A recent article in Hepatology, comments on an increase in herbal and dietary supplements (HDS) induced liver injury in the United States. The increase in incidence of HDS-induced liver injury, referenced in the article is 20%, (1) but there are some suspect research practices which may be impacting this number far more than responsibly prescribed herbal formulations.

Commentary on this article point out some crucial shortcomings, which are important to acknowledge. Stefan Gafner, PhD, chief scientific officer at the American Botanical Council, points out that the the percentages which are alluded to in this article may be true, that the toxic liver events arising from herbal supplements probably has increased over the last 10 years, but that that number is still very low(2). The method of inclusion of supplements reviewed in this article is also concerning. Many of the supplements which were suspect in the research contained anabolic steroids, labeled as esoteric herbal extracts. These supplements were not separated from other “non-illegal” formulations. Toxic adulteration was also not a concern of this study.

The most impactful element of the study is likely to be the support for green tea extract contributing to liver injury. Other articles do support this conclusion (3,4), though there are other factors including GSH status, and phenolic content of green tea extracts. This research supports the importance of considering herbal extracts potent m

edicinal agents and our responsibility to educate patients on the appropriate use of dietary supplements.

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