Gastroenterology

Volume 148, Issue 3, March 2015, Pages 517–532.e3

Reviews and Perspectives

Herbal Products and the Liver: A Review of Adverse Effects and Mechanisms

• Leonard B. Seeff^{1, ,} ,
• Herbert L. Bonkovsky²,
• Victor J. Navarro³,
• Guqi Wang⁴

doi:10.1053/j.gastro.2014.12.004

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Refers To

• Raj Vuppalanchi, Victor Navarro, Maricruz Vega, Herbert L. Bonkovsky, Leonard Seeff, Jose Serrano, Drug-Induced Liver Injury Network (DILIN)

• Herbal Dietary Supplement Associated Hepatotoxicity: An Upcoming Workshop and Need for Research

• Gastroenterology, Volume 148, Issue 3, March 2015, Pages 480-482
• •  Purchase PDF (123 K)

Referred to by

• Raj Vuppalanchi, Victor Navarro, Maricruz Vega, Herbert L. Bonkovsky, Leonard Seeff, Jose Serrano, Drug-Induced Liver Injury Network (DILIN)

• Herbal Dietary Supplement Associated Hepatotoxicity: An Upcoming Workshop and Need for Research

• Gastroenterology, Volume 148, Issue 3, March 2015, Pages 480-482
• •  Purchase PDF (123 K)

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Herbal products have been used for centuries among indigenous people to treat symptoms and illnesses. Recently, their use in Western countries has grown significantly, rivaling that of prescription medications. Currently, herbal products are used mainly for weight loss and bodybuilding purposes but also to improve well-being and symptoms of chronic diseases. Many people believe that because they are natural, they must be effective and safe; however, these beliefs are erroneous. Few herbal products have been studied in well-designed controlled trials of patients with liver or other diseases, despite testimony to the contrary. Moreover, current highly effective antiviral drugs make efforts to treat hepatitis C with herbal products redundant. Herbal products are no safer than conventional drugs and have caused liver injury severe enough to require transplantation or cause death. Furthermore, their efficacy, safety, and claims are not assessed by regulatory agencies, and there is uncertainty about their reported and unreported contents. We review the history of commonly used herbal products, as well as their purported efficacies and mechanisms and their adverse effects.

Keywords

• Dietary Supplement Health and Education Act;
• Contamination and Adulteration;
• Herbal Therapie;
• sSilymarin

Abbreviations used in this paper

• ALT, alanine aminotransferase;
• CAM, complementary and alternative medicine;
• CHC, chronic hepatitis C;
• CYP, cytochrome P450;
• DILI, drug-induced liver injury;
• DILIN, Drug-Induced Liver Injury Network;
• EGCG, epigallocatechin gallate;
• FDA, Food and Drug Administration;
• HBeAg, hepatitis B e antigen;
• HBV, hepatitis B virus;
• HCV, hepatitis C virus;
• HIV, human immunodeficiency virus;
• IFN, interferon;
• mRNA, messenger RNA;
• NAFLD, nonalcoholic fatty liver disease;
• SNMC, Stronger Neo-Minophagen C;
• TCM, traditional Chinese medicine

Conflicts of interest The authors disclose no conflicts.

Funding Supported by a grant (HL 117199) and contract (DK065201) from the National Institutes of Health (to H.L.B.), by funds provided for ancillary studies of the US Drug-Induced Liver Injury Network (to H.L.B. and V.J.N.), and by institutional funds from Carolinas HealthCare System (to G.W. and H.L.B.).

Reprint requests Address requests for reprints to: Leonard B. Seeff, MD, fax: (301) 767-0392.

Copyright © 2015 AGA Institute. Published by Elsevier Inc. All rights reserved.