Food supplements – are they safe

Abstract

Recently, it has become more and more common in practice to prescribe and use dietary supplements, often in combination with medications, for various chronic neurological disorders. Evidence of herbal and dietary supplement-induced liver injury (HILI) as part of the drug-induced liver injury (DILI) group are increasing in the literature. Such liver damage can also be caused by ingredients considered useful and harmless, such as green tea or turmeric. The mechanism is probably a form of idiosyncrasy. The clinical picture ranges from asymptomatic elevated liver enzymes, to severe liver failure and encephalopathy. It usually manifests itself with non-specific symptoms such as fatigue, anorexia, nausea or cholestasis. Usually, stopping the causative ingredient is sufficient for treatment, in more severe cases, treatment with prednisone or n-acetyl cysteine is required. In 2% of the patients, a liver transplant is required.
In conclusion, herbal products and dietary supplements are potentially beneficial in combination therapy, but they are not harmless. In comorbidities and in combinations, they can lead to hepatotoxicity and drug interactions. Further studies are needed, as well as extensive training of doctors, patients and pharmacists, as well as education and informing health authorities and the public about the possible benefits and risks of using dietary supplements and herbal products for treatment in practice.