tag:blogger.com,1999:blog-18481697069762435722023-11-16T05:25:50.379-08:00CELL-U-LOSS-KIDNEY-LIVER-SIDE EFFECTSherbalife side effects,herbalife side effects kidney,herbalife side effects 21 day cleanse,herbalife diet side effects,herbalife shake side effects,herbalife a pyramid scheme,Cancer,Damage,Pregnancy
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ravi sundaram,herbalife ravi sundaram,herbalife ravi sundaram chennai,join herbalife malaysiaLIVER AND KIDNEY CAREhttp://www.blogger.com/profile/06962952006102031340noreply@blogger.comBlogger3125tag:blogger.com,1999:blog-1848169706976243572.post-7596692536280678652012-12-03T07:34:00.005-08:002012-12-04T04:06:20.757-08:00<div dir="ltr" style="text-align: left;" trbidi="on">
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<a href="http://herbalife-kidney-effect.blogspot.in/" target="_blank"><b><span style="font-size: large;">HERBAL VS KIDNEY SIDE EFFECTS</span></b></a></div>
<h1 class="title" style="text-align: center;">
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<h1 class="title" style="text-align: center;">
<span style="font-size: medium;"><b> </b></span><a href="http://www.kidney.org/atoz/content/herbalsupp.cfm" target="_blank"><span style="font-size: large;">Use of Herbal Supplements in </span></a></h1>
<h1 class="title" style="text-align: center;">
<a href="http://www.kidney.org/atoz/content/herbalsupp.cfm" target="_blank"><span style="font-size: large;">Chronic Kidney Disease</span></a></h1>
<h1 class="title">
<span style="font-size: medium;"><b> As a chronic kidney disease (CKD) patient, you may have considered
the use of herbal products to assist you with various health concerns.
This fact sheet will give you some information to enable you to make
decisions regarding your use of herbs.</b></span></h1>
<span style="font-size: medium;"><b>Use of herbal supplements may be unsafe for CKD patients, since your
body is not able to clear waste products like a healthy person. There
are some facts about herbs that every CKD patient should know:</b></span><br />
<ul>
<li><span style="font-size: medium;"><b>Very few herbs have been studied in CKD patients. What may be safe
for healthy persons may not be safe for someone with CKD, and in fact,
could be dangerous. Therefore, you need to be very cautious about your
use of these products.</b></span></li>
<li><span style="font-size: medium;"><b>The government does not regulate herbal supplements, so the exact content of these products is unknown.</b></span></li>
<li><span style="font-size: medium;"><b>Without regulation, there are no requirements for testing, so the purity, safety and effectiveness of the products are unknown.</b></span></li>
<li><span style="font-size: medium;"><b>Herbal preparations are subject to contamination (may contain toxic heavy metals such as lead or mercury).</b></span></li>
<li><span style="font-size: medium;"><b>Products may contain minerals harmful to CKD patients, for example: potassium.</b></span></li>
</ul>
<span style="font-size: medium;"><b> Some herbs that may serve as diuretics may also cause “kidney
irritation” or damage. These include bucha leaves and juniper berries.
Uva Ursi and parsley capsules may have negative side effects as well.</b></span><br />
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<span style="font-size: medium;"><b>Many herbs can interact with prescription drugs. A few examples are
St. Johns Wort, echinacea, ginkgo, garlic, ginseng, ginger, and blue
cohosh. Transplant patients are especially at risk, as any interaction
between herbs and medications could potentially put them at risk for
rejection or losing the kidney. It is important to ask your doctor
and/or pharmacist about any herbs or medicines you want to take to avoid
potential problems.</b></span><br />
<br />
<table border="1" cellpadding="4" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td colspan="2"><div align="center">
<span style="font-size: medium;"><b>Herbs that may be toxic to the kidneys</b></span></div>
</td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Artemisia absinthium (wormwood plant)</b></span></td>
<td><span style="font-size: medium;"><b>Periwinkle</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Autumn crocus</b></span></td>
<td><span style="font-size: medium;"><b> Sassafras </b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Chuifong tuokuwan (Black Pearl)</b></span></td>
<td><span style="font-size: medium;"><b>Tung shueh</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Horse chestnut</b></span></td>
<td><span style="font-size: medium;"><b>Vandelia cordifolia</b></span></td>
</tr>
</tbody></table>
<span style="font-size: medium;"><b><br /></b></span>
<br />
<table border="1" cellpadding="4" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td colspan="5"><div align="center">
<span style="font-size: medium;"><b> Herbs that may be harmful in chronic kidney disease </b></span></div>
</td>
</tr>
<tr>
<td width="26%"><span style="font-size: medium;"><b>Alfalfa</b></span></td>
<td width="21%"><span style="font-size: medium;"><b>Buckthorn</b></span></td>
<td width="19%"><span style="font-size: medium;"><b>Ginger</b></span></td>
<td width="20%"><span style="font-size: medium;"><b>Nettle</b></span></td>
<td width="21%"><span style="font-size: medium;"><b>Vervain</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Aloe</b></span></td>
<td><span style="font-size: medium;"><b>Capsicum</b></span></td>
<td><span style="font-size: medium;"><b>Ginseng</b></span></td>
<td><span style="font-size: medium;"><b>Noni juice</b></span></td>
<td width="20%"><br /></td>
</tr>
<tr>
<td width="20%"><span style="font-size: medium;"><b>Bayberry</b></span></td>
<td width="20%"><span style="font-size: medium;"><b>Cascara</b></span></td>
<td><span style="font-size: medium;"><b>Horsetail</b></span></td>
<td><span style="font-size: medium;"><b>Panax</b></span></td>
<td><br /></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Blue Cohosh</b></span></td>
<td><span style="font-size: medium;"><b>Coltsfoot</b></span></td>
<td><span style="font-size: medium;"><b>Licorice</b></span></td>
<td><span style="font-size: medium;"><b>Rhubarb</b></span></td>
<td><br /></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Broom</b></span></td>
<td><span style="font-size: medium;"><b>Dandelion</b></span></td>
<td><span style="font-size: medium;"><b>Mate</b></span></td>
<td><span style="font-size: medium;"><b>Senna</b></span></td>
<td><br /></td>
</tr>
</tbody></table>
<span style="font-size: medium;"><b><br /></b></span>
<br />
<table border="1" cellpadding="4" cellspacing="0" style="width: 100%px;">
<tbody>
<tr>
<td colspan="2"><span style="font-size: medium;"><b>Herbs known to be unsafe for all people</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Chapparal</b></span></td>
<td><span style="font-size: medium;"><b>Pennyroyal</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Comfrey</b></span></td>
<td><span style="font-size: medium;"><b>Pokeroot</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Ephedra (Ma Huang)</b></span></td>
<td><span style="font-size: medium;"><b>Sassafras</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Lobelia</b></span></td>
<td><span style="font-size: medium;"><b>Senna</b></span></td>
</tr>
<tr>
<td><span style="font-size: medium;"><b>Mandrake</b></span></td>
<td><span style="font-size: medium;"><b>Yohimbe</b></span></td>
</tr>
</tbody></table>
<br />
<span style="font-size: medium;"><b>These lists are not necessarily complete. More information regarding
the use of herbs will become available over time. You are encouraged to
proceed with caution with <i>all</i> herbal preparations and use them only under the direction of your medical team.</b></span><br />
<span style="font-size: medium;"><b>With all of these cautions, perhaps you are wondering if use of any
herbs is a good idea. The use of common herbs, in normal amounts, when
cooking is just fine and typically recommended to enhance the flavor of
foods on a low-sodium diet.</b></span><br />
<span style="font-size: medium;"><b>So, before you take any herbal supplement, we recommend:</b></span><br />
<ul>
<li><span style="font-size: medium;"><b>Checking with your doctor, dietitian, pharmacist and/or product
manufacturer regarding safety, dosage, duration of use, interactions
with prescription drugs, etc.</b></span></li>
<li><span style="font-size: medium;"><b>Use only standardized herbal extracts made by reputable companies.</b></span></li>
<li><span style="font-size: medium;"><b>Never take more than the recommended dosage, or longer than recommended.</b></span></li>
<li><span style="font-size: medium;"><b>Do not use herbal remedies for serious illness.</b></span></li>
<li><span style="font-size: medium;"><b>Do not use herbs if considering pregnancy.</b></span></li>
</ul>
<span style="font-size: medium;"><b>Remember … natural does not mean safe, especially for CKD patients. Be smart and ask questions before using any herbal products.</b></span><br />
<span style="font-size: medium;"><b>The following references can provide additional information regarding the use of herbal supplements:</b></span><br />
<ul><span style="font-size: medium;"><b>American Botanical Council<br /><a href="http://www.kidney.org/exit_page.cfm?link=www.herbalgram.org/">www.herbalgram.org</a></b></span><br /><span style="font-size: medium;"><b>National Center for Complementary and Alternative Medicine<br /><a href="http://www.kidney.org/exit_page.cfm?link=nccam.nih.gov/">nccam.nih.gov</a></b></span><br /><span style="font-size: medium;"><b>National Library of Medicine, Medline Plus<br /><a href="http://www.kidney.org/exit_page.cfm?link=www.nlm.nih.gov/medlineplus/alternativemedicine.html">www.nlm.nih.gov/medlineplus/alternativemedicine.html</a></b>
<b><br /><a href="http://www.kidney.org/exit_page.cfm?link=www.nlm.nih.gov/medlineplus/herbalmedicine.html">www.nlm.nih.gov/medlineplus/herbalmedicine.html</a></b></span><br /><span style="font-size: medium;"><b>United States Pharmacopoeial<br /><a href="http://www.kidney.org/exit_page.cfm?link=www.usp.org/">www.usp.org</a></b></span></ul>
<span style="font-size: medium;"><b><i>PDR for Herbal Medicines</i> . Gruenwald J, Bendler T, Jaenicke C, eds. Montvale NJ: Medical Economics Company, Inc., 2000</b></span><br />
<span style="font-size: medium;"><b><i>The Honest Herbal</i> . Tyler V. Pharmaceutical Products Press, New York, 1999</b></span><br />
<div class="small">
<span style="font-size: medium;"><b>More than 20 million Americans—one in nine adults—have
chronic kidney disease, and most don't even know it. More than 20
million others are at increased risk. The National Kidney Foundation, a
major voluntary health organization, seeks to prevent kidney and urinary
tract diseases, improve the health and well-being of individuals and
families affected by these diseases, and increase the availability of
all organs for transplantation. Through its 50 affiliates nationwide,
the foundation conducts programs in research, professional education,
patient and community services, public education and organ donation. The
work of the National Kidney Foundation is funded by public donations.</b></span></div>
<span style="font-size: medium;">The National Kidney Foundation would like to thank the <br />
Council on Renal Nutrition for the development of this fact sheet.</span><br />
<br />
<span style="font-size: medium;"><span style="font-size: medium;">==================================</span></span><br />
<h1 class="title">
<a href="http://www.kidney.org/kidneydisease/aboutckd.cfm#ckd" target="_blank"><span style="font-size: large;">About Chronic Kidney Disease</span></a></h1>
<span style="font-size: medium;"><b>Chronic kidney disease (CKD) is a condition characterized by a
gradual loss of kidney function over time. To read more about kidney
function, see <a href="http://www.kidney.org/kidneydisease/howkidneyswrk.cfm">How Your Kidneys Work</a>. CKD is also known as chronic renal disease.</b></span><br />
<ul>
<li><span style="font-size: medium;"><b><a href="http://www.kidney.org/kidneydisease/aboutckd.cfm#ckd">What is Chronic Kidney Disease (CKD)?</a></b></span></li>
<li><span style="font-size: medium;"><b><a href="http://www.kidney.org/kidneydisease/aboutckd.cfm#facts">The Facts About Chronic Kidney Disease (CKD)</a></b></span></li>
<li><span style="font-size: medium;"><b><a href="http://www.kidney.org/kidneydisease/aboutckd.cfm#causes">What Causes CKD?</a></b></span></li>
<li><span style="font-size: medium;"><b><a href="http://www.kidney.org/kidneydisease/aboutckd.cfm#symptoms">What Are the Symptoms of CKD?</a></b></span></li>
<li><span style="font-size: medium;"><b><a href="http://www.kidney.org/kidneydisease/aboutckd.cfm#gfr">Learn about Glomerular Filtration Rate (GFR)</a></b></span></li>
</ul>
<span style="font-size: medium;"><b><a href="http://www.blogger.com/blogger.g?blogID=162178159833053852" name="ckd"></a></b></span>
<br />
<h2>
<span style="font-size: medium;">What is chronic kidney disease (CKD)?</span></h2>
<span style="font-size: medium;"><b>Chronic kidney disease includes conditions that damage your
kidneys and decrease their ability to keep you healthy by doing the jobs
listed. If kidney disease gets worse, wastes can build to high levels
in your blood and make you feel sick. You may develop complications like
high blood pressure, anemia (low blood count), weak bones, poor
nutritional health and nerve damage. Also, kidney disease increases your
risk of having heart and blood vessel disease. These problems may
happen slowly over a long period of time. Chronic kidney disease may be
caused by diabetes, high blood pressure and other disorders. Early
detection and treatment can often keep chronic kidney disease from
getting worse. When kidney disease progresses, it may eventually lead to
kidney failure, which requires dialysis or a kidney transplant to
maintain life.</b></span><br />
<span style="font-size: medium;"><b><a href="http://www.blogger.com/blogger.g?blogID=162178159833053852" name="facts"></a></b></span>
<br />
<h2>
<span style="font-size: medium;">The Facts About Chronic Kidney Disease (CKD)</span></h2>
<ul>
<li><span style="font-size: medium;"><b>26 million American adults have CKD and millions of others are at increased risk.</b></span></li>
<li><span style="font-size: medium;"><b>Early detection can help prevent the progression of kidney disease to kidney failure.</b></span></li>
<li><span style="font-size: medium;"><b>Heart disease is the major cause of death for all people with CKD.</b></span></li>
<li><span style="font-size: medium;"><b>Glomerular filtration rate (GFR) is the best estimate of kidney function.</b></span></li>
<li><span style="font-size: medium;"><b>Hypertension causes CKD and CKD causes hypertension.</b></span></li>
<li><span style="font-size: medium;"><b>Persistent proteinuria (protein in the urine) means CKD is present.</b></span></li>
<li><span style="font-size: medium;"><b>High risk groups include those with diabetes, hypertension and family history of kidney disease.</b></span></li>
<li><span style="font-size: medium;"><b>African Americans, Hispanics, Pacific Islanders, Native Americans and Seniors are at increased risk.</b></span></li>
<li><span style="font-size: medium;"><b>Three simple tests can detect CKD: blood pressure, urine albumin and serum creatinine.</b></span></li>
</ul>
<span style="font-size: medium;"><b><a href="http://www.blogger.com/blogger.g?blogID=162178159833053852" name="causes"></a></b></span>
<br />
<h2>
<span style="font-size: medium;">What causes CKD?</span></h2>
<span style="font-size: medium;"><b>The two main causes of chronic kidney disease are diabetes and
high blood pressure, which are responsible for up to two-thirds of the
cases. Diabetes happens when your blood sugar is too high, causing
damage to many organs in your body, including the kidneys and heart, as
well as blood vessels, nerves and eyes. High blood pressure, or
hypertension, occurs when the pressure of your blood against the walls
of your blood vessels increases. If uncontrolled, or poorly controlled,
high blood pressure can be a leading cause of heart attacks, strokes and
chronic kidney disease. Also, chronic kidney disease can cause high
blood pressure.</b></span><br />
<span style="font-size: medium;"><b>Other conditions that affect the kidneys are:</b></span><br />
<ul>
<li><span style="font-size: medium;"><b>Glomerulonephritis, a group of diseases that cause inflammation
and damage to the kidney's filtering units. These disorders are the
third most common type of kidney disease.</b></span></li>
<li><span style="font-size: medium;"><b>Inherited diseases, such as polycystic kidney disease, which
causes large cysts to form in the kidneys and damage the surrounding
tissue.</b></span></li>
<li><span style="font-size: medium;"><b>Malformations that occur as a baby develops in its mother's
womb. For example, a narrowing may occur that prevents normal outflow of
urine and causes urine to flow back up to the kidney. This causes
infections and may damage the kidneys.</b></span></li>
<li><span style="font-size: medium;"><b>Lupus and other diseases that affect the body's immune system.</b></span></li>
<li><span style="font-size: medium;"><b>Obstructions caused by problems like kidney stones, tumors or an enlarged prostate gland in men.</b></span></li>
<li><span style="font-size: medium;"><b>Repeated urinary infections.</b></span></li>
</ul>
<span style="font-size: medium;"><b><a href="http://www.blogger.com/blogger.g?blogID=162178159833053852" name="symptoms"></a></b></span>
<br />
<h2>
<span style="font-size: medium;">What are the symptoms of CKD?</span></h2>
<span style="font-size: medium;"><b>Most people may not have any severe symptoms until their kidney disease is advanced. However, you may notice that you:</b></span><br />
<ul>
<li><span style="font-size: medium;"><b>feel more tired and have less energy</b></span></li>
<li><span style="font-size: medium;"><b>have trouble concentrating</b></span></li>
<li><span style="font-size: medium;"><b>have a poor appetite</b></span></li>
<li><span style="font-size: medium;"><b>have trouble sleeping</b></span></li>
<li><span style="font-size: medium;"><b>have muscle cramping at night</b></span></li>
<li><span style="font-size: medium;"><b>have swollen feet and ankles</b></span></li>
<li><span style="font-size: medium;"><b>have puffiness around your eyes, especially in the morning</b></span></li>
<li><span style="font-size: medium;"><b>have dry, itchy skin</b></span></li>
<li><span style="font-size: medium;"><b>need to urinate more often, especially at night.</b></span></li>
</ul>
<span style="font-size: medium;"><b>Anyone can get chronic kidney disease at any age. However, some
people are more likely than others to develop kidney disease. You may
have an increased risk for kidney disease if you:</b></span><br />
<ul>
<li><span style="font-size: medium;"><b>have diabetes </b></span></li>
<li><span style="font-size: medium;"><b>have high blood pressure</b></span></li>
<li><span style="font-size: medium;"><b>have a family history of chronic kidney disease</b></span></li>
<li><span style="font-size: medium;"><b>are older</b></span></li>
<li><span style="font-size: medium;"><b>belong to a population group that has a high rate of diabetes or
high blood pressure, such as African Americans, Hispanic Americans,
Asian, Pacific Islanders, and American Indians.</b></span></li>
</ul>
<span style="font-size: medium;"><b><a href="http://www.blogger.com/blogger.g?blogID=162178159833053852" name="gfr"></a></b></span>
<br />
<h2>
<span style="font-size: medium;">Learn more About Glomerular Filtration Rate (GFR)</span></h2>
<span style="font-size: medium;"><b>GFR—glomerular filtration rate is the best test to measure your
level of kidney function and determine your stage of kidney disease.
Your doctor can calculate it from the results of your blood creatinine
test, your age, race, gender and other factors.</b></span><br />
<span style="font-size: medium;"><b>The earlier kidney disease is detected, the better the chance of slowing or stopping its progression.</b></span><br />
<h2>
<span style="font-size: medium;">What happens if my test results show I may have chronic kidney disease?</span></h2>
<span style="font-size: medium;"><b>Your doctor will want to pinpoint your diagnosis and check your
kidney function to help plan your treatment. The doctor may do the
following:</b></span><br />
<ul>
<li><span style="font-size: medium;"><b>Calculate your Glomerular Filtration Rate (GFR), which is the
best way to tell how much kidney function you have. You do not need to
have another test to know your GFR. Your doctor can calculate it from
your blood creatinine, your age, race, gender and other factors. Your
GFR tells your doctor your stage of kidney disease and helps the doctor
plan your treatment.</b></span></li>
<li><span style="font-size: medium;"><b>Perform an ultrasound or CT scan to get a picture of your
kidneys and urinary tract. This tells your doctor whether your kidneys
are too large or too small, whether you have a problem like a kidney
stone or tumor and whether there are any problems in the structure of
your kidneys and urinary tract.</b></span></li>
<li><span style="font-size: medium;"><b>Perform a kidney biopsy, which is done in some cases to check
for a specific type of kidney disease, see how much kidney damage has
occurred and help plan treatment. To do a biopsy, the doctor removes
small pieces of kidney tissue and looks at them under a microscope.</b></span></li>
</ul>
<span style="font-size: medium;"><b>Your doctor may also ask you to see a kidney specialist who will consult on your case and help manage your care.</b></span><br />
<span style="font-size: medium;"><span style="font-size: medium;"> =================</span></span><br />
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LIVER AND KIDNEY CAREhttp://www.blogger.com/profile/06962952006102031340noreply@blogger.com1tag:blogger.com,1999:blog-1848169706976243572.post-45269407072997970682012-12-03T07:34:00.003-08:002012-12-04T04:06:37.049-08:00<div dir="ltr" style="text-align: left;" trbidi="on">
<h3 class="post-title entry-title" itemprop="name">
HERBALIFE VS LIVER DAMAGE
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<a href="http://herbalifes-side-effect.blogspot.in/" target="_blank">UPDATE ON LIVER DAMAGE FROM HERBALIFE, BLACK COHOSH and KAVA</a></h1>
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<span class="meta-prep meta-prep-author"><span style="font-size: large;"><a href="http://healthspanlife.wordpress.com/" rel="home" title="Healthspanlife – the Official Life! Blog">Healthspanlife</a> </span>Posted on</span> <a href="http://healthspanlife.wordpress.com/2012/03/17/697/" rel="bookmark" title="12:00 am"><span class="entry-date">March 17, 2012</span></a> <span class="comments-link"><span class="meta-sep">|</span> <a href="http://healthspanlife.wordpress.com/2012/03/17/697/#comments" title="Comment on UPDATE ON LIVER DAMAGE FROM HERBALIFE, BLACK COHOSH and KAVA">4 Comments</a></span>
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<a href="mailto:neil.burman@gmail.com"><span style="font-family: Arial,sans-serif;">neil.burman@gmail.com</span></a><br />
16 March 2012<br />
<b><span style="font-size: medium;">it is comforting to note that there have been no new reports the past year of toxicity from these products.</span></b><br />
<b><span style="font-size: medium;">In fact some lab work seems to favour black cohosh for cancer prevention;</span></b><br />
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<b><span style="font-size: medium;"><a href="http://www.ncbi.nlm.nih.gov/pubmed#" title="Anticancer research.">Anticancer Res.</a> 2012 Jan;32(1):21-30. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22213284.1">Chemopreventive potential of black cohosh on breast cancer in Sprague-Dawley rats.</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Einbond%20LS%22%5BAuthor%5D">Einbond LS</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Soffritti%20M%22%5BAuthor%5D">Soffritti M</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Degli%20Esposti%20D%22%5BAuthor%5D">Degli Esposti D</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Tibaldi%20E%22%5BAuthor%5D">Tibaldi E</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Lauriola%20M%22%5BAuthor%5D">Lauriola M</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bua%20L%22%5BAuthor%5D">Bua L</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22He%20K%22%5BAuthor%5D">He K</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Genovese%20G%22%5BAuthor%5D">Genovese G</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Su%20T%22%5BAuthor%5D">Su T</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Huggins%20L%22%5BAuthor%5D">Huggins L</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Wang%20X%22%5BAuthor%5D">Wang X</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Roller%20M%22%5BAuthor%5D">Roller M</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Wu%20HA%22%5BAuthor%5D">Wu HA</a>. Columbia University, HHSC-1518, 701 W. 168th Street, New York, NY 10032, USA. <a href="mailto:lseinbond@gmail.com">lseinbond@gmail.com</a>
This study examines the chemopreventive potential and action of the
herb black cohosh on Sprague-Dawley rats. CONCLUSION:Our results suggest
that black cohosh may have chemopreventive potential for mammary
cancer.</span></b></div>
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<b><span style="font-size: medium;">while Herbalife has published objective rebuttals of toxicity from
Herbalife other than in isolated countries where irregular ingredients
were used in local manufacture:</span></b></div>
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<b><span style="font-size: medium;"><a href="http://www.ncbi.nlm.nih.gov/pubmed#" title="World journal of hepatology.">World J Hepatol.</a> 2011 Oct 27;3(10):275-7. <a href="http://www.ncbi.nlm.nih.gov/pubmed/22059112.1">Revisiting acute liver injury associated with herbalife products.</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Appelhans%20K%22%5BAuthor%5D">Appelhans K</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Smith%20C%22%5BAuthor%5D">Smith C</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Bejar%20E%22%5BAuthor%5D">Bejar E</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Henig%20YS%22%5BAuthor%5D">Henig YS</a>
Herbalife International of America Inc., Torrance, CA 90502, United
States. In the November 27, 2010 issue of the World Journal of
Hepatology (WJH), three case reports were published which involved
patients who had consumed various dietary supplements and conventional
foods generally marketed as weight loss products. The reference to
Herbalife products as contaminated and generally comparable to all
dietary supplements or weight loss products is not scientifically
supported. The authors provided an insufficient amount of information
regarding patient histories, concomitant medications and other
compounds, dechallenge results, and product specifications and usage.
