Hepatotoxicity associated with dietary energy supplements: use and abuse by young athletes.
In recent years there has been a significant increase in the consumption of dietary energy supplements (DES) associated with the parallel advertising against obesity and favoring high physical performance. We present the case and outcome of a young patient who developed acute mixed liver injury (hepatocellular  and cholestatic) after ingestion of various "over the counter" products to increase muscle mass and physical performance (NO Xplode®, creatine, L-carnitine, and Growth Factor ATN®). The diagnosis was based on the exclusion of other diseases and liver biopsy findings. The dietary supplement and herbal multivitamins industry is one with the highest growth rates in the market, with annual revenues amounting to billions and constantly lacking scientific or reproducible evidence about the efficacy and/or safety of the offered products. Furthermore, and contrary to popular belief, different forms of injury associated with these natural substances have been documented particularly in the liver, supporting the need of a more strict regulation.
Gastroenterology Department, National Medical Center, Hospital de Especialidades, CMN Siglo XXI, IMSS, Mexico City, Mexico.
Giovanni
G
Avelar-Escobar
Jorge
J
Méndez-Navarro
Nayeli X
NX
Ortiz-Olvera
Guillermo
G
Castellanos
Roberto
R
Ramos
Víctor E
VE
Gallardo-Cabrera
José de Jesús
Jde J
Vargas-Alemán
Oscar
O
Díaz de León
Elda V
EV
Rodríguez
Margarita
M
Dehesa-Violante
D000208:Acute Disease; D000293:Adolescent; D056352:Athletes; D054874:Athletic Performance; D015415:Biomarkers / Q000097:blood; D001706:Biopsy; D002331:Carnitine / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002779:Cholestasis / Q000097:blood / Q000139:chemically induced* / Q000175:diagnosis / Q000188:drug therapy; D003401:Creatine / Q000009:adverse effects; D019587:Dietary Supplements / Q000009:adverse effects*; D006801:Humans; D008099:Liver / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000378:metabolism / Q000473:pathology; D008111:Liver Function Tests; D008279:Magnetic Resonance Imaging; D008297:Male; D004366:Nonprescription Drugs / Q000009:adverse effects*; D058573:Performance-Enhancing Substances / Q000009:adverse effects*; D014463:Ultrasonography
D015415:Biomarkers; D004366:Nonprescription Drugs; D058573:Performance-Enhancing Substances; D003401:Creatine; D002331:Carnitine