Herbal weight-loss aids are sold for self-medication and are often used under the delusion that their natural origin ensures their safety. They are not required to conduct any benefit and risk evaluation before marketing (Yousaf et al., 2019). Nevertheless, possible risks of using herbal extracts are becoming more and more frequent in the literature. Some herbs are documented as the leading causes of herb-induced liver injury (HILI), with a potentially lethal clinical course and unexpected herb-drug interactions.
Garcinia cambogia (GC) extract and associated products are some of the most widespread supplements marketed for weight loss. In 2009, the U.S. Food and Drug Administration administered a recall of Hydroxycut products with GC due to its indirect connection to liver failure in several case reports (McCarthy et al., 2020). Although GC was asserted as the assumed cause of the hepatotoxic effects, it has never been banned because of a lack of explicit evidence. Most cases of hepatotoxicity associated with GC have come from mixed supplements or formulaic variations, making defining the causal component of supplement-induced hepatoxicity difficult.
Nevertheless, McCarthy et al. (2020) present a case of a 54-year-old woman coming to her local clinic with acute liver failure that required transplantation after ingesting GC for two months. Her initial complaints included jaundice, malaise, as well as dark urine. The findings were consistent with HILI secondary to GC, given the temporal correlation with the GC ingestion and the absence of other potential causes on serology and clinical history. Additionally, the histopathological traits were consistent with the biopsy results in published GC liver toxicity case reports.
Consequently, despite many consumers considering herbal supplements safe, the concern should be raised to increase public awareness regarding the lack of adequate regulation of supplements. Moreover, healthcare professionals should ask patients with unexplained deranged liver function or acute liver failure about food supplements for accurate diagnosis and clinical management. GC is not the only herbal supplement with possible exacerbations; thus, the matter should be monitored and adequately addressed.
References
McCarthy, R. E., Bowen, D. G., Strasser, S. I., & McKenzie, C. (2020). The dangers of herbal weight loss supplements: A case report of drug-induced liver injury secondary to Garcinia Cambogia ingestion and literature review. Pathology, 53(4), 545-547.
Yousaf, M. N., Chaudhary, F. S., Hodanazari, S. M., & Sittambalam, C. D. (2019). Hepatotoxicity associated with Garcinia cambogia: A case report. World Journal of Hepatology, 11(11), 735.
Appendix A
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Appendix B
Demographic Information for Cummings et al. (2002)’s Review
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