This information is necessary to fully assess the association of
Herbalife products in the WJH case reports. Therefore, the article does
not objectively support a causal relationship between the reported cases
of liver injury and Herbalife products or ingredients.</span></b><br />
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<b><span style="font-size: medium;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/22407600.1#" title="Pharmacoepidemiology and drug safety.">Pharmacoepidemiol Drug Saf.</a>
2012 Mar;21(3):333-4. doi: 10.1002/pds.3203. Misconceptions regarding
the association between Herbalife products and liver-related case
reports in Spain.</span></b></div>
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<b><span style="font-size: medium;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Appelhans%20K%22%5BAuthor%5D">Appelhans K</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Frankos%20V%22%5BAuthor%5D">Frankos V</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=%22Shao%20A%22%5BAuthor%5D">Shao A</a>. Source Product Compliance and Safety, Herbalife International of America, Inc, Torrance, CA, USA.</span></b></div>
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<b><span style="font-size: medium;">2 Feb 2011</span></b><br />
<b><span style="font-size: medium;">Since June 2010 there have been no new cases of toxicity from Black Cohosh, herbalife or kava reported on Pubmed.</span></b><br />
<b><span style="font-size: medium;"> BLACK COHOSH: BEGGING THE QUESTION OF INDICATION- NEED.</span></b><br />
<b><span style="font-size: medium;"> The new literature analysis <i>Suspected black cohosh
hepatotoxicity: no evidence by meta-analysis of randomized controlled
clinical trials for isopropanolic black cohosh extract </i>by <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Suspected%20black%20cohosh%20hepatotoxicity%3A%20no%20evidence%20by%20meta-analysis%20of%20randomized%20controlled%20clinical%20trials%20for%20isopropanolic%20black%20cohosh%20extract" target="_blank">Naser et al </a>from Yale , and Germany(the main producer of black cohosh BC products)- begs the question.</span></b><br />
<b><span style="font-size: medium;">As this colunm has <a href="http://healthspanlife.wordpress.com/?s=black+cohosh" target="_blank">previously reviewd </a>about
BC, women have died from or needed liver transplants after taking it..
Hence most Authorities have Black Box warning requirements Recurrences
of liver reaction have been reported on rechallenge. These scattered
cases can be argued away on metanalysis, but they cannot be ignored. One
death or acute liver failure is unacceptable when BC is never an
essential drug without other safe options. </span></b><br />
<b><span style="font-size: medium;">Another study also published now (Wang ea from the FDA Centre for Drug Evaluation ) <a href="http://www.ncbi.nlm.nih.gov/pubmed/20920542">http://www.ncbi.nlm.nih.gov/pubmed/20920542</a> contradicts the German metanalysis with more basic toxicological data: “<i>Computational
analysis of positively predicted constituents showed … specifically,
protocatechuic acid from black cohosh… predicted positive for liver
toxicity endpoints also confirmed with literature findings” </i></span></b><br />
<b><span style="font-size: medium;">Black cohosh is not physiological hormone replacement, BC is
recommended by its proponents solely for menopause symptoms (it has no
other benefits) for up to 6 months.</span></b><br />
<b><span style="font-size: medium;">So why risk, use black cohosh at all?</span></b><br />
<b><span style="font-size: medium;">Appropriate balanced hormone replacement – preferably human hormones,
not xenohormones ie hormones not found in the healthy women, and not by
swallowing it- is indicated permanently in all women .</span></b><br />
<b><span style="font-size: medium;">As previouslly pointed out in this column, the International
Menopause Society has summed it up in putting approriate HRT as the main
agent(s) for menopause symptoms as well as for its permanent
multisuystem benefits; and the human hormone gamma-aminobutyric acid
GABA as the only alternative that is both safe and cleearly proven
better than placebo for improving both hot flashes and sleep, anxiety.
Used appropriately and with sensible monitoring and dose titration, all
such hormone balance has no longterm risks.</span></b><br />
<b><span style="font-size: medium;">MDICOLEGAL LIABILITY: under the new Conumae Protection Act CPA in
South Africa, the pendulum has gone ridiculously too far. irrespective
of the onus on manufacturers and promoters of any product, the onus is
on the end-prescriber, end-dispenser to warn consumers of potential
risks, and any consumer claim for consequent damages is legally against
only the final and retail supplier.</span></b><br />
<b><span style="font-size: medium;">So no supplier of black cohosh is protected against consequent
liability unless he gets a signed waiver from the purchaser after the
recorded warning about its potential toxicity.</span></b><br />
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<b><span style="font-size: medium;">16 June 2010</span></b><br />
<b><span style="font-size: medium;">there are no new adverse toxicity reports on Hebalife, black cohosh or kava so far in 2010 .</span></b><br />
<b><span style="font-size: medium;">Both Herbalife, and black cohosh products, remain marketed and in demand in South SAfrica.</span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">There are no new serious adverse reports or concerns published on Pubmed or Google about </span><span style="font-family: Arial,sans-serif;"><b>Herbalife </b></span><span style="font-family: Arial,sans-serif;">products in 2009.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">On Pubmed there were 2 new cases of liver and coagulation problems associated with black cohosh in mid2009, from a <a href="http://www.ncbi.nlm.nih.gov/pubmed/19657787" target="_blank">Germanic </a>and an <a href="http://www.ncbi.nlm.nih.gov/pubmed/19472866" target="_blank">Italian </a>institute; and <a href="http://www.ncbi.nlm.nih.gov/pubmed/19501269" target="_blank">14 hepatitis cases </a>associated with </span><span style="font-family: Arial,sans-serif;"><b>kava </b></span><span style="font-family: Arial,sans-serif;">ingestion confirmed from around the world .</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">4 Jan 2009</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">This review is not about
benefit of black cohosh (independent trials show none for menopause
symptoms) or Herbalife (trials support that Herbalife is indeed a weight
loss aid), or kava (it is a confirmed anxiolytic analgesic euphoriant);
but about toxicity potential however rare – considering that none of
these products can make any claim to being a <i>necessity.</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Contamination aside, there are no new relevant reports on <b>Herbalife</b> the past two months on Pubmed, </span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">but indeed 4 new reports on <b>black cohosh</b>; and one on<b> kava.</b></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Lessons for black cohosh and Herbalife may be learnt from kava. </span><span style="font-family: Arial,sans-serif;"><b>Kava-kava</b></span><span style="font-family: Arial,sans-serif;">
was hastily banned eg in Europe and South Africa early this decade
owing to reputed association with hepatotoxic deaths. But on careful
study these toxicity claims appear to be uncertain. </span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">The <a href="http://en.wikipedia.org/wiki/Kava" target="_blank">claimed benefits</a>
of kava are analgesic, euphoriant and relaxant, without addiction
potential. The four trials of Kava (between 1991 and 2003, in Italy and
Germany) confirmed that kava has anxiolytic benefits in the menopause
syndrome.) . The <a href="http://en.wikipedia.org/wiki/Kava" target="_blank">hepatotoxicity (</a>not
reported from the source – Polynesia - unless taken by alcoholics) was
reported largely from western countries, where commercially sold kava
extract was apparently <a href="http://www.mja.com.au/public/issues/178_09_050503/cur10189_fm-1.html" target="_blank">differently extracted</a>, and from the aerial leftovers of the kava; whereas in Polynesia it is extracted only from the root. A recent website <a href="http://www.nlm.nih.gov/medlineplus/druginfo/natural/patient-kava.html" target="_blank">from the NIH </a>shows it is not banned there, but expresses much caution.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">A careful analysis of
kava hepatotoxicity by Teschke ea in Germany last month again finds
little evidence of toxicity if kava is taken from a reputable
manufacturer at prescribed dose and for short duration – as applies
equally to alcohol, and most drugs.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><b>Herbalife</b></span></span></b><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKcjUS1rFjhY7CT4yirm3ZmPPVo-UZFNJmYD0m2ZTRdjI1Yn2kozSkB6TZ5c1iBePh68itA7o-RH14HRyZ7LK4lOI8tJuSM53a0Ur4WLMwdRO8Rnf7kSG4LVNHfnm_zo3vY8Yob37U0Ion/s1600/ayub.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="83" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiKcjUS1rFjhY7CT4yirm3ZmPPVo-UZFNJmYD0m2ZTRdjI1Yn2kozSkB6TZ5c1iBePh68itA7o-RH14HRyZ7LK4lOI8tJuSM53a0Ur4WLMwdRO8Rnf7kSG4LVNHfnm_zo3vY8Yob37U0Ion/s400/ayub.jpg" width="400" /></a></div>
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<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">An objective NICUS
Nutritional Institute of University of Stellenbosch Report critical of
Herbalife is quoted verbatim in the Summer 2008 Newsletter of the <a href="http://www.adsa.org.za/branches/westerncapebranch/branchnewsletters/adsa%20summer%20newsletter.pdf." target="_blank">Association of Dieticians of SA.</a>
NICUS- a world authority in Nutrition – confirms it stands by this
report. It could thus be taken as a directive (to condemn Herbalife)- to
dieticians for whose professional advice some patients wrongly
substitute diet supplements; where these modalities- careful
professional diet advice and counselling, and supplements- are actually
complementary..</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">But there does not appear
to be any more evidence to condemn Herbalife than there was a year
ago. As far as Pubmed and Google reveals, the reports [to date end of
2008 on Pubmed) of adverse effects were from 4 discrete European
regions [ Iceland; Switzerland; Spain & Israel) , apparently wth
locally formulated Herbalife, not the USA main factory product, leading
to assumption of a local production fault. There appear to have been 2
cases of liver failure in some 33 affected patients, in one of whom
liver transplant became necessary but the patient died.. .</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">One cannot condemn all
babyfood because some is deliberately adulterated with melamine by
ruthless Chinese sham factories. Commercial babyfood is arguably a
necessity for many.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">We await an updated
rebuttal from Herbalife in the new year- but there does not seem to be
anything for them to add to their rebuttal of last year..There has been
no published evidence to justify update on Herbalife during 2008.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">The accusation (by one
patient, and a convicted fraudster, Minkow) of a claimed
lead-contaminated Herbalife batch in California has, strangely,
generated no updates for months now- but on the <a href="http://en.wikipedia.org/wiki/Herbalife" target="_blank">wiki herbalife update </a>,
it says "In August 2008, Minkow retracted all accusations against
Herbalife and removed any mention of the company from his Web site.[30]”
– there is no report of whether Herbalife bought his silence or not ,
which is a pity-<a href="http://www.thefreelibrary.com/Minkow+backs+down.%28HEALTH+CARE+&+BIOTECH%29%28Herbalife+Ltd.%29%28Barry...-a0185330936" target="_blank"> see also</a>. ; but see also heavy flak against <a href="http://www.mlmwatchdog.com/mlm_herbalife_2.html," target="_blank">Minkow </a>, suggesting that his whole campaign was a successful bear scam to profit from Herbalife shares.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">The current Wiki Herbalife review also quotes a new trial validating benefit for weightloss. <a href="http://www.cockeyed.com/workfromhome/epilogue/unsuccessful/unsuccessful2005.html" target="_blank">Caveat Emptor. </a></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">It may be asked why a
Nutritional authority like NICUS: warns against Herbalife but not
against the potentially fatal black cohosh. New independent analyses are
both for and against them: </span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">ie</span></span></b><br />
<span style="font-size: large;"><a href="http://en.wikipedia.org/wiki/Black_cohosh"><b><span style="font-family: Arial,sans-serif;"><b>Black Cohosh:</b></span></b></a></span><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Analyses of case reports
from Univ Florida (Palacio 2009) and Italy (Borrelli 2008) recommend
caution about black cohosh for humans in view of adverse case reports;
while a German analysis (Teschke 2008) exonerates black cohosh in every
single case till then. </span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">A trial from USA (Davis
2008) found that “black cohosh significantly increased the incidence of
lung metastases in tumor-bearing mice compared with mice fed the
isoflavone-free control diet”.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Clearly the valid divergence of opinion comes down to complex statistics of probability.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Black cohosh has been <i>associated </i>with
severe liver failure and transplantation in a number of women on a
number of continents, for which reason the local Health Products
Association, like all responsible authorities , finally agreed and
issued recommendations that Black Cohosh label must be black-boxed-
there is no justification for it’s sale as a useful product, unlike the
role than can be argued for food substitute powders.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">So why should anyone use
black cohosh for menopause symptoms (when it’s benefit seems to be
largely placebo, with grave doubt about safety) , when there are proven
safe symptom relievers eg GABA (no adverse reports); or lowdose balanced
appropriate parenteral human sex hormones (no adverse reports, and
have numerous longterm multisystem benefits- which neither black cohosh
nor GABA can claim..).</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">This review is not about
benefit, but safety. Regulators remain silent about drastically
curtailing sale of the most lethal substances in widespread
unregulated (and unnecessary) use- paracetamol, other nonsteroidal
anti-inflammatories, statins for uncomplicated mild-to-moderate
lipidemia, alcohol, tobacco and sugar, and pollution of everything by
industrial adulteration with synthetic (often estrogenic) endocrine
disruptors and virtually all fast foods with cornstarch and/or sugar.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">The hysterical approval
of diethylstilbestrol DES by the FDA by 1950, and for a massive 1950
maternity trial against all evidence (even though it’s toxicity was
recognized by 1953, it’s sale anywhaere was finally banned only 20
years later) continues to torment the original myriads of guineapig
women, their children and now grandchildren. These scandals are dictated
by individual opportunist, corporate and governmental greed, and
indifference to medical evidence and prevention.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">The analogy for black cohosh, kava and Herbalife is perhaps:</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">#the ~20year delays before the FDA would licence the lifesaving lithium salt, and metformin, in USA;</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">#the ~5year hysteria over
HRT after the Women’s Health Initiative – when the over-estimated risks
of inapproriate use of OHT in elderly women were stupidly and
harmfully (for thousands of women) extrapolated to young women and
other HRT preparations;</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">and</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">#the melamine- baby milk
formula catastrophe – the problem for the latter was exclusively some
contaminated babyfood batches made in China especially <i>for the lucrative export market. </i>.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><b>The jury</b> can thus be considered as still out on both black cohosh, kava and Herbalife, until manufacturers <i>of commercial products</i>
(not traditional preparations of eg kava and black cohosh taken by
residents who grow these) can produce evidence, confirm that the risk
was limited to specific batches of the commercial product and
adherence to accepted recommendations, and not due to other possible
risk factors.</span></span></b><br />
<br />
<h2>
<span style="font-size: large;"><span class="mw-headline" id="Side_effects"><a href="http://en.wikipedia.org/wiki/Black_cohosh"><b><span style="font-family: Arial,sans-serif;"><b>( Black Cohosh:</b></span></b></a> Side effects in wikipedia )</span></span></h2>
<b><span style="font-size: medium;">Studies on human subjects who were administered two commercially available black cohosh preparations did not detect <a href="http://en.wikipedia.org/wiki/Estrogen" title="Estrogen">estrogenic</a> effects on the breast.<sup class="reference" id="cite_ref-Ruhlen_et_al._14-1"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-Ruhlen_et_al.-14">[15]</a></sup></span></b><br />
<b><span style="font-size: medium;">No studies exist on long-term safety of black cohosh use in humans.<sup class="reference" id="cite_ref-19"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-19">[20]</a></sup> In a <a class="mw-redirect" href="http://en.wikipedia.org/wiki/Transgenic" title="Transgenic">transgenic</a> mouse model of <a href="http://en.wikipedia.org/wiki/Cancer" title="Cancer">cancer</a>,
black cohosh did not increase incidence of primary breast cancer, but
increased metastasis of pre-existing breast cancer to the lungs.<sup class="reference" id="cite_ref-Davis_et_al._20-0"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-Davis_et_al.-20">[21]</a></sup></span></b><br />
<b><span style="font-size: medium;"><a href="http://en.wikipedia.org/wiki/Hepatotoxicity" title="Hepatotoxicity">Liver damage</a> has been reported in a few individuals using black cohosh,<sup class="reference" id="cite_ref-Predny_et_al._1-3"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-Predny_et_al.-1">[2]</a></sup> but many women have taken the herb without reporting adverse health effects,<sup class="reference" id="cite_ref-21"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-21">[22]</a></sup> and a meta-analysis of several <a href="http://en.wikipedia.org/wiki/Blind_experiment" title="Blind experiment">well-controlled</a> clinical trials found no evidence that black cohosh preparations have any adverse effect on liver function.<sup class="reference" id="cite_ref-22"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-22">[23]</a></sup>
Despite a lack of conclusive evidence for a link between black cohosh
and liver damage, Australia has added a warning to the label of all
black cohosh-containing products, stating that it may cause harm to the
liver in some individuals and should not be used without medical
supervision.<sup class="reference" id="cite_ref-23"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-23">[24]</a></sup> Other studies conclude that liver damage from use of black cohosh is unlikely,<sup class="reference" id="cite_ref-Teschke_et_al.2011a_24-0"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-Teschke_et_al.2011a-24">[25]</a></sup>
and that the main concern over its safe use is lack of proper
authentication of plant materials and adulteration of commercial
preparations with other plant species.<sup class="reference" id="cite_ref-Teschke_et_al.2011b_25-0"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-Teschke_et_al.2011b-25">[26]</a></sup></span></b><br />
<b><span style="font-size: medium;">Reported direct side-effects also include dizziness, headaches, and seizures; <a href="http://en.wikipedia.org/wiki/Diarrhea" title="Diarrhea">diarrhea</a>; <a href="http://en.wikipedia.org/wiki/Nausea" title="Nausea">nausea</a> and vomiting; sweating; <a href="http://en.wikipedia.org/wiki/Constipation" title="Constipation">constipation</a>; low blood pressure and slow heartbeats; and weight problems.<sup class="reference" id="cite_ref-26"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-26">[27]</a></sup></span></b><br />
<b><span style="font-size: medium;">Because the vast majority of black cohosh materials are harvested from plants growing in the wild,<sup class="reference" id="cite_ref-Predny_et_al._1-4"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-Predny_et_al.-1">[2]</a></sup>
a recurring concern regarding the safety of black cohosh-containing
dietary supplements is mis-identification of plants causing
unintentional mixing-in (adulteration) of potentially harmful materials
from other plant sources.<sup class="reference" id="cite_ref-Predny_et_al._1-5"><a href="http://en.wikipedia.org/wiki/Black_cohosh#cite_note-Predny_et_al.-1">[2]</a></sup></span></b><br />
<br />
<br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">================================</span></span></b><br />
<h1>
<a href="http://www.ncbi.nlm.nih.gov/pubmed/22928722" target="_blank">Herbal hepatotoxicity: a tabular compilation of reported cases.</a></h1>
<div class="auths">
<span style="font-size: x-small;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Teschke%20R%5BAuthor%5D&cauthor=true&cauthor_uid=22928722"><b><span style="font-family: Arial,sans-serif;">Epub 2012 Aug 28.</span></b>Teschke R</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Wolff%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22928722">Wolff A</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Frenzel%20C%5BAuthor%5D&cauthor=true&cauthor_uid=22928722">Frenzel C</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Schulze%20J%5BAuthor%5D&cauthor=true&cauthor_uid=22928722">Schulze J</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Eickhoff%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22928722">Eickhoff A</a>.</span></div>
<div class="aff">
<h3 class="label">
<span style="font-size: medium;">Source</span></h3>
<b><span style="font-size: medium;">Department
of Internal Medicine II, Division of Gastroenterology and Hepatology,
Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the
Goethe University, Frankfurt/Main, Germany.</span></b></div>
<h3>
<span style="font-size: medium;">Abstract</span></h3>
<h4>
<span style="font-size: medium;">BACKGROUND: </span></h4>
<b><span style="font-size: medium;">Herbal
hepatotoxicity is a field that has rapidly grown over the last few
years along with increased use of herbal products worldwide.</span></b><br />
<h4>
<span style="font-size: medium;">AIMS: </span></h4>
<b><span style="font-size: medium;">To
summarize the various facets of this disease, we undertook a literature
search for herbs, herbal drugs and herbal supplements with reported
cases of herbal hepatotoxicity.</span></b><br />
<h4>
<span style="font-size: medium;">METHODS: </span></h4>
<b><span style="font-size: medium;">A selective
literature search was performed to identify published case reports,
spontaneous case reports, case series and review articles regarding
herbal hepatotoxicity.</span></b><br />
<h4>
<span style="font-size: medium;">RESULTS: </span></h4>
<b><span style="font-size: medium;">A total of 185
publications were identified and the results compiled. They show 60
different herbs, herbal drugs and herbal supplements with reported
potential hepatotoxicity, additional information including synonyms of
individual herbs, botanical names and cross references are provided. If
known, details are presented for specific ingredients and chemicals in
herbal products, and for references with authors that can be matched to
each herbal product and to its effect on the liver. Based on stringent
causality assessment methods and/or positive re-exposure tests,
causality was highly probable or probable for Ayurvedic herbs,
Chaparral, Chinese herbal mixture, Germander, Greater Celandine, green
tea, few <span class="highlight">Herbalife</span>
products, Jin Bu Huan, Kava, Ma Huang, Mistletoe, Senna, Syo Saiko To
and Venencapsan(®) . In many other publications, however, causality was
not properly evaluated by a liver-specific and for
hepatotoxicity-validated causality assessment method such as the scale
of CIOMS (Council for International Organizations of Medical Sciences).</span></b><br />
<h4>
<span style="font-size: medium;">CONCLUSIONS: </span></h4>
<b><span style="font-size: medium;">This
compilation presents details of herbal hepatotoxicity, assisting
thereby clinical assessment of involved physicians in the future</span></b><br />
<br />
<b><span style="font-size: medium;">==============================</span></b><br />
<div style="text-align: center;">
<a href="http://herbalife-side-effects.blogspot.in/" target="_blank"><span style="font-size: large;"><b>HERBALIFE VS CANCER</b></span></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
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<div style="text-align: center;">
<span style="font-size: large;"><b><span style="color: red;"><a href="http://www.representyou.com/product-liability/herbalife/side-effects/">Herbalife Side Effects HERBALIFE VS CANCER </a></span></b></span></div>
<h1>
<span style="font-size: medium;"> </span></h1>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj56NbgPEs0WPNn9e5awzHjFBH-wTPt0bv5RMhYQ_yvuLPEZKEjwhAJjZ1ybBoKnWgKog9LI79MxbimVwq36f1FsMpjglUYh6M0wuPn4WfHFAh25qKDhyphenhyphen5_CA_Ood5RSz2WTrLM03kgZlE6/s1600/livercancer.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj56NbgPEs0WPNn9e5awzHjFBH-wTPt0bv5RMhYQ_yvuLPEZKEjwhAJjZ1ybBoKnWgKog9LI79MxbimVwq36f1FsMpjglUYh6M0wuPn4WfHFAh25qKDhyphenhyphen5_CA_Ood5RSz2WTrLM03kgZlE6/s320/livercancer.jpg" width="303" /></a></div>
<h1>
</h1>
<div id="content">
<div class="wrapper single cat-post">
<h1>
<span style="color: red;"><span style="font-size: large;"><a href="http://www.representyou.com/product-liability/herbalife/hepatocellular-carcinoma-hcc/">Hepatocellular Carcinoma (HCC) Herbalife Liver Cancer</a></span></span></h1>
<b><span style="font-size: medium;">If
you or someone you know has recently been diagnosed with Hepatocellular
Carcinoma (HCC) and has a history of Herbalife supplement consumption
it may not be a coincidence. Some connections have been made between
Herbalife products and Hepatocellular Carcinoma (HCC). RepresentYou.com
is dedicated to protecting the consumer from faulty products and may be
able to help you find the origin of your disease. A number of our
panel member attorneys are familiar with the controversy surrounding
Herbalife and its supplements so please do not hesitate to call 24 hours
a day, 7 days a week to discuss you issue. Our lawyers can take your
potential Hepatocellular Carcinoma (HCC) Herbalife lawsuit on a
contingency fee basis, this means No Win, No Fee.</span></b><br />
<h2>
<span style="font-size: medium;">Herbalife and Hepatocellular Carcinoma (HCC)</span></h2>
<b><span style="font-size: medium;">Hepatocellular
Carcinoma (HCC) is primary liver cancer. The disease is usually
secondary to some preliminary and often untreated liver disease such as
toxic hepatitis and non-alcoholic steatohepatitis. Due to the dormant
nature of these less serious liver ailments they are often unrecognized
until they have attacked your liver and progressed into HCC.
hepatocellular carcinoma is one of, if not the, most developed and
serious liver diseases. More often than not it cannot be treated and
eventually leads to complete liver failure. In these cases the only way
to survive HCC is with a liver transplant.</span></b><br />
<b><span style="font-size: medium;">Like many other liver
diseases there is an established link to Herbalife supplements.
