It just calls into question Herbalifes motives when they implement artificial ingredients and claim they are for weight loss and health. As a result of the good nutrition and weight control my skin also improved further enhancing a my confidence! You want to get to that stage with a healthy diet - that's where Herbalife's goal is to help you lose weight by eating healthily. Your body should adjust to the new fat-burning metabolism within a few days and the symptoms should disappear. Nonsense we make USA people to become rich. Calcium is needed for the maintenance of normal bones and teeth. Why should I drink so much water?
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Herbalife Weight Loss Challenge Tools. Promote Your Challenge Create a challenge and promote it on popular social networks like Facebook and Twitter. Save Time, Maximize Results Spend less time crunching numbers and more time coaching your clients toward their goals. 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.
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.
Given these findings, patient was admitted to the hospital for a higher level of care. 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 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.
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. Case 2 A 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. 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.
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.
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.
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. 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. The patient was treated supportively with fluids and nutrition.
The only laboratory value to increase was the patient's serum TB, which was at 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.
At her 2-mo follow-up, the patient's icterus and jaundice had resolved completely. Case 3 A 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. 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.
An ultrasound showed borderline hepatomegaly of cm. 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. Acute liver injury induced by over the counter weight-loss herbal supplement Hydroxycut and Herbalife products have been reported previously[ 3 - 6 , 8 - 11 ].
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.
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 alphaantitripsin deficiency in all three cases. Prussian blue and copper stains did not reveal excessive iron or copper depositions in the hepatocytes and Kupffer cells.
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 Camellia sinensis , has been linked with acute liver injury in other over the counter weight-loss herbal supplements[ 12 - 20 ].
In fact, the weight-loss herbal supplement Exolise Arkophama, Carros, France , which also contained C. 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 C. Rechallenging patients with the same product led to hepatotoxicity, confirming the role of C. However, there have been cases of liver failure caused by green tea extract C.
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 C. The exact mechanism of hepatotoxicity induced by Hydroxycut is unknown. However, as this product contains green tea extract C.
Prior investigation into the mechanism of hepatotoxicity by green tea extract was inconclusive[ 21 ]. 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[ 16 ]. 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[ 8 - 11 ].
Therefore, it is difficult to identify the exact ingredient or mechanism that causes the liver injury, as in the previously documented cases[ 8 - 11 ].
In a previously reported case, one investigator was able to isolate contamination with Bacillus subtilis , in which the bacterial supernatant caused dose-dependent increase of LDH leakage in HepG2 cells[ 8 ]. Although not commonly known as a human pathogen, B. 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[ 24 ].
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[ 8 - 11 ]. Our patients had findings consistent with acute hepatitis due to drug-induced liver injury on their liver biopsy specimens. 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[ 26 ]. 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 , 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[ 27 ]. However, Hydroxycut products are currently still available in many parts of the world.
Likewise, Herbalife products are widely available globally. Furthermore, our cases once again demonstrated the importance of questioning patients regarding the usage of herbal or nutritional supplements at the time of evaluation. Sforza 28, Milano , Italy. Recent trends in use of herbal and other natural products. Two patients with acute liver injury associated with use of the herbal weight-loss supplement hydroxycut.
Acute liver injury associated with the herbal supplement hydroxycut in a soldier deployed to Iraq. Shim M, Saab S. Severe hepatotoxicity due to Hydroxycut: Severe hepatotoxicity following ingestion of Herbalife nutritional supplements contaminated with Bacillus subtilis. Association between consumption of Herbalife nutritional supplements and acute hepatotoxicity. Herbal does not mean innocuous: Hepatotoxicity associated with the consumption of herbal slimming products.
Med Clin Barc ; Hepatotoxicity associated with supplements containing Chinese green tea Camellia sinensis Ann Intern Med. Fulminant hepatitis during self-medication with hydroalcoholic extract of green tea.
Eur J Gastroenterol Hepatol. Green tea extracts and acute liver failure: Bjornsson E, Olsson R. Serious adverse liver reactions associated with herbal weight-loss supplements. Acute liver failure induced by green tea extracts: Acute hepatitis due to Exolise, a Camellia sinensis dried ethanolic extract [letter] Med Clin Barc ; Acute hepatitis associated with Camellia thea and Orthosiphon stamineus ingestion [letter] Gastroenterol Hepatol.
Hepatotoxicity associated with green tea extracts [electronic letter]. Toxicity of green tea extracts and their constituents in rat hepatocytes in primary culture. Bacillus cereus and other Bacillus species. Bacillus subtilis as a cause of cholangitis in polycystic kidney and liver disease. N Engl J Med. Slimming at all costs: Supplemental products used for weight loss. J Am Pharm Assoc ; Published online February This article has been cited by other articles in PMC.
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 yr-old woman, a yr-old woman and a 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. 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 billion won million USD in year 1 , and personal spending was approximately , won USD per year in 2. One of the leading products in Korea's dietary supplements market is aloe.
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 We report 3 cases of aloe-induced toxic hepatitis in Korea. Case 1 A 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 mg of an extract of Aloe arborescens and On admission, the patient's physical examination was normal. Preparation of aloe which the patient had taken. A Container bottle and tablets. B Packs of aloe extract. Anti-HBs IgG was positive. 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 Fig. Histopathological findings of the liver. Aloe tablets was immediately discontinued.
ALT as well as total bilirubin gradually returned to normal level over several weeks Fig. Upon discontinuation of the oral aloe preparation, liver enzymes returned to normal level. Case 2 A yr-old female patient was presented to our department with a week history of fatigue.
The patient did not take any alcohol or durgs. She had taken aloe powder containing mg of an extract of Aloe vera Fig. Physical examination revealed jaundice on her sclera. She was the sales person of the aloe product she was taking. 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 Fig. Aloe extract was immediately discontinued. 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.
Since a hepatitis recurred after re-challenge of aloe extract, we could confirm her diagnosis as aloe-induced toxic hepatitis. The type of liver injury was determined as 'hepatocellular' since R ratio was After re-challenge arrow , liver enzymes go up again. Six months later, the patient was presented to our department with a 2 week history of jaundice. We recommended admission, but she refused to be admitted and she never visited our hospital again.
Case 3 A yr-old female patient was presented to our department with a 3 month history of epigastric discomfort. The patient did not take any alcohol or drugs. She had taken aloe extracts Fig. On admission, the patient's physical examination was normal except mild tenderness on epigastric area.
Autoimmune markers were negative. Abdominal ultrasonography showed increased echogenicity of liver. After 4 days, she visited our department for follow-up. 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 8 indicate that natural substances may not be entirely safe. There are about species of aloe. Among them, particularly aloe vera has been used in phytomedicine. There have been positive reports on aloe vera as anti-inflammatory, anticancer, analgesic, anti-aging as well as liver protective. But, clinical effectiveness of aloe vera was not sufficiently defined because there were no large and randomized studies 9.
In , Korea's National Institute of Safety Research conducted an experiment on the efficacy and toxicity of aloe There was no difference of natural killer cell activity between the aloe vera 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.
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. I can buy this product locally and will get it quicker?. You will receive 8 bottles in total. Keep out of reach of children. Herbal One Garcinia Plus Garcinia extract. Garcinia Extract mg.
Reduce the formation of new fat Slimming Make the stomach feel full. Green Tea Extract mg. L - carnitine mg. What Is Garcinia Cambogia?. You are not even required to increase your exercise rate or change your diet to reap the results of HCA.