Increased Alkaline Phosphatase Associated with Brown Algae and Mushroom Extract-Containing Supplement Use

Area of Science:

• Hepatology
• Clinical Biochemistry
• Pharmacovigilance

Background:

• Drug-induced liver injury (DILI) is a significant concern in clinical practice.
• Marked elevation of alkaline phosphatase (ALP) due to exogenous substances is rare.
• This case involves a patient with chronic hepatitis B virus (HBV) infection.

Observation:

• A 47-year-old male patient presented with ALP levels 7 times the upper limit (991 U/L) during routine bloodwork.
• Other liver function tests, including ALT, AST, GGT, and bilirubin, remained within normal limits.
• The patient was concurrently taking a supplement containing brown algae and mushroom extract (Umi No Shizuku).

Findings:

• Comprehensive bloodwork and imaging studies ruled out other causes of elevated ALP, such as bone disease or liver pathology.
• Discontinuation of the brown algae and mushroom supplement resulted in a rapid and complete normalization of ALP levels.
• The temporal relationship and exclusion of other factors strongly implicate the supplement as the cause of hyperphosphatasia.

Implications:

• This case highlights the potential for herbal and dietary supplements to cause idiosyncratic elevations in liver enzymes, specifically ALP.
• Clinicians should maintain a high index of suspicion for supplement-induced hepatotoxicity, even with isolated ALP elevation.
• Further investigation into the specific components of such supplements may be warranted to identify causative agents and prevent future occurrences.