Correctly or not, doctors around the world hold the Herbalife company
responsible for certain cases of HCC. While the toxins in these
products do not directly cause the cancer many doctors are confident
that the regular use of Herbalife’s unsafe dietary, nutritional, and
skin care products can lead to any number of primary liver diseases.
For example, if toxins in the Herbalife supplements cause non-alcoholic
steatohepatits that eventually develops into hepatocellular carcinoma
then it is not a very big leap to say Herbalife should be held
accountable.</span></b><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFPxr01HCuCQ9KQWHePl2Dgl3ycq43wF9X4thujhf2Brh2Me8bol-CDrTDvqyTsdLEA0PekVBPFdtg8N5NCrKvTRx-mFi5FyV3eT6l6G-MBajK1kl7rsyKGkwExpvoz8Rh7YOJQ82c1QmF/s1600/ayub.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="83" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFPxr01HCuCQ9KQWHePl2Dgl3ycq43wF9X4thujhf2Brh2Me8bol-CDrTDvqyTsdLEA0PekVBPFdtg8N5NCrKvTRx-mFi5FyV3eT6l6G-MBajK1kl7rsyKGkwExpvoz8Rh7YOJQ82c1QmF/s400/ayub.jpg" width="400" /></a></div>
<h2>
<span style="font-size: medium;">Herbalife Death Attorneys</span></h2>
<b><span style="font-size: medium;">If
someone you know took Herbalife supplements habitually and is suffering
or has died from HCC RepresentYou.com may be able to help you find a
lawyer to build a case against the company. We understand the suggested
risks of Herbalife supplements and are dedicated to getting them off the
shelf if they are in fact dangerous. Your illness may be able to help
stop the sale of dangerous consumer products in the future. If you
believe your Herbalife regimen may have lead to your disease please do
not hesitate to call 24 hours a day, 7 days a week.</span></b></div>
</div>
<br />
<b><span style="font-size: medium;">============================= </span></b><br />
<h1>
<a href="http://www.ncbi.nlm.nih.gov/pubmed/22993667" target="_blank"><span style="font-size: medium;">A rare cause of drug-induced hepatitis in an immunocompromised patient and the role of glutathione.</span></a></h1>
<div class="auths">
<span style="font-size: x-small;"><b><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Senadhi%20V%5BAuthor%5D&cauthor=true&cauthor_uid=22993667">2012 Aug 27;4(8):248-51. Senadhi V</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Arora%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22993667">Arora D</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Arora%20M%5BAuthor%5D&cauthor=true&cauthor_uid=22993667">Arora M</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Marsh%20F%5BAuthor%5D&cauthor=true&cauthor_uid=22993667">Marsh F</a>.</b></span></div>
<div class="aff">
<h3 class="label">
<span style="font-size: medium;">Source</span></h3>
<b><span style="font-size: medium;">Viplove
Senadhi, Division of Gastroenterology and Hepatology and Brater
Scholar, Indiana Institute for Personalized Medicine, Indiana University
School of Medicine, Indianapolis, IN 46202, United States.</span></b></div>
<div class="abstr">
<h3>
<span style="font-size: medium;">Abstract</span></h3>
<b><span style="font-size: medium;">The
Food and Drug Administration (FDA) has issued a warning on numerous
herbal drugs, including many popular products at General Nutrition
Centers (GNC), regarding unstudied hepatotoxicity. There have been
recent reports of GNC products such as hydroxycut and <span class="highlight">herbalife</span>,
causing drug-induced hepatitis. Herbal medications are over-the-counter
products and are not investigated thoroughly by the FDA. Given that the
most common outpatient laboratory abnormality is elevated liver
transaminases, a sign of hepatocellular toxicity; it is not surprising
that some of these products end up causing hepatic dysfunction,
especially when taken in large volume. There are numerous herbal
supplements that are hepatotoxic, however, these medications have a much
more significant effect in human immunodeficiency virus (HIV)/ acquired
immune deficiency syndrome patients, which is secondary to depleted
glutathione. We present a rare case of drug induced hepatitis secondary
to herbal medications used to treat HIV and elucidate the role of
glutathione depletion in immunocompromised patients.</span></b></div>
<br />
<br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">================================ </span></span></b><br />
<h1>
<a href="http://www.ncbi.nlm.nih.gov/pubmed/21751292" target="_blank"><span style="font-size: large;">Continuous reporting of new cases in Spain supports the relationship between Herbalife® products and liver injury.</span></a></h1>
<h1>
<span style="font-size: xx-small;"><a href="http://www.ncbi.nlm.nih.gov/pubmed/21751292#" role="button" title="Pharmacoepidemiology and drug safety.">Pharmacoepidemiol Drug Saf.</a> 2011 Oct;20<span style="font-size: xx-small;"> </span>(10):1080-7. doi:10.1002/pds.2180. Epub 2011 Jul 12. </span><span style="font-size: x-small;"> </span></h1>
<h1>
<span style="font-size: x-small;"><a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Manso%20G%5BAuthor%5D&cauthor=true&cauthor_uid=21751292">Manso G</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=L%C3%B3pez-Rivas%20L%5BAuthor%5D&cauthor=true&cauthor_uid=21751292">López-Rivas L</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Salgueiro%20ME%5BAuthor%5D&cauthor=true&cauthor_uid=21751292">Salgueiro ME</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Duque%20JM%5BAuthor%5D&cauthor=true&cauthor_uid=21751292">Duque JM</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Jimeno%20FJ%5BAuthor%5D&cauthor=true&cauthor_uid=21751292">Jimeno FJ</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Andrade%20RJ%5BAuthor%5D&cauthor=true&cauthor_uid=21751292">Andrade RJ</a>, <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=Lucena%20MI%5BAuthor%5D&cauthor=true&cauthor_uid=21751292">Lucena MI</a>.</span></h1>
<div class="aff">
<h3 class="label">
<span style="font-size: xx-small;">Source</span><span style="font-size: xx-small;"> </span></h3>
<h3 class="label">
<span style="font-size: xx-small;">Centro de Farmacovigilancia de Asturias, Facultad de Medicina, Universidad de Oviedo, Oviedo, Spain. gmanso@uniovi.es</span></h3>
</div>
<div class="abstr">
<h3>
Abstract</h3>
<h4>
<span style="font-size: medium;">PURPOSE: </span></h4>
<b><span style="font-size: medium;">Previous
publications have linked Herbalife® products to hepatotoxicity. The
identification of earlier cases in which the culprit agent could not be
established raised the hypothesis of a possible contamination of some
specific batches of Herbalife products.</span></b><br />
<h4>
<span style="font-size: medium;">METHODS: </span></h4>
<b><span style="font-size: medium;">We
searched the Spanish Pharmacovigilance Centres' database of adverse
reactions for reports of liver injury associated with the use of
Herbalife products from 2003, when the first case was submitted, through
September 2010.</span></b><br />
<h4>
<span style="font-size: medium;">RESULTS: </span></h4>
<b><span style="font-size: medium;">The search resulted in 20
reports of liver damage (mean age, 49 years; 16 women), with 12 patients
(60%) requiring hospitalization. Hepatocellular damage predominated,
and nine (53%) of the hepatocellular cases with bilirubin values were
jaundiced, fulfilling the Hy's law criteria, which increases the risk
for serious outcomes. Two patients experienced a positive rechallenge.
One patient developed cirrhosis, whereas all the others recovered.
Causality assessment by the Karch and Lasagna modified algorithm showed a
category of definite in 1 case, probable in 14, and possible in 5.
Analysis of the different Herbalife products that each patient had taken
did not enable us to identify any commonly known hepatotoxic
ingredient.</span></b><br />
<h4>
<span style="font-size: medium;">CONCLUSIONS: </span></h4>
<b><span style="font-size: medium;">Our results support the
relationship between the consumption of Herbalife products and
hepatotoxicity, underscore the concern regarding the liver-related
safety of this dietary supplement, and emphasize the need to establish
further regulatory measures</span></b>.</div>
<span style="font-size: medium;"><b><span class="ref-cit"><span class="element-citation" id="__element-citationid1616581"> =============================</span></span></b></span><br />
<div style="text-align: center;">
<span style="font-size: large;"><b>BACTERIA IN HERBALIFE DAMAGES<span style="font-size: large;"> </span>LIVER
</b></span></div>
<div class="post-header">
</div>
<div id="kopindex">
<div style="text-align: center;">
<span style="font-size: medium;"><b>‘Bacteria in Herbalife damages liver’</b></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnzM9V_xACBrI-PBsTg2PmnrLHCFHbZiF3VuWf89cM3mELu1n25P5TGOnNvxdt-ZHKSZQg0ZDmVbB3QymbztfseAIBpS4eNsghW8bbforfTxmo9_I-DGbx8Os-RWhY5tkvUJnpYXJo3X0/s1600/01.webmd_rf_photo_of_liver_and_hepatitis_virus.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgnzM9V_xACBrI-PBsTg2PmnrLHCFHbZiF3VuWf89cM3mELu1n25P5TGOnNvxdt-ZHKSZQg0ZDmVbB3QymbztfseAIBpS4eNsghW8bbforfTxmo9_I-DGbx8Os-RWhY5tkvUJnpYXJo3X0/s320/01.webmd_rf_photo_of_liver_and_hepatitis_virus.jpg" width="320" /></a></span></div>
<span style="font-size: medium;"><br /></span></div>
<div id="bodytekst">
<span style="font-size: medium;"><b>
Two years ago liver doctors sounded the alarm about cases of <a href="http://www.google.com/custom?domains=ergo-log.com&q=liver+damage&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">liver damage</a>
in users of Herbalife products. They were unable to say which component
in Herbalife products was causing the liver damage, but researchers at
the University of Bern made an attempt to do so in an article published
this year in the Journal of Hepatology. They found the <a href="http://www.google.com/custom?domains=ergo-log.com&q=bacteria&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">bacteria</a> <i>Bacillus subtilis</i> in Herbalife products.
</b></span>
</div>
<span style="font-size: medium;"><br /></span>
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<td><span style="font-size: medium;"><b><br /></b></span>
</td></tr>
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<table align="right" cellpadding="14" cellspacing="4">
<tbody>
<tr><td><span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/herbalife.jpg" /></b></span>
</td></tr>
</tbody></table>
<div id="bodytekst">
<span style="font-size: medium;"><b>
In the article the doctors discuss two cases of people who became ill
after using Herbalife products: a man aged 78 and a woman aged 50. The
man's <a href="http://www.google.com/custom?domains=ergo-log.com&q=urine&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">urine</a>
had turned dark brown, he had hepatitis and had been feeling unwell for
a couple of weeks. He had been using the Herbalife F1 Shake [Strawberry
and Cappuccino flavours] for three years on his daughter’s advice [she
was a Herbalife salesperson], as well as various other medicines.
According to the analyses, the man had a liver complaint. When the
doctors took him off the shake his blood values recovered, but they
deteriorated again later. The doctors gave the man <a href="http://www.google.com/custom?domains=ergo-log.com&q=corticosteroids&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">corticosteroids</a> and <a href="http://www.google.com/custom?domains=ergo-log.com&q=ursodeoxycholic+acid&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">ursodeoxycholic acid</a>, after which he recovered completely. You can see the fluctuations in the man’s blood values in the graph below.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/herbalife.gif" /></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The woman sold Herbalife supplements. She took half a dozen different
Herbalife supplements, including the Personalized Protein Powder Mix
Formula 3. She had <a href="http://www.google.com/custom?domains=ergo-log.com&q=stomach+pain&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">stomach pain</a>
and hepatitis and the doctors found signs of liver damage in her blood.
They got the woman to stop taking the supplements and the graph below
shows how the liver values in her blood improved.
</b></span></div>
<span style="font-size: medium;"></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" height="320" src="http://www.ergo-log.com/plaatjes/herbalife2.gif" width="305" /></b></span>
</div>
<span style="font-size: medium;"><b></b><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The researchers examined samples from the livers of the man and the
woman and found signs of damage in both. The doctors turned the
supplements that the men and women had used inside out, but found no
contaminants: no heavy metals, no pesticides, no antibiotics, nothing.
But when they examined the Herbalife products for micro-organisms, they
did come across something. The meal substitutes the man and woman had
been using contained the bacteria
</b></span></div>
<table align="right" cellpadding="14" cellspacing="4">
<tbody>
<tr><td><span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/herbalife2.jpg" /></b></span>
</td></tr>
</tbody></table>
<span style="font-size: medium;"><b><i>Bacillus subtilis.</i> [see photo.] This was the cause of the liver complaints, according to the researchers.
</b>
</span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Hmm.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Honestly speaking, we’re not sure what to make of this. As far as we know, <i>B. Subtilis</i> is found in pretty much everything, and it’s not particularly dangerous. <a href="http://en.wikipedia.org/wiki/Bacillus_subtilis">[Wikipedia]</a>
Some studies even regard it as a <a href="http://www.google.com/custom?domains=ergo-log.com&q=probiotic&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">probiotic</a>. It would seem pretty unlikely then that B. subtilis is the cause of such serious liver damage.
</b></span></div>
<span style="font-size: medium;"><br /><b>
Source: <a href="http://www.ifik.unibe.ch/files/uploads/recentpub/bacillus_subt_herbalife.pdf">J Hepatol. 2009 Jan;50(1):111-7.</a></b></span>
<span style="font-size: medium;"><br /></span>
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<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXUxOBlINJhD_WoUBw5copMg54l6n_Mp7_MZFlWRoIeGMQz0L2WwZ_bytT7KelIf38SyPkTKRTpbRcqtTefKa693iqds4XL5Rb5_M5fdzyBdEMjgsekSkz6MFZEQUDw49wf2W-nN8t38I/s1600/ayub.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="83" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgXUxOBlINJhD_WoUBw5copMg54l6n_Mp7_MZFlWRoIeGMQz0L2WwZ_bytT7KelIf38SyPkTKRTpbRcqtTefKa693iqds4XL5Rb5_M5fdzyBdEMjgsekSkz6MFZEQUDw49wf2W-nN8t38I/s400/ayub.jpg" width="400" /></a></span></div>
<span style="font-size: medium;">
<b> </b></span>
<br />
<div id="kopindex">
<span style="font-size: medium;"><b>Bodybuilder drugs his liver to oblivion – twice</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
A medical case study that will give you goose bumps, this report from
doctors at the US Massachusetts General Hospital. The article tells
the story of a 27-year-old competitive bodybuilder and part-time
policeman who turned up at the Emergency Department.
</b></span>
</div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB1ln5zQoixAfg4cnRw2KrCc60_hQ0N1hIWBa_3bESjtRHh2X-h1_bv5SqmPMuov-LPBNYdnMif3r97EaAB_VL08kCGQDkNQiMsjoLvw6avvcwARa1Wi89itlg2KZv8zK1hOKiNbNh2cw/s1600/liver+damage.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjB1ln5zQoixAfg4cnRw2KrCc60_hQ0N1hIWBa_3bESjtRHh2X-h1_bv5SqmPMuov-LPBNYdnMif3r97EaAB_VL08kCGQDkNQiMsjoLvw6avvcwARa1Wi89itlg2KZv8zK1hOKiNbNh2cw/s1600/liver+damage.jpg" /></a></span></div>
<span style="font-size: medium;"></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The man’s been using anabolics for five years, but now he's got stomach
pains and is nauseous. The doctors do blood tests and discover
that the man’s liver is no longer functioning properly. For a start, the
concentration of the enzyme ALT is 2457 units per litre: 35
is the healthy maximum. The bodybuilder’s blood is syrupy and his
haematocrit level is fifty percent.
The bodybuilder says he injects nandrolone and takes androstenedione.
</b></span></div>
<span style="font-size: medium;"><br /></span>
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<td><span style="font-size: medium;"><b><br /></b></span>
</td></tr>
</tbody></table>
<div id="bodytekst">
<span style="font-size: medium;"><b>
The scan the doctors make of his liver shows a real mess, shown in
Picture A below. The light patches are swellings, the biggest of which
measures 10 x 10 cm.
</b></span></div>
<span style="font-size: medium;"></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/liver.jpg" /></b></span>
</div>
<span style="font-size: medium;"></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The doctors operate and discover that the liver is in an even worse
state than they had feared. The organ contains swellings that are filled
with blood. Peliosis hepatis is the doctors’ diagnosis, the same
complaint as killed Andreas Muenzer.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The doctors also found a swelling with a diameter of 23 cm. This kind of
swelling doesn’t usually get bigger than 3 cm. The doctors decide
to amputate part of the liver.
</b></span></div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSurHEoVphymg-tZUcHQMQbG-U_Hl7faTtpQvqypXP-tNMmwWSqbOZ-m-jPAMcfAK0eey8zASNv1TkLYdTn9hciyCazvFDkhKbSpsb4PmC2YaiKc8ujjhpq_R8ND65dD743r_qwqAGi_A/s1600/liver-disease2.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgSurHEoVphymg-tZUcHQMQbG-U_Hl7faTtpQvqypXP-tNMmwWSqbOZ-m-jPAMcfAK0eey8zASNv1TkLYdTn9hciyCazvFDkhKbSpsb4PmC2YaiKc8ujjhpq_R8ND65dD743r_qwqAGi_A/s320/liver-disease2.jpg" width="320" /></a></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
After the operation the bodybuilder recovers and is allowed home. When
the doctors make another scan three months later they see that the
swellings
in the remaining part of the liver have shrunk by 40 percent, Picture B
above. The bodybuilder thinks it's time to start doping again, and says
he’s
going to start again with androstenedione.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
After three years the bodybuilder returns to the doctors. Six weeks
previously he had treated himself to injections of a nandrolone
derivative.
And bingo, he’s got stomach pains again.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Three days after admission to the hospital, the bodybuilder’s heart rate
starts to increase. When the doctors make another scan – the picture
above on the right – they see that his liver is in a bad way again. The
swellings have started to grow again, and the liver has a protuberance
that has started to bleed.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The doctors discuss briefly whether they should give the guy a new
liver, but reject the idea. It would be a waste: he would only destroy
it again
with pills and injections. Alcoholics are not given a new liver either.
So they just stop the bleeding and send the bodybuilder home again.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Thinking about it, we find it difficult to believe that the bodybuilder
was only using deca and androstenedione. True, a number of cases have
been
published of bodybuilders who, as the result of a mild course of deca,
developed a blood clot the size of a brick in their stomach, or became
psychotic after one single deca injection. But to be honest, we don’t
believe those studies.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Moreover, neither androstenedione nor nandrolone is harmful to the
liver. Laboratory research on liver cells has shown this. And, by the
time the
doctors were seeing their patient, George Bush had already outlawed
androstenedione. Although androstenedione is still on the market,
bodybuilders
hardly ever use it. Why would they? In countries like the US there are
much more effective legal anabolic steroids available. But among these,
there are a number of substances that are notoriously bad for the liver.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The most dangerous is Superdrol, an anabolic that was developed at the
end of the fifties by Syntex. Doctors have recorded damaged livers and
destroyed kidneys in users of Superdrol more than once.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
This is what makes us suspect that the bodybuilder in this case study
used stronger stuff than androstenedione and deca. Bodybuilders are
often
not entirely honest about what they have been using when they visit a
doctor about medical problems. Even when being honest could have saved
their
life.
</b></span></div>
<span style="font-size: medium;"><br /><b>
Sources: <br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/18680242">World J Gastroenterol. 2008 Jul 28;14(28):4573-5.</a></b></span>
<span style="font-size: medium;">
</span>
<br />
<div id="kopindex">
<span style="font-size: medium;"><b>Bodybuilder gets jaundice from creatine and protein supplements</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
A healthy man of 27, a fanatical bodybuilder, developed liver damage and jaundice after using sports supplements
containing creatine and whey protein. Liver specialists at The Mount Sinai Medical Center in New York describe the
case in Seminars in Liver Disease.
