RESUMEN
BACKGROUND & AIMS: Garcinia cambogia, either alone or with green tea, is commonly promoted for weight loss. Sporadic cases of liver failure from G cambogia have been reported, but its role in liver injury is controversial. METHODS: Among 1418 patients enrolled in the Drug-Induced Liver Injury Network (DILIN) from 2004 to 2018, we identified 22 cases (adjudicated with high confidence) of liver injury from G cambogia either alone (n = 5) or in combination with green tea (n = 16) or Ashwagandha (n = 1). Control groups consisted of 57 patients with liver injury from herbal and dietary supplements (HDS) containing green tea without G cambogia and 103 patients from other HDS. RESULTS: Patients who took G cambogia were between 17 and 54 years, with liver injury arising 13-223 days (median = 51) after the start. One patient died, one required liver transplantation, and 91% were hospitalized. The liver injury was hepatocellular with jaundice. Although the peak values of aminotransferases were significantly higher (2001 ± 1386 U/L) in G cambogia group (P < .018), the median time for improvement in total bilirubin was significantly lower compared with the control groups (10 vs 17 and 13 days; P = .03). The presence of HLA-B∗35:01 allele was significantly higher in the G cambogia containing HDS (55%) compared with patients because of other HDS (19%) (P = .002) and those with acute liver injury from conventional drugs (12%) (P = 2.55 × 10-6). CONCLUSIONS: The liver injury caused by G cambogia and green tea is clinically indistinguishable. The possible association with HLA-B∗35:01 allele suggests an immune-mediated mechanism of injury. CLINICAL TRIALS: gov number: NCT00345930.
Asunto(s)
Enfermedad Hepática Inducida por Sustancias y Drogas , Garcinia cambogia , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Suplementos Dietéticos/efectos adversos , Garcinia cambogia/efectos adversos , Antígenos HLA-B , Humanos , Té/efectos adversosAsunto(s)
Fármacos Antiobesidad/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Garcinia cambogia/efectos adversos , Enfermedad Hepática Inducida por Sustancias y Drogas/diagnóstico , Diagnóstico Diferencial , Suplementos Dietéticos/efectos adversos , Femenino , Hepatitis Viral Humana/diagnóstico , Humanos , Persona de Mediana EdadRESUMEN
BACKGROUND: Garcinia cambogia contains hydroxycitric acid. Hydroxycitric acid is a potent competitive inhibitor of adenosine triphosphate citrate lyase which is a key enzyme in the synthesis of fatty acids. Hydroxycitric acid also regulates the level of serotonin. In these regards, hydroxycitric acid has been reported to exhibit weight loss activity. Adverse reactions of G. cambogia from numerous clinical studies demonstrated relatively mild reactions. However, there are some complications of G. cambogia reported in the past: acute liver injury, acute hepatitis, and hepatic failure. However, ocular complications of G. cambogia have not been reported yet. CASE PRESENTATION: A 35-year-old female visited our clinic with decreased vision in the left eye and ocular pain in both eyes for the last 6 days. She also complained of headache, dizziness, and nausea. She had taken G. cambogia extract more than the recommended dose. There was myopic shift with anterior chamber shallowing in both eyes, especially in the left eye. Moreover, swelling and retinal folds of peripapillary retinal nerve fiber layer and macula were observed in both eyes. These ocular complications of G. cambogia extract resolved after discontinuation of the extract and topical and oral steroid treatment. Herein, we report the first case of ocular complications of G. cambogia extract diet pill assessed with optical coherence tomography of optic disk and macula along with dual Scheimpflug analyzer. CONCLUSION: It is necessary that physicians dealing with obesity advice patients about possible visual disturbance of this extract when taken in overdose so that they can see an ophthalmologist immediately.
