Background/Aims
Nutritional supplements are frequently considered to be harmless but indiscriminate
use of unlabelled ingredients may lead to significant adverse reactions.
Methods
In 2004, identification of four index cases of acute hepatitis associated with Herbalife® intake led to a ministry of health investigation in all Israeli hospitals. Twelve
patients with acute idiopathic liver injury in association with consumption of Herbalife® products were investigated.
Results
Eleven of the patients were females, aged 49.5 ± 13.4 y. One patient had stage I primary biliary cirrhosis and another had hepatitis
B. Acute liver injury was diagnosed after 11.9 ± 11.1 months of initiation of Herbalife® consumption. Liver biopsies demonstrated active hepatitis, portal inflammation rich
with eosinophils, ductular reaction and parenchymal inflammation with peri-central
accentuation. One patient developed sub-fulminant and two fulminant episodes of hepatic
failure. Hepatitis resolved in eleven patients, while one patient succumbed to complications
following liver transplantation. Three patients resumed consumption of Herbalife® products following normalization of liver enzymes, resulting in a second bout of
hepatitis.
Conclusions
An association between intake of Herbalife® products and acute hepatitis was identified in Israel. We call for prospective evaluation
of Herbalife® products for possible hepatotoxicity. Until then, caution should be exercised by
consumers, especially among individuals suffering from underlying liver disease.
Keywords
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Article info
Publication history
Published online: August 02, 2007
Accepted:
June 6,
2007
Received in revised form:
June 4,
2007
Received:
April 19,
2007
Associate Editor: C.P. DayFootnotes
☆The authors who have taken part in this study declared that they do not have anything to disclose regarding conflict of interest with respect to this manuscript.
Identification
Copyright
© 2007 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.