</b></span>
</div>
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRCsgXrYmgHY5LulG-9NlT2fmD92SXXPW_EOyvwkdmFkW1hJyVUJpWoxEVjEHw4MBN4wZY_lEzFSPhCJxrLP2nRqjtCRz_HnrHMPbC6mrPEOfQ_0ABp92rjLATcOqN_2cNM7gAMVLo4fA/s1600/ucsf044_liveranatomy_562x525.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="372" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRCsgXrYmgHY5LulG-9NlT2fmD92SXXPW_EOyvwkdmFkW1hJyVUJpWoxEVjEHw4MBN4wZY_lEzFSPhCJxrLP2nRqjtCRz_HnrHMPbC6mrPEOfQ_0ABp92rjLATcOqN_2cNM7gAMVLo4fA/s400/ucsf044_liveranatomy_562x525.jpg" width="400" /></a></span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The man in the case study had no pain and did not feel unwell, but because he showed signs of jaundice he went to
hospital. There the doctors discovered that his blood contained high levels of bilirubin, a substance that should
have been removed by the liver. The man’s blood also contained high amounts of the enzyme alkaline phosphatase and
creatinine. The first substance can be an indication of liver malfunction. The second is a waste product of
creatine.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
In people with jaundice, the skin and whites of the eyes turn yellow [see pic below], but this is not necessarily
cause for alarm. Bilirubin is not a dangerous substance, and may even be an endogenous antioxidant. But jaundice is a
sign that something is wrong with the liver, and it therefore needs to be taken seriously.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP7jz9pw8DqaTAWtam4dgk-3Vjc5Qw6ZVD6vUDwsYJ5RLwmqb_Gw-WfC8RfMkvgBtJ03e99yJsi99u6hyH6GGBrhjA2Lnt5PfUHcchV7uj_V2g3h-PFD2OWk6cZkxxAwbGH-Wnd3ONyBw/s1600/Jaundice.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="185" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgP7jz9pw8DqaTAWtam4dgk-3Vjc5Qw6ZVD6vUDwsYJ5RLwmqb_Gw-WfC8RfMkvgBtJ03e99yJsi99u6hyH6GGBrhjA2Lnt5PfUHcchV7uj_V2g3h-PFD2OWk6cZkxxAwbGH-Wnd3ONyBw/s320/Jaundice.jpg" width="320" /></a></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"></span>
</div>
<div id="bodytekst">
<span style="font-size: medium;"><b>
When the doctors examined the bodybuilder’s liver they saw that the organ was no longer removing bile. The ducts that
should have been doing so were blocked. The scientific term for this is cholestasis.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The bodybuilder had been taking creatine for nine months and whey protein for one month. The doctors thought that this
might be responsible for his condition. When the man stopped taking the supplements, his liver returned to normal and
the jaundice disappeared. If doctors come across healthy athletes with an abnormal liver, the researchers write, then
they should ask whether the athletes are using potentially 'dangerous' supplements like whey protein and creatine.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/liver.gif" /></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
We put ‘dangerous’ in quotes advisedly. We don’t actually believe that healthy people can get jaundice from creatine and
proteins. We agree with the opinion of a blogger – who by the way also works at Gaspari Nutrition – at bodybuilding.com
who suspects that the bodybuilder in question was also using steroids, and developed jaundice as a result of these.
<a href="http://blog.bodybuilding.com/StudiesAndResearch/2008/05/23/the-experts-sometimes-arent-experts/">[bodybuilding.com 2008/05/23]</a></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
It wouldn’t be the first time that bodybuilders have run into trouble for using hardcore doping materials, go to a doctor
and then don’t tell the whole truth about what they are using. In the past we have written about a bodybuilder who had
taken <a href="http://www.ergo-log.com/dnpdeath.html">an overdose of DNP</a>, got sick and went to hospital – where he died because he didn’t
dare to say what he had been using. In another article a bodybuilder <a href="http://www.ergo-log.com/hcg.html">almost lost a testicle</a> because
at first he didn’t tell the doctors that he had been using Pregnyl.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
There are plenty of reports in the medical literature of the side-effects supplements or low doses of doping drugs, which
should be enough to make the readers’ hair stand on end. But these reports are probably the result of silent use of
forbidden substances – and in high quantities. For example, there was the bodybuilder who said he had developed gyno from
using Tribulus terrestris supplements.
<a href="http://www.ncbi.nlm.nih.gov/pubmed/15454201">[Breast. 2004 Oct;13(5):428-30.]</a> Other bodybuilders have said
that they got <a href="http://www.ergo-log.com/superdrolliver.html">liver damage from androstenedione</a> and a blood clot the size of a brick from
taking deca and proviron.
<a href="http://www.ncbi.nlm.nih.gov/pubmed/10206841">[N Engl J Med. 1999 Apr 8;340(14):1123-4.]</a></b></span>
</div>
<span style="font-size: medium;"><br /><b>
Sources: <br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/18452122">Semin Liver Dis. 2008 May;28(2):226-31.</a></b></span>
<span style="font-size: medium;">
</span>
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<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4hG8aImVE0ypifc7htDhw8zGXDjEUUnsUG5GgKxQKKrGWU9FJmLTbkiTXKlGFx1poJp3AYMJoGjJhp8JS34rmcxP1ZMgjTemlyypx_APonzBlNhTVPC6RtH5TOUmp42QXXKq7bdITFrA/s1600/liver+segments+-+illab258_420x267.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4hG8aImVE0ypifc7htDhw8zGXDjEUUnsUG5GgKxQKKrGWU9FJmLTbkiTXKlGFx1poJp3AYMJoGjJhp8JS34rmcxP1ZMgjTemlyypx_APonzBlNhTVPC6RtH5TOUmp42QXXKq7bdITFrA/s320/liver+segments+-+illab258_420x267.jpg" width="320" /></a></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="kopindex">
<span style="font-size: medium;"><b>Supplement protects steroids users’ livers </b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
A preparation made by Natterman, which supposedly protects the liver and which chemical athletes are using more and more
often: Greek researchers refer to it in their study as compound N. The researchers, at Thessaly University, set up an
experiment to determine whether compound N really works.
</b></span>
</div>
<span style="font-size: medium;"><br /></span>
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<table align="left" cellpadding="14" cellspacing="4">
<tbody>
<tr><td><span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/essentiale.jpg" /></b></span>
</td></tr>
</tbody></table>
<div id="bodytekst">
<span style="font-size: medium;"><b>
After a bit of surfing we worked out that Compound N is Essentiale forte.
<a href="http://www.google.nl/search?hl=en&q=%22Essentiale+forte%22&meta=">[Google]</a></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
A packet contains a couple of dozen capsules, each of which contains 300 mg of polyene phosphatidylcholine. This is
choline-phosphoric acid with two unsaturated fatty acids attached, usually linoleic acid. It probably resembles the
phosphatidylcholine found in soya.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
In addition, each capsule contains 6 mg of vitamin B1, 6 mg of vitamin B2, 6 mg of vitamin B6, 6 mcg of vitamin B12,
30 mg of nicotinamide and 6 mg of vitamin E.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The Greeks, who by the way have also done research on the psychological effects of anabolic steroids, did an experiment
with three hundred and twenty athletes. Half of them, one hundred and sixty athletes, used steroids. Of these chemical
athletes, the researchers gave forty Essentiale forte: two capsules a day taken with food.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
All of the chemical athletes took steroids and the researchers monitored them for eight weeks. The list below gives you
an idea of what the Greek bodybuilders were using.
</b></span></div>
<span style="font-size: medium;"><br /><b><br /></b></span>
<br />
<table align="right" cellpadding="14" cellspacing="1"><tbody>
<tr valign="top">
<td><span style="font-size: medium;"><b><br /></b></span>
</td></tr>
</tbody></table>
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/kuurtjes.essentiale.gif" /></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Yes, the list puzzled us too. Quinbolone? [An enol-ether of boldenone – Ed.] Oxabolone? [Nandrolone with a hydroxyl
group on C4 – Ed.] Are these products still on the market? And where are the 'new' designer steroids? Surely athletes
in Greece use products like 1-Test and Madol too?
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Still.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
During the eight-week period the researchers measured the athletes’ concentrations of the following enzymes: aspartate
aminotransferase (AST/SGOT), alanine aminotransferase (ALT/SGPT), lactate dehydrogenase (LDH), alkaline phosphatase (ALP),
gamma-glutamyltranspeptidase (gamma-GT) and creatine kinase (CK).
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The more enzymes in the blood, the harder a time the liver is having.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The figure below shows what happened to the liver enzyme concentrations. Group A = chemical athletes who took
Essentiale forte as well. Group B = chemical athletes who did not take a liver-protection supplement. Group C =
‘natural’ athletes.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/essentiale.enzymen.gif" /></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The researchers are not sure how phosphatidylcholine and vitamins protect steroids users’ livers. They suspect that
the mixture strengthens the membranes of the liver cells. The livers of steroids users have to work hard to break down
all the extra substances they are subjected to. And as a result the liver cells ‘cut down’ on metabolising fats. The
liver gets fattier because the liver cells are no longer burning fat well [beta-oxidation – Ed.] and maintenance of
the cell membranes made up of fatty acid chains gets neglected. The supplement helps the liver cells to perform these
functions.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Sounds attractive, but to be honest we find it difficult to believe that simply taking vitamin B pills and lecithin
capsules can protect steroids users’ livers. And we’re probably not the only ones who are sceptical. Reading between
the lines you can also see that the Greeks had trouble getting their study published.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
That’s why they use long-winded sentences like: "the results from our cohort of similarly exercising individuals suggest
that polyunsaturated phospholipids in combination with vitamins of the B complex protect hepatic cells from AAS-induced
damage." According to the Greeks Compound N is not a supplement but "a controlled pharmaceutical agent".
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
But still. It’s not totally impossible that the Greeks have discovered something that will enable thousands of steroids
users to juice more safely.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst3">
<span style="font-size: medium;"><b>
Sources: <br /><a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17852158">Clin Toxicol (Phila). 2008 Jan;46(1):57-66.</a></b>
<b><br /></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div class="separator" style="clear: both; text-align: center;">
<span style="font-size: medium;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4hG8aImVE0ypifc7htDhw8zGXDjEUUnsUG5GgKxQKKrGWU9FJmLTbkiTXKlGFx1poJp3AYMJoGjJhp8JS34rmcxP1ZMgjTemlyypx_APonzBlNhTVPC6RtH5TOUmp42QXXKq7bdITFrA/s1600/liver+segments+-+illab258_420x267.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="203" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi4hG8aImVE0ypifc7htDhw8zGXDjEUUnsUG5GgKxQKKrGWU9FJmLTbkiTXKlGFx1poJp3AYMJoGjJhp8JS34rmcxP1ZMgjTemlyypx_APonzBlNhTVPC6RtH5TOUmp42QXXKq7bdITFrA/s320/liver+segments+-+illab258_420x267.jpg" width="320" /></a></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="kopindex">
<span style="font-size: medium;"><b>More damaged livers from superdrol and madol</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Liver specialists at the Henry Ford Hospital in Detroit have reported another three cases of bodybuilders who
developed <a href="http://www.ergo-log.com/liver.html">liver damage</a> as a result of using designer supplements. The men used Anabolic Xtreme’s
<a href="http://www.google.com/custom?domains=ergo-log.com&q=superdrol&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">Superdrol</a> or BMF Hardcore’s M-Test 2, a product containing the steroid
<a href="http://www.google.com/custom?domains=ergo-log.com&q=madol&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">madol</a>.
</b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The Superdrol user was 21. He was nauseous, had stopped eating, had <a href="http://www.google.com/custom?domains=ergo-log.com&q=jaundice&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">jaundice</a> and itched all over. He’d been using
</b></span></div>
<table align="left" cellpadding="14" cellspacing="4">
<tbody>
<tr><td><span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/superdrol2.jpg" /></b></span>
</td></tr>
</tbody></table>
<span style="font-size: medium;"><b>
Superdrol for a couple of months and his liver was not functioning properly. His data is shown in the table below,
under the heading Patient 1.
</b>
</span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
When the symptoms had got worse after two weeks, the doctors gave him prednisone. The anti-inflammatory worked and
after another six weeks, he'd made a pretty good recovery.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Superdrol is a steroid whose structure and synthesis resemble those of
<a href="http://www.google.com/custom?domains=ergo-log.com&q=oxymetholone&sa=+search+&sitesearch=ergo-log.com&client=pub-7117181179885591&forid=1&ie=ISO-8859-1&oe=ISO-8859-1&hl=en">oxymetholone</a>. It was also developed and tested
in the late fifties by the makers of oxymetholone, the American pharmaceutical company Syntex. Although superdrol
[see structural formula below] looked like a promising anabolic steroid in animal tests, in subsequent tests potential
side effects showed up.
</b></span></div>
<table align="right" cellpadding="14" cellspacing="4">
<tbody>
<tr><td><span style="font-size: medium;"><b><img alt="Superdrol" border="0" src="http://www.ergo-log.com/plaatjes/superdrol.gif" /></b></span>
</td></tr>
</tbody></table>
<span style="font-size: medium;"><b>
Syntex decided not to put Superdrol on the market. But that didn’t stop designer supplement makers from marketing the
forgotten steroid years later.
</b>
</span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The effects of this move are clearly seen in the medical journals. In 2006 doctors in Phoenix, Arizona published an
article on the case of bodybuilder who became fatally ill after using superdrol.
<a href="http://www.ncbi.nlm.nih.gov/pubmed/16952289?dopt=AbstractPlus">[Am J Gastroenterol. 2006 Nov;101(11):2659-62.]</a>
A few months later doctors at Johns Hopkins University published another case and a case in which another designer steroid
– Halodrol – had caused liver damage.
<a href="http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=ShowDetailView&TermToSearch=17509944">[Clin Gastroenterol Hepatol. 2007 Jul;5(7):809-12.]</a>
And another few months after that, doctors from Burlington wrote about five more bodybuilders who had developed
liver problems as a result of superdrol. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18187367">[Clin Gastroenterol Hepatol. 2008 Feb;6(2):255-8.]</a></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
What patient 2 used was not clear, but it contained at least DHEA. Of the three men referred to in the study, number 2
got off the most lightly. He recovered spontaneously a couple of weeks after he had stopped using the supplement.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<table align="right" cellpadding="14" cellspacing="1"><tbody>
<tr valign="top">
<td><span style="font-size: medium;"><b><br /></b></span>
</td></tr>
</tbody></table>
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/designer.liver.gif" /></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Patient 3 used M-Test 2, a designer supplement containing the steroid madol. [Structural formula shown below.] Madol was
rediscovered by Patrick Arnold, who produced it as an invisible steroid for Balco, but it was picked up later by designer
supplement manufacturers. Madol was also developed by Syntex, a manufacturer that carried out promising animal tests on it
in the sixties.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<table align="right" cellpadding="14" cellspacing="14">
<tbody>
<tr><td><span style="font-size: medium;"><b><img alt="Madol" border="0" src="http://www.ergo-log.com/plaatjes/madol4.gif" /></b></span>
</td></tr>
</tbody></table>
<div id="bodytekst">
<span style="font-size: medium;"><b>
Not much is known about the side-effects of madol. It is not carcinogenic, say German researchers. But they did discover that
it <a href="http://www.ergo-log.com/pheraplexheart.html">enlarged</a> the heart muscle in animal tests. The enlargement itself was not dangerous, but the researchers were not entirely
convinced. In the bodybuilding circuit however there are few stories around of users who have developed liver problems as a
result of using madol.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The sick madol user had to be given prednisone in the end, after which he recovered.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The doctors did not test the preparation the patient had used. And we
wonder quite honestly if it only contained madol. According
to the study, the bodybuilder became ill after he had taken 57 capsules
over a period of a few weeks. That would be impossible with
</b></span></div>
<table align="left" cellpadding="14" cellspacing="14">
<tbody>
<tr><td><span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/mtest2.jpg" /></b></span>
</td></tr>
</tbody></table>
<span style="font-size: medium;"><b>
just madol. Methyl-1-testosterone and superdrol are a different kettle
of fish, but with madol we can hardly imagine this kind of
thing happening.
</b>
</span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
BMF Hardcore, the maker of M-Test, has heavier oral designer supplements
among its products. The Canadian government has issued
warnings about these. Maybe something went wrong during the production
of M-Test 2. Or perhaps the doctors got it wrong that Patient
3 used the BMF product.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
The doctors also read a couple of articles written by colleagues and
summarized the information they found. This resulted in the
table you see here below.
</b></span></div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b><img alt="" border="0" src="http://www.ergo-log.com/plaatjes/designer.liver2.gif" /></b></span>
</div>
<span style="font-size: medium;"><br /></span>
<br />
<div id="bodytekst">
<span style="font-size: medium;"><b>
Liver specialists should get extra training on designer supplements that
contain oral anabolic steroids, the article concludes.
"The rapid reporting of several cases of AAS-induced liver injury from
dietary supplements emphasizes the growing emergence and
importance of this condition and the need for clinicians to become aware
of the sequelae of jaundice and renal failure, especially
among young men who are unknowingly consuming hepatotoxic agents."
</b></span></div>
<br />
<div id="bodytekst3">
<span style="font-size: small;"><b>
Sources: <br /><a href="http://www.ncbi.nlm.nih.gov/pubmed/19238093">J Clin Gastroenterol. 2009 Feb 20. [Epub ahead of print].</a></b></span></div>
<span style="font-size: medium;"><b><span class="ref-cit"><span class="element-citation" id="__element-citationid1616581">============================= </span></span></b></span><br />
<br />
<br />
<h1 class="content-title">
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/"><span style="font-size: large;">Acute liver injury induced by weight-loss herbal supplements</span></a></h1>
<h1 class="content-title">
<span class="citation-abbreviation">World J Hepatol. </span><span class="citation-publication-date">2010 November 27; </span><span class="citation-volume">2</span><span class="citation-issue">(11)</span><span class="citation-flpages">: 410–415. </span></h1>
<div>
<h1>
<span style="font-size: medium;">NCBI</span><span style="font-size: medium;"> The National Center for Biotechnology Information advances science and
health by providing access to biomedical and genomic information.</span></h1>
<span class="fm-vol-iss-date">Published online 2010 November 27. </span> <span class="doi">doi: <a href="http://dx.crossref.org/10.4254%2Fwjh.v2.i11.410" target="pmc_ext">10.4254/wjh.v2.i11.410</a></span></div>
<div class="inline_block three_col va_top show-overflow align_right">
<div class="fm-citation-ids">
<div class="fm-citation-pmcid">
<span class="fm-citation-ids-label">PMCID: </span>PMC3004035</div>
</div>
</div>
<div class="sec" id="__abstractid1381237">
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__abstractid1381237title">
<span style="font-size: large;">Abstract</span></h2>
<div>
<div id="__pid1381238">
<span style="font-size: medium;"><b>We
report three cases of patients with acute liver injury induced by
weight-loss herbal supplements. One patient took Hydroxycut while the
other two took Herbalife supplements. Liver biopsies for all patients
demonstrated findings consistent with drug-induced acute liver injury.
To our knowledge, we are the first institute to report acute liver
injury from both of these two types of weight-loss herbal supplements
together as a case series. The series emphasizes the importance of
taking a cautious approach when consuming herbal supplements for the
purpose of weight loss.</b></span></div>
</div>
<div class="sec">
<span style="font-size: medium;"><b class="kwd-title">Keywords: </b><b><span class="kwd-text">Hydroxycut, Herbalife, Hepatotoxicity, Herbal, Weight-loss</span></b></span></div>
</div>
<div class="sec" id="__secid1292138">
<div class="goto jig-ncbiinpagenav-goto-container">
<span style="font-size: medium;"><b><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#ui-ncbiinpagenav-2" role="button" title="Go to other sections in this page">Go to:</a></b></span></div>
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__secid1292138title">
<span style="font-size: medium;">INTRODUCTION</span></h2>
<div id="__pid1601964">
<span style="font-size: medium;"><b>We have seen a significant increase in the popularity and usage of over the counter herbal supplements over the past few years[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/15710790" role="button">1</a>].
Unfortunately, the majority of these herbal supplements are not
regulated by drug administrations worldwide. Many herbal supplements
contain compounds that carry potentially severe side effects including
hepatotoxicity. We report three cases of acute liver injury induced by
weight-loss herbal supplements. Hydroxycut (MuscleTech, Mississauga,
Ontario, Canada) (case 1) and Herbalife (Herbalife, Los Angeles, USA)
(cases 2 and 3) supplements were the suspected culprits of acute liver
injury. Hydroxycut is a popular dietary supplement consisting of a
variety of herbal mixtures that claims to enhance the weight loss
process[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#B2" role="button">2</a>].
Acute liver injury associated with Hydroxycut use has been previously
reported, but only one case had liver biopsy data showing cholestasis
and portal inflammation[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/15767636" role="button">3</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19058338" role="button">6</a>].
Similarly, Herbalife weight-loss dietary products are popular
supplements consisting of a variety of herbal mixtures that claim to
facilitate weight reduction[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#B7" role="button">7</a>].
Cases of acute liver injury after consumption of Herbalife products
have been previously reported, with two patients developing fulminant
liver failure requiring liver transplantation. The first patient
survived while the second died[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" role="button">8</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17335732" role="button">11</a>]. In all of our cases, we were able to demonstrate drug-induced acute liver injury on liver biopsy specimens.</b></span></div>
</div>
<div class="sec" id="__secid1629901">
<div class="goto jig-ncbiinpagenav-goto-container">
<span style="font-size: medium;"><b><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#ui-ncbiinpagenav-2" role="button" title="Go to other sections in this page">Go to:</a></b></span></div>
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__secid1629901title">
<span style="font-size: medium;">CASE REPORT</span></h2>
<div class="sec sec-first" id="__secid1631908">
<h3>
<span style="font-size: medium;">Case 1</span></h3>
<div id="__pid1631912">
<span style="font-size: medium;"><b>A
31-year-old woman presented to our hospital complaining of 2-wk history
of fatigue, jaundice, and nausea. She denied any prior medical or
surgical conditions, family history of liver disease, and acetaminophen
or prescription medication use. She further denied history of blood
transfusion, tattoo, alcohol use, or recreational drug use. She had been
taking Hydroxycut for one year to enhance her weight loss. She had been
taking the recommended dose of 2 tablets twice a day.</b></span></div>
<div id="__pid1631918">
<span style="font-size: medium;"><b>The
patient was afebrile with normal hemodynamics upon presentation. Her
physical examination was remarkable for generalized jaundice, scleral
icterus, and mild upper quadrant tenderness to palpation without rebound
or guarding. Initial laboratory studies were significant for serum
aspartate aminotransferase (AST) level of 1407 U/L (normal range 15-41),
serum alanine aminotransferase (ALT) level of 1278 U/L (normal range
7-35), serum alkaline phosphatase of 256 U/L (normal range 38-126),
serum total bilirubin (TB) of 7.1 mg/dL (normal range 0.2-1.2), and
international normalized ratio (INR) of 1.3 I/U (normal range 0.8-1.2).
Given these findings, patient was admitted to the hospital for a higher
level of care.</b></span></div>
<div id="__pid1280813">
<span style="font-size: medium;"><b>Standard blood tests were
negative for hepatitis A, B, C, E, Ebstein Barr virus (EBV),
cytomegalovirus (CMV), human immunodeficiency virus (HIV), antinuclear
antibody, anti-smooth muscle antibody, anti-liver/kidney microsomal
antibody, alpha-1-antitrypsin deficiency, and anti-mitochondrial
antibody. Serum acetaminophen and urine toxicity screens were negative.