Asunto(s)
Dieta/efectos adversos , Garcinia cambogia/efectos adversos , Glaucoma de Ángulo Cerrado/inducido químicamente , Extractos Vegetales/efectos adversos , Retina/efectos de los fármacos , Tomografía de Coherencia Óptica/métodos , Uveítis/inducido químicamente , Adulto , Femenino , Glaucoma de Ángulo Cerrado/diagnóstico , Humanos , Retina/patología , Uveítis/diagnósticoRESUMEN
Garcinia cambogia is a Southeast Asian fruit becoming increasingly popular as a weight management supplement. Hydroxycitric acid (HCA) is the primary active ingredient which demonstrates serotonergic- and muscarinic-enhancing properties via inhibition of selective serotonin reuptake and acetylcholinesterase. We report a young adult female with no history of bipolar disorder who developed mania and psychosis approximately 1 week following initiation of G cambogia and the Cleanse and Detox™ dietary supplement manufactured by Apex Vitality Health. She presented with a predominantly expansive mood, psychomotor agitation, disorganized and pressured speech, flight of ideas, grandiosity, delusions, and auditory hallucinations. Following discontinuation of G cambogia and the initiation of lithium and quetiapine, the patient experienced rapid and progressive mood stabilization and was discharged after 8 days. Seven previous case reports associating (hypo)mania and/or psychosis with G cambogia consumption have been published. The chronology of mania and/or psychosis onset may appear between 1 and 8 weeks following initiation of G cambogia. Psychiatric symptoms have resolved with G cambogia discontinuation in some instances and may not require chronic pharmacotherapy. Our report should encourage further research and case reports regarding this adverse event and the reconciliation of complete herbal supplement use at clinic visits and hospital admissions.
Asunto(s)
Trastorno Bipolar/etiología , Suplementos Dietéticos/efectos adversos , Garcinia cambogia/efectos adversos , Trastornos Psicóticos/etiología , Trastorno Bipolar/tratamiento farmacológico , Femenino , Frutas , Garcinia cambogia/química , Humanos , Trastornos Psicóticos/tratamiento farmacológico , Factores de Tiempo , Adulto JovenRESUMEN
Herbal weight-loss supplements are sold as self-medication products, and are often used under the misconception that their natural origin guarantees their safety. Food supplements are not required to provide any benefit/risk profile evaluation before marketing; however, possible risks associated with use of herbal extracts in food supplements are becoming more and more documented in the literature. Some herbs are listed as the leading cause of herb-induced liver injury, with a severe or potentially lethal clinical course, and unpredictable herb-drug interactions. Garcinia cambogia (GC) extract and GC-containing products are some of the most popular dietary supplements currently marketed for weight loss. Here, we present four cases of acute liver failure in women taking GC extract for weight loss, and a literature review of clinical evidences about hepatic toxicity in patients taking dietary supplements containing GC extract.
Asunto(s)
Suplementos Dietéticos/efectos adversos , Garcinia cambogia/efectos adversos , Fallo Hepático Agudo/etiología , Pérdida de Peso/efectos de los fármacos , Adulto , Estudios de Casos y Controles , Enfermedad Hepática Inducida por Sustancias y Drogas/complicaciones , Enfermedad Hepática Inducida por Sustancias y Drogas/epidemiología , Femenino , Humanos , Fallo Hepático Agudo/epidemiología , Pruebas de Función Hepática/métodos , Persona de Mediana EdadRESUMEN
[Full article available at http://rimed.org/rimedicaljournal-2017-10.asp].
Asunto(s)
Diabetes Mellitus Tipo 1/complicaciones , Cetoacidosis Diabética/inducido químicamente , Garcinia cambogia/efectos adversos , Obesidad/tratamiento farmacológico , Pancreatitis/inducido químicamente , Fitoterapia/efectos adversos , Extractos Vegetales/efectos adversos , Fármacos Antiobesidad/uso terapéutico , Cetoacidosis Diabética/diagnóstico , Femenino , Humanos , Persona de Mediana Edad , Obesidad/complicaciones , Pancreatitis/diagnóstico , Extractos Vegetales/uso terapéuticoRESUMEN
Traditional herbal products are widely used in Australia to treat a broad range of conditions and diseases. It is popularly believed that these products are safer than prescribed drugs. While many may be safe, it is worrying that the specific effects and harmful interactions of a number of their components with prescription medications is not well understood. Some traditional herbal preparations contain heavy metals and toxic chemicals, as well as naturally occurring organic toxins. The effects of these substances can be dire, including acute hepatic and renal failure, exacerbation of pre-existing conditions and diseases, and even death. The content and quality of herbal preparations are not tightly controlled, with some ingredients either not listed or their concentrations recorded inaccurately on websites or labels. Herbal products may also include illegal ingredients, such as ephedra, Asarum europaeum (European wild ginger) and endangered animal species (eg, snow leopard). An additional problem is augmentation with prescription medications to enhance the apparent effectiveness of a preparation. Toxic substances may also be deliberately or inadvertently added: less expensive, more harmful plants may be substituted for more expensive ingredients, and processing may not be adequate. The lack of regulation and monitoring of traditional herbal preparations in Australia and other Western countries means that their contribution to illness and death is unknown. We need to raise awareness of these problems with health care practitioners and with the general public.
