title: Herbal does not mean innocuous: ten cases of severe hepatotoxicity associated with dietary supplements from Herbalife products.
abstract: OBJECTIVE
  Herbal agents are popular and perceived as safe because they are supposedly 'natural'. We report 10 cases of toxic hepatitis implicating Herbalife products.
  
  
  METHODS
  To determine the prevalence and outcome of hepatotoxicity due to Herbalife products. A questionnaire was sent to all public Swiss hospitals. Reported cases were subjected to causality assessment using the CIOMS criteria.
  
  
  RESULTS
  Twelve cases of toxic hepatitis implicating Herbalife preparations (1998-2004) were retrieved, 10 sufficiently documented to permit causality analysis. Median age of patients was 51 years (range 30-69) and latency to onset was 5 months (0.5-144). Liver biopsy (7/10) showed hepatic necrosis, marked lymphocytic/eosinophilic infiltration and cholestasis in five patients. One patient with fulminant liver failure was successfully transplanted; the explant showed giant cell hepatitis. Sinusoidal obstruction syndrome was observed in one case. Three patients without liver biopsy presented with hepatocellular (2) or mixed (1) liver injury. Causality assessment of adverse drug reaction was classified as certain in two, probable in seven and possible in one case(s), respectively.
  
  
  CONCLUSIONS
  We present a case series of toxic hepatitis implicating Herbalife products. Liver toxicity may be severe. A more detailed declaration of components and pro-active role of regulatory agencies would be desirable.
authors: University Hospital of Bern, Gastroenterology Clinic, Bern, Switzerland.
authors: Alain M
authors: AM
authors: Schoepfer
authors: Antoinette
authors: A
authors: Engel
authors: Karin
authors: K
authors: Fattinger
authors: Urs A
authors: UA
authors: Marbet
authors: Dominique
authors: D
authors: Criblez
authors: Juerg
authors: J
authors: Reichen
authors: Arthur
authors: A
authors: Zimmermann
authors: Carl M
authors: CM
authors: Oneta
mesh_terms: D000328:Adult; D000368:Aged; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000453:epidemiology* / Q000473:pathology; D019587:Dietary Supplements / Q000009:adverse effects*; D029789:Ephedra / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011795:Surveys and Questionnaires; D013557:Switzerland / Q000453:epidemiology
chemical_list: C087890:Herbalife