Serum ceruloplasmin, ferritin, iron studies, and immunoglobulins were
all within the normal range. Right upper quadrant ultrasound showed
diffuse echogenicity of the liver. Liver biopsy was performed and showed
multi-lobular necrosis consistent with acute toxic necrosis and
fulminant hepatitis (Figure <a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F1/"><span style="position: relative; text-decoration: none;"><span class="figpopup-sensitive-area" style="left: -3.5em;">(Figure1</span></span>1</a>).</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F1">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F1/" target="figure"><img alt="Figure 1" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/bin/WJH-2-410-g001.gif" title="Figure 1" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F1">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F1/" target="figure">Figure 1</a></b></span></div>
<div>
<span style="font-size: medium;"><b>Liver
biopsy showed extensive patchy areas of multilobular necrosis with only
bile ducts remaining, extensive ductal metaplasia, severe lymphocytic
and macrophages infiltration of portal tracts and lobular parenchyma and
patchy plasma cell infiltrates. ...</b></span></div>
</div>
</div>
<div id="__pid1577348">
<span style="font-size: medium;"><b>The
patient’s liver function tests peaked 4 d after admission with serum
AST level of 1613 U/L, ALT level of 1227 U/L, serum alkaline phosphatase
of 268 U/L, serum TB of 10.5 mg/dL, and INR staying at 1.3 I/U. She did
not develop evidence of hypoglycemia or portal-systemic encephalopathy.
Her jaundice and scleral icterus resolved over the following 2-wk. Her
liver tests gradually improved within the following few months.</b></span></div>
</div>
<div class="sec" id="__secid1575790">
<h3>
<span style="font-size: medium;">Case 2</span></h3>
<div id="__pid1575794">
<span style="font-size: medium;"><b>A
37-year-old woman presented to our hospital with a 1-mo history of
diffuse abdominal pain, mild nausea, and painless jaundice. She denied
any past medical or surgical history, family history of liver disease,
or any alcohol or illicit substance abuse. She admitted that she had
been taking Herbalife dietary supplements for the past 3-mo in an
attempt to lose weight. Her Herbalife regimen consisted of the Formula
One Nutritional Shake Mix, the Multivitamin Complex, the Cell Activator,
the Cell-U-Loss, the Herbal Concentrate Original, and the Total Control
formula.</b></span></div>
<div id="__pid1577350">
<span style="font-size: medium;"><b>The patient was afebrile with normal
vital signs on presentation. Her physical exam was noticeable for
bilateral scleral icterus and generalized jaundice. Her abdominal exam
revealed a non-tender, non-distended abdomen with no stigmata of liver
disease. Initial laboratory studies were significant for an AST level of
2199 U/L, serum ALT level of 2068 U/L, serum alkaline phosphatase of
185 U/L, and TB of 15.3 mg/dL. All other laboratory values, including
amylase, lipase, and INR, were within normal limits. Given these lab
abnormalities, the patient was admitted to the hospital for further
work-up.</b></span></div>
<div id="__pid1575797">
<span style="font-size: medium;"><b>Standard blood tests were negative for
hepatitis A, B, C, E, EBV, CMV, HIV, antinuclear antibody, anti-smooth
muscle antibody, anti-liver/kidney microsomal antibody,
alpha-1-antitrypsin deficiency, and anti-mitochondrial antibody. Serum
acetaminophen and urine toxicity screens were negative. Serum
ceruloplasmin, ferritin, iron studies, and immunoglobulins were all
within normal range. A computerized tomography (CT) scan of the abdomen
and pelvis with intravenous (IV) contrast showed multiple low-density
lesions in the liver measuring up to 8-mm. A liver biopsy revealed acute
necrotizing hepatitis both centrolobular and periportal, consistent
with a drug-induced etiology (Figure <a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F2/"><span style="position: relative; text-decoration: none;"><span class="figpopup-sensitive-area" style="left: -3.5em;">(Figure2).</span></span>2</a>).
However, her liver biopsy specimens also showed evidence of bridging
fibrosis, which suggest some degree of chronic liver disease but with
drug-induced injury in addition.</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F2">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F2/" target="figure"><img alt="Figure 2" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/bin/WJH-2-410-g002.gif" title="Figure 2" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F2">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F2/" target="figure">Figure 2</a></b></span></div>
<div>
<span style="font-size: medium;"><b>Liver
biopsy was performed and showed periportal bridging fibrosis, ductal
metaplasia, cholestasis, moderate intralobular lymphocytic infiltration,
and troxis necrosis and apoptosis consistent with drug-induced
hepatitis on top chronic liver disease. ...</b></span></div>
</div>
</div>
<div id="__pid1290083">
<span style="font-size: medium;"><b>The
patient was treated supportively with fluids and nutrition. Her liver
tests steadily declined from the day of admission and on hospital day 8
(day of discharge) her liver tests revealed a AST level of 1788 U/L, ALT
level of 1501 U/L, and serum alkaline phosphatase of 183 U/L. The only
laboratory value to increase was the patient's serum TB, which was at
29.9 mg/dL on discharge. The patient did not develop encephalopathy,
hypoglycemia, or any other complications. The patient was followed for
several months, throughout which her symptoms continued to improve.</b></span></div>
<div id="__pid1290085">
<span style="font-size: medium;"><b>At
her 2-mo follow-up, the patient's icterus and jaundice had resolved
completely. Her labs at this time showed a serum AST level of 51 U/L,
serum ALT level of 43 U/L, serum alkaline phosphatase of 65 U/L, and
serum TB of 1.1 mg/dL.</b></span></div>
</div>
<div class="sec sec-last" id="__secid1617390">
<h3>
<span style="font-size: medium;">Case 3</span></h3>
<div id="__pid1617394">
<span style="font-size: medium;"><b>A
53-year-old previously healthy woman presented with a 3-wk history of
painless jaundice and pruritus. She denied any family history of liver
disease, or any alcohol or illicit substance abuse. She had not been
taking any new prescribed medications. On further questioning about
over-the-counter supplements she divulged a 4-mo history of consuming
various Herbalife weight loss products in the form of shakes, teas and
pills.</b></span></div>
<div id="__pid1266835">
<span style="font-size: medium;"><b>On physical exam the patient’s vital
signs were within normal limits. On general inspection she had scleral
icterus and jaundice, with evidence of excoriations. A 2-cm palpable
liver edge could be appreciated, that was tender to touch. There were no
other signs of chronic liver disease. Initial laboratory values
revealed a hepatocellular pattern of injury, with an AST of 1282 U/L,
ALT of 983 U/L, and alkaline phosphatase of 292 U/L, with a TB of 18.2
mg/dL. An ultrasound showed borderline hepatomegaly of 17-cm.</b></span></div>
<div id="__pid1266842">
<span style="font-size: medium;"><b>Standard
blood tests for hepatitis A, B, C, E, EBV, CMV, HIV, antinuclear
antibody, anti-smooth muscle antibody, anti-liver/kidney microsomal
antibody, alpha-1-antitrypsin deficiency, and anti-mitochondrial
antibody were negative. Serum acetaminophen and urine toxicity screens
were negative. Serum ceruloplasmin, ferritin, iron studies, and
immunoglobulins were all within normal range.</b></span></div>
<div id="__pid1532905">
<span style="font-size: medium;"><b>Liver biopsy was performed and showed cholestasis, consistent with drug induced hepatitis (Figure <a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F3/"><span style="position: relative; text-decoration: none;"><span class="figpopup-sensitive-area" style="left: -3.5em;">(Figure3).</span></span>3</a>). 2-mo after complete abstinence from the Herbalife supplements her jaundice resolved, as did her liver tests.</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F3">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F3/" target="figure"><img alt="Figure 3" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/bin/WJH-2-410-g003.gif" title="Figure 3" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F3">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/figure/F3/" target="figure">Figure 3</a></b></span></div>
<div>
<span style="font-size: medium;"><b>A
liver biopsy revealed acute hepatitis characterized by hepatocellular
injury, with periportal fibrosis, cholestasis, ductal metaplasia and
diffuse intralobular and periportal troxis necrosis consistent with a
drug-induced etiology. Intralobular lymphocytic ...</b></span></div>
</div>
</div>
</div>
</div>
<div class="sec" id="__secid1287277">
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<h2 class="head no_bottom_margin ui-helper-clearfix" id="__secid1287277title">
<span style="font-size: medium;">DISCUSSION</span></h2>
<div id="__pid1287283">
<span style="font-size: medium;"><b>Acute
liver injury induced by over the counter weight-loss herbal supplement
Hydroxycut and Herbalife products have been reported previously[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/15767636" role="button">3</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19058338" role="button">6</a>,<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" role="button">8</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17335732" role="button">11</a>].
These case reports were limited by the fact that liver biopsies were
performed in only a few patients, confirming clinical suspicions
histologically. In terms of our patients, all three had liver biopsy
performed and all showed some common morphological features including
diffuse lymphocytic infiltration of sinusoids and portal tracts, ductal
metaplasia and toxic necrosis. Some variations of morphological features
could be explained by predominance of intrinsic or idiosyncratic
mechanisms of hepatic injury, individual patient response to the
affecting drug and duration of injury. The patients’ liver biopsy
specimens were stained with periodic acid-Schiff (PAS) stain with
diastase. No hyaline globules were identified in any of the three cases.
The absence of histological findings and the fact that our patients had
no history of chronic obstructive pulmonary disease excluded diagnosis
of alpha-1-antitripsin deficiency in all three cases. Prussian blue and
copper stains did not reveal excessive iron or copper depositions in the
hepatocytes and Kupffer cells.</b></span></div>
<div id="__pid1472223">
<span style="font-size: medium;"><b>Only one
previous case of Hydroxycut-induced acute liver injury had reported
findings on liver biopsy. Although the most likely explanation for the
mechanism of liver injury caused by these herbal products is
idiosyncratic reaction, one of the ingredients in Hydroxycut, green tea
extract (<i>Camellia sinensis</i>), has been linked with acute liver injury in other over the counter weight-loss herbal supplements[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/16389263" role="button">12</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#B20" role="button">20</a>]. In fact, the weight-loss herbal supplement Exolise (Arkophama, Carros, France), which also contained <i>C. sinensis</i>, was withdrawn from the market because it was linked to multiple cases of liver injury[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/16148563" role="button">13</a>].
Furthermore, several cases of hepatotoxicity were associated with
another herbal weight-loss supplement, Cuur (Scandinavian Clinical
Nutrition, Sweden), which also contains the ethanolic dry extract of
green tea (<i>C. sinensis</i>)[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17562348" role="button">15</a>]. Rechallenging patients with the same product led to hepatotoxicity, confirming the role of <i>C. sinensis</i>[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/16389263" role="button">12</a>,<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17133573" role="button">16</a>].
In all reported cases of acute liver injury induced by Hydroxycut,
patients’ liver function tests recovered over time following cessation
of the product. However, there have been cases of liver failure caused
by green tea extract <i>C. sinensis</i>, requiring orthotopic liver transplantation[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/16148563" role="button">13</a>,<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17133573" role="button">16</a>].</b></span></div>
<div id="__pid1484927">
<span style="font-size: medium;"><b>The
liver biopsy obtained in our patient who took Hydroxycut showed
multi-lobular necrosis consistent with acute toxic necrosis and
fulminant hepatitis. These findings are similar to the findings in
patients with liver injury associated with green tea extract <i>C. sinensis</i>, where prominent necrosis with inflammatory reaction is the hallmark presentation[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17562348" role="button">15</a>,<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17133573" role="button">16</a>].</b></span></div>
<div id="__pid1252465">
<span style="font-size: medium;"><b>The exact mechanism of hepatotoxicity induced by Hydroxycut is unknown. However, as this product contains green tea extract <i>C. sinensis</i>,
it is possible that this may play a role in acute liver injury caused
by Hydroxycut. Prior investigation into the mechanism of hepatotoxicity
by green tea extract was inconclusive[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/15621343" role="button">21</a>].
Others have hypothesized that a possible allergic reaction to the green
tea extract, contamination during the production of the extract or a
metabolic idiosyncrasy are possible mechanisms of liver injury in these
patients[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17133573" role="button">16</a>].</b></span></div>
<div id="__pid1276802">
<span style="font-size: medium;"><b>Both
of our patients took several Herbalife weight-loss herbal products
concurrently, similar to most of the previously reported cases of
hepatotoxicity due to Herbalife products[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" role="button">8</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17335732" role="button">11</a>].
Therefore, it is difficult to identify the exact ingredient or
mechanism that causes the liver injury, as in the previously documented
cases[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" role="button">8</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17335732" role="button">11</a>]. In a previously reported case, one investigator was able to isolate contamination with <i>Bacillus subtilis</i>, in which the bacterial supernatant caused dose-dependent increase of LDH leakage in HepG2 cells[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" role="button">8</a>]. Although not commonly known as a human pathogen, <i>B. subtiliis</i> has been reported to cause food poisonings and a case of cholangitis in an immunocompromised patient[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#B22" role="button">22</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/8678036" role="button">23</a>].
Investigators have also suggested that another explanation for
hepatotoxicity due to Herbalife products could be secondary to locally
restricted contamination with chemicals such as softeners,
preservatives, flavor enhancers, pesticides, or heavy metals either
intentionally added during the production process or contained in the
unrefined raw herb extracts[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/12490687" role="button">24</a>].</b></span></div>
<div id="__pid1476820">
<span style="font-size: medium;"><b>To date, Herbalife has refused to provide detailed analyses of their products’ composition and ingredients[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17692988" role="button">25</a>].
This contamination hypothesis could also explain the different patterns
of pathology seen on liver biopsy specimens previously observed in
patients with hepatotoxicity from Herbalife products as both
predominantly cholestatic injury pattern and acute hepatitis pattern
have been reported[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" role="button">8</a>-<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17335732" role="button">11</a>]. Our patients had findings consistent with acute hepatitis due to drug-induced liver injury on their liver biopsy specimens.</b></span></div>
<div id="__pid1385587">
<span style="font-size: medium;"><b>Due
to the obesity epidemic, the usage of weight-loss herbal supplements
has flourished. Green tea extract is one of the key components in many
of the over-the-counter weight-loss herbal supplements. Although
significant liver injury induced by herbal supplements taken for weight
loss purposes is a rare event, we cannot ignore the fact that there have
been multiple reported cases in the medical literature of
hepatotoxicity associated with weight-loss herbal supplements including
Hydroxycut and Herbalife products. Even though our patients successfully
recovered from the adverse reactions, we must bear in mind that the
hospitalization and medical care of these patients were associated with
significant cost and healthcare resource utilization, while there is no
evidence that herbal supplements can help with weight-loss[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/14965155" role="button">26</a>].
We must also consider the impact on patients with underlying chronic
liver disease, in whom herbal weight loss medications could cause
worsening in their synthetic function and even fulminant failure. In May
of 2009, the US Food and Drug Administration warned consumers to
immediately stop using Hydroxycut products, citing linkage to liver
damage in one patient who died due to liver failure[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#B27" role="button">27</a>].
However, Hydroxycut products are currently still available in many
parts of the world. Likewise, Herbalife products are widely available
globally. Therefore, it is these authors’ view that closer monitoring of
patients taking weight-loss herbal supplements as well as tighter
regulation from government drug agencies is warranted. Furthermore, our
cases once again demonstrated the importance of questioning patients
regarding the usage of herbal or nutritional supplements at the time of
evaluation.</b></span></div>
</div>
<div class="sec" id="__fn-groupid1275268">
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<span style="font-size: medium;"><b><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#ui-ncbiinpagenav-2" role="button" title="Go to other sections in this page">Go to:</a></b></span></div>
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__fn-groupid1275268title">
<span style="font-size: medium;">Footnotes</span></h2>
<div class="fm-sec half_rhythm small">
<div id="__pid1478348">
<span style="font-size: medium;"><b>Supported by Harbor UCLA Medical Center and The Division of Gastroenterology</b></span></div>
<div id="__pid1478351">
<span style="font-size: medium;"><b>Peer
reviewers: Mary Ko Manibusan, Co-Chair, US Environmental Protection
Agency, Office of Pesticide Programs, Health Effects Division - Crystal
City, 8136 Viola Street, Springfield, VA 22152, United States; Ferruccio
Bonino, Professor, Chief, Scientific Officer, Fondazione IRCCS Ospedale
Maggiore Policlinico Mangiagalli e Regina Elena, Via F. Sforza 28,
Milano 20122, Italy</b></span></div>
<div id="__pid1478358">
<span style="font-size: medium;"><b>S- Editor Zhang HN L- Editor Hughes D E- Editor Liu N</b></span></div>
</div>
</div>
<div class="sec" id="__ref-listid1275205">
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<span style="font-size: medium;"><b><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/#ui-ncbiinpagenav-2" role="button" title="Go to other sections in this page">Go to:</a></b></span></div>
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__ref-listid1275205title">
<span style="font-size: medium;">References</span></h2>
<div class="ref-list-sec sec" id="reference-list">
<div class="ref-cit-blk half_rhythm" id="B1">
<span style="font-size: medium;"><b><span class="ref-label">1.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid1275213">Kelly
JP, Kaufman DW, Kelley K, Rosenberg L, Anderson TE, Mitchell AA. Recent
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<span style="font-size: medium;"><b><span class="ref-label">2.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid1384798"> Available from: <a href="http://www.hydroxycut.com/products/hydroxycut/index.shtml" target="pmc_ext">http://www.hydroxycut.com/products/hydroxycut/index.shtml</a>.</span></span></b></span></div>
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<span style="font-size: medium;"><b><span class="ref-label">6.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid1504999">Dara
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<span style="font-size: medium;"><b><span class="ref-label">7.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid1467083"> Available from: <a href="http://products.herbalife.com/weight-management" target="pmc_ext">http://products.herbalife.com/weight-management</a>.</span></span></b></span></div>
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<span style="font-size: medium;"><b><span class="ref-label">8.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid1581318">Stickel
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<br />
<span style="font-size: x-small;">==================================</span><br />
<h1 class="content-title">
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/"><span style="font-size: large;">Aloe-induced Toxic Hepatitis</span></a></h1>
<span style="font-size: x-small;"><b><span class="citation-abbreviation">J Korean Med Sci. </span><span class="citation-publication-date">2010 March; </span><span class="citation-volume">25</span><span class="citation-issue">(3)</span><span class="citation-flpages">: 492–495. </span></b></span><br />
<div>
<span style="font-size: x-small;"><b><span class="fm-vol-iss-date">Published online 2010 February 17. </span> <span class="doi">doi: <a href="http://dx.crossref.org/10.3346%2Fjkms.2010.25.3.492" target="pmc_ext">10.3346/jkms.2010.25.3.492</a></span></b></span></div>
<div class="inline_block three_col va_top show-overflow align_right">
<div class="fm-citation-ids">
<div class="fm-citation-pmcid">
<span style="font-size: x-small;"><b><span class="fm-citation-ids-label">PMCID: </span>PMC2826749</b></span></div>
</div>
</div>
<h1 class="content-title">
<b><span style="font-size: x-small;"><a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Yang%20HN%5Bauth%5D">Ha Na Yang</a>,<sup>1</sup> <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Kim%20DJ%5Bauth%5D">Dong Joon Kim</a>,<sup><img alt="corresponding author" src="http://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/corrauth.gif" /></sup><sup>1</sup> <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Kim%20YM%5Bauth%5D">Young Mook Kim</a>,<sup>1</sup> <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Kim%20BH%5Bauth%5D">Byoung Ho Kim</a>,<sup>1</sup> <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Sohn%20KM%5Bauth%5D">Kyoung Min Sohn</a>,<sup>1</sup> <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Choi%20MJ%5Bauth%5D">Myung Jin Choi</a>,<sup>1</sup> and <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Choi%20YH%5Bauth%5D">Young Hee Choi</a><sup>2</sup></span></b></h1>
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<b><span style="font-size: x-small;"><a href="http://www.blogger.com/blogger.g?blogID=162178159833053852">Author information ►</a> <a href="http://www.blogger.com/blogger.g?blogID=162178159833053852">Article notes ►</a> <a href="http://www.blogger.com/blogger.g?blogID=162178159833053852">Copyright and License information ►</a></span></b></div>
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<b><span style="font-size: x-small;">This article has been <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/citedby/">cited by</a> other articles in PMC.</span></b></div>
</div>
</div>
<div class="sec" id="__abstractid2703206">
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<b><span style="font-size: x-small;"><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#ui-ncbiinpagenav-2" role="button" title="Go to other sections in this page">Go to:</a></span></b></div>
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__abstractid2703206title">
<span style="font-size: medium;">Abstract</span></h2>
<div>
<div id="__p1">
<span style="font-size: medium;"><b>Aloe
has been widely used in phytomedicine. Phytomedicine describes aloe as a
herb which has anti-inflammatory, anti-proliferative, anti-aging
effects. In recent years several cases of aloe-induced hepatotoxicity
were reported. But its pharmacokinetics and toxicity are poorly
described in the literature. Here we report three cases with
aloe-induced toxic hepatitis. A 57-yr-old woman, a 62-yr-old woman and a
55-yr-old woman were admitted to the hospital for acute hepatitis. They
had taken aloe preparation for months. Their clinical manifestation,
laboratory findings and histologic findings met diagnostic criteria
(RUCAM scale) of toxic hepatitis. Upon discontinuation of the oral aloe
preparations, liver enzymes returned to normal level. Aloe should be
considered as a causative agent in hepatotoxicity.</b></span></div>
</div>
<div class="sec">
<span style="font-size: medium;"><b class="kwd-title">Keywords: </b><b><span class="kwd-text">Aloe, Hepatitis, Toxic</span></b></span></div>
</div>
<div class="sec" id="__sec1">
<div class="goto jig-ncbiinpagenav-goto-container">
<span style="font-size: medium;"><b><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#ui-ncbiinpagenav-2" role="button" title="Go to other sections in this page">Go to:</a></b></span></div>
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__sec1title">
<span style="font-size: medium;">INTRODUCTION</span></h2>
<div id="__p2">
<span style="font-size: medium;"><b>The
demand for dietary supplements has continually increased in recent
years as the concept of 'well being' widely spread in Korea. The market
value for dietary supplements in Korea was approximately 600 billion won
(600 million USD) in year 2005 (<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#B1" role="button">1</a>), and personal spending was approximately 950,000 won (950 USD) per year in 2005 (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17380073" id="__tag_191763882" role="button">2</a>). One of the leading products in Korea's dietary supplements market is aloe.</b></span></div>
<div id="__p3">
<span style="font-size: medium;"><b>Aloe
has been purported to have positive effects on wound healing, recovery
from burn injury, cell growth, and immune modulation. However, cases of
aloe-induced toxic hepatitis have been reported since 2005. In
particular, there have been one each in Germany (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/15633238" id="__tag_191763890" role="button">3</a>), Turkey (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17142185" id="__tag_191763891" role="button">4</a>), and USA (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17726067" id="__tag_191763885" role="button">5</a>). In Switzerland (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/17692989" id="__tag_191763887" role="button">6</a>),
10 cases of hepatotoxicity associated with dietary supplements from
Herbalife® products were reported. Although 2 of those 10 cases took
aloe preparation, the causality assessment between aloe and toxic
hepatitis could not be done due to multiple Herbalife® products.</b></span></div>
<div id="__p4">
<span style="font-size: medium;"><b>We report 3 cases of aloe-induced toxic hepatitis in Korea.</b></span></div>
</div>
<div class="sec" id="__sec2">
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<span style="font-size: medium;"><b><a class="tgt_dark page-toc-label jig-ncbiinpagenav-goto-heading" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#ui-ncbiinpagenav-2" role="button" title="Go to other sections in this page">Go to:</a></b></span></div>
<h2 class="head no_bottom_margin ui-helper-clearfix" id="__sec2title">
<span style="font-size: medium;">CASE REPORTS</span></h2>
<div class="sec sec-first" id="__sec3">
<h3>
<span style="font-size: medium;">Case 1</span></h3>
<div id="__p5">
<span style="font-size: medium;"><b>A
57-yr-old female patient with a 2 month history of dyspepsia was
presented to our department. Past medical history and family history did
not reveal any significant disease. She also used drugs for arthralgia
intermittently for several years. She did not take any alcohol. She had
taken aloe tablets containing 250 mg of an extract of <i>Aloe arborescens</i> and 28.5 mg of an extract of <i>Aloe vera</i> (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F1/">Fig. 1</a>) for about 6 months prior to the admission. On admission, the patient's physical examination was normal.</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F1">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F1/" target="figure"><img alt="Fig. 1" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/bin/jkms-25-492-g001.gif" title="Fig. 1" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F1">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F1/" target="figure">Fig. 1</a></b></span></div>
<div>
<span style="font-size: medium;"><b>Preparation of aloe which the patient had taken. (<b>A</b>) Container bottle and tablets. (<b>B</b>) Packs of aloe extract.</b></span></div>
</div>
</div>
<div id="__p6">
<span style="font-size: medium;"><b>Laboratory
abnormalities included aspartate aminotransferase (AST) 331 IU/L,
alanine aminotransferase (ALT) 565 IU/L, alkaline phosphatase (AP) 309
IU/L. Anti-HAV IgM, anti-HCV, HCV PCR, and anti-HEV IgM were negative.
