Determination in 2018. Complementary medicine manufacturers could no longer create their own benefits, also known as indications. Instead, they had to use a TGA-approved list.Harvey stated that Harvey allowed the natural and complementary therapies industry to create the list. This led to 86% of the 1,021 permitted indications being supported by traditional evidence rather than scientific. This effectively eliminated the need for complementary medicine to have a scientific proof base. It is not surprising that the number of medicines listed as traditional uses and containing herbs has increased.Harvey stated that there is no pre-market evaluation done by the TGA and that limited post-marketing surveillance indicates a high degree of regulatory non-compliance.Harvey also stated that herbal and dietary supplements bought online from overseas are exempted from Australian regulatory oversight.Low-risk products do not necessarily mean that there is no risk. TGA should increase post-marketing surveillance of listed products, particularly Chinese traditional and Ayurveda medicines, which have been linked to adverse events, contamination, and adulteration. The findings should be made public.The Royal Australian College of General Practitioners and Choice, Friends of Science in Medicine, and other groups have requested an educational statement regarding the promotional materials and packs of traditional medicines. For example, "This product is based upon traditional beliefs and no modern scientific evidence."Harvey stated that the TGA and industry opposed this. However, it is still necessary.
