The Liver, Herbal Use and Allergy

A 38 year old man was referred to me for running up an abnormal liver function test. The enzymes produced by liver cells were high indicating liver injury. And as often the case, the patient doesn't feel any pain or discomfort. Neither does he display any signs or symptoms like nausea,vomiting or jaundice. It is, by and large, an incidental finding on the part of the health-screening program. The test was done two weeks prior to his seeing me.

I also observe that when the hepatocellular enzymes are elevated so is blood cholesterol indicating the inability of the liver to process cholesterol within its metabolic cycle.

As per my practice, I go through with the patient on what he has been taking for the last few months. Among the usual agents causing liver injuries being drugs/medications (slimming pills, " traditional Chinese medicine"), alcohol and herbal preparations.

Yes, he admitted he started taking a herbal preparation early in the year (2013). And he told me an interesting story of being admitted to the hospital for observation on two occasions due to high fever and itchiness in his body about two weeks after the daily ingestion of the preparations. He was treated for allergy.   And according to him he has never had similar problems before. Feeling something amiss, he went for the screening program.

I advised him to stop immediately the herbal intake and put him on a two-month of liver treatment and will monitor his liver function after four months. He is also asked to monitor his incidents of allergy.

I have seen so many patients having this herbal induced liver injury. I just wonder whether the effects would just stop after one ceases herbal use or whether there is a threshold where there is a point of no return?

Imagine the liver is a big organ, minor injuries in parts of it would not have significant physical effects to the person. With continued ingestion, cumulative effects will result and would be too late already for someone to show the signs and symptoms of liver failure. It is well-known that the liver has a great capacity to compensate, meaning it can go on functioning while it is diseased  till it is too late. You can see these compensatory effects in alcoholic liver disease.

I have come across two cases of fatal liver failure due to spirulina ingestion in the hospital where I previously worked.

For those who take herbal preparations, do test your liver function before it is too late.