Anti-HBs IgG was positive. There was no serologic evidence for recent
infections with cytomegalovirus (CMV), Epstein-Barr-virus (EBV), or
herpes simplex virus (HSV). Autoimmune markers were all negative.
Abdominal ultrasonography showed reduced echogenicity of liver.
Dilatation of intra- or extrahepatic bile ducts was absent. Liver biopsy
revealed moderate portal infiltrates consisting of eosinophilis,
neutrophils, and monocytes. There were inflammatory cell infiltration
and acidophil body on the hepatic lobule. There was no bile stasis (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F2/">Fig. 2</a>).</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F2">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F2/" target="figure"><img alt="Fig. 2" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/bin/jkms-25-492-g002.gif" title="Fig. 2" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F2">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F2/" target="figure">Fig. 2</a></b></span></div>
<div>
<span style="font-size: medium;"><b>Histopathological findings of the liver. (<b>A</b>) The portal area and lobular area show inflammatory cell infiltration (H&E, ×100). (<b>B</b>) The acidophilic body and ballooning cell change are noted (H&E, ×200).</b></span></div>
</div>
</div>
<div id="__p7">
<span style="font-size: medium;"><b>Aloe
tablets was immediately discontinued. ALT was highest (926 IU/L) on the
12th day of admission and gradually decreased to 452 IU/L on the 25th
day of admission. ALT as well as total bilirubin gradually returned to
normal level over several weeks (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F3/">Fig. 3</a>).
Using the Roussel Uclaf Causality Assessment Method for determining
drug hepatotoxicity (RUCAM) scale, this case was scored as 'probable' (<a class="fig-table-link table figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/table/T1/">Table 1</a>).
The type of liver injury was determined as 'hepatocellular' since R
ratio (serum activity of ALT/serum activity of AP) was 10 (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/2254635" id="__tag_191763892" role="button">7</a>).</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F3">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F3/" target="figure"><img alt="Fig. 3" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/bin/jkms-25-492-g003.gif" title="Fig. 3" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F3">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F3/" target="figure">Fig. 3</a></b></span></div>
<div>
<span style="font-size: medium;"><b>Case 1. Upon discontinuation of the oral aloe preparation, liver enzymes returned to normal level.</b></span></div>
</div>
</div>
<div class="table-wrap iconblock ten_col whole_rhythm clearfix" id="T1">
<span style="font-size: medium;"><b><a class="table img_link icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/table/T1/" target="table"><img alt="Table 1" border="0" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/table/T1/?report=thumb" title="Table 1" /></a></b></span><br />
<div class="icnblk_cntnt">
<div>
<span style="font-size: medium;"><b><a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/table/T1/">Table 1</a></b></span></div>
<div>
<span style="font-size: medium;"><b>RUCAM score of these cases</b></span></div>
</div>
</div>
</div>
<div class="sec" id="__sec4">
<h3>
<span style="font-size: medium;">Case 2</span></h3>
<div id="__p8">
<span style="font-size: medium;"><b>A
62-yr-old female patient was presented to our department with a week
history of fatigue. Past medical history and family history did not
reveal any significant disease. The patient did not take any alcohol or
durgs. She had taken aloe powder containing 420 mg of an extract of <i>Aloe vera</i> (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F1/">Fig. 1B</a>)
for about 3 months prior to the admission. Physical examination
revealed jaundice on her sclera. She was the sales person of the aloe
product she was taking.</b></span></div>
<div id="__p9">
<span style="font-size: medium;"><b>Laboratory abnormalities
included AST 1,477 IU/L, ALT 1,564 IU/L, total bilirubin 14.64 mg/dL.
Anti-HAV IgM, anti-HCV, HCV PCR, and anti-HEV IgM were negative.
Anti-HBs IgG was positive. IgM antibody for HSV was in trace, IgM
antibody for CMV was negative. Abdominal ultrasonography was normal.
Liver biopsy revealed severe portal and lobular infiltrates consisting
of neutrophils and monocytes. There were several acidophilic bodies and
ballooning cell change in hepatic lobule. There were bile-stasis and
bile stained Kupffer cells (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F2/">Fig. 2B</a>).</b></span></div>
<div id="__p10">
<span style="font-size: medium;"><b>Aloe
extract was immediately discontinued. ALT gradually decreased to 452
IU/L which was lower than half of the peak value on the 17th day of
admission. When she was discharged ALT and AST were normal. We explained
to her about the aloe-induced hepatotoxity and advised not to take it
anymore. However, the patient started taking the same aloe extract again
1 month after her discharge from the hospital. A month later, follow-up
liver function test showed AST 477 IU/L, ALT 785 IU/L, and AP 165 IU/L (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F4/">Fig. 4</a>).
Since a hepatitis recurred after re-challenge of aloe extract, we could
confirm her diagnosis as aloe-induced toxic hepatitis. The RUCAM scale
was scored as 'definite' (<a class="fig-table-link table figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/table/T1/">Table 1</a>). The type of liver injury was determined as 'hepatocellular' since R ratio was 39.</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F4">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F4/" target="figure"><img alt="Fig. 4" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/bin/jkms-25-492-g004.gif" title="Fig. 4" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F4">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F4/" target="figure">Fig. 4</a></b></span></div>
<div>
<span style="font-size: medium;"><b>Case
2. Upon discontinuation of the oral aloe preparation, liver enzymes
returned to normal level. After re-challenge (arrow), liver enzymes go
up again.</b></span></div>
</div>
</div>
<div id="__p11">
<span style="font-size: medium;"><b>Six months later, the
patient was presented to our department with a 2 week history of
jaundice. Laboratory test showed AST 752 IU/L, ALT 1,135 IU/L, AP 243
IU/L and total bilirubin 15.81 mg/dL. We recommended admission, but she
refused to be admitted and she never visited our hospital again.</b></span></div>
</div>
<div class="sec sec-last" id="__sec5">
<h3>
<span style="font-size: medium;">Case 3</span></h3>
<div id="__p12">
<span style="font-size: medium;"><b>A
55-yr-old female patient was presented to our department with a 3 month
history of epigastric discomfort. Past medical history and family
history did not reveal any significant disease. The patient did not take
any alcohol or drugs. She had taken aloe extracts (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F1/">Fig. 1</a>)
for about 5 months prior to the admission. On admission, the patient's
physical examination was normal except mild tenderness on epigastric
area.</b></span></div>
<div id="__p13">
<span style="font-size: medium;"><b>Laboratory abnormalities included AST 344 IU/L,
ALT 666 IU/L, AP 298 IU/L. Anti-HAV IgM, anti-HCV, HCV PCR, and anti-HEV
IgM were negative. Anti-HBs IgG was positive. Autoimmune markers were
negative. Abdominal ultrasonography showed increased echogenicity of
liver. Dilatation of intra- or extrahepatic bile ducts was absent.</b></span></div>
<div id="__p14">
<span style="font-size: medium;"><b>Aloe
extract was immediately discontinued. ALT was highest (666 IU/L) on the
2nd day of admission, and gradually decreased. ALT was 484 IU/L on her
discharge (on the 5th day of admission). After 4 days, she visited our
department for follow-up. Liver function test was normal at that time
(AST 29 IU/L, ALT 11 IU/L, AP 190 IU/L) (<a class="fig-table-link fig figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F5/">Fig. 5</a>). The RUCAM scale was scored as 'probable' (<a class="fig-table-link table figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/table/T1/">Table 1</a>). The type of liver injury was determined as 'hepatocellular' since R ratio was 11.</b></span></div>
<div class="fig iconblock ten_col whole_rhythm clearfix" id="F5">
<span style="font-size: medium;"><b><a class="icnblk_img figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F5/" target="figure"><img alt="Fig. 5" class="small-thumb" src="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/bin/jkms-25-492-g005.gif" title="Fig. 5" /></a></b></span><br />
<div class="icnblk_cntnt" id="lgnd_F5">
<div>
<span style="font-size: medium;"><b><a class="figpopup" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/figure/F5/" target="figure">Fig. 5</a></b></span></div>
<div>
<span style="font-size: medium;"><b>Case 3. Upon discontinuation of the oral aloe preparation, liver enzymes returned to normal level.</b></span></div>
</div>
</div>
</div>
</div>
<div class="sec" id="__sec6">
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<h2 class="head no_bottom_margin ui-helper-clearfix" id="__sec6title">
<span style="font-size: medium;">DISCUSSION</span></h2>
<div id="__p15">
<b><span style="font-size: medium;">The
major driving force for the growth of the dietary supplements market is
the perception that 'they are safe because they are natural'. However,
the recently reported cases of hepatotoxicity induced by natural
substances (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/16171893" id="__tag_191763889" role="button">8</a>) indicate that natural substances may not be entirely safe.</span></b></div>
<div id="__p16">
<b><span style="font-size: medium;">There are about 400 species of aloe. Among them, particularly <i>aloe vera</i> has been used in phytomedicine. There have been positive reports on <i>aloe vera</i> as anti-inflammatory, anticancer, analgesic, anti-aging as well as liver protective. But, clinical effectiveness of <i>aloe vera</i> was not sufficiently defined because there were no large and randomized studies (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/10885091" id="__tag_191763884" role="button">9</a>). In 1994, Korea's National Institute of Safety Research conducted an experiment on the efficacy and toxicity of aloe (<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#B10" role="button">10</a>). There was no difference of natural killer cell activity between the <i>aloe vera</i>
gel treated and control animals. To observe the toxicity of aloe gel,
rats were given the high dose aloe orally. Any adverse effects were not
detected in hematological test, serum biochemistry, and
histopathological examination.</span></b></div>
<div id="__p17">
<b><span style="font-size: medium;">There are no specific
tests or diagnostic criteria for herbinduced hepatic injury. Careful
history taking, laboratory finding, and histopathology are used to
diagnose it. The best way to determine causing agent is re-challenging.
But it is not ethical and not applicable. Instead, the RUCAM scale is
used (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/2254635" id="__tag_191763883" role="button">7</a>, <a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/16481640" id="__tag_191763888" role="button">11</a>).</span></b></div>
<div id="__p18">
<b><span style="font-size: medium;">Since
patients usually do not regard dietary supplements as 'real' medicine,
they may fail to mention it when physicians query medication history.
Physicians should keep in mind that dietary supplements can be the cause
of hepatotoxicity when querying medication history, and should educate
the lay public.</span></b></div>
<div id="__p19">
<b><span style="font-size: medium;">There are three types of acute liver injury by drug or herb (<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#B12" role="button">12</a>):
hepatocellular, cholestatic, and mixed type. Our cases are
characterized as hepatocellular; there is a predominant initial
elevation of the ALT level. There are two proposed pathogeneses of drug
induced liver disease (<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#B13" role="button">13</a>):
direct toxicity and idiosyncratic mechanism. It is more likely that an
idiosyncratic immunological mechanism (hypersensitivity) is responsible
for the cases. A role for hypersensitivity is further supported by the
presence of eosinophilic granulocytes in the periportal fields seen in
the biopsy. Hypersensitivity to aloe has been described in humans (<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/7416761" id="__tag_191763886" role="button">14</a>), and the patch test or allergic skin test showed positive results (<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2826749/#B15" role="button">15</a>).</span></b></div>
<div id="__p20">
<b><span style="font-size: medium;">Herb
induced liver injury is an important problem in clinical setting,
because it can be an etiology of undiagnosed acute hepatitis. However,
there are few available data about the incidence and clinical
manifestation of dietary supplements such as aloe. Our cases emphasize
that physicians should consider various dietary supplements as causative
agents for hepatotoxicity.</span></b></div>
</div>
<div class="sec" id="__ref-listid3056003">
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<h2 class="head no_bottom_margin ui-helper-clearfix" id="__ref-listid3056003title">
References</h2>
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</div>
</div>
<span style="font-size: medium;"><b><span class="ref-cit"><span class="element-citation" id="__element-citationid1616581">===========================</span></span></b></span><br />
<h1 class="content-title">
<a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208182/"><span style="font-size: large;">Revisiting acute liver injury associated with herbalife products</span></a></h1>
<div class="half_rhythm">
<div class="contrib-group fm-author">
<span style="font-size: x-small;"><b><a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Appelhans%20K%5Bauth%5D">Kristy Appelhans</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Smith%20C%5Bauth%5D">Casey Smith</a>, <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Bejar%20E%5Bauth%5D">Ezra Bejar</a>, and <a href="http://www.ncbi.nlm.nih.gov/sites/entrez?cmd=search&db=PubMed&term=%20Henig%20YS%5Bauth%5D">Y Steve Henig</a></b></span></div>
</div>
<div class="fm-panel small half_rhythm">
<div class="togglers">
<span style="font-size: x-small;"><b><a href="http://www.blogger.com/blogger.g?blogID=162178159833053852">Author information ►</a> <a href="http://www.blogger.com/blogger.g?blogID=162178159833053852">Article notes ►</a> <a href="http://www.blogger.com/blogger.g?blogID=162178159833053852">Copyright and License information ►</a></b></span></div>
</div>
<div class="sec" id="__abstractid4062193">
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<h2 class="head no_bottom_margin ui-helper-clearfix" id="__abstractid4062193title">
Abstract</h2>
<div>
<div id="__p4">
<span style="font-size: medium;"><b>In
the November 27, 2010 issue of the World Journal of Hepatology (WJH),
three case reports were published which involved patients who had
consumed various dietary supplements and conventional foods generally
marketed as weight loss products. The reference to Herbalife products as
contaminated and generally comparable to all dietary supplements or
weight loss products is not scientifically supported. The authors
provided an insufficient amount of information regarding patient
histories, concomitant medications and other compounds, dechallenge
results, and product specifications and usage. This information is
necessary to fully assess the association of Herbalife products in the
WJH case reports. Therefore, the article does not objectively support a
causal relationship between the reported cases of liver injury and
Herbalife products or ingredients.</b></span></div>
</div>
<div class="sec">
<span style="font-size: medium;"><b class="kwd-title">Keywords: </b><b><span class="kwd-text">Herbalife, Liver, Hepatotoxicity, Weight loss products, Dietary supplements</span></b></span></div>
</div>
<div class="sec" id="__sec1">
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<h2 class="head no_bottom_margin ui-helper-clearfix" id="__sec1title">
TO THE EDITOR</h2>
<div id="__p5">
<span style="font-size: medium;"><b>In the November 27, 2010 issue of the <i>World Journal of Hepatology</i> (<i>WJH</i>),
three case reports were published which involved patients who had
consumed various dietary supplements and conventional foods generally
marketed as weight loss products. Case 1 involved a patient who did not
consume Herbalife products, while Cases 2 and 3 each reportedly consumed
various Herbalife products. Herbalife fundamentally disagrees with the
conclusions made by the authors with regard to any cause and effect
relationship related to the intake of Herbalife products. First,
Herbalife is not a single product and no unique suspect product or
ingredient has been implicated in this paper amongst the reported cases.
In addition, the authors arbitrarily compared cases involving the use
of a single product (Hydroxycut) with patients who consumed a group of
totally unrelated products produced by the company Herbalife. To bundle a
brand of products such as Herbalife with another company that sells
different products simply because they are all dietary supplements is
not valid. Finally, there are specific considerations, in regard to the
two patients who consumed Herbalife products, that would render many of
the observations and conclusions discussed by the authors as speculative
and unsubstantiated. The specific and factual points supporting these
views are further detailed below.</b></span></div>
<div id="__p6">
<span style="font-size: medium;"><b>Case 2 describes a
37-year-old female who developed symptoms of abdominal pain, mild
nausea, and painless jaundice 1 mo prior to presenting at the hospital[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/21173910" id="__tag_239495704" role="button">1</a>].
Several pertinent negatives were disclosed by the authors, including
autoimmune markers and viral serology. According to the authors, the
patient did not report any pre-existing medical conditions for which the
onset had preceded the use of Herbalife products. However, the
pathology assessment concluded that this patient’s biopsy result was
consistent with chronic liver disease, in which case Herbalife products
were thought to have had an additive effect. This opinion contradicts
repeated statements by the authors that acute liver injury in each case
report was due to the use of herbal weight loss products. In addition,
the etiology of the pre-existing condition was not identified by the
authors, and there was no discussion regarding the role of the condition
in the acute onset of her symptoms. Furthermore, the dosage and
frequency at which this patient consumed Herbalife products is unknown.
Finally, the inconsistency of the objective findings with the patient’s
reported medical history would suggest that further investigation is
warranted. This should include a review of the patient’s pre-existing
condition, potential use of medications prescribed for her condition,
other compounds she may have been consuming, and the status of her
health prior to the reported incident. In the absence of the
aforementioned data, the exclusion of possible differential diagnoses is
not well-supported.</b></span></div>
<div id="__p7">
<span style="font-size: medium;"><b>Case 3 describes a 53-year-old
female who developed symptoms of painless jaundice and pruritus 3 wk
prior to presenting at the hospital[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/21173910" id="__tag_239495706" role="button">1</a>].
This patient denied family history of liver disease, but no discussion
was provided regarding her own medical history, other than the fact that
she reportedly denied the use of alcohol and did not engage in “illicit
substance abuse”. The authors further stated that the patient had not
been prescribed any new medications, which implies that she may have
been taking other agents concomitantly. However, information regarding
the use of concomitant medications, or the conditions for which she may
have been receiving treatment, was not disclosed. Such information is
critical and should have been obtained through follow-up review of the
patient’s previous medical records. Without this information, it is
unknown whether concomitant medication(s) were withdrawn and/or
accounted for during the dechallenge process. The patient’s use of
Herbalife products was also not specified by product names and it is
unknown whether the dosage and frequency of consumption was adherent to
recommendations indicated on the product label(s). In addition to the
absence of the aforementioned pertinent patient data, there are various
refutable facts that remain in regard to the comments and conclusions
made by the authors.</b></span></div>
<div id="__p8">
<span style="font-size: medium;"><b>In their <i>WJH</i> article, the
authors concluded that it was difficult to isolate a single ingredient
or mechanism associated with acute liver injury for either patient
consuming Herbalife products[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/21173910" id="__tag_239495703" role="button">1</a>].
In an effort to discuss potential causative agents for the reported
conditions in these patients, the authors extraneously reference
previously published case reports involving Herbalife products,
including those of two consumers who reportedly developed hepatotoxicity
following exposure to <i>Bacillus subtilis</i> (<i>B. subtilis</i>)[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" id="__tag_239495700" role="button">2</a>].</b></span></div>
<div id="__p9">
<span style="font-size: medium;"><b>In
review of this reference, it has been noted that there were various
critical deficiencies in the scientific methodology used to isolate <i>B. subtilis</i>
in the Herbalife samples reported to have been contaminated. For
example, a dose dependent increase in LDH leakage in HepG2 cells was
observed in the experimental assay, but investigators did not present
any control data for their experiments, nor did they present any data
that suggested this assay is a valid proxy for liver injury in healthy
individuals “<i>in vivo</i>”. Neither patient reported symptoms consistent with classical <i>B</i>. <i>subtilis</i>
food poisoning and they did not report testing the product for the
detection of cerulide or any of the reported heat-stable toxins
associated with certain strains of <i>B. subtilis</i>. Furthermore, the investigators did not enumerate the levels of <i>B. subtilis</i>
in the products tested or report testing relevant specimens from the
patients for these organisms or their toxins. This was a crucial step
missing in the reported investigation as all previous documented reports
find that high levels of the organism must be consumed to cause
illness. Herbalife products, consumed by the patients described in the <i>WJH</i> article, to date show no evidence of <i>B. subtilis</i> contamination. <i>B. subtilis</i>
infections are relatively rare and seldom contracted through food
sources. This bacterium is actually ubiquitous in nature and generally
recognized as safe with a history of safe use in food, and is considered
to be safe for the production of enzymes or ingredients for use in
food[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208182/#B3" role="button">3</a>]. There have been reported cases of <i>B. subtilis</i>-related
gastroenteritis and other complications, usually involving
immuno-compromised patients or those with other underlying chronic
illnesses, which did not appear to be the case for any of the patients
presented in the <i>WJH</i> article. Therefore, it is highly unlikely that <i>B. subtilis</i>
could be the cause or have contributed to the severe hepatotoxicity of
patients in either the referenced article or the two patients discussed
in the <i>WJH</i> article.</b></span></div>
<div id="__p10">
<span style="font-size: medium;"><b>The <i>WJH</i> authors
also suggest intentional or incidental contamination of Herbalife
ingredients and identify various potential sources, including unrefined
raw herbal extracts, heavy metals, pesticides, and additives[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/21173910" id="__tag_239495702" role="button">1</a>].
However, some of the additives mentioned as potential contaminants by
the authors (e.g., flavoring, colors, and preservatives) are commonly
used and well-documented industry-wide as safe for consumption in
conventional foods, as well as dietary supplements,. In addition,
authors also reference an article from 2002 that reviews possible
contamination sources inherent to herbal remedies marketed without
proper quality control measures in place[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208182/#B5" role="button">5</a>].
Herbalife is not specifically implicated in the referenced article, yet
the authors imply that Herbalife product contamination and lack of
quality control contributed to the liver injury. The authors’ assumption
is wrong and does not take into consideration that the United States
FDA requires dietary supplement manufacturers to use current Good
Manufacturing Practices (cGMPs) in the production of dietary
supplements[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/12490687" id="__tag_239495701" role="button">4</a>].
