Hepatotoxicity of dietary supplements and herbal extracts

Hepatotoksičnost dodataka prehrani je sverastući zdravstveni problem. Zbog manjka regulacije i standardizacije u proizvodnji, uz širokodostupnost pripravaka, zdravstveni radnici moraju biti na oprezu prilikom preporuke ovakvih proizvoda. Jetra je glavni organ metabolizma ksenobiotika te je kao takva sklona oštećenjima različitim mehanizmima stoga je ključno poznavati laboratorijske parametre i kliničke simptome oštećenja jetre kako bi se pacijente znalo pravovremeno upozoriti na mogućnost hepatotoksičnog djelovanja pripravka. Uz nekoliko analiziranih pripravaka koji su dostupni u Republici Hrvatskoj poput suplemenata koji sadrže ekstrakt crvene riže ili zelenog čaja, u radu je anketirano 105 studenata Farmaceutsko-biokemijskog fakulteta Sveučilišta u Zagrebu u vezi procjene njihovih znanja i stavova o hepatotoksičnosti dodataka prehrani i biljnih ekstrakata. Najveći broj studenata nije bio upoznat ili je nedovoljno upoznat s utjecajem biljnih pripravaka na jetru te smatra da se mora dodatno educirati i povećati oprez prilikom preporuke i/ili korištenja istih. Ono što i dalje ostaje problem je slaba dokazivost uzročno-posljedične veze između pripravaka i njihovih utjecaja na jetru zbog prisutnosti politerapije te ostalih rizičnih čimbenika u etiologiji oštećenja jetre. Iako ne postoje direktni i konačni zaključci o kompletnom utjecaju obrađenih pripravaka na jetru, potreban je dodatni oprez kako bi se rizik od štetnog utjecaja na jetru smanjio te odabrao pravi pripravak za pojedinog pacijenta kao temelj personalizirane medicine čemu moderna struka, uključujući i medicinu temeljena na dokazima, teže.Hepatotoxicity of dietary supplements is a growing health problem. Due to the lack of regulation and standardization in production, together with the wide availability of products, health professionals must be careful when recommending such supplements. Liver is the main organ of xenobiotic metabolism and as such is prone to damage by various mechanisms. Therefore, it is crucial to know the laboratory parameters and clinical symptoms of liver damage so that the patients could be warned in time about the possible hepatotoxic side effects. In addition to several analyzed supplements available in the Republic of Croatia, such as ones containing red rice extract or green tea extracts, a total of 105 students of the Faculty of Pharmacy and Biochemistry of the University of Zagreb were interviewed to assess their knowledge and attitudes regarding hepatotoxicity of dietary supplements and plant extracts. Most students were not familiar or were insufficiently familiar with the effect of herbal preparations on the liver and believe that additional education should be provided with increased caution when recommending and / or using these supplements. What remains a problem is the poor provability of a cause-and-effect relationship between preparations and their effects on the liver due to the presence of polytherapy and other risk factors in the etiology of liver damage. Although there are currently no direct and definitive conclusions about the complete impact of treated supplements on the liver, extra caution is needed to reduce the risk of adverse effects on the liver and choose the right product for the right patient as the end goal of evidence-based medicine