Unveiling the hidden risk: Herbal and dietary supplement consumption in liver disease patients

The use of herbal products and dietary supplements (HDS) carries a potential risk of liver toxicity. Data on HDS consumption among patients attending liver disease clinics remain unexplored.

To determine the frequency, types and reasons for HDS consumption in patients attending a specialized liver disease outpatient clinic.

Prospective study including consecutive patients attending the hepatology outpatient clinic at the Hospital Clínic of Barcelona from June 2023 to October 2023. Following a standard medical visit, a trained nurse conducted a structured interview to assess HDS consumption.

A total of 150 patients were included, with a median age of 59 (IQR: 49-67) and male predominance (56%, n=84). Only 12 patients (8%) reported HDS consumption during a standard medical interview, while the number increased to 92 (61%) after nurse-led structured interview. The primary reasons for dietary supplements use included vitamin supplementation (43%), fitness improvement (10.5%) and hair/nail health (10.5%). For herbal products, the most common reason for use was pleasure (73%). Reported HDS products with potential hepatotoxicity (levels A and B) were green tea (n=16), turmeric with black pepper (n=11), aloe (n=2), greater celandine (n=1) and black cohosh (n=1).

HDS use is highly prevalent among patients with liver disease, but a structured interview is crucial to detect their consumption, as they usually forget spontaneous reporting. Importantly, a significant proportion of these products carry a risk of hepatic toxicity, underscoring the need for increased patient education and clinical vigilance.