The goal of these regulations is to “ensure that a dietary supplement
contains what the manufacturer intends” and meets specifications to
ensure the dietary supplement contains the correct ingredient, purity,
strength and composition intended. Herbalife has rigorous processes in
place concerning quality control, including extensive safety reviews
based on existing literature for product ingredients, testing to confirm
that labeled ingredients are present in finished goods, and to assure
all tested ingredients meet product specifications on an ongoing basis.
In addition to complying with cGMP regulations, Herbalife acts in
accordance with other generally recognized industry standards or
requirements by sourcing and testing raw materials to further ensure
that the final product complies with specifications for identity,
purity, potency and contaminants.</b></span></div>
<div id="__p11">
<span style="font-size: medium;"><b>The authors also try to implicate the <i>Camellia sinensis</i> (<i>C. sinensis</i>) used in Herbalife’s tea drink products by citing case reports of liver injury in association with ethanolic extracts of <i>C. sinensis</i>, which contain a concentrated fraction of EGCG[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/21173910" id="__tag_239495705" role="button">1</a>].
The most important safety consideration for green tea is the extraction
method. The historical data supporting the safety of green tea is based
on the consumption of an aqueous extract over thousands of years,
specifically, the typical three cups per day that are commonly consumed
in Asian countries. Aqueous extracts of green tea are quite different
from solvent extractions, which are commonly used to concentrate select
fractions of green tea, such as EGCG or caffeine. Again, the <i>WJH</i>
authors have not considered the clinical significance of potential
differences in raw material processing amongst manufacturers, controls
for contamination and identification of raw materials, and the
implication of these differences when reviewing published case reports
of liver injury. In addition, the authors state that Herbalife has
refused to provide detailed analyses of ingredients and formulations,
although no attempt was made by these authors to contact Herbalife to
obtain further information regarding Herbalife products or ingredients.
Herbalife has, to date, remained compliant with all formal regulatory
requests and requirements for product information.</b></span></div>
<div id="__p12">
<span style="font-size: medium;"><b>The authors state that significant liver injury induced by herbal supplements is a rare event[<a class="cite-reflink bibr popnode tag_hotlink tag_tooltip jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pubmed/21173910" id="__tag_239495707" role="button">1</a>].
This statement is true as approximately 20 to 50 percent of all cases
presenting as hepatotoxicity are cryptogenic leading to the incidental
association of liver disease with a group of products in the absence of
specific evidence[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208182/#B5" role="button">5</a>].
While this disease is the most common cause of drug withdrawal during
post-marketing surveillance, it is an uncommon cause of liver disease.
The background incidence of hepatotoxicity in populations is clearly
comparable to the reported incidence of immunoallergic and
individualistic reactions to allergens in foods, supplements, or the
environment. For example, in a study of 71 000 North Americans in 1992,
the background rate of idiopathic or cryptogenic liver disease was 24
cases per 100 000 individuals compared to 14 per 100 000 attributed to
cases of hepatitis B, 25 per 100 000 due to alcoholism, and 7 per
100 000 to other viral illnesses[<a class="cite-reflink bibr popnode jig-ncbipopper" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3208182/#B6" role="button">6</a>].
While the spectrum of liver diseases may well have changed since 1992
when this survey was done, idiopathic liver disease remains a
significant percentage of all cases. Therefore, it is particularly
important in making such associations to have incontrovertible evidence
such as is often available for prescription drugs where, under
controlled conditions, a cause-effect relationship can be established.</b></span></div>
<div id="__p13">
<span style="font-size: medium;"><b>Finally,
the authors also state that existing case reports of dietary
supplement-induced hepatotoxicity include patients with pre-existing
liver disease and that weight loss supplements could worsen such
conditions in these patients. However, this effect could occur from many
different substances, including over-the-counter and prescription
medications, as these patients may be “pre-sensitized” due to an
underlying hepatic condition.</b></span></div>
<div id="__p14">
<span style="font-size: medium;"><b>In conclusion, the
reference to Herbalife products as contaminated and generally comparable
to all dietary supplements or weight loss products is not
scientifically supported. Further information regarding patient
histories, concomitant medications and other compounds, dechallenge
results, and product specifications and usage is indicated to assess
fully the association of Herbalife products in the <i>WJH</i> case
reports. Therefore, the article does not objectively support a causal
relationship between the reported cases of liver injury and Herbalife
products or ingredients.</b></span></div>
</div>
<div class="sec" id="__fn-groupid4109041">
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<span style="font-size: x-small;">Footnotes</span></h2>
<div class="fm-sec half_rhythm small">
<div id="__p15">
<span style="font-size: x-small;"><b>Peer
reviewers: Jordi Muntan¨¦, PhD, Unidad de Investigacion, Hospital
Universitario Reina Sof¨ªa, Av. Men¨¦ndez Pidal s/n, Cordoba 14004,
Spain</b></span></div>
<div id="__p16">
<span style="font-size: x-small;"><b>S- Editor Zhang SJ L- Editor Hughes D E- Editor Zheng XM</b></span></div>
</div>
</div>
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<h2 class="head no_bottom_margin ui-helper-clearfix" id="__ref-listid4109060title">
<span style="font-size: x-small;">References</span></h2>
<div class="ref-list-sec sec" id="reference-list">
<div class="ref-cit-blk half_rhythm" id="B1">
<span style="font-size: x-small;"><b><span class="ref-label">1.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid4109069">Chen
GC, Ramanathan VS, Law D, Funchain P, Chen GC, French S, Shlopov B,
Eysselein V, Chung D, Reicher S, et al. Acute liver injury induced by
weight-loss herbal supplements. <span class="ref-journal">World J Hepatol. </span>2010;<span class="ref-vol">2</span>:410–415. <span class="nowrap">[<a class="int-reflink" href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004035/">PMC free article</a>]</span> <span class="nowrap">[<a href="http://www.ncbi.nlm.nih.gov/pubmed/21173910" target="pmc_ext">PubMed</a>]</span></span></span></b></span></div>
<div class="ref-cit-blk half_rhythm" id="B2">
<span style="font-size: x-small;"><b><span class="ref-label">2.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid4067484">Stickel
F, Droz S, Patsenker E, Bögli-Stuber K, Aebi B, Leib SL. Severe
hepatotoxicity following ingestion of Herbalife nutritional supplements
contaminated with Bacillus subtilis. <span class="ref-journal">J Hepatol. </span>2009;<span class="ref-vol">50</span>:111–117. <span class="nowrap">[<a href="http://www.ncbi.nlm.nih.gov/pubmed/19010564" target="pmc_ext">PubMed</a>]</span></span></span></b></span></div>
<div class="ref-cit-blk half_rhythm" id="B3">
<span style="font-size: x-small;"><b><span class="ref-label">3.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid4067562"><span class="ref-journal">Biotechnology Program Under the Toxic Substances Control Act (TSCA)</span> Bacillus subtilis Final Risk Assessment; 1997. Feb, Available from:
<a href="http://www.epa.gov/biotech_rule/pubs/fra/fra009.htm" target="pmc_ext">http: //www.epa.gov/biotech_rule/pubs/fra/fra009.htm</a>.</span></span></b></span></div>
<div class="ref-cit-blk half_rhythm" id="B4">
<span style="font-size: x-small;"><b><span class="ref-label">4.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid4067596">De Smet PA. Herbal remedies. <span class="ref-journal">N Engl J Med. </span>2002;<span class="ref-vol">347</span>:2046–2056. <span class="nowrap">[<a href="http://www.ncbi.nlm.nih.gov/pubmed/12490687" target="pmc_ext">PubMed</a>]</span></span></span></b></span></div>
<div class="ref-cit-blk half_rhythm" id="B5">
<span style="font-size: x-small;"><b><span class="ref-label">5.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid4067639"><span class="ref-journal">Implementation of FDA's Current Good Manufacturing Practices for Dietary Supplements.</span> [cited 2007 Oct 24]. Available from:
<a href="http://www.fda.gov/Food/DietarySupplements/GuidanceComplianceRegulatoryInformation/RegulationsLaws/ucm174152.htm#slide" target="pmc_ext"> http://www.fda.gov/Food/DietarySupplements/GuidanceComplianceRegulatoryInformation/RegulationsLaws/ucm174152.htm#slide</a>.</span></span></b></span></div>
<div class="ref-cit-blk half_rhythm" id="B6">
<span style="font-size: x-small;"><b><span class="ref-label">6.</span> <span class="ref-cit"><span class="element-citation" id="__element-citationid4067668">Walker AM, Cavanaugh RJ. The occurrence of new hepatic disorders in a defined population. <span class="ref-journal">Post-marketing Surveill. </span>1992;<span class="ref-vol">6</span>:107–117.</span></span></b></span></div>
</div>
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<h1 id="page-title">
<a href="http://suite101.com/article/do-herbalife-products-cause-hepatitis-a313934"><span style="font-size: large;">Do Herbalife Products Cause Hepatitis?</span></a></h1>
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<h1 id="page-title">
<b><span style="font-size: medium;">Multiple
medical resources have found that there are <span style="font-size: large;"><span style="color: red;">2,000,000 people around the
world </span></span>who are offering products that may <span style="font-size: large;"><span style="color: red;">make you very sick.</span></span></span></b></h1>
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<b><span style="font-size: medium;">Herbalife
is a publicly traded company based out of Los Angeles, California.
Since 1980 it has allowed people the opportunity to become independent
sales reps with the opportunity to lead others to do the same in the
form of multi-level marketing, or network marketing.</span></b><br />
<b><span style="font-size: medium;">Like any large organization with several decades of experience, there
are some controversies behind this one. For example, in 1986, the state
of California claimed that the company made inflated claims regarding
income potential for which Herbalife settled for $850,000, and in 2004
thousands of current and former distributors took the company to court
on the grounds of running a <a href="http://suite101.com/article/signs-that-a-network-marketing-opportunity-is-a-pyramid-scheme-a241526">pyramid scheme</a>. Herbalife settled the latter case for $6,000,000 (less than $700 each).</span></b><br />
<b><span style="font-size: medium;">Along with these legal matters are much more pressing health
concerns. Several medical resources have found that Herbalife products
may actually <a href="http://www.ncbi.nlm.nih.gov/pubmed/19157382">cause hepatitis</a>.</span></b><br />
<b><span style="font-size: medium;"><b>What is Hepatitis and How is it Caused?</b></span></b><br />
<b><span style="font-size: medium;">Hepatitis can be characterized as an inflammation of the liver. One
visible symptom is jaundice, and less visible ones are lack of appetite
and a feeling of overall discomfort.</span></b><br />
<b><span style="font-size: medium;">Hepatitis is typically caused by a virus, but it can also be caused
by toxins when taken regularly, such as alcohol or an infection that is
already present. The question on many people's minds regarding Herbalife
products would be, how could these products be linked to infecting
those who take them?</span></b><br />
<b><span style="font-size: medium;">The answer is in the ingredients. There has to be something toxic in
some or all of the products released by the company, but it is hard to
know which ones because the FDA does not regulate herbal supplements the
same way it does medicine. This is why athletes find out via heart
attack that ephedrine is not so great, and how health conscious people
discover that they may be poisoning themselves the hard way, as reported
in a 2007 article published in <i>The Journal of Hepatology </i>titled "<a href="http://www.ikp.unibe.ch/lab2/herbalife2007.pdf">Herbal Does not Mean Innocuous</a>."</span></b><br />
<b><span style="font-size: medium;"><b>Countries That Have Reported Illness Links to Herbalife</b></span></b><br />
<b><span style="font-size: medium;">It is important to note where the sources are that have reported on
Herbalife. This is because some people go on the attack against
networking companies because they think they are dangerous or terrible,
and some <a href="http://suite101.com/article/karl-marx-and-frederick-engels-communism-a202245">governments are anti-capitalistic</a>, so they would be against a company like Herbalife because they do not want their people to have too much freedom and control.</span></b><br />
<b><span style="font-size: medium;">In 2004, 12 patients in Israeli hospitals with severe liver problems
had one thing in common. They were taking an Herbalife supplement that
aided digestion. When their liver enzymes normalized, they resumed their
normal regimen of the product and were sick again.</span></b><br />
<b><span style="font-size: medium;">The 2007 article noted from the European<i> Journal of Hepatology </i>had
several sources, one of which was medical professionals from
Switzerland. In it, the ten most severe cases covered showed two
patients with "certain causality" while the other eight had "probable
causality." The duration of the illness ranged from two months to twelve
years.</span></b><br />
<b><span style="font-size: medium;">The objective here is not to demonize a company or industry, but to
alert consumers that when Herbalife distributors pitch the quality of
their products, they may be pitching high-end hepatitis. And while the
ingredients linked to causing disease in the past may have been rid of,
it does not mean that today's products are safe.</span></b><br />
<b><span style="font-size: medium;">Without FDA interaction, humans are the test subjects for herbal
supplements. The best way to go when it comes to supplements is to use
one with a long track record of not hurting its users.</span></b><br />
<b><span style="font-size: medium;"><b>Jan. 5 update from the author: </b>On December 23,
George Fischer and one of his doctors had a conference call with me.
During the course of that conversation, they promised that they would
send me information contradicting the reporting in the Journal of
Hepatology. No such contact has been made since.</span></b></div>
</div>
</div>
<br />
<br /></div>
</div>
</div>
===========================================<br />
<br />
<h2>
<span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">LIVER DAMAGE IN EUROPE ASSOCIATED WITH HERBALIFE USE:</span></span></h2>
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><b>4 Sept 2007 Review </b><br />
The following reports below of HerbaLife-associated liver failure appear on Medline – from Spain, then Israel and Switzerland.<br />
:The July 2007 reports of the two dozen Herbalife-associated hepatitis
cases from Israel & Switzerland reveal that liver problems occurred
after about 5 months on the products; and that relapse occurred in about
20% on rechallenge with Herbalife ie in this percentage the association
is proven.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Herbalife results for
weight control have been reported as good. The only problem is
historical according to the current Wikipedia entry: “Some of the
original Herbalife weight loss products contained the active ingredient
Ma Huang or Sida cordifolia, two herbs containing ephedrine alkaloids.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Adverse reactions
involving the company’s Thermojetics original green tablets were
recorded by the U.S. Food and Drug Administration and Herbalife
subsequently stopped using ephedrine in its products in the face of
rising insurance premiums.[3][4] The U.S. FDA banned supplements
containing ephedra in 2004.[5]“</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">It is possible that the
case reports below are unrelated to Herbalife itself , or that in those
countries ephedra-containing Herbalife was still in use at the time, or
that potentially hazardous herbs etc were added locally.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">From Yahoo.com, there is an <a href="http://www.icelandreview.com/icelandreview/daily_news/?cat_id=16567&ew_0_a_id=262714" target="_blank">authoritative rebuttal</a> from Iceland dated February 2007.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">A score of drugs and
herbs can cause liver damage, topical ones – albeit rarely- include
mushrooms; black cohosh and kava – see a <a href="http://en.wikipedia.org/wiki/Hepatitis#Drug_induced_hepatitis." target="_blank">recent list</a>.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Drugs like ticrynafen,
methyldopa and cerivastatin were discarded among other reasons because
of liver problems, which are among many reasons why necessary sex
hormone contraception and replacement should rather not use designer
patent ie synthetic drugs, and especially not by mouth (hepatic first
pass effect).</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">So it is always difficult
to blame a single product, as the ongoing debate about black cohosh
shows – which many “first world” regulators have “black boxed” ie added a
compulsory warning to black cohosh warnings.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">As with black cohosh, with a rare adverse event report, users of such products must weigh up for themselves. </span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">As they say, since
Herbalife tends to be custom-made in each country, with numerous
ingredients (some undisclosed), it is so far impossible to incriminate
whether the cause was local product corruption, or some appreoved
component, of which the known possible culprits are ephedra and camelia.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Other known hepatotoxic
herbs like black cohosh, kava and mushrooms were not mentioned. A few of
the patients had viral hepatitis. Only 7 cases had also taken other
known potential liver sensitizers – some synthetic sex hormones (4),
aspirin (3), statin (1) and hydrochlorothiazide(1), of which 2 cases had
positive recurrence of hepatitis on rechallenge with Herbalife.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">UCT Medicines Information
Centre is unaware of any such problems locally, and can recollect only
perhaps 2 queries about Herbalife in some 23 years. Clarification is
awaited from Herbalife headquarters.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">From Swiss data the
estimated incidence was below 2 cases per million Herbalife users, but
both studies were based only on hospital records.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Considering the severe
global problem of hepatitis from other causes (due to alcohol;
obesity/diabetes (steatohepatitis, sulphonylureas, glitazones); numerous
infections; carbon tetrachloride; synthetic sex hormones (oral
contraception and postmenopausal hormone therapy) , mushrooms,
antibiotics and antivirals, , autoimmune disease, antiepileptics,
nifedipine, amitryptiline, allopurinol, nonsteroidal anti-inflammatories
including aspirin and paracetamol , black cohosh, kava, antifungals and
paracetamol), and that the rare adverse association of herbalife with
liver damage may well have been limited only to Herbalife products made
in those three “European” countries at that time, there is clearly no
cause for alarm about Herbalife – just awareness.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">The urgent problem of
endemic liver disease is rather the avoidance of infections and
potentially hazardous antimicrobials; mushrooms; carbon tetrachloride,
alcohol excess; sale pf paracetamol without inclusion of protective
vitamins and N-acetyl cysteine; and avoidance of potential hepatotoxins
which are rarely if ever justified considering their risks, and safe
effective alternatives available for eg statins, sulphonylureeas,
glitazones, black cohosh, kava, non-steroidal anti-inflammatories; oral
sex hormones; and sulphonylureas.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">The centuries-proven
plant galega officinalis (extract) metformin after 85years of modern use
remains the only drug proven in longterm use to both reduce liver
damage, lipidemia, thrombosis, adiposity and insulin resistance, and
thus almost halve the incidence of new diabetes, hypertension/vascular
disease, cancer and thus all-cause premature medical mortality.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">Thus appropriate general
use of metformin with long-proven vitamins, minerals, biologicals, safe
herbs, fish oil and systemic human sex hormones – combined with prudent
lifestyle and largely natural fresh foodstuffs- – does away with most of
the well-known potential hepatitis drug risks listed above.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;">In defence of free market
enterprise and choices, those who choose convenience safe proven food
substitutes or other complementary products as part of an acceptable
balanced regime advocated by suppliers like Herbalife do well, they
should just be sure of the ingredients and supplier; and they should
report and discuss what they use with some knowledgable up-to-date
healthcare provider.</span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><b>Response</b> <b>from</b> <b>Herbalife </b></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><b>04.09.07</b><br />
<b>Herbalife’s South Africa CEO responds reassuringly:</b></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>Good day,<br />
Herewith a statement from Herbalife in response to the issues raised by yourself earlier in the week:</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>While we are aware of
reports of abnormal liver function blood tests such as those reported
by Dr. Oneta, our extensive consultation with internationally recognised
liver experts has led repeatedly to the conclusion that these
associations in time cannot be linked to any Herbalife product.</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>These small numbers
of reports are anecdotal and millions of satisfied customers all over
the world have been using our products for more than 27 years. All
Herbalife products are formulated and manufactured in accordance with
strict standards overseen by the Herbalife Scientific Advisory Board,
which is chaired by David Heber, M.D., Ph.D., F.A.C.P., F.A.C.N. Quality
control is overseen by our Scientific Affairs Group, chaired by Y.
Steve Henig PhD and made up of an international panel of experts in
nutrition and botanical dietary supplements.</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>Herbalife products,
which are now sold in 65 countries, are formulated, registered and
labelled in accordance with the regulatory requirements in every market
where sold. All Herbalife products are safe to consume as directed.</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>Many consumers who
choose to use Herbalife weight-management products for weight loss are
overweight, some significantly so. Pre-existing medical conditions such
as obesity and diabetes can be associated with non-alcoholic fatty liver
disease, a disorder that may return certain types of abnormal blood
test results. These test results, therefore, may have nothing to do with
any herbal supplement, but rather are the result of a pre-existing
medical condition. In addition, it is possible for an individual to have
an allergic reaction to our products, the same way one might to any
food product; for example, strawberries or shellfish. Herbalife supports
the recommendation that consumers visiting their doctors for medical
treatment inform them of any supplements they may be taking.</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>As a socially
responsible company, we operate an adverse event reporting procedure
that deals with the small number of queries we have from doctors and
consumers and we operate an open dialogue policy with the medical
community. All adverse event reports are investigated thoroughly in
consultation with the consumer and the physician (if they are available)
to fully understand the facts. None have resulted in the compulsory
withdrawal of any product, ever. In the United States, Herbalife
actively lobbied Congress to pass legislation mandating the submission
of all dietary supplement and over-the-counter drug serious adverse
events to the Food & Drug Administration. That new law takes effect
December 22, 2007.”</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>REFS:</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>J Hepatol. 2007
Oct;47(4):521-526. Herbal does not mean innocuous: Ten cases of severe
hepatotoxicity associated with dietary supplements from Herbalife((R))
products. Schoepfer AM, ea.University Hospital Bern, Switzerland.<br />
METHODS: To determine the prevalence and outcome of hepatotoxicity due
to Herbalife((R)) products. A questionnaire was sent to all public Swiss
hospitals. Reported cases were subjected to causality assessment using
the CIOMS criteria. RESULTS: <b>Twelve cases of toxic hepatitis implicating Herbalife((R)) preparations (1998-2004)</b>
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.
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((R)) products. Liver toxicity may be severe. A more detailed
declaration of components and pro-active role of regulatory agencies
would be desirable.</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>J Hepatol. 2007
Oct;47(4):514-520. Association between consumption of Herbalife((R))
nutritional supplements and acute hepatotoxicity. Elinav E, ea -Hebrew
University Medical Center, Israel.<br />
: In 2004, identification of four index cases of acute hepatitis
associated with Herbalife((R)) intake led to a ministry of health
investigation in all Israeli hospitals. <b>Twelve patients with acute idiopathic liver injury</b> in association with consumption of Herbalife((R)) products were investigated.<br />
RESULTS: Eleven of the patients were females, aged 49.5+/-13.4 y. One
patient had stage I primary biliary cirrhosis and another had hepatitis
B. Acute liver injury was diagnosed after 11.9+/-11.1 months of
initiation of Herbalife((R)) consumption. <b>Liver biopsies demonstrated active hepatitis</b>, portal inflammation rich with eosinophils, ductular reaction and parenchymal inflammation with peri-central accentuation.<br />
. CONCLUSIONS: An association between intake of Herbalife((R)) products
and acute hepatitis was identified in Israel. We call for prospective
evaluation of Herbalife((R)) products for possible hepatotoxicity.</i></span></span></b><br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>Med Clin (Barc). 2007 Feb 17;128(6):238-9.<br />
[Hepatotoxicity associated with the consumption of herbal slimming products] Duque JM,ea. [Article in Spanish] Letter</i></span></span></b><br />
<br />
<b><span style="font-size: medium;"><span style="font-family: Arial,sans-serif;"><i>============================== </i></span></span></b><br />
<br />
<div dir="ltr" style="text-align: left;">
<br />
<span style="font-family: Arial; font-size: xx-small;"> J Hepatol (2007) 0: .</span>
<br />
<br />
<span style="font-family: Impact,sans-serif; font-size: 2em;">Herbal does not mean innocuous: Ten cases of severe hepatotoxicity associated with dietary</span>
<br />
<br />
<div>
<a class="addthis_button" href="http://www.addthis.com/bookmark.php?v=250&username=chesketh">
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</div>
<br />
<span style="font-size: x-small;"><b><span style="font-family: Arial;">
<a href="http://www.camresearch.net/showcitationlist.php?surname=Schoepfer&initials=AM">AM Schoepfer</a>, <a href="http://www.camresearch.net/showcitationlist.php?surname=Engel&initials=A">A Engel</a>, <a href="http://www.camresearch.net/showcitationlist.php?surname=Fattinger&initials=K">K Fattinger</a>, <a href="http://www.camresearch.net/showcitationlist.php?surname=Marbet&initials=UA">UA Marbet</a>, <a href="http://www.camresearch.net/showcitationlist.php?surname=Criblez&initials=D">D Criblez</a>, <a href="http://www.camresearch.net/showcitationlist.php?surname=Reichen&initials=J">J Reichen</a>, </span></b></span></div>
<span style="font-size: x-small;"><b><span style="font-family: Arial;"><a href="http://www.camresearch.net/showcitationlist.php?surname=Zimmermann&initials=A">A Zimmermann</a>, <a href="http://www.camresearch.net/showcitationlist.php?surname=Oneta&initials=CM">CM Oneta</a>
</span>
</b></span><br />
<br />
<b><span style="font-family: Arial; font-size: medium;">
BACKGROUND/AIMS: Herbal agents are
popular and perceived as safe because they are supposedly 'natural'. We
report 10 cases of toxic hepatitis implicating Herbalife((R)) products.
