A recent study has highlighted the growing concern of liver injury cases linked to herbal and dietary supplements. The study by Dr Emily Nash from the Royal Prince Alfred Hospital found that of the 69 non-paracetamol liver injuries, 15 involved herbal and dietary supplements. The study authors were prompted to do the study after noticing the increasing number of patients with liver damage from drugs that we do not usually associate with harm including bodybuilding and weight loss supplements. These numbers may seem small however it’s worth noting too that the study only looked at more severe cases so who knows the true scale of damage being done.[1][2]. The study is of interest because it prompts us to consider the regulation of supplements and other alternative therapies. Some governments have called for stricter labelling of products for example stating “This product is based on traditional beliefs and not modern scientific evidence” to highlight the difference but of course industry may have a different opinion.
In PCOS circles, we often chat about our supplements and which ones we should take to help manage our symptoms. Some of us with PCOS are swamped by sellers as we have become a well known target audience for supplements. Many of us have questioned whether what we are doing is safe and if the supplements really do work. But how do we really know? This is a real problem in PCOS. Again, it highlights the lack of research in PCOS. We really do need more robust research so that we know our safety is not being compromised. We already know that PCOS increases our risk of developing NAFLD so we need to be aware of which supplements could potentially harm us[3].
In an earlier blog we wrote about the conflicting opinions on the use of Berberine and how some countries have issued warnings about supplements that contain it [4] and yet it is marketed for use in PCOS. A report by the UK Herbal Medicines Advisory Committee (HMAC) for the Herbal Medicines and Practitioners Working Group (HMPWG) concluded that herbal medicinal products, like all other medications, can have pharmacological effects and can give rise to significant adverse effects or interactions with existing medications. They add that toxicity is also a problem with some low-grade products containing toxic ingredients due to misidentification and substitution. The report acknowledges the difficulty members of the public can have in identifying competent practitioners who can supply supplements. They also found evidence that practitioners lacking expertise are treating vulnerable groups, and that less responsible practitioners may purchase unlicensed herbs from sources with no reliable quality standards [5]
The International PCOS Guidelines mentions only Inositol and we really need to know if this is safe for all of those with PCOS and we look forward to seeing some larger scale randomized control trials[6]. Inositol is well known for its insulin sensitizing properties and beneficial effects on metabolism however, it is quite surprising to find that inositol-based treatments for PCOS seem to be randomly chosen and are often combined with useless or even counterproductive molecules, all of which can weaken myo-inositol’s efficacy. Such treatments clearly lack therapeutic rationale[7] There is a need for more science based studies on the use of Inositol in PCOS treatment.
Furthermore, the digitalisation of our lives means social media is flooded with scores of captivating marketing material and unscientifically founded claims many of which appear to have replaced traditional advice provided by professionals. A recent netnographic analysis of marketing of sports supplements found that there is a tendency to replace professional advice with unsolicited social media claims. The authors add that some users may not even be aware of how they could be exposing themselves to potent and highly toxic drugs.[8]
It is important therefore not to trivialise the use of supplements in PCOS. While we wait for more much-needed research to be carried out we need to be aware of these potential problems. Always check with your GP or healthcare provider for possible interactions with other medications and monitor how your supplement affects you. Not everyone with PCOS is the same so we don’t all need to use the same things. We trust that, in time, research will help catch up and help keep us safe.
This is not medical advice. If you need medical advice please consult your doctor.
(c) PCOS VITALITY 2021
References
[1] E. Nash, A. Sabih, J. Chetwood, G. Wood, K. Pandya, T. Yip, A. Majumdar, G.W. McCaughan, S.I. Strasser, K. Liu, Drug‐induced liver injury in Australia, 2009–2020: the increasing proportion of non‐paracetamol cases linked with herbal and dietary supplements, Med. J. Aust. 215 (2021) n/a-n/a. https://doi.org/10.5694/MJA2.51173.
[2] Dietary supplements causing severe liver injuries in Australians, with some requiring transplants, study shows | Health | The Guardian, (n.d.). https://www.theguardian.com/australia-news/2021/jul/26/dietary-supplements-causing-severe-liver-injuries-in-australians-with-some-requiring-transplants-study-shows (accessed August 2, 2021).
[3] B. Kumarendran, M.W. O’Reilly, K.N. Manolopoulos, K.A. Toulis, K.M. Gokhale, A.J. Sitch, C.N. Wijeyaratne, A. Coomarasamy, W. Arlt, K. Nirantharakumar, Polycystic ovary syndrome, androgen excess, and the risk of nonalcoholic fatty liver disease in women: A longitudinal study based on a United Kingdom primary care database, PLOS Med. 15 (2018) e1002542. https://doi.org/10.1371/JOURNAL.PMED.1002542.
[4] Berberine...metabolic master switch or something to ditch?, (n.d.). https://www.pcosvitality.com/post/berberine-metabolic-master-switch-or-something-to-ditch (accessed August 2, 2021).
[5] Safety, regulation and herbal medicines: a review of the evidence A report prepared by the UK Herbal Medicines Advisory Committee (HMAC) for the Herbal Medicines and Practitioners Working Group (HMPWG), 2014.
[6] H.J. Teede, M.L. Misso, M.F. Costello, A. Dokras, J. Laven, L. Moran, T. Piltonen, R.J. Norman, M. Andersen, R. Azziz, A. Balen, E. Baye, J. Boyle, L. Brennan, F. Broekmans, P. Dabadghao, L. Devoto, D. Dewailly, L. Downes, B. Fauser, S. Franks, R.M. Garad, M. Gibson-Helm, C. Harrison, R. Hart, R. Hawkes, A. Hirschberg, K. Hoeger, F. Hohmann, S. Hutchison, A. Joham, L. Johnson, C. Jordan, J. Kulkarni, R.S. Legro, R. Li, M. Lujan, J. Malhotra, D. Mansfield, K. Marsh, V. McAllister, E. Mocanu, B.W. Mol, E. Ng, S. Oberfield, S. Ottey, A. Peña, J. Qiao, L. Redman, R. Rodgers, L. Rombauts, D. Romualdi, D. Shah, J. Speight, P.M. Spritzer, E. Stener-Victorin, N. Stepto, J.S. Tapanainen, E.C. Tassone, S. Thangaratinam, M. Thondan, C.-R. Tzeng, Z. van der Spuy, E. Vanky, M. Vogiatzi, A. Wan, C. Wijeyaratne, S. Witchel, J. Woolcock, B.O. Yildiz, Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome, Fertil. Steril. 110 (2018) 364–379. https://doi.org/10.1016/j.fertnstert.2018.05.004.
[7] S. Roseff, M. Montenegro, Inositol Treatment for PCOS Should Be Science-Based and Not Arbitrary, (2020). https://doi.org/10.1155/2020/6461254.
[8] V. Catalani, A. Negri, H. Townshend, P. Simonato, M. Prilutskaya, A. Tippett, O. Corazza, The market of sport supplement in the digital era: A netnographic analysis of perceived risks, side-effects and other safety issues, Emerg. Trends Drugs, Addict. Heal. 1 (2021) 100014. https://doi.org/10.1016/J.ETDAH.2021.100014.