Asunto(s)
Suplementos Dietéticos/efectos adversos , Medicina de Hierbas/métodos , Plantas Tóxicas/efectos adversos , Adulto , Australia , Concienciación , Preescolar , Suplementos Dietéticos/toxicidad , Femenino , Garcinia cambogia/efectos adversos , Garcinia cambogia/toxicidad , Interacciones de Hierba-Droga , Medicina de Hierbas/legislación & jurisprudencia , Humanos , Masculino , Necrosis Hepática Masiva/inducido químicamente , Necrosis Hepática Masiva/cirugía , Metales Pesados/toxicidad , Persona de Mediana Edad , Preparaciones de Plantas/uso terapéutico , Preparaciones de Plantas/toxicidad , Plantas Tóxicas/toxicidad , Riesgo , Control Social FormalAsunto(s)
Fármacos Antiobesidad/efectos adversos , Trastorno Bipolar/inducido químicamente , Garcinia cambogia/efectos adversos , Medicamentos sin Prescripción/efectos adversos , Fitoterapia/efectos adversos , Adulto , Fármacos Antiobesidad/uso terapéutico , Trastorno Bipolar/terapia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Medicamentos sin Prescripción/uso terapéuticoAsunto(s)
Fármacos Antiobesidad/efectos adversos , Suplementos Dietéticos/efectos adversos , Obesidad/tratamiento farmacológico , Obesidad/psicología , Pérdida de Peso/efectos de los fármacos , Adulto , Carnitina/efectos adversos , Femenino , Garcinia cambogia/efectos adversos , Humanos , Trastornos Psicóticos/etiologíaRESUMEN
Millions of Americans regularly use herbal supplements, but many are unaware of the potential hidden dangers. Numerous supplements have been associated with hepatotoxicity and, indeed dietary/herbal supplements represent an increasingly common source of acute liver injury. We report a case of acute liver failure requiring liver transplantation associated with the use of Garcinia cambogia, a supplement widely promoted for weight loss. When patients present with acute hepatitis or liver failure from an unknown etiology, a careful history of supplement use should be performed.
Asunto(s)
Fármacos Antiobesidad/efectos adversos , Garcinia cambogia/efectos adversos , Fallo Hepático Agudo/inducido químicamente , Preparaciones de Plantas/efectos adversos , Biopsia , Femenino , Humanos , Fallo Hepático Agudo/diagnóstico , Fallo Hepático Agudo/cirugía , Pruebas de Función Hepática , Trasplante de Hígado , Persona de Mediana Edad , Fitoterapia , Plantas Medicinales , Medición de Riesgo , Factores de Riesgo , Resultado del TratamientoRESUMEN
A previously healthy 48-year-old woman was evaluated for lightheadedness and chest heaviness 2 weeks after starting the herbal supplement Garcinia cambogia. She was found to be hypotensive and had an elevated serum troponin level. The patient had a progressive clinical decline, ultimately experiencing fulminant heart failure and sustained ventricular arrhythmias, which required extracorporeal membrane oxygenation support. Endomyocardial biopsy results were consistent with acute necrotizing eosinophilic myocarditis (ANEM). High-dose corticosteroids were initiated promptly and her condition rapidly improved, with almost complete cardiac recovery 1 week later. In conclusion, we have described a case of ANEM associated with the use of Garcinia cambogia extract.