METHODS: To determine the prevalence and outcome of hepatotoxicity due
to Herbalife((R)) 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((R)) 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((R)) products.
Liver toxicity may be severe. A more detailed declaration of components
and pro-active role of regulatory agencies would be desirable.<br />
=====================</span></b><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOXE8lSS2qi6-dZIuG_L3yLsiZ_ephPbNFPHqeOCcv0jeAUQ2r4wPXvuACOsWX3TPGvvjz9OMVVVNA8aTmYsLaPteh9iJCgI5DRIg7XfeS8e2-UcUIiaVtPhZ52Y8O0JoUVJncTPDRH3mi/s1600/good.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="292" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjOXE8lSS2qi6-dZIuG_L3yLsiZ_ephPbNFPHqeOCcv0jeAUQ2r4wPXvuACOsWX3TPGvvjz9OMVVVNA8aTmYsLaPteh9iJCgI5DRIg7XfeS8e2-UcUIiaVtPhZ52Y8O0JoUVJncTPDRH3mi/s320/good.jpg" width="320" /></a></div>
<br />
<b><span style="font-size: x-small;"><br /><span class="long_text" id="result_box" lang="en"><span title="Risultati su una ricerca di studi che evidenziano gli effetti dell'utilizzo di prodotti Herbalife per dimagrire."><span style="font-size: medium;">Results of a search for studies that show the effects of using Herbalife products for weight loss.</span></span><span title="Il sito ufficiale è: http://www.ncbi.nlm.nih.gov/pubmed?term=herbalife"> </span></span></span></b><br />
<b><span style="font-size: x-small;"><span class="long_text" id="result_box" lang="en"><span title="Il sito ufficiale è: http://www.ncbi.nlm.nih.gov/pubmed?term=herbalife">The official website is: <a href="http://www.ncbi.nlm.nih.gov/pubmed?term=herbalife">http://www.ncbi.nlm.nih.gov/pubmed?term=herbalife</a></span></span></span></b></div>
LIVER AND KIDNEY CAREhttp://www.blogger.com/profile/06962952006102031340noreply@blogger.com4tag:blogger.com,1999:blog-1848169706976243572.post-24985382154106574592012-12-03T07:34:00.001-08:002012-12-04T04:06:58.417-08:00<div dir="ltr" style="text-align: left;" trbidi="on">
<h3 class="post-title entry-title" itemprop="name">
<a href="http://herbalife-sideeffects.blogspot.in/2012/03/blog-post_428.html">HERBALIFE SIDE EFFECTS</a>
</h3>
<div class="post-header">
</div>
<div dir="ltr" style="text-align: left;">
<div style="text-align: center;">
</div>
<div style="text-align: center;">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQwHgdNjex2purS3wiDq8zGxbMY6SGhXAGDgAYlh0oXu2foLT5UwWsl16eKEuxtRgGEd1QKpFBEddl_PoYYuEOtnqj8xcz6yfKwC04YTl-Lgy7dVaEp99P8hasbvSyFhTBL7RBGFn1SBTw/s1600/herbalife+could+damage.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="81" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhQwHgdNjex2purS3wiDq8zGxbMY6SGhXAGDgAYlh0oXu2foLT5UwWsl16eKEuxtRgGEd1QKpFBEddl_PoYYuEOtnqj8xcz6yfKwC04YTl-Lgy7dVaEp99P8hasbvSyFhTBL7RBGFn1SBTw/s320/herbalife+could+damage.jpg" width="320" /></a></div>
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<br />
<span style="font-weight: bold;"><a href="http://herbalife-sideeffects.blogspot.in/2012/03/blog-post_3601.html" target="_blank"><span style="font-size: 180%;">Herbalife Side Effects</span></a><br /><span style="font-size: 130%;">Some
people experience unpleasant side effects when using various Herbalife
products. These are described and addressed in this article for your
safety and well-being.<br /><span style="font-size: 180%;">Bloating:</span></span></span><br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4sDhff3py0jZvA14EgcZeidCCWlsIdRueed6dsEyoYcC_phcKcF8VZ8r334Yg9XJT17CQO0st2m8g-53WRkMBELxj7a71K-TagRpvJTGC6khzKyRBB01oZPDs883nXhPdOHx986Ya1v0d/s1600/belly2.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj4sDhff3py0jZvA14EgcZeidCCWlsIdRueed6dsEyoYcC_phcKcF8VZ8r334Yg9XJT17CQO0st2m8g-53WRkMBELxj7a71K-TagRpvJTGC6khzKyRBB01oZPDs883nXhPdOHx986Ya1v0d/s1600/belly2.jpg" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr-zRAH62PoOCd16zWTh-4D93Ui5CjKBh1QXUnY_vYzvuuM6yi2hzEjdo4Zvw1WTZO01EAbcvw0ml9f2rMrBKO9yIWiVuJkaatVJUsF_EJdIrtawEuNLvD8OK9EKzND3Kt09t1CbKiBFwo/s1600/dry.jpg" style="margin-left: 1em; margin-right: 1em;"><br /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;">If you
experience bloating, try changing the portion size to reduce this
feeling. Enjoy healthy snacks during the day and smaller meals to assist
your digestion. If you are using the shake mix as a meal replacement
you may want to reduce the portion size or frequency.</span></span><span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;"> </span></span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;">Dry Mouth: </span></span></span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr-zRAH62PoOCd16zWTh-4D93Ui5CjKBh1QXUnY_vYzvuuM6yi2hzEjdo4Zvw1WTZO01EAbcvw0ml9f2rMrBKO9yIWiVuJkaatVJUsF_EJdIrtawEuNLvD8OK9EKzND3Kt09t1CbKiBFwo/s1600/dry.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="217" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhr-zRAH62PoOCd16zWTh-4D93Ui5CjKBh1QXUnY_vYzvuuM6yi2hzEjdo4Zvw1WTZO01EAbcvw0ml9f2rMrBKO9yIWiVuJkaatVJUsF_EJdIrtawEuNLvD8OK9EKzND3Kt09t1CbKiBFwo/s320/dry.jpg" width="320" /></a><br />
<span style="font-weight: bold;"><span style="font-size: 130%;">Some
people report that their mouth is dry after black or fruit tea. Detox
products often produce thirst so you can try increasing your intake of
water. Dryness from using the shakes can be caused by acid reflux since
it contains guar gum and psyllium husk. These have expanding properties,
which can cause reflux. Guar bean is high in protein and oil and guar
gum is used worldwide in many beverages, foods and supplements. In
significant quantities, guar gum dehydrates the body and can cause some
serious side effects. However, it is regulated by the FDA who only
permits extremely small quantities of it in food. Guar gum in the shake
mix is used to emulsify or bind the particles and has been determined to
be of insignificant quantities.<br /><span style="font-size: 180%;">Heart Palpitations:</span></span></span><br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKCpIwHk1l89qUmRjp-nCLb1NhMd87uzrn-bXbRbJEexeP-UoqEyjakJjCvSm6iKc9e2CXO2TIWWYm5Vu2Gqw1hpoCDXwzyYPoLOBSvs-Qk9fHlEMwZMFjIMs7_XeWiWyX-R1mQpgHkinK/s1600/484681-26722-19.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhKCpIwHk1l89qUmRjp-nCLb1NhMd87uzrn-bXbRbJEexeP-UoqEyjakJjCvSm6iKc9e2CXO2TIWWYm5Vu2Gqw1hpoCDXwzyYPoLOBSvs-Qk9fHlEMwZMFjIMs7_XeWiWyX-R1mQpgHkinK/s1600/484681-26722-19.jpg" /></a></div>
<br />
<span style="font-weight: bold;"><span style="font-size: 130%;">Palpitations
may be from caffeine sensitivity. The tea does have caffeine in it so
you could either stop using the tea or eventually you will get used to
caffeine and the palpations should recede. The shake mix does not
contain any caffeine.<br />In the nineties it was found that Ephedra
caused increased heart rate and Herbalife discontinued using Ephedra in
any of its products.<br /><span style="font-size: large;">Upset Stomach, Headache and Fevers:</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7m9pf_GNzCZOz0oL4Biuqxhh4yxk5wYMRHLn2zaTkTn47ts_-vcLxMOv7soui9iPb-2OYxdr40Kv7Rj0hyphenhyphenRM3yl9bd1vbeDhyMwQkHBDhTYLPm1qbOcztHtPTzU9YDDIcBqzRs5CHVN4K/s1600/UpsetTummy-illus.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="105" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg7m9pf_GNzCZOz0oL4Biuqxhh4yxk5wYMRHLn2zaTkTn47ts_-vcLxMOv7soui9iPb-2OYxdr40Kv7Rj0hyphenhyphenRM3yl9bd1vbeDhyMwQkHBDhTYLPm1qbOcztHtPTzU9YDDIcBqzRs5CHVN4K/s320/UpsetTummy-illus.png" width="320" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;"> </span>In
the first few days, many years of accumulated toxins and waste in the
body begin to be expelled. Diarrhea, headaches, fever or nausea can
arise.<br />These are temporary symptoms and will subside whether you
continue the diet or not. The discomfort is not very common but happens
to some people. Once you are detoxified you should feel great however.
The body has toxins or free radicals surrounded by fat molecules, and
when burning these fat molecules, the toxins are released into the
bloodstream for elimination. They circulate through the body and are
filtered out by the kidneys and liver. This can take up to 2 weeks.
Areas where toxins and pollutants are expelled from the body can display
reactions. You can first use a detoxification program to cleanse your
system before starting the weight loss program if you wish.</span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;">Unpleasant-Smelling Urine or Perspiration:</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVkMIOS1-zB3JzB7zifes0yPqFKSFnZN-lOhzHhw9L68gccmoFWxgasJGoArQwp2-RhVln-2xOoFNfsb8jII51oKzyTPIvpQK7z6LZk7Wv9duIegwHcTrwLzgT4G6HNpAvg0GImCzqJ4_a/s1600/smellbad.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVkMIOS1-zB3JzB7zifes0yPqFKSFnZN-lOhzHhw9L68gccmoFWxgasJGoArQwp2-RhVln-2xOoFNfsb8jII51oKzyTPIvpQK7z6LZk7Wv9duIegwHcTrwLzgT4G6HNpAvg0GImCzqJ4_a/s1600/smellbad.jpg" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;"> </span>This
is another possible reaction to the body cleansing that is not caused
by the products, but the waste you are cleaning out. The products are
working just as they should.</span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;">Allergic Reaction and Blocked Sinuses:</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwpeIkxH5ssIiqcMRyNzemvFsPam_u61iVwhZjgKI8cVNZ0ohb_zs6MGacGAH5gqkDyEYEDRXoaJY8ZG_aKHwAtfZjb5yohMjGFTghCjG3YXllUO8zKg3PCXY_KvlO8VXBZmbPHwPrdnVx/s1600/allergy.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="193" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjwpeIkxH5ssIiqcMRyNzemvFsPam_u61iVwhZjgKI8cVNZ0ohb_zs6MGacGAH5gqkDyEYEDRXoaJY8ZG_aKHwAtfZjb5yohMjGFTghCjG3YXllUO8zKg3PCXY_KvlO8VXBZmbPHwPrdnVx/s320/allergy.jpg" width="320" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;"> </span>People
who are very allergic to fish need to know that some Herbalife products
contain fish oil. See a medical specialist to determine if this is an
allergic reaction. Sinuses are especially sensitive because they are
soft tissue. Sinus irritations should clear in 1 to 3 weeks but if they
get worse, discontinue using the product and consult a medical
professional.<br /><span style="font-size: large;">Malnutrition</span>:<br />Beware
of nutrient deficiency when losing weight. The Herbalife ShapeWorks
program recommends that along with the 2 shakes and one healthy meal,
you should add the Multivitamins and Cell Activator to ensure that you
are getting enough nutrition. Cell Activator helps increase your
nutrient absorption from food.<br /><span style="font-size: 180%;">Stimulants:</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3y8PzdZHyu3p5945CdXqWTX6kPXHTTQmUb_7nkJ3qVfqwIIR8dlVvbm-7rC97kYMGyUtBG6Rj9kvFZ9lz8-gky09f_VJrjdzGtr44T5x1TxCvPwcGKKGCgkGg5hlttCQIdalqyelvO8xc/s1600/stimulant_drug_abuse.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="177" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh3y8PzdZHyu3p5945CdXqWTX6kPXHTTQmUb_7nkJ3qVfqwIIR8dlVvbm-7rC97kYMGyUtBG6Rj9kvFZ9lz8-gky09f_VJrjdzGtr44T5x1TxCvPwcGKKGCgkGg5hlttCQIdalqyelvO8xc/s320/stimulant_drug_abuse.png" width="320" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: 180%;"> </span>Caffeine
in green tea is not the same as in coffee. It is slower-acting and has a
calmer quality. But if you feel too stimulated try half a cup instead
of a whole cup for a while.<br /><span style="font-size: large;">Swollen Legs:</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPpfYhCbLbDqpZmneBpb7F_kKad5RLDtgnsUA456r3Ur0fs6n88Ur6MDk-tOuXI78_lEeyS6mzMhlqNrZ62WT6qy2xeVj9QzDBKvOSsV5RvMoZbhj3f9eK6oyWXQHJ_L-ZQiOg6ZU6Nqf2/s1600/leg.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="220" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgPpfYhCbLbDqpZmneBpb7F_kKad5RLDtgnsUA456r3Ur0fs6n88Ur6MDk-tOuXI78_lEeyS6mzMhlqNrZ62WT6qy2xeVj9QzDBKvOSsV5RvMoZbhj3f9eK6oyWXQHJ_L-ZQiOg6ZU6Nqf2/s320/leg.jpg" width="320" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;"> </span>This
might indicate an allergic reaction to an ingredient in the Herbalife
products. Please show your doctor the product labels and ask his advice.
It would be best to discontinue using the product until you know what
the cause of your swelling is.<br /><span style="font-size: 180%;">Stomach Acidity:</span></span></span><br />
<br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidVg35ATHcb5RkT6S2KZjIP0zPivmOlN_zGYR5_bdnUQsEeoYctu6LzOGar_kXqFDnErhGLyNMvo_7dEMZOY2yg7Uu6GzQ2rfO-M1OyjNY0yi0Vd9ifnmv0i2ZFhKfdMAe4Z-D7lox1JHi/s1600/10JULY.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEidVg35ATHcb5RkT6S2KZjIP0zPivmOlN_zGYR5_bdnUQsEeoYctu6LzOGar_kXqFDnErhGLyNMvo_7dEMZOY2yg7Uu6GzQ2rfO-M1OyjNY0yi0Vd9ifnmv0i2ZFhKfdMAe4Z-D7lox1JHi/s1600/10JULY.jpg" /></a></div>
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<a href="http://www.blogger.com/blogger.g?blogID=162178159833053852" style="margin-left: 1em; margin-right: 1em;"><img alt="" border="0" height="200" src="data:image/png;base64,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" style="cursor: move;" width="200" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;">If you
are using Cell-U-Loss, try discontinuing it and see if that reduces your
symptoms. If so, then Cell-U-Loss is not for you. If acidity persists
when you are not taking it, there is some other cause. Cell-U-Loss
contains 3 ingredients which may be causing the acidity: Apple Cider
Vinegar, Vitamin C and Iron. It also contains herbs that have diuretic
properties such as couch grass and corn silk extract.</span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: 180%;">Pregnancy: </span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaN0vuuxIdD3J2lO2Zu6xOY6fTuCqPmswssYyrapQfBNYQuetcWhPqM0rkCSZlhAoNom8aCatchBrJYglQ7JGyH8iC3_I6p8SCuIPOKaUyRWIM7-Yh9yNYaRBsaPBxXamQcmFY9DQG2-5f/s1600/pregnancy1.gif" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiaN0vuuxIdD3J2lO2Zu6xOY6fTuCqPmswssYyrapQfBNYQuetcWhPqM0rkCSZlhAoNom8aCatchBrJYglQ7JGyH8iC3_I6p8SCuIPOKaUyRWIM7-Yh9yNYaRBsaPBxXamQcmFY9DQG2-5f/s320/pregnancy1.gif" width="320" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;">Total
Control (the metabolism booster) carries a warning to not be used by the
pregnant, lactating (or those that want to get pregnant). Rapid weight
loss and stimulants during breastfeeding can release too many toxins
into your blood stream and thus into your milk. This can cause a
decrease in your milk supply and be unhealthy for your baby. Avoid the
stimulants in Total Control and the Herbal Tea, which contain caffeine.
Herbalife products have nutrition labels that show warnings to guide
women who are pregnant, nursing or who may become pregnant.</span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: 180%;">Rashes:</span></span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: 180%;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTIYrSq0UzJM8pxN9RwyKCgi3-n2UIDFTrC7X_375LQaU12WJzbJUCLig_ChJrseSZZbgirENHOSJsyvvWU84puMkHTVBOY4kLDEQSCzmQcrc5z4oGJisd2ZcaXJb-WnJ-eiPb_Ewy9tVO/s1600/photosofskinrashes.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="176" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgTIYrSq0UzJM8pxN9RwyKCgi3-n2UIDFTrC7X_375LQaU12WJzbJUCLig_ChJrseSZZbgirENHOSJsyvvWU84puMkHTVBOY4kLDEQSCzmQcrc5z4oGJisd2ZcaXJb-WnJ-eiPb_Ewy9tVO/s320/photosofskinrashes.jpg" width="320" /></a> </span><br />These
are the most commonly reported side-effects that happen when the body
is de-toxifying. Redness, blotchy skin and irritation can arise. Your
skin being the largest organ, has the most cells to repair and also
discharges toxins. It takes about 2 weeks to cleanse the blood stream
and during this time the departing toxins can be irritating. Exercise
produces sweat and will release toxins that can irritate the skin.
Herbal Aloe Soothing Gel can provide symptomatic relief.</span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;">Hair Loss or Breakage:</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieoQTfHwlx6U9IjAlpw2Mi1Tjp4p8gqhpakpN5W-2CrpKRcTNyQbxqSlOfvVvPptgGhf-zEimSP0IVU34mPleISGuI2arWBbtmSTjqt-kd0NN06tYbcW57RNNeT-x28D6HysQXeyEImmEy/s1600/A-young-woman-removing-ha-007.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEieoQTfHwlx6U9IjAlpw2Mi1Tjp4p8gqhpakpN5W-2CrpKRcTNyQbxqSlOfvVvPptgGhf-zEimSP0IVU34mPleISGuI2arWBbtmSTjqt-kd0NN06tYbcW57RNNeT-x28D6HysQXeyEImmEy/s1600/A-young-woman-removing-ha-007.jpg" /></a></div>
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: large;"> </span>Formula
1 Nutritional Shake Mix has been shown to improve skin, hair and nail
growth. If you experience hair loss early in your weight loss program,
this is because damaged cells are being repaired or replaced. When
beginning a weight loss program, your body will target the most damaged
cells. Hair usually has the oldest cells and is thus the first target
for renewal. Hair soon becomes healthier than before so you need not
worry about this.</span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: 180%;">General Detoxing Effects:</span></span></span><br />
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiTsi12_3rCqbqX2S19W7_S6HaAC9Jiu4h1QZznTdrMU9386udf4iqVv5vvFW2yXIlo3r24HvS0h4HTErPrEqaALzAl0P5yDJt2U_IE363iM8mW6QXmcLw2jQPgGOUOn6IYjQErmaMRMnU/s1600/toxic-logo-colour.png" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiTsi12_3rCqbqX2S19W7_S6HaAC9Jiu4h1QZznTdrMU9386udf4iqVv5vvFW2yXIlo3r24HvS0h4HTErPrEqaALzAl0P5yDJt2U_IE363iM8mW6QXmcLw2jQPgGOUOn6IYjQErmaMRMnU/s1600/toxic-logo-colour.png" /></a><span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: 180%;"> </span> </span></span><br />
<span style="font-weight: bold;"><span style="font-size: 130%;">It is
very well known that at the beginning of a diet or fast there may be
some adverse side effects. These usually subside within a few weeks
however. If you detoxify for a few days using plain water, fruit or
vegetables you will also experience some side effects. When we have
better nutrition, or when toxic substances such as coffee, tea,
chocolate, tobacco, salt, and pepper are discontinued, amazing changes
take place. Our bodies discard the lower grade materials and tissues to
make room for newer, healthier ones.<br /><span style="font-size: medium;">Weight Gain:</span></span></span><br />
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIX2FnzNPlMY-MwjuCH794xUozh7hlH4eqiknNeSMHKTrPu1W4Mf53piX5U4cNblpAm8y78GCJqiOkajtV1UxSZi7pxnsgj8a-y6bNwDvW03NSOFH7xkrCRQ7jXnW_vGVqDJ-cYkv5W1Lt/s1600/holiday-weight-gain.jpg" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhIX2FnzNPlMY-MwjuCH794xUozh7hlH4eqiknNeSMHKTrPu1W4Mf53piX5U4cNblpAm8y78GCJqiOkajtV1UxSZi7pxnsgj8a-y6bNwDvW03NSOFH7xkrCRQ7jXnW_vGVqDJ-cYkv5W1Lt/s1600/holiday-weight-gain.jpg" /></a></div>
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<span style="font-weight: bold;"><span style="font-size: 130%;"><span style="font-size: medium;"> </span>An
ideal weight-loss rate is between 3 and 5 pounds per week. If you lose
weight gradually and are getting proper nutrition, it will stay off.
Moderate exercise like walking is necessary to get the fat burning
process going. Adequate hydration (drinking water regularly) is
essential to flush the toxins.<br />Do not try to stop any Herbalife side
effects by taking drugs. Either let the healing take its natural course
or stop using the product if you experience an allergic reaction.</span></span><br />
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